Knowledge

Knowledge can be defined and described in a number of ways. There are five ways of
knowing (Cipriano, 2007) that are useful in understanding how one knows something. A
nurse might use all or some of these ways of knowing when providing care.
1. Empirical knowing focuses on facts and is related to quantitative explanations
predicting and explaining.
2. Ethical knowing focuses on a persons moral valueswhat should be done.
3. Personal knowing focuses on understanding and actualizing a relationship between a
nurse and a patient, including knowledge of self (nurse).
4. Aesthetic knowing focuses on the nurses perception of the patient and the patients
needs, emphasizing the uniqueness of each relationship and interaction.
5. Synthesizing, or pulling together the knowledge gained from the four types of
knowing, allows the nurse to understand the patient better and to provide higher
quality care.
The ANA (2010b) identified the key issues related to the knowledge base for nursing
practice, both theoretical and evidence-based knowledge. This is the basic knowledge that
every nurse should have to practice. Nurses use this knowledge base in collaboration with
patients to assess, plan, implement, and evaluate care (pp. 1314).
1. Promotion of health and wellness
2. Promotion of safety and quality of care
3. Care, self-care processes, and care coordination
4. Physical, emotional, and spiritual comfort, discomfort, and pain
5. Adaptation to physiologic and pathophysiologic processes
6. Emotions related to experiences of birth,
7. growth and development, health, illness, disease, and death
8. Meanings ascribed to health and illness, and other concepts
9. Linguistic and cultural sensitivity
10. Health literacy
11. Decision making and the ability to make choices
12. Relationships, role performance, and change processes within relationships
13. Social policies and their effects on health
14. Healthcare systems and their relationships to access, cost, and quality of health care
15. The environment and the prevention of disease and injury
KnowledgeManagement
Knowledge work plays a critical role in healthcare delivery today, and nurses are knowledge
workers. Forty percent or more of workers in knowledge-intense businesses, such as a
healthcare organization, are knowledge workers (Sorrells-Jones, 1999). Knowledge
managementincludes both routine work (such as taking vital signs, administering

medications, and walking a patient) and nonroutine work, which (1) involves exceptions, (2)
requires judgment and use of knowledge, and (3) may be confusing or not fully understood.
In a knowledge-based environment, a persons title is not as important as the persons
expertise, and use of knowledge and learning are important. Knowledge workers actively use:
1. Collaboration
2. Teamwork
3. Coordination
4. Analysis
5. Critical thinking
6. Evaluation
7. Willingness to be flexible
Knowledge workers recognize that change is inevitable and that the best approach is to be
ready for change and view it as an opportunity for learning and improvement. Nurses use
knowledge daily in their workboth routine and nonroutineand must have the
characteristics of the knowledge worker. They work in an environment that expects
healthcare providers to use the best evidence in providing care. Transitioning to an
evidence-based practice requires a different perspective from the traditional role of nurse as
doer of treatments and procedures based on institutional policy or personal preference.
Rather, the nurse practices as a knowledge worker from an updated and ever changing
knowledge base (Mooney, 2001, p. 17). The knowledge worker focuses on acquiring,
analyzing, synthesizing, and applying evidence to guide practice decisions (DickensonHazard, 2002). The knowledge worker uses synthesis, competencies, multiple intelligences, a
mobile skill set, outcome practice, and teamwork, as opposed to the old skills of functional
analysis, manual dexterity, fixed skill set, process value, process practice, and unilateral
performance (Porter-OGrady & Malloch, 2007). This nurse is a clinical scholar. The
employer and patients value a nurse for what the nurse knows and how this knowledge is
used to meet patient care outcomesnot just for technical expertise or caring, though these
are also important (Kerfoot, 2002). This change in a nurses work is also reflected in the
Carnegie Foundation Report on nursing education, as reported by Patricia Benner and
colleagues (2010). Benner suggested that instead of focusing on content, nurse educators
need to focus on teaching the skills of how to access information, use and manipulate data
(such as those data available from patient information systems), and document in the
electronic interprofessional format.

Theoretical framework Rokeachs

(1968) work as an attitude theorist focuses on beliefs, attitudes, and
values.
The definition of value is important to understand Rokeach. As
defined by
Rokeach (1968), I consider a value to be a type of belief, centrally
located within ones
belief system, about how one ought or ought not to behave, or
about some end
state
existe
nce worth or not worth obtaining (p. 124). Rokeach further believed
that attitudes
are more specific than values, but values provide the basis for
attitudes. It is interesting
to note that Rokeachs first published study was sponsored by
Abraham Maslow.
According to Rokeach (1971), the research effort since 1966 at
Michigan State focused on a systematic investigation of the effects
of experimentally induced feelings of self dissatisfaction on long
range changes in values, attitudes, and behaviors.
Use of the theoretical approach differed from other approaches
used in experimental social psychology in the following three major
ways:
1.Understanding that in order to create cognitive or attitude change,
inconsistency is necessary. In contemporary methods, the
inconsistency is created by either inducing a person to engaging in
behavior or to expose him to information about attitudes or values
that are incompatible with his own; however, under this theory, the
person would be made consciously aware of the inconsistency
within his own value belief system.
2.Contemporary social psychology focuses on the concept of
attitude on theories of attitude change; however, this theory focuses
on the concept of value and on a theory of value change. Therefore,
the assumption is that values are more fundamental than attitudes
and moreover, that values are the basis of attitudes and behavior.
3.The measurement of dissonance differs from contemporary where
at least two elements has some dissonant in relation to one
another. Under this theory, two elements, normally referred to as

cognitions, do not vary from one situation to another, but are

invariant across all situations. In other words, if the two are
satisfied with each other, they are consonant and satisfied with their
self; however, if the two are dissatisfied, they are dissonant and that
leads the person to become dissatisfied with their self (Rokeach,
1971). In one experiment, Rokeach (1970) studied different sects of
religions, and the nonbelievers, trying to ascertain their value
systems. In order to conduct this research, Rokeach utilized the
Rokeach Value Survey. This instrument was a simple two part scale
that consists of 18 goals or terminal values such ascomfortable life
and world at peace in which the interviewee was asked to rank in
order of importance the 18 goals. Additional to this, 18 means,such
as honest and courageous, would be the best means to meet the
goals. The results did find that different religions ranked goals and
means differently, as did the nonbelievers. Rokeach believed that
values were enduring beliefs that relate to life goals and the way
people attain those goals. This was the purpose of this experiment.
Other experiments used The Rokeach Value Survey as well. The
major findings of Experiment 1 were (a) that induced states of self
dissatisfaction concerning ones values and attitudes led to highly
significant changes in values and attitudes that were vident three
five months after the experimental treatment. Moreover, (b)
measures of self Satisfaction dissatisfaction, obtained at the end of
the experimental session, predicted the value changes that were to
be observed three weeks and three five months afterward
(Rokeach, 1971, p. 455). Other such experiments had similar
results.