LUSL 3406 – Nursing Inquiry PDF

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LUSL 3406 – Nursing Inquiry LA 1: Introduction Never, ever … Do a search just to find articles that support your idea Avoid confirming your bias  HAVE AN OPEN MIND  If you already ‘know’ then why search the literature? “Your assumptions are your windows on the world. Scrub them off every once in a while, or the light won't come in.” Isaac Asimov Sit down before fact with an open mind. Be prepared to give up every preconceived notion. Follow humbly wherever and to whatever abyss Nature leads or you learn nothing. Don’t push out figures when facts are going in the opposite direction.” Anatomy of an article . . .  Abstract  Introduction / Background / No title  Methods  Results  Discussion  Conclusion(s)  References No need to begin at the beginning and end at the end 1. Abstract 2. Discussion 3. Results 4. Conclusion

2 SLC (Kingston) format & sample LA2: Overview of ontology & Epistemology What is knowledge? Understanding is knowing how the object of the knowledge works & how to use it Wisdom / intelligence is the proper application of knowledge and understanding Tangent à Faith is belief without knowledge or belief in contradiction to knowledge  Knowledge has both:  a NATURE (Ontology)  a WAY TO BE KNOWN (Epistemology) Let’s dwell on Ontology  “What is the nature of knowledge” IS the ontology question If nothing else you need to know . . .  The dominant perceptions of ontology are:  Realism/Positivism & Relativism/Constructionism  Also should understand the ontological perceptions of postmodernism, critical reality & other terms introduced in this course Ontology - Our KNOWLEDGE (the things that we know) are our REALITIES - Every REALITY (every piece of our knowledge) has a nature - So …. ONTOLOGY is the NATURE of knowledge - Ontological questions are questions about the nature of the natural and the social worlds  The NATURE (of knowledge; of reality) is most commonly:  A ‘truth’ (Realism)  A construction (Relativism)  A mix of truth and construction Realism / positivism

3  Realism is a priori knowledge in that it is knowledge that is known independent of experience  non-empirical à it exists even before we experience (or create) it  We become aware of a priori (positivist/realist) knowledge by deductive reasoning Relativism  Relativist knowledge is a posteriori knowledge in that it is knowledge that is known because of experience, because we create it  empirical à its existence is derived from a lived experience  arrived at following an experience of some sort using inductive reasoning  Ontology exists for a piece of knowledge; it also exists for a body of knowledge (or reality)  An ontology is also a formal, explicit specification of a shared concept  It provides a shared vocabulary & taxonomy which creates a domain . . . such as nursing  In other words – not only is ontology the nature of knowledge, an ontology is the definition of objects and/or concepts, and their properties and relations within an identified arena  Ontologies are the structural frameworks for organizing information about the world or some part of the world  Hence there is a nursing ontology or an ontology of nursing  Most ontologies, such as nursing, include descriptions of individuals (objects), classes (concepts), attributes, & relations  Individuals: instances or objects (basic or "ground level" objects)  Classes: sets, collections, concepts  Attributes: aspects, properties, features, characteristics, or parameters that objects have  Relations: ways in which classes and individuals can be related to one another  Ontologies can have:  Restrictions: formally stated descriptions of what must be  Rules: statements in the form of an if-then (antecedent-consequent) sentence  Axioms: assertions  Events: changes in attributes or relations Axioms Rules or principals that many people accept without evidence as being truths  Golden Rule à Do unto others as you would have them do unto you Some summary points . . .  An ontology is:  A specification of a concept ▪ More about concepts with Learning Activity 3  Often confused with epistemology, which is about how we know something (how knowledge was created)  An ontology is a description (like a formal specification of a program) of the concepts and relationships that can exist for an collective such as a profession ▪ Nursing is/has an ontology (SEE HANDOUT) Epistemology  Epistemology is the relationship between the knower (you) and the knowledge (the reality)  This means that epistemology is HOW you know what you know

4 If nothing else you need to know . . . We gain (new) scientific knowledge (mostly) through two research approaches/lenses (paradigms) - Qualitative & Quantitative How do we know? You should know Carper ad nauseum by now, but if not … Carper’s model of knowing in nursing  Empirics (the ‘science’ of nursing, logical positivism)  Aesthetics (subjective, praxis, the ‘art’ of nursing)  Ethics  Personal meaning In the Carper (1978) model:  Empiric knowing is based on the assumption that what is known is accessible through the physical senses, particularly seeing, touching, and hearing, and draws on traditional ideas of science. Empiric knowing is grounded in scientific theories and knowledge (the SCIENCE of nursing)  Aesthetic knowing involves deep appreciation of the meaning of a situation, bringing to reality something that would not otherwise be known (the ART of nursing; EMPATHY)  Ethical knowing involves making judgments about what ought to be done, what is good, what is right, and what is responsible (all actions that are subject to judgements of what is RIGHT and WRONG)  Personal knowing concerns the inner experience of being a holistic, authentic self with full awareness that makes meaningful, shared human experience possible (e.g., Therapeutic use of self; Therapeutic relationship) All knowledge is subject to change and revision  Facts (realism) change when we learn new facts  Meaning (relativism) changes when context changes  An so reality changed  A realist piece of knowledge changed  A ‘truth’ changed Moving back to epistemology . . .  Epistemology is:  The study of knowledge and justified belief  Concerned with the following questions: ▪ What are the necessary and sufficient conditions of knowledge? ▪ What are its sources? ▪ What are the structures of the sources of knowledge, and what are the limits of these structures? Inquiry paradigms give rise to research methodologies  Quantitative Inquiry  Experiments  Quasi-experiments  Descriptive (exploratory) studies  Qualitative Inquiry  Phenomenology (can be descriptive/exploratory)

5  Ethnography  Grounded theory The Cascade

Realism vs. relativism (ontologies)  Truth (positivism) is a given  But meaning (relativism) has been a struggle  Can meaning be measured and interpreted?  If social context shapes health & illness experiences, we need to understand the meaning of the social context in order to manage health & illness experiences  But there are risks to measuring and applying what is interpretive (relativist)  How far can you transfer results to other individuals and/or other contexts  EVERYTHING can change when CONTEXT changes  So, nursing praxis has adopted epistemological diversity  That is, multiple ways of knowing:  Positivist scientific evidence underpins nursing science  For holistic practice (adding in the art of nursing) , we add (construct) contextual meaning  If nursing is both a science and an art, where do you draw the line as to what you are willing to consider as evidence?  Quantitative research = evidence  Qualitative research = evidence  Are case studies evidence?  Is expert opinion evidence?  So, what is evidence & what is knowledge?  Tarlier’s premise is that research ‘evidence’ from diverse epistemologies produce truth + meaning that are adapted into a dynamic body of knowledge (that

6 which we call nursing) through a selective process that allows acceptance, modification and rejection  Both positivist and relativist perceptions of reality provide scientific knowledge  Scientific knowledge is fallible as it is shaped by the conceptual frameworks within which scientists / clinicians (researchers) operate Post-Modernism  The idea that even truths, facts are understood / learned/ discerned through our 5 senses and our interaction with the world and therefore may not be explicitly factual / truthful  That is, facts are understood relative to our interaction with our world Critical Realism  Combines realist ontological perspective (theory of being) with relativist epistemology (theory of knowledge)  Premise is that critical realism provides a philosophically grounded framework that can be used to underpin research into causal mechanisms (i.e., what causes things to happen)  Relevance to nursing practice:  Critical realism is commonly used in theory driven practice, program evaluation & policy evaluation  It is most strongly related to the post-positivist / post-modernist ontological perspective  Critical realism reaches to understand mind independent ‘truth’ by studying a minddependent (meaning) aspect of the world Reasoning  Quantitative inquiry uses DEDUCTIVE (going from the general to the specific) reasoning  Qualitative inquiry uses INDUCTIVE (going from the specific to the general) reasoning  Post-modernists & Critical realists use both deductive and inductive reasoning

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LA 3: Realism, Modernism and the Quantitative Development of Knowledge Positivist reality / realism  Realist ontology is a belief that a reality driven by scientific or natural laws exists  Realist knowledge is objective  Realism seeks out truths  TRUTH (‘laws’; positivist knowledge)is observable, verifiable and replicable  TRUTH is neutrally observed  free from biases  TRUTH can change over time as more knowledge is found …. so, phenomena such as meanings and experiences are outside the scope of positivism  Generally for your purposes you can assume that **** Realism = positivism = modernism Quantitative Inquiry Quantitative research is rooted in realist (positivist) ontology  Remember … Realist ontology is a belief that a reality driven by scientific or natural laws exists  Realism is objective knowledge Reasoning  Quantitative inquiry uses INDUCTIVE reasoning to form a hypothesis, but then uses DEDUCTIVE (going from the general to the specific) reasoning to find knowledge Quantitative inquiry  Researcher bias is avoided  Quantitative inquiry attempts to understand the ‘etic’ nature of the knowledge through objective observation and measurement to form generalizable truths ▪ an ‘etic’ account is a description in terms that can be applied outside of the context in which the knowledge was learned

8 ▪ etic knowledge is context neutral Inquiry paradigms give rise to research methodologies  Quantitative Inquiry  Experiments  Quasi-experiments  Descriptive (exploratory) studies Quantitative Methodologies Inquiry  Experiments  Variables ▪ Independent variable is manipulated ▪ Effect on dependent variable is measured  Sample is randomly selected  Data is mathematically analyzed (descriptive and inferential statistics)  Can find ‘causal’ relationships  Quasi-experiments  Variables ▪ Independent variable is manipulated ▪ Effect on dependent variable is measured  Sample is NOT randomly selected  Data is mathematically analyzed (descriptive and inferential statistics)  Can find ‘associations’ but NOT causal relationships between variables  Descriptive studies  Factors are identified  Sample is USUALLY randomly selected  Data is mathematically analyzed (descriptive and inferential statistics)  Can find ‘associations’ between factors Tangent Understanding causal vs. associational (correlational) relationships  Relationships between factors are defined by quantitative research  Causal relationship ONLY discovered by true experiments (e.g., double blind clinical trials) ▪ Heparin CAUSES reduced clotting  Associational relationships suggested by quasi-experimental and descriptive studies ▪ Bruises are ASSOCIATED with pain Scientific observations are fallible as they are shaped by the conceptual frameworks within which scientists (researchers) operate The results of quantitative research  Causation  Association  Results that are generalizable (applicable) to a broader population Sampling  We achieve generalizability by using probability sampling  But what is sampling? Sampling is choosing who is in the study Quantitative studies use probability sampling

9 Probability Sampling  Any method of sampling that uses some form of random selection  Random selection assures that each individual/unit in your population has an equal probability of being chosen  Most common approaches to probability sampling  Simple Random Sampling  Stratified Sampling  Cluster Sampling  Systematic Sampling  (simple) Random Sampling  Individuals from the population are chosen in such a way that every individual in the population has an equal chance to be the sample actually selected  Stratified Sampling  partition the population into groups based on a factor that may influence the variable that is being measured  these groups are called strata  obtain a simple random sample from each group  collect data from within each group

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Cluster Sampling  divide the population into groups (clusters) without separating out the groups by differences in a factor  each cluster should be heterogeneous  select one of the clusters  obtain a simple random sample from that cluster  obtain data from a sample within that cluster Systematic sampling  select a random starting point  select a fixed, periodic interval  collect data on participants that ‘sit’ at each of the selected points

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LA 4:Relativism and the qualitative development of knowledge Relativism / constructionism:  Relativist ontology is a belief that knowledge is relative to the experience and the experiencer & that knowledge exists in the form of multiple mental constructions that are dependent on the persons who hold them  Relativist knowledge is subjective  Relativist knowledge is constructed (interpreted) from experiences and gives MEANING Qualitative Inquiry Qualitative research is rooted in relativist (constructionist / interpretative) ontology  Constructionist ontology is a belief that knowledge is relative to the experience and the experiencer & that knowledge exists in the form of multiple mental constructions that are dependent on the persons who hold them  Relativism is subjective knowledge Reasoning  Qualitative inquiry uses INDUCTIVE (going from the specific to the general) reasoning  Inductive reasoning  Clinicians use inductive reasoning to INFER (retroduce) a diagnosis through the presence of symptoms that are known to be associated with a disease  Go from specific knowledge (the symptoms) to general knowledge (diagnosis) Inquiry paradigms give rise to research methodologies  Qualitative Inquiry  Phenomenology (can be descriptive / exploratory)  Ethnography  Grounded theory  Narrative research  Participatory action research

11  Case study  Historical research Qualitative Inquiry  Researcher (and participant) bias is embraced  Qualitative knowledge is created through interaction between the researcher and the researched  It searches for MEANING not truth  Uses natural inquiry methods that, like quantitative approaches, requires precision, logical reasoning and attention to evidence  The data may not be directly seen  The goal of the qualitative research paradigm is to understand lived experiences from the point of view of those who lived them  Qualitative inquiry attempts to understand the ‘emic’ perspective of experience through subjective, constructed experience to form theoretical, transferable constructions  The qualitative researcher’s goal is to interpret or construct subjective meaning  So, you can use the same event to find different meanings if there is more than one perspective

Etic vs. emic – an interesting perspective - Etic statements arise from the perceptions of the culture-bearers themselves, while emic statements build on discrimination that mean something to the people watching/hearing it. In clinical practice, the client holds the emic perspective while the nurses hold the etic perspective. - Qualitative knowledge is bound by the context within which it is created - It is transferrable NOT generalizable Qualitative Methodologies  Phenomenology  The study of human experience; the study of how individuals perceive and interpret events and one's relationship to those events  Grounded Theory  The generation of a theory through the identification of key elements of a phenomenon and then categorizing the relationships of those elements to the context in which the phenomenon occurred  Ethnography  The study of cultures and of behaviours, values and/or relationships within cultures  Narrative research  The study of oral or written stories that describe a series of events  Narrative analysis interprets / explains events relative to outcomes  Participatory action research  Researchers and participants engage equally to define and examine the research  Case study  In depth study of a situation, event or case  Case may be a patient, a group, an organization  Historical research

12  Looking for patterns or trends within past events  Often uses biographies or social histories Sampling for Qualitative knowledge development - Purposeful sampling  Convenience sampling  Snowball sampling  Contrast case sampling  Maximum variation sampling - Convenience sampling  Participants are selected because they happen to be available - Snowball sampling  Identify some (at least two) individuals who are relevant to the study  Then asking them to locate other participants  Ask the new participants to locate other participants  And so on . . .

Maximum variation sampling  Identify a factor important to the study  Select participants tht represent a wide range of variation within that factor  Make sure that participants with each variation in the factor are included Contrast case sampling  Identify two or more population groups with distinct characteristics relative to the study  Select participants from within each group Applying Knowledge Using knowledge – from novices to experts Just knowing – what is intuition?  Experts seem to use intuition  Novices don’t have it to use  Intuition = understanding or knowing without an explicit rationale  Is this a valid or invalid approach to clinical judgement?  Dreyfus’ 6 aspects of intuitive judgement:  Pattern recognition  Similarity matching  Commonsense understanding  Skilled know-how  Sense of salience  Deliberative rationality Dreyfus cont’d  Pattern recognition  A perceptual ability to recognize relationships without prespecifying the components of the situation  Recognition of configurations and relationships

13 ▪ Novices use lists ▪ Experts recognize patterns of responses across a specific patient population  Similarity matching  Subconscious recognition of ‘fuzzy’ resemblances despite marked differences from past situations ▪ See something and ‘select’ what it is ▪ Makes problem identification possible in highly ambiguous circumstances  e.g., a mass casualty situation in an ER  Commonsense understanding  A deep grasp of the culture and language of a situation so that flexible understanding in diverse situations is possible ▪ e.g., bell sounds repeatedly in a building you have never been in before, but you assume it is a fire alarm because ‘that makes sense’

 Skilled know-how  “embodied intelligence”  The body ‘takes over’ a skill ▪ e.g., driving home; tactile stimulation to an apneic neonate  Sense of Salience  This is to live in a meaningful world where events stand out as more or less important relative to each other  See what is ‘relevant’; ignore what is not ▪ e.g., focus on the bleed and screen out the hiccup  Deliberative rationality  A way to clarify your perspective by considering how your interpretation of a situa...