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research-article2013
NSQXXX10.1177/0894318413510636Nursing Science QuarterlyFawcett and Lee
Letter to the Editor
Advancing Nursing Knowledge: A Response to Burns’ Letter to the Editor
Nursing Science Quarterly 2014, Vol 27(1) 88–90 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318413510636 nsq.sagepub.com
Jacqueline Fawcett, RN; PhD; FAAN1 and Rebecca C. Lee, RN; PhD2 We are pleased to have this opportunity to respond to Jade Burns’ (2013) letter to the editor, “The neomodernism approach: Professional development of baccalaureate level nurses.” We thank Ms. Burns for her interest in our essay, “The influence of the metaparadigm of nursing on professional identity development among RN-BSN students” (Lee & Fawcett, 2012) and for stimulating our thinking beyond the metaparadigm of nursing as a way to involve students in nursing knowledge development.
A Plethora of Paradigms We first must ask, what does Burns (2013) mean by a paradigm? Paradigms may be philosophical, which sometimes are referred to as worldviews. Examples of the plethora of philosophical paradigms includes organicism, mechanism, change, persistence, simultaneity, totality, particulate-deterministic, interactive-integrative, unitary-transformative, reaction, reciprocal interaction, simultaneous action, modernism, postmodernism, and neomoderism (Fawcett, 1993; Fawcett & DeSanto-Madeya, 2013; Parse, 1987; Reed, 2006). Paradigms also may be conceptual. More specifically, paradigm is the term used in some disciplines for what in nursing is known as a conceptual model of nursing. Examples of nursing conceptual models are Johnson’s behavioral system model, King’s conceptual system, Levine’s conservation model, Neuman’s systems model, Orem’s self-care framework, Rogers’ science of unitary human beings, and Roy’s adaptation model (Fawcett & DeSanto-Madeya, 2013). Paradigms remind the members of a discipline about its values and beliefs and provide frameworks for the practice, education, and research activities needed to develop knowledge. In essence, paradigms provide the foundation upon which a discipline is built, the horizon upon which a discipline explores phenomena, and the vision of what the discipline can become. An important point to ponder as we reflect on the nature of paradigms is whether the multiple philosophical and conceptual paradigms of nursing define our discipline, or does our discipline define the paradigms we embrace? We invite readers to contribute their ideas about this point. The perspective from which nurse researchers ask questions and investigate problems is influenced by the ontological and epistemological assumptions of the philosophical
and conceptual paradigms they adopt. In addition, researchers determine methodologies to be used for investigation including how data are collected, analyzed, and interpreted through the lens of philosophical and conceptual paradigms (Monti & Tingen, 1999).
Co-Creators of Knowledge A particularly provocative point in Burns’ (2013) letter is the idea of baccalaureate nursing students as co-creators of knowledge, rather than relegating knowledge development to students and graduates of research doctoral programs. The idea of baccalaureate students as knowledge co-creators is consistent with the neomodern paradigm of knowledge producer (Reed, 2006). That baccalaureate nursing students are not yet thought of as co-creators of knowledge or knowledge producers may be attributed to the hierarchy of knowledge development advocated by the American Association of Colleges of Nursing (AACN), with students and graduates of research doctoral programs regarded as the stewards of new knowledge development and students and graduates of baccalaureate and practice doctoral programs regarded as the stewards of knowledge application in practice. For example, the Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008) do not include development of new knowledge, but rather highlight “identification of practice issues; appraisal and integration of evidence; and evaluation of outcomes” (p. 15). This educational essential typically is operationalized in the baccalaureate nursing curriculum as one course focusing on evaluation of research for evidence-based practice, and at least some discussion of practice issues and evaluation of outcomes of nursing interventions in other courses, especially courses focusing on development of clinical reasoning and clinical skills. Similarly, the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006) highlight “translation of new science, its application and evaluation [as well as generation of] evidence through … practice to guide improvements in practice and outcomes of care” (p. 12). This educational essential typically is operationalized in the 1
University of Massachusetts Boston, Boston, USA University of Cincinnati, Cincinnati, OH, USA
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Fawcett and Lee Doctor of Nursing Practice program curriculum as one or more courses focusing on evidence-based practice and quality improvement projects. Although the essentials of baccalaureate nursing education prescribe the more passive role for graduates as appliers of knowledge, other published guidelines suggest that professional responsibility includes being active participants in knowledge production. Recognition that knowledge creation is a circular, dynamic process in which each member of the discipline is fully involved is embedded in the Code of Ethics for Nursing (American Nurses Association, 2001). Provision 7 of the Code affirms that nurses will participate in the advancement of the profession through contributions to knowledge development, and that all nurses can participate through development, evaluation, dissemination, and application of knowledge in practice. Therefore, it seems logical that if we expect all nurses to participate in development of knowledge, then we must socialize students into that role. In support of this position, Benner, Sutphen, Leonard, and Day (2009) have called for a radical transformation of nursing education that supports the transformation of practicing nurses’ identity by encouraging and guiding their participation as producers of knowledge, rather than merely users of knowledge. This position is consistent with the neomodern philosophical paradigm.
nursing (Reilly, 1975, p. 567) could be in the form of published metanarratives (Whall, Sinclair, & Parahoo, 2006) and similar formats for disseminating the results of generating new theories and testing existing theories. We caution the partners to not focus solely on nursing science, which implies an emphasis on empiricism, but instead focus on all of the nursing discipline-specific knowledge needed for theorybased (evidence-based) nursing practice, including five types of theories–empirical, aesthetic, ethical, personal knowing, and sociopolitical (Carper, 1978; White, 1995). We also caution readers to acknowledge unknowing as another type of nursing theory (Munhall, 1993), which may be either a facilitator or a barrier to the advancement of the other five types of theories. The challenges to the idea of partnerships are political and practical. Politically, consideration must be given to the willingness of nursing program administrators and chief nursing officers in healthcare agencies to establish an effective infrastructure that provides necessary resources. A forerunner of these partnerships is the academic-service partnerships that undergird the Dedicated Education Unit initiative (Mulready-Shick, Kafel, Banister, & Mylott, 2009; Murray & James, 2012).
Partnerships for Knowledge Development
The discipline of nursing has been characterized by great diversity of philosophical and conceptual paradigms and modes of inquiry, as we attempt to answer the ontological, epistemological, and practical questions of our time (Steeves & Kahn, 1995). It is only by acknowledging and exploring the various paradigmatic approaches for nursing that we can come to recognize and value the commonality as well as diversity of scholarship in our discipline. Burns (2013) questions what will be the “best” paradigm for nursing science. Watson (1985) commented that the best paradigm for nursing “must allow human phenomena to emerge and still be investigated” and the methods of inquiry used to generate nursing knowledge must be such that the “humanness of a relationship between two beings is neither diminished nor lost” (p. 9). A paradigm that disallows the valuable input from diverse stakeholder perspectives dehumanizes a discipline. We maintain that there is no one best philosophical paradigm or conceptual model for nursing knowledge development. Consequently, we advocate teaching not only the metaparadigm of nursing (Lee & Fawcett, 2012), but also providing an overview of various philosophical and conceptual paradigms in an introductory baccalaureate nursing program course. Subsequently, deeper content about the philosophical and conceptual paradigms used by each faculty member for his or her work can be provided in theory-practice courses. The members of the discipline of nursing have always employed multiple and diverse epistemologies, even if we have not explicitly recognized and acknowledged these ways of developing knowledge. We maintain that our comprehensive
Nursing is a human practice endeavor, and as such is concerned with developing knowledge that is relevant to and needed to guide practice. “Development of knowledge that is intentionally relevant to nursing practice requires the process of knowledge development to be embedded in nursing practice” (Reed & Schearer, 2011, p. x). Therefore, we join Burns (2013) in recommending that the time has come to move from a hierarchical approach to nursing knowledge development to an egalitarian approach in which baccalaureate, practice doctoral, and research doctoral program students join with nurse educators, staff nurses, nurse administrators, and patients to form partnerships for nursing discipline-specific knowledge development. These partnerships will focus on conceptual model-guided, theory-based (evidence-based) practice, with an emphasis on reflection, analysis, and evaluation of the practice methodologies used. The formation of partnerships requires that all of us embrace and applaud the value of each student, educator, staff nurse, administrator, and patient as a unique contributor to nursing knowledge development. In the epistemological sense of knowledge development, giving voice to each person recognizes that no one voice is privileged over another, but rather all are co-creators, with the resultant whole being greater than the sum of the parts. The documentation that moves the knowledge development initiatives beyond the partners’ “private image” of
Conclusion
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approach to knowing is a defining characteristic of our ontology, and one upon which we will continue to build new knowledge that will guide the future of our discipline. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
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