LEARNING OBJECTIVES
Reading and reflecting on this article will enable you to:

• Define nursing scholarship and explain its significance to improvement in healthcare delivery, and in particular, to patient- and family/whānau-centred care
• Describe enablers and barriers to scholarly practice
• Identify effective ways to integrate scholarly practice into your practice
• Understand different perspectives and applications of scholarly nursing practice.

One of the key competencies that nurses are asked to demonstrate is applying best or evidence-based practice to their professional work.

In order to work professionally, nurses need to be more aware of how they ‘know’ this and how to incorporate these ways of knowing into their everyday nursing practice.¹

One critical element of best practice is the development and maintenance of the nurse-patient relationship. The ability to think critically, question practice, and to be current with evidence-based knowledge are all vital for nurses’ accountability. These elements, along with idea and knowledge dissemination, innovation, and reflection are the basis of best practice and continuing professional development.²

Regardless of the theory or the definition of nursing scholarship, the intention is that knowledge development advances nursing practice, and therefore, improves patient-centered care. By understanding scholarly practice, nurses’ pursuit of knowledge and development of roles to improve and enhance patient-centred care is clear. We first present Boyer’s definition of scholarship and then move on to summarise Chinn and Krammer’s five patterns of knowing as a way to holistically develop scholarly practice. We look in particular at the relationship between Chinn and Krammer’s notion of emanicipatory knowing and the concept of praxis – that is, where nurses thoughtfully reflect and act to make things better.

Defining scholarly practice

Boyer’s seminal work on scholarship includes four domains: discovery, integration, teaching and application.

Discovery, is the discovery of new knowledge. New knowledge can be obtained through research,^3,4,5,6 and involves differing viewpoints.⁴ Integration explains patterns and relationships of new knowledge, such as implementing research into clinical practice.⁴ Sharing knowledge is considered the scholarship of teaching³ and involves role-modelling and mentoring⁴ so that meaning is conveyed to others.³ Application links everyday life with the theory of discovery.³Boyer argued for a more inclusive meaning of scholarship, recognising that “knowledge is acquired [and shared] through research, through syntheisis, through practice and through teaching”.^7,8

It is argued that nursing scholarship can consist of many overlapping knowledge components that, when taken as a whole, is conceptually fluid.^1,5 Scholarship can be viewed as the shared responsibility of nurses to collaborate with other health professionals to achieve optimal health outcomes for patients and their families.^1,5

Table 1: Knowing and Knowledge

 Source: Chinn & Krammer, 2011.

Key concepts

• Scholarship plays an integral part of nursing. Reflective practice and patterns of knowing play a role in knowledge development.
• Nurses have an obligation to themselves, their patients, and nursing as a discipline to actively take part in the realms of scholarship.^1,5
• Nurses can contribute to nursing scholarship in any nursing role and regardless of their place of work.^1,5,9
• Scholarship is a continuous process. Functions of scholarship overlap, but one does not have to do it all to be considered a scholar.⁸
• Nursing scholarship involves accountability, responsibility and professional development for the improvement of the health of individual, communities and healthcare delivery.
• Patient-centred care and collaboration are key underpinning values of nursing scholarship, and in particular, the ongoing development of knowledge.
• Philosophical enquiry remains critical to scholarly practice. It gives focus to nursing research and anchors nursing care decisions and actions.¹⁰

Table 2: Patterns of knowing

 Source: Chinn & Krammer, pp. 14 -15, 2011.

Enablers and barriers to scholarly practice

There is concern that Boyer’s idea of scholarship does not encompass new and creative ideas and instead relies on conventional ideas of knowledge development and a focus on traditional methods.^11,12,13 However, Boyer argued that it is up to institutions to ensure that all functions of scholarship are encouraged.⁸

Boyer’s work is a useful starting point when examining scholarship, but every discipline has its own body of knowledge that differentiates it from other professions, and nursing is no different.^1,14,15

Barriers to nursing scholarship may include time pressures, staffing issues, constant interruptions, and balancing multiple roles.¹⁶Unsuccessfully attempting to balance all scholarship areas may cause conflict, leading to fragmentation of nursing care rather than improvements.¹⁷

It has been argued that nurses familiar with philosophical thinking are better able to progress and understand the everyday phenomena of nursing practice.18 Knowledge of philosophical approaches can help with the identification and analysis of present and emerging problems; philosophical enquiry is integral to developing both practice and knowledge to address unmet needs.19 Grace and Perry²⁰ present the notion of critical consciousness as the foundation for which nursing philosophical inquiry begins, whether it be applied as individual self-reflection or disciplinary self-reflection where philosophical questioning takes place in the literature or other public forums.

Different forms of scholarship lead to different forms of knowledge. Arguably, it is the responsibility of all nurses to holistically develop their nursing knowledge to lead improvements in healthcare delivery, and in particular, patient-centred care. For nurses to be scholarly, it requires that all the fundamental patterns of knowing be encompassed in nursing practice, regardless of role or practice area.^21,22

Fundamental patterns of knowing

Chinn and Kramer²² suggest that knowledge development encompasses five patterns of knowing. They have extended Carpers’ initial four fundamental patterns of knowing – based on ideas, research, and insights of nursing scholars – and provide each pattern of knowing with dimensions to illustrate this (refer Table 2)²². The embedding of the four fundamental knowing patterns additional to emanicipatory knowing symbolises the need to examine and understand both practice and interdisciplinary approaches to knowledge development, and in relation to praxis and emancipatory change (refer Tables 2 and 3).

The cycle of praxis proposed by Chinn and Krammer portrays scholarly practice as practice leading to beneficial change and requiring the integration of all the patterns of knowing to be effective. Praxis and practical reasoning unfold in contexts that are profoundly interpersonal and relatively unpredictable. The practice of nursing is an intentional and deliberate action, guided by nursing science and other sources of knowledge, performed by nurses, and intended for the benefit of persons and society.²³

Emanicipatory knowing is about having the capacity as nurses to be aware of and to critically reflect upon the social, cultural, and political status quo and why it came to be that way.22 The integrated expression of emancipatory knowledge is praxis.²² Chen and Krammer emphasise ’integrated’ because they believe the action and reflection of true praxis must be grounded in all knowing patterns to be effective.

True praxis is grounded in emancipatory, ethical, personal, aesthetic and empirical knowledge. Praxis at an individual level occurs when unjust conditions that limit one’s own, or others, abilities and experiences are recognized, and upon reflection, there is a growing realisation that things could be different.²² Praxis as a collective endeavour requires reflection and action with others who are engaged in creating social and political change.

When members of a discipline such as nursing engage in praxis at a collective level, they can create substantial change.
Patients have the right to be offered care based on the best evidence available. Care is offered within the bounds of ethics, for care in a fundamental sense belongs to the patient/whānau, the consumer of care²³ (refer Table 3). It is emphasised that scholarship works well when nurses have as much contact with their patients as possible1 and that the perspectives, needs, and experiences of patients are understood.

How can nurses integrate scholarly practice?

Nursing scholarship requires skills and knowledge to come together with education and experiences.¹¹ Professionally, nurses are asked to share their knowledge with each other and other disciplines to ensure a central patient focus. Integration of scholarship requires nurses to be patient-focused, regardless of their role. Awareness and critical reflection are essential elements of emancipatory knowing²² and scholarly practice. It requires an understanding of the powerful dynamics that create knowledge and of the social and political contexts that shape and influence prevailing epistemologies of knowing and learning.^{1,3,4,5,6,7,22}

A nurse’s ability to deal with healthcare change depends on the amount of control they have over their own systems of care. This is achieved through accountability, responsibility, and the ability to evaluate work.²⁴ Ongoing nursing development24 ensures nurses respond to the fluctuating needs of patients, their families/whānau and the community.^22,25 An example in New Zealand of a nursing role developing to improve health service delivery is the diabetes nurse specialist prescriber role.²⁶

One way of empowering patients and their communities is through improved health services.²⁷This helps to create community change addressing issues of inequality – one of the underpinning values in the nursing Code of Conduct.²⁸ Developing relationships takes time; nurses must realise the importance of this and be willing to listen to the patient as well as others.²⁹ Nurses must be responsible for asserting the connection between nursing and the health of the community.³⁰ In order to do this, nurses need to know their community, so approprate health services can be developed.31 Continuity and coordination of nursing care, communication, and collaboration is also required to ensure patients are placed at the centre of care.³²

If nurses continue to communicate openly and freely with patients, and collaboratively set goals, this will contribute to improved patient outcomes and decreased adverse events.^11,18 It is the nurses responsibility to continue to have an awareness of the impact of illness and to stay patient focused.¹⁸ . It is important that everyone is working towards the same goal whilst recognising the role that each individual brings.

Emanicipatory knowing is different but related to problem-solving, in that it requires a deep awareness of sometimes hidden injustices, and a viewing of the larger picture to seek correcting social processes. Emanicipatory knowing, like scholarly practice, involves a constant interaction between action and reflection. Praxis requires going beyond personal reflection to deliberately uncover what is unfair and unjust and to envision how it could be different, and to form alternate explanations and possibilities for change. Emanicipatory knowing is key to nursing scholarship. We encourage nurses to develop an awareness of their pattern of nursing knowledge and to extend all patterns in the interest of scholarly practice.

There are a range of theories in nursing that are capable of guiding nursing practice across a range of situations and events, and these reflect the maturity of nursing’s knowledge base. Most importantly, whatever your role or practice area, consider the utility of nursing knowledge as being more broad and inclusive than any isolated application of knowledge. Develop your nursing knowledge and structure scholarly activities to support emancipatory change.²³

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About the authors:

Louise Carrucan-Wood RN, BN, PgDip Nurs (Distn), MHSc (First Class Honours) is a professional teaching fellow and a PhD candidate at the School of Nursing, at the University of Auckland.

Lauren Porten RN, BHSc (Nurs), PG Dip HSc is a master’s student at the School of Nursing and a clinical nurse specialist in haematology services at Auckland District Health Board.

This article was peer reviewed by:
Dr Isabel Jamieson RN PhD senior lecturer (CPIT) & adjunct senior fellow (University of Canterbury)

Dr Jocelyn Peach RGoN MBS PhD director of nursing & midwifery & emergency systems planner, Waitemata District Health Board

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THE HOUR OF POWER:

Reading the article and undertaking this Are you a nurse scholar? learning activity is equivalent to 60 minutes of professional development.
Discuss all your answers with a peer.