Knowledge and action in nursing : a critical approach to the practice worlds of four nurses : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in nursing at Massey University

Abstract

This thesis provides an interpretive critique of the way in which knowledge is viewed, transmitted and crystallised in the practice worlds experienced by four registered nurses working in acute care hospital settings. The theoretical assumptions of critical social theory underpin both the methodological approach (case study) and the analysis of data. In-depth, unstructured interview, a critically reflexive dialogue between the investigator and participant focussed on the practice world experiences of the nurse, was the principle research method. A brief analysis of documentation was also undertaken. It is argued that previous studies related to nursing practice, and to the social worlds of nursing, have been limited by their failure to take account of the socio-political context in which nursing takes place. There has also been a tendency to treat the transmission of knowledge in nursing and nursing practice as a passive process of information exchange. No account of socially generated constraints on personal and professional agency, or of systematic distortions in communication within the practice setting are therefore given. The analysis of data in this study demonstrates the way in which constraints on personal and professional agency were experienced by each of the four participants. In particular, practice expressing the participants' professional nursing knowledge and values was often denied in the face of shared understandings reflective of the institutional ideology. These shared understandings included a belief in the legitimacy of medical domination over other social actors and the support of doctor, rather than nurse or patient, centred practices. The study demonstrates that the way that nurses and other social actors come to 'know' and interpret their social worlds is dependent on the socio-political context in which that knowledge is produced. It also shows how this knowledge may be treated as though it were 'an object'. This tendency to treat existing social relationships and practices as 'natural', hence unchallengeable masks possibilities for transformative action within the practice of nursing. It is argued that a particular form of knowledge is required if nurses are to overcome the types of constraint experienced by these four nurses. This knowledge, emancipatory knowledge, is that developed in the process of shared, socially critical self-reflection rather than solitary, self-critical reflection.