How has R & S Ch 2 helped you answer the question as to how knowledge (or theory) is generated in nursing practice?
This week I want you to address the following questions in your single discussion post to learn what you have gleaned from the reading:
1. How has R & S Ch 2 helped you answer the question as to how knowledge (or theory) is generated in nursing practice?
2. Eleven tenets of intermodernism were proposed. What is another that you might add beside one of the letters?
3. How closely do you identify with the perspectives of this new philosophical view?
4. Do you disagree with some tenets?
Throughout the reading of this chapter, I have been able to understand the development of knowledge in nursing practice better than before. While reading about intermodernism, some facts stuck with me. For example, one of its tenets is empiricism which “Valorizes the perspectives of patients and families as central in the discovery and justification of knowledge” (Reed and Shearer, 2018). Empiricism itself is a theory that believes that all knowledge is derived from sensory experience. But Knowledge is not only obtained through experience but also by the reflection of these. In the article “Patient and Nurse Experiences of Theory-based Care”, study findings support reflection as a process of “moving away from the immediate to gain understanding and perspective of the whole” (Flanagan, 2009). Experience without reflection will not lead to knowledge development. Reflection allows us to make sense of what’s experienced in practice.
Something that I really like about intermodernism is that it is not white and black. It acknowledges that knowledge development can both be a systematic and messy process. Furthermore, I learned that “Knowledge need not be handed down when it is generated in practice” (Reed and Shearer, 2018). “Theoretical ideas inspire and guide the research, but it is the practice of nursing that actually motivated knowledge development” (Reed and Shearer, 2018). These are some of the facts that stuck with me, and support my belief that knowledge is generated through the practice of nursing and the experiences that come with it. It also added to my understanding that experiences alone will not form knowledge but if we reflect and think about these experiences we can then create more knowledge.
Another tenet I would add would be expansiveness because as we previously discussed, “knowledge is emergent and expands with every experience, and every turn” (Reed and Shearer, 2018). With time knowledge continues to expand and new technology and new information will call for the creation of new knowledge. I believe that this would go hand in hand with the tenet of discovery.
I identify closely with the tenet of “in-betweenness”, and the tenet of “openness”. One does not have to choose a side when it comes to theories. In the same way, nurses don’t have to pick a side, we can use the knowledge we learned in nursing school, and through our books, but we can also create our own knowledge through experiences and over time as new information is created and technology moves forward. I don’t see myself getting stuck in the past but rather accepting the new knowledge and merging it with previous knowledge to be a well-rounded nurse.
I don’t completely disagree with the tenet of reality, but it is the one I agree with the least. It states that “reality is found neither out there (independent of the thinker) nor completely within the thinker” (Reed and Shearer, 2018). It states that it emerges through the nurse’s theories and interactions, but to me, reality is not something that “emerges” reality is already there and as nurses, we have to deal with reality. Reality is the way things actually are not the way we want them to be.
References
Reed, P. G., & Shearer, N. B. (2018). Nursing Knowledge and Theory Innovation: Advancing the science of practice (2nd ed.). New York, NY: Springer Publishing Company, LLC.
Flanagan, J. (2009). Patient and nurse experiences of theory-based care. Nursing Science Quarterly, 22(2), 160–172. https://doi.org/10.1177/0894318409331937
After reading R & S Ch 2, Peplau’s Cycle of Inquiry has helped me to understand how knowledge (or theory) can be generated in nursing practice. In Peplau’s knowledge transformation approach, nurses are at the center of theory, and they interact with patients, develop therapeutic and interpersonal relationships and use the interpersonal process strategy for generating the nursing knowledge (Reed & Shearer, 2018, p. 34). Peplau’s stepwise approach of transforming practice knowledge to nursing knowledge provides guides to nurses to use their theoretical understanding and personal knowledge while participating in the interpersonal process with a patient, and then “peeled out” the hypothesis drawn on from nurses’ observations to explain observed phenomena and finally, apply the theoretical knowledge through interactions with patients. After evaluating the test results, the resulting knowledge becomes part of a practicing nurse’s repertoire of knowledge, which undergoes transformation and validation in subsequent nurse-patient encounters (Reed & Shearer, 2018, p. 36). The knowledge we developed through knowledge transformation will help in reflective nursing practice, which means when provided with time for reflection on self and the patient interactions, the nurse is renewed and results in an ability to engage in the patient care situations with increased awareness and an understanding about potential transformation (Flanagan, 2009, p.161).
I would add “E” as ethics besides the eleven tenets of intermodernism. Ethics is the moral philosophy that talks about what is morally right and wrong and is an inseparable part of any profession including research and practice. For practice nurses, ethics provides a framework to help them ensure the safety of patients and their fellow healthcare workers.
I enjoyed reading all intermodern perspectives of this new philosophy and connected myself in some context to all the tenants. I found strongly identified myself with the “Openness” tenet. In my perspective, healthy comments and feedback always push us towards the betterment, open for new ideas, open to new thought processes and beliefs, and being open to critique, self-correction, and change and an ongoing reflection on one’s theory and practice are essential in knowledge development” (Reed & Shearer, 2018, p. 30).
I reviewed all the tenets of intermodernism and I truly value all of them and there are not any reasons to disagree. As Reed & Shearer (2018) states “the list of tenets of intermodernism is incomplete and open (p.31)”, instead, I would like to add my perspectives of new tenet, “Ethics” on the list.
References
Reed, P. G., & Shearer, N. B. (2018). Nursing knowledge and Theory Innovation: Advancing the Science of Practice (2nd ed.). New York, NY: Springer Publishing Company.
Flanagan, J. (2009). Patient and nurse experiences of theory-based care. Nursing Science Quarterly, 22(2), 160-172. https://doi.org/10.1177/0894318409331937
In Chapter 2, Reed and Shearer discuss the background behind many major theories in science and tie this to the theories of nursing. Reed and Shearer outline knowledge acquisition for science in general, and then highlight how the earliest guiding principles of science theory such as “use of reason, questioning, and skepticism” are still a major part of nursing knowledge and theory today (Reed & Shearer, 2017, p. 26). This chapter emphasizes that most of nursing theory borrows from existing theories and expands on the general tenets, allowing nurses and nurse theorists to “think about what features [they] would like or need in a philosophy of science to facilitate knowledge development through [their] practices of science and nursing care” (Reed & Shearer, 2017, p. 27). The authors also reiterate that in nursing knowledge, there are many factors in a nurse’s life and career that may be “regarded as opportunities that enrich rather than constrain knowledge” (Reed & Shearer, 2017, p.27). This chapter truly makes it apparent that nursing knowledge is an ever-evolving situation and that theory is accessible and relevant to all practicing nurses as “theory can emerge out of the practice of nursing and nurses’ caregiving situations” (Reed & Shearer, 2017, p. 32).
After reviewing both readings this week, I feel that the tenet of “reflection” should be added to the eleven existing tenets. While the tenet of “Openness” does touch upon “ongoing reflection of one’s theory and practice,” I feel that reflection on one’s own biases, knowledge deficits and personal experiences should be a full tenet. R & S mention that one of Peplau’s ideas in her “Cycle of Inquiry” is that “a nurse enters a situation with a theoretical understanding, personal bias, and previously acquired knowledge” (p. 34). Furthermore, in the article by Flanagan (2009), the idea of “reflection” is recognized as a “process to gain insight into actions” (p. 160). The group of nurses in Flanagan’s article adopted a reflective process and “As a result of the reflective process, new insights may result in evolution of both self and other. The process is a transformative one, which can lead to a more desirable practice that acknowledges the uniqueness of person” (Flanagan, 2009 p. 161). While the tenet of “Openness” is important, I feel one cannot be truly “open” to new knowledge and criticism/feedback unless one has reflected on one’s self and has an understanding of one’s strengths and weaknesses.
Overall, after reviewing the eleven tenets of the Intermodern perspective, I feel that my personal values and beliefs tend to align with this theory overall. I was surprised to see the tenet of “Romanticism” that “recognizes the reality of the human quest for meaning, goodness, and beauty,” as this is not something that I would automatically think of when thinking about nursing knowledge and theory (Reed & Shearer, 2017, p. 30). However, upon further consideration, as the practice of nursing is considered by many as an art and science (myself included) this tenet makes sense.
References
Flanagan, J. (2009). Patient and nurse experiences of theory-based care. Nursing Science Quarterly, 22(2), 160–172. https://doi.org/10.1177/0894318409331937
Reed, P. G., Shearer, N. C., (2017). Nursing Knowledge and Theory Innovation advancing the Science of Practice (2nd Ed.). Springer Publishing Co.