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Nursing perspective is a reflection of the nurse’s concern in developing knowledge that positively affects the care nurses give, empowering nurses to optimize patient health outcomes, educating clients to take ownership of their care and health journey, and supporting the community (Meleis, 2018). Meleis is specifically focused on the development of substantive nursing knowledge that has a firm basis in reality and is, therefore, meaningful. Meleis (1987) identified two strategies to facilitate development of substantive nursing knowledge.
“The first strategy is to focus the debates, the critiques, and the discussions on the nursing domain, that is, on the business of nursing” (Meleis, 1987, p.
7). Historically, nurses have debated the presence or absence of nursing theory and which research approaches yielded the best results; Meleis called for nurses to abandon this debate and instead reignite their passion to develop substantive theory focused on practice context (Chinn & Kramer, 2015). Knowledge development must be focused on the business of nursing and nursing practice with goal of answering questions with answers that actually help patients.
She pleads for nurses to have passion “for the knowledge itself and not how we get the knowledge” (Meleis, 1987, p. 8).
Meleis’ second strategy requires a new understanding of two dualities: particularism and holism and received and perceived views (Meleis, 1987). Nurses have studied both individual parts of a human’s makeup and the unitary human being as a whole person and have used the perspective that meets the goals of a particular study. While nursing’s perspective is to consider the client as a whole person, research strategies corresponding with such ontology is inadequate and may limit further knowledge development (Meleis, 1987).
Meleis argues the need “to resolve the issue of availability of research methods and designs to represent both” particularism and holism (Meleis, 1987, p. 8).
The second duality is received view and perceived view. While researchers promote the received view for its objectivity, empirical single truth, clinicians prefer the perceived view where their beliefs are driven by phenomenological and interpretive philosophies (Meleis, 1987). Meleis’ plea for substantive knowledge requires that the discipline of nursing determine which questions are “more amenable to and congruent with which ontological beliefs and selected philosophical modes of inquiry (Meleis, 1987, p. 8).
Angle of Vision
Describe Kim’s concept of nursing’s “angle of vision”. Does it resonate with yours?
Kim (2000) explains nursing’s desire to understand “nursing phenomena forces us to view reality with a nursing angle of vision” (Kim, 2000, p. 31). The nurse’s angle of vision centers those elements assessed as critical while moving less significant needs to the periphery of the angle of vision. The determination of this resonating with me is situationally dependent.
In an emergency or urgent situation, when time is of the essence and rapid assessment with intervention is necessary, the need to identify and prioritize needs and interventions is apparent. This requires a sound nursing knowledge base and keen critical thinking and clinical reasoning skills. In this case, less significant needs lack value in comparison to the vital intervention need. The urgent or emergent scenario correlates well with Kim’s angle of vision.
Using this concept in all scenarios causes me to question if this concept could facilitate holistic care and when, if ever, would peripheral needs be addressed. Would the nurse’s subjectivity determine the care? Does the client have a voice? Would developing a rapport fall within or outside the angel of vision? How important is family involvement? With this concept, is the nurse considering the patient’s needs and wants or are priorities based solely on the needs identified by the nurse?
Munhall (1993) emphasizes “nurses must understand that their perceptions of the world and of health may or may not assist the patient” (Munhall, 1993, p. 242). Munhall (1993) discusses how unknowing is a “de-centering process from one’s own organizing principles of the world” and that it is “essential to the understanding of subjectivity and perspectivity” of the client (Munhall, 1993, p. 239-240). To understand and empathize with the client, Munhall (1993) enforces the role unknowing plays. I agree with Munhall that “knowing is wonderful, but it is just a guiding means” (Munhall, 1993, p. 244). Only when the nurse “unknows” does she achieve openness, which is where true understanding and empathy occur.
Public and private knowledge compared and contrasted with knowing and knowledge
Discuss Kim’s differentiation of “public” and “private” knowledge.
A widely accepted phenomena in the discipline of nursing is that our unique nursing perspective contributes to the holistic care to the client. Chinn and Kramer (2015) indicated that despite nursing practice being almost exclusively based on empiric evidence, this knowledge inadequately represents the reality or totality of nursing practice. Therefore, “moving to a conceptualization of knowledge that more fully embraces the whole of practice will serve to impart value to what has been intangible” (Chinn & Kramer, 2015 p. 20).
Chinn and Kramer (2015) differentiate knowing and knowledge by referring to knowing as “ways of perceiving and understanding the Self and the world” and knowledge as “knowing that is expressed in a form that can be shared or communicated with others” (Chinn & Kramer, 2015, p. 3).
Kim (2000) also acknowledges ambiguity between an individual practicing nurse’s knowledge and nursing discipline knowledge as a whole. She attributes the ambiguity and confusion to nursing scholars who are both practitioners and researchers and “contribute to the development of the public knowledge and at the same time are generators of their own private knowledge” (Kim, 2000, p. 3). Practitioners, in fact, use both private and public knowledge as they use the discipline of nursing knowledge combined with each nurse’s personal knowledge gained from experiences. She clarifies this confusion by dividing knowledge into private knowledge and public knowledge. Private knowledge is an individual nurse’s knowledge gained through her own experiences; while public knowledge may be obtained through an individual nurse’s scientific processes, it is objective and oriented to the discipline of nursing (Kim, 2000). Public knowledge, therefore, includes the knowledge distributed during formal nursing education. From this foundation, through experiences and self-reflection, the nurse builds her personal knowledge.
While the connection of both public and personal knowledge as well as knowing and knowledge is evident, nursing knowledge development is focused at the discipline level to enrich and enhance general nursing knowledge. Hence, Kramer’s and Chinn’s knowledge and Kim’s public knowledge are the primary concerns for this course.
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