LECTURE NOTES

ON
SOURCES OF
ACQUIRING
KNOWLEDGE

GUIDED BY: PREPARED BY:

Mrs. .Prema.P Ms. Remya Mathews

Principal I M.Sc (N)
N.C.O.N N.C.O.N
Raichur Raichur

SUBMITTED ON : 10-8-09

METHODS OF ACQUIRING KNOWLEDGE

INTRODUCTION
 Knowledge is a complex, multifaceted concept. Information sources
for clinical practice vary in dependability and validity. A brief
discussion of some alternative sources of evidence shows how
research based information is different. Nursing has historically
acquired knowledge through traditions, authority, experience,
borrowing, trial and error, role modelling and mentorship, intuition,
reasoning and research.

SOURCES OF ACQUIRING KNOWLEDGE

TRADITION
 − The word ‘ tradition’ means “ a long established custom “ or “ the
passing on of customs or beliefs from generation to generation “
− Many questions are answered and problems solved based on
inherited customs or traditions
− Traditions include truths on beliefs that are based on customs and
past trends
− Traditions can positively influence nursing practice because they
were developed from past experiences
− Traditions can also narrow and limit the knowledge sought for
nursing practice
− The nurses on patient care units quickly inform new staff members
about the accepted or traditional behaviour of the unit

Eg: The idea of providing a patient with a clean, safe, well ventilated
environment originated with Florence Nightingale( 1859 ).

Advantages
− It is efficient as an information source
− Tradition or custom also facilitates communication by providing a
common foundation of accepted truth

Disadvantages
− Tradition may interfere with the ability to perceive alternatives
− There is growing concern that many nursing interventions are based
on tradition , customs and “ unit culture” rather than on sound
evidence
− Traditions are difficult to change because they have existed for long
periods of time and are frequently supported by people with power
and authority
− Many traditions have not been evaluated or tested for accuracy or
efficiency
 − Traditions that have not been supported through research tend to be
persist

AUTHORITY
− The term ‘ authority ‘ means ‘ a person or body with special power ‘
− An authority is a person with expertise and power who is able to
influence opinion and behaviour
− There are authoritative people who will give decisions in making
judgment on an issue by virtue of specialized training or experience
where we had no direct experience
− Knowledge acquired from authority is illustrated when one person
credits another person as the source of information
− Nurses who publish articles and books or develop theories are
frequently considered authorities
− An expert is only an authority when addressing his or her area of
expertise
− Authorities in nursing must have both expertise and power

Advantages
− Authorities will give guidance and specialized training in fields
where we had no direct experience

Disadvantages
− Knowledge obtained from these authorities can be inaccurate
− Knowledge acquired from these authorities has frequently not been
validated and although it may be useful , it must be verified through
research

EXPERIENCE
− Experience means ‘practical involvement in an activity, event etc’.
− Experience represent a familiar and functional source of knowledge
− Personal experience involves gaining knowledge by being personally
involved in an event , situation or circumstance
Eg: Two or three cardiac patients follow similar post operative sleep
patterns. This observation may lead to some interesting discoveries
with implications for nursing interventions.

Benner ( 1984 ) described 5 levels of experience in the

developmental of clinical knowledge and expertise i.e.
− Novice
− Advanced beginner
− Competent
− Proficient
− Expert

Novice nurses have no personal experience in the work that they

are to perform , but they have pre conceived notions and
expectations about clinical practice that are challenged, refined ,
confirmed or disconfirmed by personal experience in a clinical
settings

The advanced beginner has just enough experience to recognize

and intervene in recurrent situations.
eg: The advanced beginner nurse is able to recognize and intervene
to meet patients mobility needs.

Competent nurses frequently have been on job from 2 years to 3

years and often their personal experiences enable them to generate
and achieve long range goals and plans. Through experience,
competent nurse is able to use personal knowledge to take
conscious, deliberate actions that are efficient and organized.
 Proficient nurse views the patient as a whole and as a member of a
family and community. The proficient nurse recognizes that each
patient and family respond differently to illness and health.

The expert nurse has an extensive background of experience and is

able to identify accurately and intervene skillfully in a situation. The
dynamics of expert nursing practice need to be clarified through
research.

Advantages
− Experience is the foundation and stimulus for learning
− Learners actively construct their experience
− Learning occurs during personal experience and enables the nurse
to cluster ideas in to a meaningful whole
− In nursing personal experience enables one to gain skills and
expertise by providing care to patients and families in clinical
settings

Disadvantages
− Each individuals experience is fairly restricted
− Another limitation of experience is that the same objective event is
usually experienced or perceived differently by two individuals.

BORROWING
− Borrowing in nursing involves appropriation and use of knowledge
from other fields or disciplines to guide nursing practice
− Some nursing leaders have described part of nursing knowledge as
information borrowed from disciplines such as medicine, sociology,
psychology, physiology and education

Nursing has borrowed in to two ways,

 1) Some nurses have taken information from other disciplines and
applied it “ directly “ to nursing practice.
This information was not integrated within the unique focus of
nursing.
eg: Some nurses have used the medical model to guide their
nursing practice, thus focusing on the diagnosis and treatment of
disease.

2) Another way of borrowing is the integration of information from

other disciplines within the focus of nursing which is more
functional in nursing

Advantages
− Borrowing helps nurses use advances in technology to become
highly specialized and focused on the detection and treatment of
disease to the exclusion of health promotion and illness prevention.

Disadvantages
− Since disciplines share knowledge , it is sometimes difficult to know
where the boundaries exist between nursing knowledge based and
that of other disciplines
− Borrowed knowledge has not been adequate for answering many
questions generated in nursing practice

TRIAL AND ERROR

− In this approach , alternatives are tried successively until a solution
to a problem is found
− Trial and error is an approach with unknown outcome used in a
situation of uncertainty , when other source of knowledge are
unavailable
 Eg: May patients dislike the taste of potassium chloride solution.
Nurses try to disguise the taste of the medication in various ways
until one method meets with the approval of the patient.

Advantages
− Trial and error offer a practical means of securing knowledge
− Due to its uncertainty , nurses must use trial and error in providing
nursing care

Disadvantages
− There is frequently no formal documentation of effective and
ineffective nursing actions
− Using this strategy, knowledge is gained from experience but it
often not shared with others
− The trial and error way of acquiring knowledge can also be time
consuming , because multiple interaction might be implanted before
one is found to be effective
− There is also a risk of implementing nursing actions that are
detrimental to a patients health
− This method is haphazard and the knowledge obtained is often
unrecorded and hence inaccessible in subsequent clinical studies

ROLE MODELLING AND MENTORSHIP

− Role modelling is learning by imitating the behaviour of an exemplar
− An exemplar or role model is viewed as knowing the appropriate and
rewarded roles for a profession and the roles reflect the attitudes
and include the standards and name of behaviour for that profession
− An intense form of role modelling is Mentorship
− In a mentorship, the expert nurse serves as a teacher sponser
guide, exemplar and counselor for the novice nurse
− There is an investment of time and active involvement that results
in a close, personal mentor-mentee relationship. This relationship
 promotes a mutual exchange of ideas and aspirations relative to the
mentee’s care plans. The mentee assumes the values, attitudes and
behaviour of the mentor while gaining intuitive knowledge and
personal experience

Advantages
− It enables novice nurses to learn through interaction with or to
follow examples set by expert nurses
− The mentor – mentee relationship promotes a mutual exchange of
ideas and aspirations relative to the mentee’s career plans
− Mentorship is essential for building research competence in nursing

Examples of role models:- Admired teachers, practioners,

researchers, illustrious individuals who inspire students through
their examples.

Disadvantages
− Both the mentor and mentee invest equal time and active
involvement which results in a close, personnel mentor-mentee
relationship

INTUITION
− Intuition means ‘ acquiring knowledge by ourselves’
− It is a type of knowledge that cannot be explained on the basis of
reasoning or prior instruction
− Intuition is an insight on understanding of a situation or event as a
whole that usually cannot be logically explained
− The knowledge is incorporated so deeply within that it is difficult to
bring it consciously to the surface and express it in a logical manner
− Even though intuition is often unexplained, it has some important
scientific uses
Advantages
− Intuition is the result of deep knowledge
− A burst of intuition may identify a problem for study, indicate,
important values for measure or link two ideas together in
interpreting the findings

Disadvantages
− Intuition cannot be explained with ease scientifically and people are
uncomfortable with it
− Intuition is unexplainable
− It is difficult to develop policies and practices for nurses on the basis
of intuition
− Intuition is generally considered unscientific and unacceptable for
use in research

REASONING

Introduction
Reasoning is the processing and organizing of ideas in order to reach
conclusions. Through reasoning people are able to “make sense” of both
their thoughts and experiences.

Types of reasoning

Reasoning is also classified by the discipline of logic into,

− Inductive Bandman and Bandmann, 1988 , Chin &
− Deductive Krawmer 1991

Inductive reasoning
− It is the process of developing generations from specific
observations.
 Eg: The nurse may observe the anxious behaviour of ( specific )
hospitalized children and conclude that ( in general ) children’s
separation from their parents is stressful

Deductive Reasoning
− It is the process of developing specific predictions from general
principles
Eg. If we assume that separation anxiety occurs in hospitalized
children ( in general ), then we might predict that ( specific )
children in memorial Hospital whose parents do not room-in will
manifest symptoms of stress.

Advantages and Disadvantages

Both systems of reasoning are useful as a means of understanding and
organizing phenomena and both play a role in nursing research.
However reasoning in and of itself is limited because the validity of
reasoning depends on the accuracy of the information with which one
starts and reasoning may be an insufficient basis for evaluating accuracy.

Patterns of reasoning
− Patterns of reasoning are used to develop theories and to plan and
implement research
− Stevens identified 4 patterns of reasoning as being essential to
nursing, i.e,
1) Problematic
2) Operational
3) Dialectic
4) Logistic

Problematic Reasoning
Problematic reasoning involves identifying a problem and the factors
influencing the problem, selecting solutions to the problems and resolving
the problem.
For eg: Nurses uses problematic reasoning in the nursing process to
identify nursing diagnosis and to implement nursing interventions to
resolve these problems.
− Problematic reasoning is also evident in the identification of a
research problem

Operational Reasoning
− Operational reasoning involves the identification and discrimination
between many alternatives or view points. The focus is on the
process ( debating alternatives ) rather than on resolution
− Nurses uses operational reasoning in developing realistic,
measurable goals with patients and families
− Debating which measurement methods on data analysis technique
to use in a study requires operational thoughts

Dialectic Reasoning
− Dialectic reasoning involves looking at situations in a holistic way
− A dialectic thinker believes that the whole is greater that the sum of
the parts and that the whole organizes the parts
For eg: A nurse using dialectic reasoning would view a patient as a
person with strength and weakness who is experiencing illness.
− Dialectic reasoning also includes examining factors that are opposite
and making sense of them by merging them in to single unit or idea
, which is greater than either alone
Eg: Analyzing studies with conflicting findings and summarizing
these findings to determine the current knowledge base for a
research problem requires dialectic reasoning

Logistic Reasoning
 − The aim of logistic is to determine truth or to explain and predict
phenomena
− Logistic reasoning is used to break the whole into parts and that can
be carefully examined as can the relationship among the parts
− Logistic reasoning is the opposite of dialectic reasoning
− A logistic reasoner assumes that the whole is the sum of the parts
and the part organize the whole
− Logistic reasoning is uses frequently in research to select a study
design, plan and implement data collection and select analysis
technique

Eg: A patient states that she is cold and the nurse logically
examines the following parts and their relationships,
1) Room temperature
2) Patient temperature
3) Patients clothing
4) Patient activity

CONCLUSION

Acquiring knowledge through tradition, authority, borrowing, trial

and error, personnel experience, role-modelling, intuition and
reasoning is important in nursing. However these ways of acquiring
knowledge are inadequate in providing a scientific knowledge base
for nursing. Research is needed to generate new, accurate scientific
 information to direct nursing practice. Because the knowledge
nurses need is not only narrow and specific but also broad and
holistic, a variety of research methods are needed to generate
nursing knowledge. Thus knowledge is acquired is a variety of ways
and is expected to be an accurate reflection of reality.

REFERENCE

− Denise. F.Polit, Cheryl Tatano Beck, Nursing Research – Principles

and methods, 7th Edition, Wolters Kluwer company publications,
page. No. 11-13
− Nancy Burns, Susan.K.Groove, Practice of Nursing Research,
Saunder Elsevier, 5th Edition, Page.no.6-7,10-12
− www.google.com