Good Practice Case Study

Ways of Knowing & Research Literacy in Undergraduate Nursing - Health and Behavioural Sciences

Contributed by: Dr Margaret Wallace, Faculty of Health and Behavioural Sciences.

These strategies were originally developed by Dr Margaret Wallace, Prof Patrick Crookes, Ms Chris Brewer, Dr Allison Shorten and colleagues in Learning Development. They have been further developed by the Nursing subject coordinators.

Abstract:

Research subjects are built into each year of undergraduate Nursing. These gradually develop student understanding. By the time students reach the end of their course, some are potential researchers and all are committed to evidence-based practice.

Aims:

Our students don`t view themselves as being the most academically inclined, yet all of our graduates need to be able to understand and use research in their practice. We`ve aimed to build research awareness, access and appreciation in our students through engaging curriculum design.

Context:

Approximately 200 students were involved spread over three locations, Wollongong, Bega and Shoalhaven. All of our students attend tutorials, clinical simulations and clinical placements. Students may either attend lectures (Wollongong) or access recordings of lectures (Bega and Shoalhaven).

Outcomes:

• Our graduates have increased awareness, access and appreciation of evidence-based practice.
• As practitioners, they are better equipped to incorporate changing professional knowledge into their practice.
• We have published three articles and presented at conferences in the UK and Canada.

What was done?

NURS164, Patterns of Knowing in Nursing

In their first academic session, we pose the students a question: "what is the knowledge you need and where does it come from"?

Barbara Carper`s (1978) four ways of knowing are introduced:

• empirical
• aesthetic
• personal
• ethical.

The students then explore where they will find each of these in the curriculum. They look at articles that apply each way of knowing to a topic (elder care).

The subject is team-taught, and each way of knowing is woven through the lecture series. We give emphasis to ethical and legal issues, as well as critical thinking and argument.

Another question we pose is, "what are the skills you need to become an investigator"? Tutors remind students about the Independent Learners Introductory Program (ILIP100). A lecture and hands-on workshop is given by a librarian, and students learn library search strategies and correct referencing. A "treasure hunt" is used to get students familiar with the catalogue. The students sit an ungraded online quiz that tests their quoting, paraphrasing and acknowledgment of sources. In class the tutors provide students with a sample assignment that has been annotated by Learning Development.

All of this is preparation for a major assessment. Each student chooses two case studies, one discussed in class/groupwork and one chosen independently, and then writes a reflective piece on using Carper`s model to understand different perspectives of the case studies. A second part of the assignment extends this reflection into law and ethics. We ask for references from supplied e-readings and the textbook.

NURS264, Reflection and Practice

We look more deeply into sources of evidence, and further develop students` critical thinking and reflection skills. In tutorials, students are encouraged to share stories and reflect on the ways of knowing that they contain. We examine arguments and discourses. During the session, students work on their ability to present logical arguments and critique the arguments of others.

For their assignment, students take a dramatic episode or movie with a health care setting, and draw it as a conceptual map. They look at behaviours, sources of knowledge and responses. They connect the topic to the literature. Each group gives a presentation, which must include references, and submits a reflection.

NURS364, Research Appreciation and Application

Our message to students in their final year is that although not all graduates will become researchers, all graduates need to be able to appreciate and apply research. A registered nurse needs to be aware of how their knowledge informs practice, and appreciate evidence-based practice. They need to know how to find out about new knowledge and implement change management.

Students examine literature from an evidence perspective. Which assertions in articles and textbooks are backed up by evidence? They learn about a hierarchy of evidence and how to understand and evaluate qualitative research. Basic statistical methods are covered. During the session, we ask different researchers come in to talk to students about their research.

In their first assessment, we ask students to formulate a nursing question on a topic of their choice, carry out a literature review and draw a conclusion. For their second, students work in groups and critically analyse the methodology of a published research article.

Key dates:

ngoing. The Nursing curriculum has been progressively developed over a number of years. The original NURS121 was introduced in 1997, and NURS164 began in 2002. In 2008 we began our new curriculum and so we now have NMIH102 Patterns of Knowing in Nursing, NMIH204 Reflection and Practice and NMIH303 Evidence Appreciation and Application in Health Care Practice.

Critical success factors:

• Support from the Head of School
• "Powerhouse" individuals who are prepared to put work into making the change happen
• Grants through ESDF and Faculty Scholars to provide funding support for the people working on change
• Collaboration with the Library, Learning Development, CEDIR
• Acknowledgment of everyone`s contribution. While this can`t fully cover the effort involved, it helps when people feel recognised
• Writing about it. This generates profile and interest
• Finally, letting go, by handing over to new staff. An individual isn`t going to have enough energy to continually support a program for ten years. New people have to be enthused and take ownership.

Review and improvement:

An evaluation was carried out by surveying students. This showed improved information literacy skills. It also showed that students` levels of self-confidence in developing search strategies and accessing current research evidence increased after the 100-level information literacy program. The other theme that comes through in the focus groups we have conducted is what we might call "retrospective appreciation" where students indicate that they did not fully appreciate the usefulness of the research skills they developed until their final year of study.

In 2009, reflection on student evaluations has resulted in the use of a more structured assessment task for NMIH102. It is designed to reduce student anxiety about structuring their writing and help them to focus on providing good explanations and arguments.

Future plans:

Two other ways of knowing are emerging from the literature, socio-political knowing and unknowing. These may be incorporated in future years. It is Ruth White who writes about socio-political knowing when she says,

What appears to be missing [from Carper`s "ways of knowing"] is the context - the socio-political environment of the persons and their interaction. This represents a fifth pattern of knowing essential to an understanding of all the others.

The other patterns address the "who", the "how" and the "what" of nursing practice. The pattern of socio-political knowing addresses the "wherein". It lifts the gaze of the nurse from the introspective nurse-patient relationship and situates it within the broader context in which nursing and health care take place. It causes the nurse to question the taken-for-granted assumptions about practice, the profession and health policies (White, pp 83-84).

"Unknowing" is that capacity described by Munhall (1993) to put aside their usual pattern of knowing to be open to considering other possibilities, interpretations, and perceptions (Wong, 1998) apart from those usually offered by their knowledge and perceptions.

References

B Carper (1978), "Fundamental Patterns of Knowing in Nursing", Advances in Nursing Science, vol 1 no 1, pp 13-23.

Milne, C, Wallace, M and Porter, A (1999), "Coming to Terms with Statistical Literacy: Developing a University-wide Introductory Program", Of Significance. . ., vol 1 no 1, pp 35-40.

Munhall, P L (1993), "Unknowing: Toward Another Pattern of Knowing in Nursing", Nursing Outlook, vol 41, pp 125-8.

Shorten, A, Wallace, M C and Crookes, P A (2001), "Developing Information Literacy: A Key to Evidence-based Nursing", International Nursing Review, vol 48, pp 86-92.

Wallace, M C, Shorten, A and Crookes, P A (2000), "Teaching Information Literacy Skills: An Evaluation", Nurse Education Today, vol 20 no 6, pp 485-9.

Wallace, M C, Shorten, A, Crookes, P A, McGurk C and Brewer, C (1999), "Integrating Information Literacies into an Undergraduate Nursing Programme", Nurse Education Today, vol 19 no2, pp 136-41.

Wallace, M C, Shorten, A and Russell, K G (1997), "Paving the Way: Stepping Stones to Evidence-Based Nursing", International Journal of Nursing Practice, vol 3, pp 147-52.

White, R (1995) "Patterns of Knowing: Review, Critique and Update". Advances in Nursing Science, vol 17 no 4, pp 73-86.

Wong, S T (1998), "Outcomes of Nursing Care: How do we Know?", Clinical Nurse Specialist, vol 12 no 4, pp 147-51.