"ways of knowing" vs. "evidence-based practice"
I followed up on some of the references to that last journal article, and will be gleefully skewering them here soon. I didn't get too far with the articles at work today -- too much time running jobs and attempting to fill yet another schedule opening and generally tripping over my co-workers in that veal pen of an office. I did, however, identify a nursing theory catchphrase that is legitimately used maybe one time in a thousand in the literature. The remaining 999 times are, I believe, indicative of academic sloth and should be considered a violation of the civil rights of anyone who's taken the time to seek education past the eighth grade level.
I speak, of course, of "ways of knowing".
"Ways of knowing" is the hearts and flowers print scrub set of nursing theory. It sets nursing back to the Stone Age and puts it on a par with phrenology. It fails at its attempt to honor the importance of intuition and experience; it only discredits the importance of measurable phenomena.
To me, it's incredible hubris for nursing academics to discuss "ways of knowing", as if a "truth" were unassailable because it cannot be independently proved or disproved. I think that the scientific tradition is truly humble when it discusses all but the most fundamental laws of physics as "theory".
I think that intuition is just the way that some people process information. The process is strictly cognitive, there is no magic about it, and it is not infallible. Intuition happens when the subconscious picks up on some stimuli from the outside world and deems it important, in spite of the fact that the conscious brain has placed it in the spam folder. This does not, however, impact the reality of the outside stimulus -- and if it can be isolated by the thinker, the thought process ceases to be intuitive.
As an example, let's look at pediatric assessment. Any EMS provider with decent experience can tell you a story about walking into a job and knowing from across the room that the kid "was fine" or "looked like shit". Intuition, right? Perhaps. There are plenty of providers out there who can accurately and consistently perform this basic sick / not-sick assessment without being able to articulate what precisely it was that they saw that led them to that conclusion. And, thank God, they do it without describing it as "EMS ways of knowing".
There is nothing intuitive, however, about an EMS provider going to a PEPP class and learning the pediatric assessment triangle and learning how to tell from across the room based on MEASURABLE phenomena whether the kid is "fine" or "looks like shit". It only looks like intuition, or magic, if you don't know what the person is looking for.
The problem with nursing theory and research relying so heavily on ethereal "ways of knowing" as an explanation or rationale is that they are impossible to teach, document, bill for or research meaningfully. There is plenty in both nursing and medicine we won't be able to explain, or can't explain yet, and that's fine. Read anything in pharmacology and you will see the phrase, "the exact mechanism of action is not well understood". But to stop the discourse at "it's a nurse thing, you wouldn't understand," is a total cop-out, and the ones who wind up suffering the most from the lack of understanding are nurses.
I speak, of course, of "ways of knowing".
"Ways of knowing" is the hearts and flowers print scrub set of nursing theory. It sets nursing back to the Stone Age and puts it on a par with phrenology. It fails at its attempt to honor the importance of intuition and experience; it only discredits the importance of measurable phenomena.
To me, it's incredible hubris for nursing academics to discuss "ways of knowing", as if a "truth" were unassailable because it cannot be independently proved or disproved. I think that the scientific tradition is truly humble when it discusses all but the most fundamental laws of physics as "theory".
I think that intuition is just the way that some people process information. The process is strictly cognitive, there is no magic about it, and it is not infallible. Intuition happens when the subconscious picks up on some stimuli from the outside world and deems it important, in spite of the fact that the conscious brain has placed it in the spam folder. This does not, however, impact the reality of the outside stimulus -- and if it can be isolated by the thinker, the thought process ceases to be intuitive.
As an example, let's look at pediatric assessment. Any EMS provider with decent experience can tell you a story about walking into a job and knowing from across the room that the kid "was fine" or "looked like shit". Intuition, right? Perhaps. There are plenty of providers out there who can accurately and consistently perform this basic sick / not-sick assessment without being able to articulate what precisely it was that they saw that led them to that conclusion. And, thank God, they do it without describing it as "EMS ways of knowing".
There is nothing intuitive, however, about an EMS provider going to a PEPP class and learning the pediatric assessment triangle and learning how to tell from across the room based on MEASURABLE phenomena whether the kid is "fine" or "looks like shit". It only looks like intuition, or magic, if you don't know what the person is looking for.
The problem with nursing theory and research relying so heavily on ethereal "ways of knowing" as an explanation or rationale is that they are impossible to teach, document, bill for or research meaningfully. There is plenty in both nursing and medicine we won't be able to explain, or can't explain yet, and that's fine. Read anything in pharmacology and you will see the phrase, "the exact mechanism of action is not well understood". But to stop the discourse at "it's a nurse thing, you wouldn't understand," is a total cop-out, and the ones who wind up suffering the most from the lack of understanding are nurses.
posted by Nurse Cha at 7:22 PM
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