Knowledge-in-Action Theory-in-Use & Clinical Choice During Clinical Performance

1. Knowledge Utilisation Colloquium 2005 Melbourne Knowledge-in-ActionTheory-in-Use&Clinical Choice During Clinical Performance Cheryle Moss Victoria University of Wellington

2. Background • A Hermeneutic Study • Experienced Nurses’ in Everyday Practice • Their Moral Choices & Associated Knowledge Comportment • KU Findings of Interest

3. 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

4. Significant Interplay • Between • Context, Knowledge & Personal Preferences • In the • Constitution of Theory-in-Use • In • Practice Performance

5. ‘Signatory Styles’ Highly Individualised… • Practice Preferences • Clinical Interests • Ways of Responding to Contextual Clinical Concerns… Leading to Distinctive Performances

6. ‘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.

7. 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

8. 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

9. 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

10. Knowledge-in-Action Within particular acts of care • The nurses integrated & used different forms of knowledge • Accounts were rich with ‘local theories-of-action

11. Theories-in-use • Derived from previous experience • Contained performance ‘maxims’ • Drew on theoretical & technical clinical knowledge & on personal knowledge of people & their human conditions

12. 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

13. Moral Knowing as an Integratory Force For The construction of care & The utilisation of other forms of knowledge

14. 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

15. 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

16. Knowledge Utilisation Theory The clinical performance of individuals further exploration of • Knowledge-in-Use • Theories-of-Action • Choices-in-Action

17. Thank-you for listening &for the opportunity to participate in KU05