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Knowledge-in-ActionTheory-in-Use
&Clinical Choice
During Clinical PerformanceCheryle Moss
Victoria University of Wellington
Knowledge Utilisation Colloquium 2005
Melbourne
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Background
A Hermeneutic Study
Experienced Nurses’ in Everyday Practice Their Moral Choices & Associated Knowledge
Comportment
KU Findings of Interest
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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
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Significant Interplay
Between Context, Knowledge & Personal Preferences
In the Constitution of Theory-in-Use
In Practice Performance
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‘Signatory Styles’
Highly Individualised… Practice Preferences Clinical Interests Ways of Responding to Contextual
Clinical Concerns…
Leading to Distinctive Performances
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‘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.
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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
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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
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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
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Knowledge-in-Action
Within particular acts of care The nurses integrated & used different
forms of knowledge Accounts were rich with ‘local theories-of-
action
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Theories-in-use
Derived from previous experience
Contained performance ‘maxims’
Drew on theoretical & technical clinical
knowledge & on personal knowledge of
people & their human conditions
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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
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Moral Knowing as an Integratory Force
For
The construction of care
&
The utilisation of other forms of knowledge
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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
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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
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Knowledge Utilisation Theory
The clinical performance of individuals
further exploration of Knowledge-in-Use Theories-of-Action Choices-in-Action
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Thank-you for listening
&for the opportunity to participate
in KU05