Knowledge-in-ActionTheory-in-Use

&Clinical Choice

During Clinical PerformanceCheryle Moss

Victoria University of Wellington

Knowledge Utilisation Colloquium 2005

Melbourne

Background

A Hermeneutic Study

Experienced Nurses’ in Everyday Practice Their Moral Choices & Associated Knowledge

Comportment

KU Findings of Interest

Situated at the Individual

Adds to understanding of how practice performance is constructed

The ways that individuals vary in their practice choices

The aspects in clinical presentations that ‘spark’ them

The ways in which different knowledge is selected, integrated, & utilised in the context of particular practices

Significant Interplay

Between Context, Knowledge & Personal Preferences

In the Constitution of Theory-in-Use

In Practice Performance

‘Signatory Styles’

Highly Individualised… Practice Preferences Clinical Interests Ways of Responding to Contextual

Clinical Concerns…

Leading to Distinctive Performances

‘Signatory Styles’

The nurses’ ways of engaging &

responding to the practice needs of

patients in their contexts of care were so

individually distinctive that they could be

considered to have ‘signatory styles’ in

their clinical performances.

Construction of Acts

Mediation b/n Context & Interest The nurses all mediated their

contexts of practice & their practice interests

in the construction of individual acts of care

The Process of Mediation

Highly influenced by… Reading of what was practical, doable,

needed & what could be fitted in relation to… perceived patient interests & needs

& their own sense of what was desirable,

good & right

Knowledge-in-Action

During the construction of care… Choices-in-action were active & dynamic Local knowledge utilisation in any given

aspect of the clinical performance was Anchored by & integrated into the overall

‘moral’ positioning of the clinical undertaking

Knowledge-in-Action

Within particular acts of care The nurses integrated & used different

forms of knowledge Accounts were rich with ‘local theories-of-

action

Theories-in-use

Derived from previous experience

Contained performance ‘maxims’

Drew on theoretical & technical clinical

knowledge & on personal knowledge of

people & their human conditions

Theories-in-use

Were held & constructed through the nurse’s…

own sense of identity personal philosophy of practice

the sense of what was practical, possible & needed in the context

Moral Knowing as an Integratory Force

For

The construction of care

&

The utilisation of other forms of knowledge

Topography of Moral Knowing

Four distinct layers of knowledge utilisation within a practice event…

1 Personal-professional moral platform for performance

2 Negotiating moral boundaries in relation to context & what is possible

Topography of Moral Knowing

3 Utilising multiple forms of knowledge as local theory in use as inextricably linked to moral knowing

4 Engaging with specific moral & ethical puzzles & problems

Knowledge Utilisation Theory

The clinical performance of individuals

further exploration of Knowledge-in-Use Theories-of-Action Choices-in-Action

Thank-you for listening

&for the opportunity to participate

in KU05