NURSING KNOWLEDGE DEVELOPMENT

Nursing Knowledge Development



Abstract

This paper explores Habermas' knowledge constitutive interests as a basis for clinical effectiveness. Clinical effectiveness and evidence based practice are clarified and Habermas interpretation of critical theory is introduced as an instrument which could arguably fulfil the needs of both concepts. The knowledge constitutive interests have the capacity to encompass science and evidence based practice via technical knowledge, the practical interests via interpretive knowledge and the freedom to change practice via emancipatory knowledge. This gives an opportunity for technical science and interpretive knowledge to facilitate the liberation of nurses via clinical effectiveness. The paper culminates in the presentation of a visual model to articulate this proposal.

Nursing Knowledge Development

Introduction

This paper will commence with an explanation of clinical effectiveness how it should be distinguished from, and incorporate, evidence based practice. It will then be argued that Habermas' knowledge constitutive interests comprise a potentially useful model, which could emancipate clinical effectiveness. It is a widely held belief that nursing science is developed predominantly through a combination of theory, research and practice. Each component enjoys periods of popularity, which is often dictated by the prevailing ethos of the time. Which elements have the most influence on how heath care is delivered is determined in part by the way it complements the other realms of health care. How these components collectively assist nursing practise does not attract overwhelming consensus and continues to be one of the major issues debated by clinicians, academics, researchers, politicians and administrators. Identifying ways to facilitate the collaboration between these aspects of health care remains crucial to nursing's development and the betterment of health in society.

Theory in Nursing

Meleis and Price (1988) asserted that nursing theory guides practice provides guidance for research and answers questions gathered from practice. Lutijens and Horon (1992) talk of theory, research and practice as being a cyclical process that defines nursing science with practice serving as the catalyst. Despite the interrelatedness of these elements, Fawcett (1978) warns that theory development and research are excursions into the trivial when presented in isolation. However, nursing developed essentially as a profession of 'doing' despite nursing education moving into a university setting and adopting a scientific framework. Watson (1981) believes that the scientific models utilised in nursing education were not congruent with existing theories, thereby creating a theoretical gap.

Wilson (1995) described knowing as becoming more valuable than doing, and because nursing's uniqueness in providing holistic care was not addressed with theories and research, the gap was perpetuated. Wilson believed the incongruence between traditional research philosophy and the essence of nursing resulted in many nurses failing to recognise the relationship between theory, research and practice. Bear in mind that a logical positivist philosophy has dominated most of science from the 1920's to the 1960's.

During this period nursing developed nursing diagnoses, which Powers (1993) now sees as being based on assumptions of outdated philosophy and suggests this has had a negative impact on patients by creating dependence on expert nursing treating the problems that were created socially and ...