Honors Research in Nursing: Integration of Theory and Evidence-Based Practice Using Multiple Modalities of Thinking
Buckner, Ellen B., Journal of the National Collegiate Honors Council
Clinical judgment in nursing requires integration of a broad set of concepts from patho-physiological processes and situation-specific assessments to human caring and interpersonal communication. Nursing students consistently report difficulty in understanding and applying the complexities and ambiguities of care. They often perceive mixed messages and competing perspectives that cannot be resolved; their increasing frustration can produce anxiety about the conceptual tasks of scholarship. Honors research in nursing addresses this problem directly. Students have the opportunity to develop project ideas through all phases of the research process. They select a clinical question, relate it to nursing theory and current literature, design a project plan and implement the plan. In this process they experience first-hand how a single mode of thinking can be tracked through conceptualization to practice. Data-based research supports the student's transition to valuing evidence-based practice. As different students have considered different clinical questions, a variety of modes of thinking have been observed. Deductive, inductive and intuitive ways of understanding have been chosen for varied Honors research projects. This analysis looks at the process of Honors research in the discipline of nursing and how Honors students can use the process to provide an advanced foundation for practice in the discipline.
REVIEW OF LITERATURE
Different modes of thinking can pose difficulties for nursing students as they attempt to integrate performance approaches to care for a given client/patient or group of clients/patients. Competing approaches produce ambiguities, even for the most mature student or seasoned practitioner. Numerous authors have recognized the inherent complexity of nurses' ways of knowing. Berragan (1998) states that different models and ways of knowing are used for different fields of nursing and different nursing situations. Lauri and Salantera (1998) recommend that we explore the relationship between the nurse's structure of knowledge and how nurses use knowledge for decision-making in difficult situations. Other authors have recognized the role of intuition in nursing practice (Benner & Tanner, 1987; Rose & Parker, 1994; Berragan, 1998; McCutcheon & Pincombe 2001; Truman, 2003). Intuition is a manifestation of transpersonal caring and includes understandings of self-awareness through reflection (Leners, 1992).
Tanner (1998), a major national leader in nursing today, states that clinical judgment should be grounded in evidence-based practice. Diers (1995), another nationally recognized spokesperson for nursing, broadens that focus to include clinical scholarship as an alternative, though not a substitute, form of intellectual activity that may be comparable to research as a means of supporting nursing practice. These authors and others have sought to describe the importance of deliberate cognitive processes in nurses' actions.
In the 1990's there was a concerted effort in nursing education to improve students' critical thinking skills. That emphasis, however, has been criticized as developing only negative views of practice components, with the result of increasing frustration among clinicians. Some authors have taken issue with the call to increase critical thinking in nurses as the most important task of nursing education. Greenwood (2000) states that nursing education's emphasis on critical thinking skills fails to take into account the complexity of human cognition and clinical nursing practice. She states that human cognition includes both unconscious and tacit processes and requires interpretation of competing clinical and non-clinical cues and goals. Cody (2002) advocates a broader knowledge base in nursing. She states that using critical thinking as the cornerstone of nursing education leaves the profession with a starkly delimited base. The use of theories and frameworks enriches critical thinking and facilitates processes that are creative, constructive and relational. …