The practice turn in nursing epistemology.

Nursing is a fascinating discipline. Nurses have the honor and expertise to participate closely in human healing processes of individuals, families, communities, and other systems of care. Yet, because the practitioner’s expertise in healing is not fully understood, some account for it by relying on concepts (like intuition, tacit knowing, and gut feelings) that render nursing knowledge more mystical than professional. Admittedly, there are elements of mystery in nurses’ patterns of knowing. However, contrary to philosophers of science Reichenbach and Popper, the context of discovery is not primarily mystical territory (Lamb & Easton, 1984), and this author believes it both possible and beneficial to obtain better explanations of how nursing knowledge is produced in the practice setting. Furthermore, trends in practice regarding evidence-based nursing, an intensified interest in advanced practice degrees, and the rise of the Doctorate of Nursing Practice degree all necessitate inquiry into nursing’s epistemological infrastructure. In this column, the author proposes a rationale and a framework for thinking about knowledge production in nursing practice. For too long, nursing has sustained the myth of the theorypractice gap and promulgated science as distinct from the discipline’s art or practice. The researcher has been portrayed as the producer who hands down scientific knowledge to the clinician: as the applier of knowledge, sometimes supplier of ideas or researchable problems, and maybe even tester of knowledge, but rarely the producer. This traditional model of nursing knowledge production not only misrepresents and constrains the knowledge potential in nursing, but it marginalizes the practitioner and distances patients from knowledge development. There is a great need for inquiry into whether and how nurses produce knowledge through their practice. The results are likely to extend the science of nursing practice well beyond descriptions of intuition and gut feelings. Granted, knowledge from other sciences can be useful for application perhaps with some reformulation, and therefore does not need to be produced in the context of nursing practice. But to the extent that nurses strive to facilitate patients’ resources and participation in care and healing processes, it seems logical that a nurse/patient practice-centered model rather than a researcher-centered model of knowledge production be employed. For example, knowledge generated through practice can more effectively address the thorny epistemologic problem of who can speak for others; practicebased knowledge equips the nurse to speak not for the patient, but with the patient (Alcoff, 1995). Precursors to this practice turn in epistemology, so called by Rouse (2002), were evident in nursing over a half century ago. And during the last decade, scholars within and outside of nursing increasingly acknowledged the role of human practices in knowledge production and critiqued orthodox epistemology with its one path to scientific knowledge. Editor’s Note: Any comments about this dialogue should be addressed to the Editor for possible inclusion in Letters to the Editor. For other information, contact Pamela G. Reed, RN, PhD, FAAN, 5520 E. Silver Mine Place, Tucson, AZ 85721; phone: (520) 6264038; e-mail: [email protected]