Knowing nursing through inquiry: engaging students in knowledge creation

Two nurse educators share a nursing knowledge course, which was created as a forum for questioning and discovery, thereby revealing a process of knowing nursing through inquiry. The process of inquiry in nursing praxis is emphasized, facilitating students' understanding that they are knowledge-users and creators. With students, we explore the construction of praxis, which includes being/becoming (ontology), knowing (epistemology), and doing (actions with consequences). Nursing knowledge is understood to arise from philosophy, world views, nursing theories, patterns of knowing, evidence-based research, and standards of practice. Students are encouraged to critically reflect on and use what is congruent with their praxis and to construct new knowledge. Exemplars from nurse educators and students are presented as evidence of our claim for furthering the science of nursing education.     

Developing the nurse as a knowledge worker in health — learning the artistry of practice

Nursing in the future will be a promoter of health and well-being. This paper argues that health has been inadequately conceptualised and the knowledge base required by nurses to practice as'knowledge workers'in health gain poorly defined. An epistemology for nursing is proposed that considers knowledge to be a construction of empirical, clinical and personal ways of knowing, contextualised within the activity of the nurse as 'knower'. The difficulties nursing has in defining and developing this unique epistemology are discussed. Lastly, the implications this unique epistemology will have for nursing education are explored. The author draws upon personal experience to explore and propose the use of clinical supervision as a tool which can be used by lecturers to coach nurses in the artistry of reflection in action, thus developing the therapeutic skills and knowledge base necessary to promote health as a holistic, multi-dimensional, dynamic, evolving and transforming process.     

Continuing the cultural competency journey through exploration of knowledge, attitudes, and skills with advanced practice psychiatric nursing students: an exemplar

Numerous training and education programs have evolved to address culturally competent health care delivery. This article describes an exemplar educational approach used to teach cultural competency to beginning graduate psychiatric mental health nursing students. Using interactive strategies delivered within the 4 phases of the curriculum, the approach has been shown to facilitate students' ongoing journey to cultural competence. Building on baccalaureate nursing competencies, the course addresses attitudes, knowledge, skills, and cultural humility to strengthen cultural self-assessment, cross-cultural clinical practice expertise, and the use of culturally appropriate research for graduate students.     

A dialogue about two nursing science traditions: the Roy adaptation model and the human becoming theory

The authors engage in a dialogue about the ontology, epistemology, and methodologies in research within their respective theoretical perspectives, the Roy adaptation model and the human becoming theory, insofar as these represent different paradigms in nursing science. In the discussion of ontology as the lens through which humans view their world, they articulate the primacy of ontology over methodology in shaping knowledge development.     

Does constructivist epistemology have a place in nurse education?

Nursing students who undertake the bachelor of nursing degree program are adults, many of whom are considered mature students. As such, they have significant life experiences and a vast amount of knowledge that has been acquired both formally and informally. Much of formal education historically, and even today, is content and curriculum driven, and teacher focused. Constructivist epistemology offers an alternative to traditional pedagogy in that it is student focused and considers previous learning done by the students as a foundation upon which to modify, build, and expand new knowledge. Constructivism also appears to be congruent with adult education theory and therefore offers great potential for the enhancement of self-directed learning. It enhances empowered learning because of the consideration of prior knowledge and the ownership of learning by the students. Implicit in this is the development of metacognitive skills that are an important facet of active and self-directed learning. As a result of undergraduate learning within a constructivist framework, there are likely to be benefits for nurses in the practice setting for making the transition from inexperienced to experienced practitioners. Constructivist learning frameworks provide learning skills that enhance knowledge acquisition with understanding.     

Exploring the heart of ethical nursing practice: implications for ethics education

The limitations of rational models of ethical decision making and the importance of nurses' human involvement as moral agents is increasingly being emphasized in the nursing literature. However, little is known about how nurses involve themselves in ethical decision making and action or about educational processes that support such practice. A recent study that examined the meaning and enactment of ethical nursing practice for three groups of nurses (nurses in direct care positions, student nurses, and nurses in advanced practice positions) highlighted that humanly involved ethical nursing practice is also simultaneously a personal process and a socially mediated one. Of particular significance was the way in which differing role expectations and contexts shaped the nurses' ethical practice. The study findings pointed to types of educative experiences that may help nurses to develop the knowledge and ability to live in and navigate their way through the complex, ambiguous and shifting terrain of ethical nursing practice.     

Ethical nursing practice: inquiry-in-action

Although the need to theorize ethics within the complexities of nursing practice has been identified within the nursing literature, to date the link between ethics epistemology and specific nursing actions has received limited attention. In particular, little exploration has been carried out to examine how nurses 'know' what is ethical and the knowledge they draw upon to inform their nursing actions within the complexities of their everyday practice. This study describes a participatory inquiry project that focused on developing and articulating an epistemology of ethics while in the midst of everyday nursing work. Epistemological and methodological insights are discussed in light of the challenges nurses face in contemporary healthcare contexts.     

Processes in the creation and diffusion of nursing knowledge: an examination of the developing concept of family-centred care

The creation of a knowledge base to underpin and direct nursing practice has been the pursuit of nurse academics, educationists and practitioners over recent decades Much of this work has concerned the explication of major theories of nursing, whilst some has sought to elucidate specific areas of knowledge This paper outlines processes of creation and diffusion, considering the influence of factors from both within and without the nursing profession on the epistemology of its knowledge base An examination of the developing concept of family-centred care is utilized to illustrate the convolutionary process of knowledge creation     

Nursing practice as bricoleur activity: a concept explored

The debates concerning the nature of nursing practice are often rooted in tensions between artistic, scientific and magical/mythical practice. It is within this context that the case is argued for considering that nursing practice involves bricoleur activity. This stance, which is derived from the work of Levi-Strauss, conceives elements of nursing practice as an embodied, bricoleur practice where practitioners draw on the 'shards and fragments' of the situation-at-hand to resolve the needs of the individual patient for whom they care. This conceptualisation of nursing practice will be analysed with a particular emphasis on its implication for nursing epistemology, pedagogy and praxis. The evidence to support this argument is drawn from empirical work that investigated nurses' use of intuition, the work of Levi-Strauss, and issues in nursing epistemology and ontology. The paper itself is written from the perspective of a bricoleur who uses 'bits and pieces' from the domains of nursing, philosophy, psychology, education, sociology and anthropology.     

Empowerment Strategies in Nursing Education

Abstract Building on the already substantial body of literature on education for population-focused practice, this article incorporates the teaching of empowerment strategies into this literature. These strategies provide a framework for teaching nursing students to promote the health of populations by shifting their focus of care to one that is compatible with principles of primary health care and health promotion within a context of health care reform. Since 1989, education for these shifts in practice has taken place within a clinical studies course on population-focused practice and has continued to evolve within an innovative nursing curriculum developed by The University of Victoria and its collaborative partners in nursing education in British Columbia, Canada. Faculty have worked to develop innovative teaching strategies and practica that provide students with opportunities to practice empowerment strategies with populations. Examples of how students have learned and practiced these strategies in a baccalaureate nursing program at the University College of the Cariboo in Kamloops, British Columbia, Canada provide useful illustration of the shifts in nursing education that are needed to shape the next era of health care.     

When nursing education becomes political: Norm-critical perspectives in a campus-based clinical learning environment

Nursing education is in the process of incorporating critical thinking, social justice, and health inequality perspectives into educational structures, aspiring to help nursing students develop into professional nurses prepared to provide equal care. Norm criticism is a pedagogical philosophy that promotes social justice. This qualitative case study aimed to gain an understanding of and elaborate on an educational development initiative in which norm criticism was incorporated into the composition of a new campus-based clinical learning environment for nursing education. By analyzing documents and interviews with the help of reflexive thematic analysis three themes were generated: “Intention to educate beyond nursing education,” “Educating in alliance with society,” and “The educative ambiguity of the Clinical Learning Centre.” The case study indicates that the incorporation of norm criticism into a campus-based clinical learning environment may encourage nursing students to evolve social skills for nursing practice that support health equality within healthcare. By collaborating with society, nursing education can considerably improve its educational frameworks in alignment with societal demands. However, the inclusion of norm criticism in a setting such as a campus-based clinical learning environment entails a clash with established institutionalized norms and being perceived as too proximate to politics.     

Epistemology at work: the ontological relationship between feminist methods, intersubjectivity and nursing research--a research exemplar

This article explores the importance of strong epistemological and ontological links in nursing research by examining the design and process of a recent research project. The research topic concerns the relationship between self-concept and nursing practice. In this article, the authors demonstrate that commitment to a methodologically consistent process and the necessary associated epistemological and ontological positions provides a depth and structure to nursing research. It is the authors' belief that such consistency within research acts to strengthen the research process, and consequently strengthens nursing's research base and knowledge.     

Development of a new undergraduate palliative care knowledge measure

Compassionate, competent, and holistic care is at the core of palliative care nursing. Knowledge of primary palliative care concepts is a fundamental expectation of graduating nursing students. The release of updated national educational competencies in palliative care coupled with a new palliative care curriculum for prelicensure nursing students created a need to measure acquisition of new knowledge. The purpose of this paper is to describe development and psychometric evaluation of a new palliative care measure. Development of the new measure was guided by an expert team of palliative care educators, incorporating existing knowledge measures as well as content from the newly developed curriculum. A 4-step process resulted in development of a 27-item measure reflecting the 17 new core competencies for undergraduate palliative care education. Initial pilot testing in a sample of 262 nursing students demonstrated good internal consistency (Cronbach's α = 0.70), with a 2-factor model that aligns with multiple national expectations for primary palliative care. This study is the first to align knowledge items with national palliative care competencies and care domains. Further psychometric testing will be conducted as well as large multisite research collaborations to test curriculum implementation and use this knowledge measure in prelicensure nursing education.     

Assimilating sociology: critical reflections on the 'Sociology in nursing'debate

We are witnessing the emergence of a 'new nursing'. In part, this has been associated with the adoption of a 'holistic' model of health and a commitment to a holistic curriculum within nurse education. The role of sociology within the nursing enterprise has been the subject of much debate. This paper seeks to further this debate by arguing that sociology is invaluable to nursing for many reasons but that its value may be undermined as a consequence of being overly constrained within the nursing arena, at the mutual expense of both sociology and the long term interests of nursing itself. This paper will suggest that central to an understanding of how this 'surplus constraint' of sociology occurs is an understanding of the manner in which the holistic model has been adopted in much of nursing and nurse education. The'indeterminacy' of the holistic model is such that it has empowered a questionable eclecticism, marginalized philosophical controversies within nursing theory, disguised difficult epistemological and ontological conflicts associated with competing claims to truth and facilitated the operation of a form of power whereby sociology has been excluded, at the very moment of its apparent inclusion. This paper goes on to argue that the value of sociology to nursing is dependent upon: firstly, a more systematic and rigorous discussion of its relationship to, and role within, nursing and secondly, a movement away from an implicit 'assimilation' model regarding the incorporation of sociology into nursing towards a more 'multicultural' approach. Only under such circumstances may sociology's value to nursing be realized but in a manner that places an importance on maintaining the ontological and epistomological integrity of the sociological tradition.     

Re‐conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice

Jacqueline Fawcett's nursing metaparadigm—the domains of person, health, environment, and nursing—remains popular in nursing curricula, despite having been repeatedly challenged as a logical philosophy of nursing. Fawcett appropriated the word “metaparadigm” (indirectly) from Margaret Masterman and Thomas Kuhn as a devise that allowed her to organize then‐current areas of nursing interest into a philosophical “hierarchy of knowledge,” and thereby claim nursing inquiry and practice as rigorously “scientific.” Scholars have consistently rejected the logic of Fawcett's metaparadigm, but have not yet proposed a substantially agreed‐upon alternative. Through an analysis of articles introducing and critiquing Fawcett's metaparadigm, I argue for a re‐conceptualized metaparadigm that articulates nursing's ontology. What exists for the nursing discipline are not already‐demarcated metaparadigm domains, but rather interdependent, dynamic relations that constitute people, including nurses, in their health/environment circumstance. The nursing discipline aims to skillfully access this dynamic relationality as the basis for action and reflection to produce both positive health trajectories and knowledge that facilitates future action and reflection. Further inquiry into the onto‐epistemology of nursing will produce a more robust understanding of nursing practice, science, and philosophy, and clarify its unique contribution to health and healthcare.     

Diagnostic reasoning among second-year nursing students

This paper reports on a study investigating the relationship of nursing students' approaches to learning and processing of information, science content knowledge, ability in interpreting and organizing clinical data (nursing assessment), and logical reasoning ability with the accuracy and quality of the nursing diagnosis made in a simulated diagnostic reasoning task. One hundred and sixty-nine second-year pre-service nursing students participated in the study. Results of path analyses indicated a set of pathways from surface approach to low-quality nursing diagnosis that reflected less competent diagnostic reasoning; and a second set from deep/achieving approach through content knowledge and logical reasoning to higher-quality nursing diagnosis that reflected more competent diagnostic reasoning. The implications of these findings for nurse education are discussed.     

Standardized testing in nursing education: Preparing students for NCLEX-RN® and practice

Standardized testing that predicts nursing student success accurately and identifies weak content areas has played a critical role in nursing education. Critics of such testing lament the harm of this type of testing, often misinterpreting common practices as well as overlooking all value. The goal of nursing school is to graduate competent professionals with adequate knowledge to practice safely, who can pass the NCLEX-RN® and gain employment. The use of standardized exit exams or comprehensive exams that are valid and reliable should be embraced as evidence-based, academically rigorous evaluation tools, much like the discipline of education has embraced the Praxis Exam. This paper will present evidence supporting the value of “program exit standardized testing” and address the importance of assessing students and focusing on minimum competency. As a profession that prides itself on the use of evidence to guide practice, we need to use evidence to guide policy development with respect to the use of standardized testing in nursing education.     

Evaluating a problem based learning course: an action research study

Problem based learning (PBL) has been widely used in the United States, United Kingdom and Australasia in undergraduate nursing education to develop critical thinking and problem solving skills. PBL has been used since 1996 in a Bachelor of Nursing course at a New Zealand tertiary institution, and several modifications have been made to foster effective learning. The 'pure' PBL process has been adapted to move students gradually from teacher direction to taking responsibility for their learning. This has provided the opportunity for students to develop critical thinking, problem solving, information retrieval and evaluation skills, and group process skills over an 18-week period. Because rigorous evaluation of these changes had not been formally undertaken, the purpose of this study was to evaluate how the current format was developing students' understanding and integration of knowledge. Two cycles of the action research method (Cardno and Piggot-Irvine, 1994) were used, involving 4 lecturers and 17 students. Data was collected both quantitatively and qualitatively over a 16-week period. Findings indicated the importance of: explaining the purpose and process of PBL; communicating in detail the role of both students and lecturers; keeping communication lines open; addressing timetabling issues and valuing this method of learning for nursing practice. Implications for nursing education are addressed.