A review of Chapter 4 Nursing Knowledge: Science, Practice, and Philosophy by Mark Risjord

Shane Cantrell

Practice values and the disciplinary knowledge base

First Thoughts

• Testing the knowledge that was implicit in practice• Three levels of theory in the natural and social sciences*• Nursing needed more**

Dickoff and James’ practice theory

Values and theory testing

• The goal is what the nurse ought to strive for• Therefore this is a value-judgment• We need to test nursing interventions for value, but how??

• Study about Postoperative vomiting*

• But was it truly good (palatable)**

• Testing palatability*• How do we go about doing this?

•Orlando—meet the patient’s needs and relieving distress**•Dumas and Leonard protocol (ADPIE) **

•Relieving distress through Assessment, Diagnosis, Planning, Intervention, and Evaluation (the beginnings of ADPIE) rough draft

Challenges to Dickoff and James’ criteria

Kuhn Paradigm Shift

• Practice theory was not possible*

• Nursing was more of a moral value decision making that should go with ethical theories instead of scientific ones

Beckstrand’s critique

• Battle between is this intervention truly good? Value-laden theory• Instrumental vs Intrinsic**

Beckstrand’s critique

• Strict separation of scientific and ethical knowledge in nursing• Four domains of knowing• Empirics, esthetics, personal

knowledge, and ethics• Keep empirics and ethics

separate……domains or patterns

Carper’s fact-value distinction

• The obfuscation* of evaluative commitments• Yeo argues they should be blended**• Moral influences on research (biases and

assumptions)• Ethical reflection is a necessary component

of empirical inquiry

• The disintegration of nursing knowledge• Carper is wishy washy , separate but ☺

interrelated and interdependent (How can this be?)

Problems with patterns

• The role of theory in ethical knowledge*• Yeo basically said we are in trouble if we

rely on ethical theory to make nursing decisions• Seedhouse said that ethical theories will

tell us how to act is an “ethics myth” • Plugging topics into a mathematical formula

will not help A + B = C, where A is a situation, B is an ethical theory, and C equals the outcome or goal**

Problems with patterns

• We need a blended ethical and empirical pattern, but how? • Egg yolks

Problems with patterns

• Sociopolitical knowing• Additional pattern• Nurses should be engaged in social issues,

e.g. poverty, unemployment, and drug addiction• Commitment to political causes, advocacy,

and engagement in political debate*

Problems with patterns