Knowing in Nursing: Concept Analysis - Term Paper Example

? Knowing: A Concept Analysis Knowing: A Concept Analysis Nurses encounter different types of patients who have different kindsof diseases in their world of profession. All nurses who work in patient care settings therefore need to develop an understanding as well as focus on the different variables of human nature. Nurses need to be knowledgeable and develop a clear understanding of their patients to enable them create an effective patient- nurse relationship as well as provide the best care they can. Nurses also need to understand their clinical settings for them to be able to handle challenges that come up in the profession. This paper will explore knowing as a concept analysis in nursing since it is a subject of great relevance in this field. Knowing a patient is an important issue that has been identified in recent studies being carried out in nursing practice. Developing a clear patient understanding will assist in creating a cherished relationship as nurses will treat their patients as unique individuals. According to recent research, knowing a patient entails two components, which are, selection of individual interventions and general patient understanding. There are three important factors that that are important in knowing a patient and they include: experience that a nurse has gained in the practice of caring for patients, a sense of closeness which has developed between a nurse and a patient as well as chronological events which have taken place in a clinical setting (Radwin, 1996). Literature review Knowing in nursing refers to a unique type of knowledge in every individual that is developed when there is an interface between objective knowledge and individual’s subjective perspective based on personal experience (Fagerstrom and Tofthagen, 2010). Knowing is a process which keeps changing and it will result from transformations and reflections that will occur as a person lives and interacts with the world. Nurses are able to draw their knowledge of knowing from various experiences in their day to interactions and this enables them to form their nursing judgments (Klassen, 2010). According to Carper (1978), there are four different patterns of knowing in nursing field and they include: aesthetic knowing, personal knowing, empirical knowing as well as ethical knowing. A fifth different way of knowing has been added by Chinn and Kramer (2008), which is emancipatory knowing. This pattern of knowing plays a huge role of identifying political, social as well as economic factors that will lead to the occurrence of inequalities in the health sector. Another definition has been developed by Liaschenko and Fischer (1999), which describes knowing in nursing as development of a clear understanding of the nursing language as an attribute which comprises of knowledge of pathophysiology, therapeutic protocols as well as processes of the many diseases. Another author, Bonis, has carried out an analysis based on the concept of knowing in nursing and came up with a definition. According to Bonis, knowing in nursing is defined as a unique individual knowledge developed over a long time due to the individual’s view on his/her own life experiences (Bonis, 2009). Bonis further adds that knowing in nursing is developed when the medical practitioner is able to reflect on his own professional as well as personal experiences. This process of reflection will play a great role in transforming the perspectives of most nurses since they will develop a clear understanding of the settings in which they work as well as the patients with whom they are in continuous interaction with. The literature review has identified various definitions of the concept of knowing in nursing and this has helped me in synthesis of another definition. Knowing in nursing is defined as a process by which a nurse develops an understanding of a patient situation whose main focus is based on how a patient responds to medication and care within the setting of a health care system. Knowing in nursing should enable the nurse to develop a personal knowledge that gives him/her a clear description of the life experiences of the patient with whom they are in continuous interaction. Antecedents of the Concept of Knowing According to Avant and Walker (2005), identification of precedents is an important procedure that will make positive contributions in analysis of any concept. Antecedents are able to capture the events that occur before knowing is attained. Antecedents of knowing are reflection, experience and awareness. Reflection is an important aspect that will contribute towards development of knowing in nursing. Reflection is necessary in cultivation of knowing since it facilitates the development of a clear understanding of medical practices (Freshwater, 2002). Nurses who have the virtue of knowledge will develop efficient reflective skills that give them the capabilities of viewing clinical events and patients from multiple perspectives. This enables nurses to come up with effective medical solutions as they have a clear understanding of both their patients and clinical events. To develop the virtue of knowing, a nurse should first of all be able to reflect on his/her practices with insight levels as well as self awareness (Christley, et. al, 2005). Knowing in nursing can be attained once a nurse gains substantial experience in the clinical sector. Experience is an important factor that will enable a nurse to acquire the skills of knowing. It also plays a vital role of integrating a nurse’s inner reality into that of the clinical environment (Tanner, 2006). Experience will ensure that a nurse is familiar with most clinical concepts and he/she will therefore understand what is expected of him/her. Nurses will be able to perform their duties more diligently and effectively therefore ensure that they provide the best medical care to their patients. Experience will also ensure that nurses avoid making medical errors that could be of great harm to their patients (Risjord, 2011). A nurse’s own inner reality is made up of what he/she believes in and their values about cultural and professional identity. A nurse should be aware of the experiences of his/her patients for him to be able to take care of the patient as participants in nursing care rather than view them as objects. Awareness will enable a nurse develop an internal representation of the interaction which take place between human beings and their environments and this will give them a greater understanding of how human beings would respond to potential problems associated with health. A sense of awareness will give a nurse the feeling of being a medical practitioner who can carry out his/her duties responsibly and with great skills (Ohlen and Segesten, 1998). Critical Attributes Critical attributes provide insight into the concept of knowing as they tend to come up from time to time depending on circumstances. It is also believed that the attributes will evolve as more understanding of the concept of knowing continue to emerge. A clear attribute of knowing as a concept is successful decision making and this will enable nurses to handle difficult situations in a professional manner. Consequences The concept of knowing has been seen to have consequences. Many outcomes may occur if the concept of knowing is not present. If knowing is not achieved by a nurse, it may result into negative patients’ outcomes. Also, a nurse may not be able to make expert decisions and this may be characterized by not knowing the patient. When a concept of knowing is not present, the nurse may not have a clear idea regarding theories and assumptions will also lack. A nurse may not be able to come up with appropriate proportions and interventions and he/she may as well be believed to be in the field of nursing without the necessary knowledge (Locsin and Urnell, 2009). Model case and Additional cases According to Avant and Walker (2005), a model case is described as a model exemplar that includes all antecedents as well as attributes. The following exemplar illustrates the model case of knowing in a real life situation. Francis is a nurse in a city clinic. He has to examine a cancer patient who has come into the clinic to receive treatment. Francis asks the patient to explain why she did not sought treatment early enough as the cancer is in it advanced stage. He also asks why the patient has never been to the clinic to get a Pap smear test yet the services are free of charge. He listens carefully as the patient goes ahead to explain her reasons as to why she had not visited the clinic before. She explains how she resides in an insecure neighborhood where there are thugs who harass residents and that factor makes her be afraid of leaving her house. She adds that she only seeks medical help when symptoms appear. According to the patient, her safety is more important than seeking preventive health care. This model case includes all the important attributes necessary to the concept of knowing. Antecedents of awareness and experience are present in this model case. Francis has gained experience in his nursing profession and his ability to listen carefully to his patient helped him to develop a sense of knowing of the community in which his patient lives. He therefore concludes that in order for the patient to be able to access medical services, issues in her community should first be addressed. Knowing of the nurse has enabled him to develop a deeper understanding of his patient as well as her community at large (Locsin and Urnell, 2009). Caring to understand a patient’s world would require a nurse to suspend his/her biases, theories as well assumptions as this will allow for clarity in understanding what it means or what it feels like to be the other person. This way, a nurse will be able to provide the highest level of care possible and will be viewed as a nurse who is making great efforts in trying to understand his/her patients (Radwin, 1996). A contrary case can help to clarify knowing as a concept as it gives a representation of what the concept does not entail. A patient admitted at a hospital is constantly misunderstood by the nurses who are attending to him. He is regarded as if he has no authority whatsoever since interventions are done to him without his consent. Nurses ignore his constant pleas for understanding time over time and to make his situation worse, they are used as a negative diagnosis of his state of mind. This contrary case does not contain of the attributes associated with knowing as a concept in nursing. The antecedent of experience is present since the nurses in the hospital setting have worked for some time yet it tends to produce a negative relationship with knowing. A related case tends to show the ideas that appear to be closely related to the concept being studied but they indeed differ upon close examination (Avant and Walker, 2005). A young nursing instructor checked into a hospital late in the evening and carried on with her duty of assigning patients’ to the nursing interns in the hospitals. The instructor carried this out by pairing a patient who had a similar disease or condition to what a student was studying. She did this so she could help each student put into practice their class theory and she also believed that it was an important learning guide technique. This shows that the instructor was objectifying patients. The instructor posted the assignments to the students and each student went ahead to prepare a care plan based on the characteristics of the patients’ condition provided in their assignments. The students used text books to prepare their patients plan. They were yet to meet their patients and truly understand their conditions as well as their experiences. This shows that the students were unknowing of their patients’ experiences as they had not developed knowledge which may be considered to be truly objective. This is because they developed plans of care for their patients when they had no clear knowledge about the subjective world of the patients. This case may appear to demonstrate the concept of knowing but in real case it shows a nurse and students who do not have enough time to plan their duties and check on their patients personally. Empirical Referents Empirical referents are important in practice since they tend to provide a nursing practitioner with clear phenomena that can be used as observation tools to identify any concepts which exist in particular patients (Avant and Walker, 2005). In the nursing field, knowing is usually measured indirectly and this is mostly done by measuring the ability of a nurse to make successful decisions. Measuring knowing indirectly ensures that its outcomes can be measured as consequences, for example, poor nurse- patient relationship or even as an antecedent which entails prior knowledge of the concept. An empirical referent must involve an effective decision making process that can be used to identify a situation that may result due to not knowing (Knafl and Rodgers, 2000). Conclusion The concept analysis of knowing has illuminated an area in which nursing has developed its own habitat in health care research. This concept reflects how an individual’s experiences on issues regarding health and illness help one to focus. This concept analysis based on Avant and Walker’s framework has provided important evidence to this phenomena. More information has been obtained that will be useful in the field of nursing. The concept of knowing in nursing therefore needs to be thoroughly explored so as to develop a clear understanding for all people. References Avant, K. and Walker, L. (1995). Strategy for theory construction in nursing. 3rd edition. Norwalk, CT: Appleton & Lange. Bonis, S. A. (2009). Knowing in Nursing: A Concept Analysis. Journal of Advanced Nursing, 65(6), 1328-1341. Chinn, P. L., & Kramer, M. K. (2008). Integrated theory and knowledge development in nursing (seventh Ed.). St. Louis: Mosby Elsevier Christley, Y, McCallum, L, McMillan, L and O’Neill, A. (2005). Practical Wisdom in Nursing Practice: A Concept Analysis. Retrieved from http://www.rcn.org.uk/__data/assets/pdf_file/0010/445816/Research2012Mo15.pdf Fagerstrom, L. M. and Tofthagen, R. (2010). Rodgers' evolutionary concept analysis--a valid method for developing knowledge in nursing science. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21070310 Freshwater, D. (2002). Therapeutic Nursing: Improving Patient Care Through Self-Awareness and Reflection. London: SAGE. Klassen, E. F. (2010). Defining Ourselves Through Our Stories: Building Learning Communities for Public Health Nurses. Retrieved from http://nursing.uvic.ca/research/documents/Klassen_E.pdf Knafl, A. K and Rodgers, B. L. (2000). Concept Development in Nursing: Foundations, Techniques and Applications. Michigan: Saunders. Liaschenko, J., & Fisher, A. (1999). Theorizing the knowledge that nurses use in the conduct of their work. Scholarly Inquiry for Nursing Practice: An International Journal, 13(1), 29-41. Locsin, C. R and Urnell, J. M. (2009). A Contemporary Nursing Process: The (Un)Bearable Weight of Knowing in Nursing. New York: Springer Publishing Company. Ohlen, J., & Segesten, K. (1998). The Professional Identity of the Nurse: Concept Analysis and Development. Journal of Advanced Nursing, 28(4), 720-727. Radwin, E. L. (1996). Knowing the Patient': A Review of Research on an Emerging Concept. Journal of Advanced Nursing. Volume 23, Issue 6. 1142-1146. Risjord, M. (2011). Nursing Knowledge: Science, Practice and Philosophy. New York: John Wiley and Sons. Tanner, C. A. (2006). Thinking like a Nurse: A_Research-Based Model of Clinical Judgment in Nursing. Journal of Nursing Education, 45(6), 204-211. Read More