Journal of Nursing Education

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GUEST EDITORIAL 

The Reconstruction of Professional Knowledge

Laurel A Eisenhauer, RN, PhD, FAAN

Abstract

Most definitions of and criteria for the term "profession" include the concept of a profession or a professional having a unique and specialized body of knowledge that is used in service to society. Becker (1962) described professions as "occupations which possess a monopoly of some esoteric and difficult body of knowledge...." (p. 35). Technological advances and changes in society and health care delivery are challenging us to look at what it means to be a professional or to have professional knowledge in the world of today and tomorrow.

The rapid pace of knowledge development, resulting from advances in scientific research, is being further accelerated by the use of computers and other technologies which are providing for greater storage of information as well as greater access to the information by the general public and health care professionals. Because of the Internet, individuals now have access to a variety of worldwide sources of information, including medical databases and full texts of medical and health-related journal articles. The public learns about medical research findings from the media rather than through a health care professional. Therefore, health information, once the exclusive province of the medical or health care professional, is no longer locked up in medical libraries or journals available only to professionals. Concurrently, professional knowledge is being transformed into expert systems, algorithms, protocols, critical pathways, and evidenced-based practice. These attempts to standardize patient care and knowledge base needed for that care can result in greater safety and cost effectiveness and even greater achievement of outcomes for most patients. However, they also can result in "mindless" care leading to negative outcomes for the atypical patient.

The challenge is to consider what it really means to have professional knowledge in today's world. The focus of professional knowledge needs to be on the clinical judgment of a professional- not on the professional's knowledge per se- but rather on how and when the information is used appropriately by the professional in the care of patients. This depends greatly on the professional's ability to understand the individual patient, in terms of their health problems and responses to them, and to know how to apply knowledge.

Thus, the health professional needs to have patient knowledge to exercise expert clinical judgment (Jenny & Logan, 1992; Radwin, 1995). Expert judgment also involves knowledge of "phenomenology in motion"- the trajectory of the patient's unique responses. This knowledge is gained primarily from the patient and from "clinical experience'' or exposure to a wide variety of patients with both predictable and unpredictable courses of illness or treatment. Professional knowledge requires the use of critical thinking and clinical judgment to transform information into personally significant meaning. It involves the ability to analyze a person or situation thoroughly to determine: 1) when and if certain information is appropriate or whether a protocol is appropriate or inappropriate in the given circumstance, and 2) the trajectory of a particular situation, based on formal knowledge (e.g., research) and clinical practice experience, to know when and if a protocol will continue to be appropriate.

The distinctness or uniqueness of a specific profession (e.g., nursing versus medicine) can be seen as less related to the knowledge base than to the specific profession's ways of thinking about a given phenomenon. The modes of inquiry into the variables affecting a client or a situation provide the uniqueness of professional knowledge. How does this profession decide the nature of the problem and what that profession can do about it? What data (patient variables) does it consider? In educating professionals, the emphasis needs to be on learning not only what to do and how to…

Most definitions of and criteria for the term "profession" include the concept of a profession or a professional having a unique and specialized body of knowledge that is used in service to society. Becker (1962) described professions as "occupations which possess a monopoly of some esoteric and difficult body of knowledge...." (p. 35). Technological advances and changes in society and health care delivery are challenging us to look at what it means to be a professional or to have professional knowledge in the world of today and tomorrow.

The rapid pace of knowledge development, resulting from advances in scientific research, is being further accelerated by the use of computers and other technologies which are providing for greater storage of information as well as greater access to the information by the general public and health care professionals. Because of the Internet, individuals now have access to a variety of worldwide sources of information, including medical databases and full texts of medical and health-related journal articles. The public learns about medical research findings from the media rather than through a health care professional. Therefore, health information, once the exclusive province of the medical or health care professional, is no longer locked up in medical libraries or journals available only to professionals. Concurrently, professional knowledge is being transformed into expert systems, algorithms, protocols, critical pathways, and evidenced-based practice. These attempts to standardize patient care and knowledge base needed for that care can result in greater safety and cost effectiveness and even greater achievement of outcomes for most patients. However, they also can result in "mindless" care leading to negative outcomes for the atypical patient.

The challenge is to consider what it really means to have professional knowledge in today's world. The focus of professional knowledge needs to be on the clinical judgment of a professional- not on the professional's knowledge per se- but rather on how and when the information is used appropriately by the professional in the care of patients. This depends greatly on the professional's ability to understand the individual patient, in terms of their health problems and responses to them, and to know how to apply knowledge.

Thus, the health professional needs to have patient knowledge to exercise expert clinical judgment (Jenny & Logan, 1992; Radwin, 1995). Expert judgment also involves knowledge of "phenomenology in motion"- the trajectory of the patient's unique responses. This knowledge is gained primarily from the patient and from "clinical experience'' or exposure to a wide variety of patients with both predictable and unpredictable courses of illness or treatment. Professional knowledge requires the use of critical thinking and clinical judgment to transform information into personally significant meaning. It involves the ability to analyze a person or situation thoroughly to determine: 1) when and if certain information is appropriate or whether a protocol is appropriate or inappropriate in the given circumstance, and 2) the trajectory of a particular situation, based on formal knowledge (e.g., research) and clinical practice experience, to know when and if a protocol will continue to be appropriate.

The distinctness or uniqueness of a specific profession (e.g., nursing versus medicine) can be seen as less related to the knowledge base than to the specific profession's ways of thinking about a given phenomenon. The modes of inquiry into the variables affecting a client or a situation provide the uniqueness of professional knowledge. How does this profession decide the nature of the problem and what that profession can do about it? What data (patient variables) does it consider? In educating professionals, the emphasis needs to be on learning not only what to do and how to do it but also whether it should be done. Learning should also focus on why not as well as why. Emphasis also belongs on the process of finding and evaluating information and how to leam and apply it, rather than on the transfer of information from books or faculty to students. Professionals (and health care consumers) need to be taught how to locate appropriate information and how to evaluate information- no matter how it is received. Learning how to survive the information explosion means knowing not only how to access the most accurate and current information needed but how to classify and apply this information. A conceptual framework or paradigm of the profession can provide the structure necessary to organize present and future facts and information. Nursing education needs to go beyond teaching the nursing process as linear problem solving. Professional education needs to focus on the processes of critical thinking and the critical analyses of information, whether that is patient data, protocols, or research findings. Determining and teaching only the critical information needed immediately in common clinical situations should constitute the basis for required content; priority should then be given to teaching the student where and how to find other information not needed routinely or initially and how to apply relevant information to each unique patient or situation.

It can be seen that professional knowledge is not facts or information. Rather it is the application of knowledge through the use of critical thinking skills in clinical judgment that results from knowledge of the patient. The uniqueness of a specific profession, defined by it's use of knowledge in service to society (criterion for a profession), is at a crucial point in today's health care system. Nursing as a profession needs to focus on refining, validating, and explicating this "newer" view of professional knowledge and what it means to be a health care professional before the health care system deconstructs and destroys patients' access to professionals who can apply knowledge for thenbenefit and safety. Society is in danger of being deprived of nursing's unique professional thinking skills in the maelstrom of technological and health care delivery change.

References

  • Becker, H.S. (1962). The nature of a profession. In Education for the professions: The 61st yearbook of the National Society for the Study of Education, Part II. Chicago: University of Chicago Press.
  • Jenny, J., & Logan, J. (1992). Knowing the patient: One aspect of clinical knowledge. Image: The Journal of Nursing Scholarship, 24(4), 254-258.
  • Radwin, L. (1995). Knowing the patient: A process model for individualized interventions. Nursing Research, 44(6), 364-369.

10.3928/0148-4834-19980201-03

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