Research overview and key findings

Nursing Epistemology: Personal and Kinesthetic Knowledge

Richard Noss, Stefano Pozzi, Celia Hoyles begin their article "Meanings of average and variation in nursing practice" with the central question: "what mathematics -- if any -- do people do in their working lives?" (Noss, Pozzi, Hoyles, 1999, p.25). In short, how is the pragmatic deployment of mathematics in one's working life different from the way that the use of mathematics is taught in textbooks? The focus of their article Educational Studies in Mathematics is how individuals can be error-prone on tests of empirical knowledge, yet be mostly error-free in practical contexts. They studied pediatric nurses and asked them to determine a hypothetical patient's blood pressure based upon a chart, as a way of testing the nurse's conceptions and mental images of average and variation (Noss, Pozzi, Hoyles, 1999, p.27). Nurses were chosen for these mathematicians's research because nursing practice has always involved making sense of quantitative information through the measurement, recording and interpretation of patient data (Noss, Pozzi, Hoyles, 1999, p.29).

The researchers were surprised to discover that even when determining a patient's blood pressure, nurses were more apt to use intuition than mathematically certain methods. The nurses were more inclined to rely upon their past experience: "The nurses used a variety of strategies, almost all of which would be judged 'wrong' on the straightforward criteria of general mathematical correctness, e.g. 'I looked at the chart and judged which was the middle range' or 'At a glance, all the systolic pressures are on or around 110 mm Hg'. Yet they made perfect sense and were correct as estimates of the child's blood pressure -- a kind of everyday average" (Noss, Pozzi, Hoyles, 1999, p.35). "Another feature common to all the interviews was that the nurses tended to superimpose on the BP chart a personal narrative of what the baby might have been doing, as illustrated by Abigail, when asked to compare the average systolic blood pressure before and after midday" (Noss, Pozzi, Hoyles, 1999, p.37). It was not enough or meaningful to determine hypothetical blood pressure based upon statistics, a relevant patient history had to be constructed, even though the patient was not 'real.' This shows that 'ways of knowing' for nurses in practice, even regarding something as directly calculable as blood pressure is often based in experiential as well as empirical science.

While the article Educational Studies in Mathematics highlights the discrepancy between book and experiential learning in mathematics, the article "Interprofessional perspectives on teamwork in health care" highlights the difficulties experienced by nurses working on management teams in hospitals, and allowing their disciplines' framework of knowledge to be accepted as equal to their physician-colleagues. "There is a discrepancy between nursing's and medicine's views and expectations of 'interdisciplinary team'" (Temkin-Greener 2000, p. 641). While medicine sees nurses in a subordinate role, in a team context, the profession of nursing sees its contribution as unique. Nursing leaders have fought to define nurses as nurses, not mere 'physician-extenders.' But when surveyed, physicians on 'interdisciplinary teams' in healthcare settings with a stress upon equality showed a lack of enthusiasm about the 'team' concept and the unique contribution of nursing. The physician's responses suggested that the viewed "teamwork as a nursing concept, beneficial primarily to nursing and used to 'usurp' the traditional authority of medicine in health care provision" and said that teamwork was merely buzzword deployed by management, with little relevance to their practice (Temkin-Greener 2000, p. 647).