At the moment of practice
‘What counts as nursing knowledge remains a contested area with a range of arguments and approaches …. and numerous points of contention’, so say Bonner & Lloyd in the introduction to their paper in this issue of JAN (pp. 1213–1221).
Yes indeed, a huge literature on ‘the nature of nursing knowledge’ has accumulated ever since Carper’s (1978) seminal paper was published under the title of ‘fundamental patterns of knowing in nursing’. The concept of ‘occupational knowledge’ in general is incredibly complex. The nature of nursing knowledge is no exception to that general complexity. However, there is now a basic consensus in the nursing literature. This is well demonstrated in a concept analysis we published in JAN a couple of years ago (Bonis 2009) in which it was concluded that ‘knowing in nursing’ is a uniquely personal type of knowledge constructed of objective knowledge interlaced with an individual’s subjective perspective on their personal experience.
But how does this play out in everyday practice? What is exciting about Bonner and Lloyd’s newly published JAN paper is that it is empirically based and grounded in practice. Their work is philosophically framed, as of course it should be, but their root concern is about how nurses locate and use information in practice. And, of course, this is what we – especially practising nurses and nurse educators – really want and need to understand if knowledgeable practice is to be achieved consistently in day-to-day nursing. Nursing knowledge is revealed at the moment of practice, say Bonner and Lloyd, and that is what they set out to investigate.
They undertook their study in the field of renal nursing practice, specifically in two satellite renal units, in Australia, that provide haemodialysis and peritoneal dialysis for people who have end-stage kidney disease. This setting is one in which the role of nurses is critical and often highly autonomous, and in which nurses must draw on a diverse range of information. But the value of this paper is not confined to renal nursing: it has relevance for any field of practice. Bonner and Lloyd used qualitative research techniques to thematically analyse the transcripts from hour-long interviews with six registered nurses in which they were asked to reflect on their information practices. So, note that this was a small study, and one which relies on nurses’ accounts and not also on observation of actual practice. The authors acknowledge that their study has limitations. But it also has richness of content, and of commentary, that makes it a really interesting and insightful paper.
Bonner and Lloyd conclude that epistemic, social and corporeal knowledge all do play a role in everyday nursing practice. They argue that understanding this is important because it demonstrates that nurses must engage with all three modalities to provide effective, efficient and holistic patient care. Understanding how nurses use knowledge at the moment of practice is an emergent line of research in this long-running field of enquiry. It is an exciting and important one. The need for nursing practice to be knowledge-based only increases in importance as healthcare systems worldwide become ever more pressurized and complex.