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Utbildnings- och kultursociologi
Sociology of Education and Culture at Uppsala University
This document is an historical remnant. It belongs to the collection Skeptron Web Archive (included in Donald Broady's archive) that mirrors parts of the public Skeptron web site as it appeared on 31 December 2019, containing material from the research group Sociology of Education and Culture (SEC) and the research programme Digital Literature (DL). The contents and file names are unchanged while character and layout encoding of older pages has been updated for technical reasons. Most links are dead. A number of documents of negligible historical interest as well as the collaborators’ personal pages are omitted.
The site's internet address was since Summer 1993 www.nada.kth.se/~broady/ and since 2006 www.skeptron.uu.se/.
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Utbildnings- och kultursociologi
Sociology of Education and Culture at Uppsala University
URL of this page is www.skeptron.uu.se/broady/sec/p-heyman-95-summary.htm
This is a HTML version of the English summary, pp, 259–271, in Ingrid Heyman: Gånge hatt till... Omvårdnadsforskningens framväxt i Sverige. Sjuksköterskors avhandlingar 1974–1991 (Letting the Hat Rule... The emergence of nursing research in Sweden. Doctoral theses written by nurses 1974–1991). Göteborg: Daidalos, 1995.
Summary
During the last few decades in Sweden a new domain for research has emerged, usually called "omvårdnadsforskning" (caring and nursing research). The term "omvårdnad" is problematic because of its dual meaning, "nursing" and "caring". In this summary, the term nursing is used, referring to both nursing and caring.
Studies in the field of nursing and caring may appear in many disciplines. It is a theoretical and practical problem to determine what kind of research to analyse in order to describe and understand this new domain. Nurses are important agents and I decided to limit my work to doctoral dissertations at Swedish universities written by graduate nurses. The first nurse thesis appeared in 1974. My study covers all nurse theses up to 1991. They are 65 in total. My data emanate from text analysis of these dissertations and a mailed questionnaire to the authors (response rate 94%).
The purpose of this study, which is both theoretical and empirical, is to get a deeper understanding of how the new domain of research in nursing was established in Sweden and how it has developed. The main questions posed at the onset were
Many attempts have been made to understand the establishment and development of scientific disciplines. According to the French sociologist, Pierre Bourdieu, it is of utmost importance for predecessors of any science to thoroughly reflect upon its theories, perspectives, methodologies, techniques, or, in short, its scientific tools. Such scholarly reflection and critique is always important, but especially so in a new domain of research.
A review of studies dealing with nursing science, education and social work is presented. All of these fields of scholarship are highly dependent on the social contexts they investigate. The latter are normative and ideological in nature which means that there is a tendency also for research on phenomena pertaining to these fields, to be normative.
To be able to answer some of the questions mentioned above, I have used the conceptual framework of Pierre Bourdieu. Before any deeper analysis was carried out, it became evident that the doctoral theses written by nurses constitute a divergent whole. This gave reason to try to map out the similarities and differences of the theses. The concept of field was quite appropriate for this endeavour. The concept of field also served as an analytical instrument to illuminate epistemological questions, i.e. questions concerning the boundaries and possibilities of scientific knowledge rather than ontological ones.
In the Bourdieu tradition, as in this study, the researchers are encouraged to investigate on the one hand the space of possibilities scientific traditions, standpoints in scholarly debates, different tools, perspectives, techniques, etc. and on the other hand, the social field where agents and institutions occupy different positions. In principle, the possibilities are infinite, but inaccessible to reach for every individual, i.e. they are not all visible within the persons horizon.
The authors of the theses in nursing research are influenced in their actions and thoughts by principles acquired through experiences earlier in life, i.e. dispositions that allow them to estimate that some ways into the academic world are more convenient than others. The writers also have different backgrounds in terms of schooling, education, experiences from the life of work, from academic studies at home and abroad, etc. In the analyses, I have used the term social capital to designate contacts and relations with relatives, education, and type of professions in the families of the authors. As educational capital I have considered earlier education and living and/or studying abroad. Memberships on examination boards, service as opponents of field-specific doctoral dissertations, memberships in committees deciding on grants of money or admission to doctoral studies, positions as professor, lecturer, etc. have been looked upon as capital of university power. As indicators of capital of scientific power and prestige, I have considered qualities like membership in groups of researchers, the number of doctoral students, the number of scholarly conferences attended, the scientific production of articles, books and chapters, professional responsibilities such as function as reviewer of manuscripts submitted for publication, editor, chairman of distinguished conferences, etc.
All these different types of capital are inspired by Pierre Bourdieus well-known book on Homo Academicus, 1984, in which he also investigated indicators of intellectual celebrity and capital of political power and dispositions and also of economic power. However, in this study, my primary interest has been to outline the new domain of nursing research and the positions the researchers have taken on scientific issues. My analysis of the social room is restricted mostly to epistemological standpoints held by the researchers, except for some indicators of types of capital mentioned above.
Data from the 65 theses, written by nurses in Sweden 19741991, and their answers to a questionnaire is used to construe an image of the emerging field of nursing research by means of correspondence analysis. This is a statistical method in which the researcher can handle qualitative data in a quantitative way. It is essential that interpretations are not built into data before the analysis is carried through. The variables and modalities are thus composed of raw, factual information and compound information is avoided, i.e. groups of variables summarised by one single variable. In the French tradition of correspondence analysis, developed by Jean-Paul Benzcri, the researcher splits the variables into modalities with no other specific structure than that of a nominal variable.
A set of characteristics relate to the form of the theses, another to the content and yet another one concerns organisational adherence for example the faculty and the university where the thesis was defended. In the present study, raw data are predominating. An example: it is a distinguishing quality whether a thesis is written in Swedish or English. In this case language is regarded as the variable with two logically interdependent modalities: Swedish and English.
The correspondence analysis shows a specific profile for every individual or thesis. When profiles are similar they reveal near relations to each other. In the graphs, such similarities, which result from the correspondence analyses, point out different groups at a certain distance from each other. The closer the components are on the "map", the more characteristics they have in common and the more distant from the antipod, characterised by an opposite set of modalities.
For a long time in Sweden, it has not been possible for nurses aiming at doctoral degrees to have access to research groups, departments or faculties with special interest in nursing or caring. Such departments were established in Ume 1987, in Uppsala 1988 and in Link�ping 1989. Instead, the nurses in this study had to find other ways. Twenty-eight different departments or combinations of departments at three faculties have been involved in the education of the nurse researchers. Being a nurse did not automatically mean that research was focused on phenomena related to nursing. Six of these authors have concentrated their efforts to phenomena outside nursing.
Of the dissertations under review, 42 of the 65 have been presented at faculties of medicine, 22 in social science, and only one within a faculty of the humanities. Two-thirds of the theses are written in English and the rest in Swedish. There are two forms for presenting doctoral theses in Sweden. One form is the monograph, most often to be found in faculties of social science and humanities. Twenty-five out of 65 theses are monographs. The other form, 40 out of 65, mainly found in medical science and experimental psychology, is a compilation of previously published articles, merged and summarised in a shorter text. In my study, I call the latter type of thesis a polygraph in analogy with monograph.1
In order to grasp the most characteristic qualities in theses written by nurses, I have used many different techniques. Some techniques were aimed at categorising the research tools, designs and approaches used by the authors. Other techniques were used to describe different influences from other sciences, shown by, for example, "borrowed" theories, models of design and methods.
In the following, I will present three representations of nurses theses. The first one has its basis in a correspondence analysis with variables related to, above all, form and content. In the second one, I have related the theses to nursing and caring. All theses did not fit in that analysis which was the reason for the third representation. In this final one, 59 theses are categorised as relevant for health, caring and nursing research.
As mentioned above, the variables must not be "contaminated" by interpretations before a correspondence analysis begins. That is why some interesting variables could not be included in the basis for the analysis. The method itself is limited only to give a static representation of a dynamic process. Even the venture to reduce all the theses written during nearly two decades in the same two-dimensional categorisation can of course lead to misrepresentation.
The first factor, or dimension, in a correspondence analysis reveals the most conspicuous differences in the data. In this case, the first factor points out indications of different scientific traditions. The cluster of theses aggregated in the one end of the first factor have many things in common with theses written by medical doctors in the clinical area. The researchers have often made use of an experimental design, i.e. the investigations are carried out under controlled conditions. Furthermore, they have used groups of subjects for experiment and control, made physiological measurements, made use of questionnaires or other instruments, and handled their data by analytical statistics. The references to literature are mainly to medical sciences. The theses are often supervised by medical researchers and presented at departments inside medical faculties. The theses consist in many cases of five or six articles in a polygraph. The articles have on the average two to six authors. The summary is usually short: 25 to 40 pages and the whole theses usually consists of less than 100 pages.
The opposite cluster in the first factor differs in nearly all aspects. The theses in this pole are characterised by being monographs written in Swedish, in volumes of 201 to 404 pages. The number of references is often high, 201 to 505. The table of contents usually reveals what the book is about, in contrast to the former group where the table of contents is structured in analogy with the steps in a research process. The theses in this cluster are defended at faculties of social science and mainly at departments for education, sociology, or the so called Theme-studies at Link�ping university which are multidisciplinary in nature.
Texts or living persons were sources that provided the authors data for research. If data emanated from individuals, the groups of interest were small: less than fifty persons. Analyses of data were mainly carried out in a qualitative fashion. More references were made to many other disciplines, in comparison with the first group. For example, more than every tenth reference was made to education, more than every third to nursing and very few, if any, to medicine. References to philosophy, ethics, history of science, law and fiction or belles lettres also occurred.
The second factor in the correspondence analysis is more difficult to attach a meaning to, but it tends to either emphasize nursing or non-nursing. The cluster at one of the poles is not possible to interpret, but the other one is sociologically relevant and highly interesting. Specifically, the theses in this group are mainly characterised by being presented in Ume at the Departments for Advanced Nursing, Medicine or Geriatrics. The articles in polygraphs are sometimes published in journals specialized on nursing and amount to seven or eight, i.e. more than in the first group. The theses in this cluster consist of more pages than in the first cluster 101 to 200 and the summaries are slightly longer: 41 to 50 pages. The lists of literature are more evenly distributed among different scientific fields.
With support from correspondence analyses, it becomes evident that nursing research in Sweden is far from a one-sided activity. On the contrary, the three different clusters I have just presented, do not have common research problems. The authors have used different scientific tools and techniques to gather, construct and handle their data. They have been inspired by different sciences, their scope narrow or broad differs as well as the style of writing.
The conclusion I draw, is that nurses as scholars can be looked upon as belonging to at least one of two distinctly separate traditions inside the scientific world: biomedical research and some of the traditions inside social science. Within the second cluster, close to social science, there are examples of theses inspired by different interpretative traditions such as phenomenology, hermeneutics, grounded theory, symbolic interactionism or ethnography. The third cluster mentioned above, seems to try to merge components from the medical with the social sciences and to integrate qualitative and quantitative data.
In a second representation, I relate the theses to a model of nursing and caring. The two concepts are far from being precise and clear quite the opposite. A review of the literature on this subject, mainly from the Nordic countries and the US, shows many different standpoints taken by researchers. In my view, nursing corresponds to the strategies, in a broad sense, taken by nurses. A nurse of today should ideally have knowledge in psychology, sociology, anthropology, medicine, pharmacology, chemistry, administration, and education. In other words, a whole bundle of sciences contributes to the professional knowledge of nursing. Nursing is carried out in different ways depending on the context. A school-nurse and a nurse in a surgical ward or an operating room do not have many tasks in common, but they still are "doing nursing".
Caring on the other hand is grounded in morals and ethics and refers to human life in common. It has much to do with trust, engagement, responsibility and respect. All personnel who work with groups of individuals who are dependent on others for example in health- and medical care or in social wel-fare can embrace the caring dimension in their work. It could be looked upon as a quality aspect. It is certainly possible to do the work without caring but in that case the work tend to be more soulless, technical and formalised. Nursing and caring constitute together the Swedish concept "omv�rdnad".
The doctoral theses have been related to this definition of "omv�rdnad". About two thirds of them have highlighted phenomena exclusively belonging to nursing. Some examples are: how and why decubitus-sores emanate, how pain, ache and hurt vary during the process of childbirth, how a ward can be organized so that patients can increase their influence and care more for themselves, how patients can be better informed to "dispel the fear of the unknown" in imminent examinations, how rehabilitation programs can be organized for patients after myocardial infarction or stroke and how to treat dysfunctional bladder in children. These theses, which I have categorized as belonging to the dimension of nursing, have an outspoken interest in improving nursing practice, to be useful in the work of nurses and to develop their skills. The results from these studies can presumably accelerate the process of professionalisation in nursing.
Considerably fewer of the doctoral theses have focused on the dual phenomena: caring and nursing. These theses highlight interaction, interpretation and understanding. In some of these theses, the authors have taken the perspective of the personnel, for instance how nurses tend to ascribe meaning into very vague expressions of demented patients. In some other theses, the patients themselves have been given a voice, i.e. an emic approach has been used. The authors have talked to people with the aim of understanding how subjects can manage their illnesses and, in addition, the health care system and how the illness had intervened in their total lives. The nurses work or the organisation of health care is by no means in focus, but rather the patients subjective apprehension of their own health, their situation and their contacts with the health care system.
Many sciences have contributed to the theses on nursing, above all medicine and psychology, but also, to some extent, education, sociology, and administrative science. Psychology has been the greatest contributor to theoretical perspectives in the new domain of nursing while medicine, obviously, has been the most popular model of how to design studies, mainly in clinical settings.
The main stream of doctoral dissertations consist of quantitative clinical studies with an emphasis on correlations between different variables. The theses aim to improve nursing practice and to facilitate the nurses work. Often the starting point has been medically defined: a disease, sign of disease, or injury. Most of the theses are descriptive but also prescriptive, above all in the conclusions. The scientific questions emanate from practice and the results are brought back again. mile Durkheims concept, practical theory, is adequate for this type of theses whose purpose are to highlight and improve practice. Only a few theses are about patients subjective apprehension of their health.
Another cluster of theses include studies of knowledge and competence, often with a perspective from social or behavioural sciences. The main part throw light upon educational questions in a narrow sense, i.e. are about phenomena inside nursing education at different levels. Some other theses are devoted to competence in a broader sense. Some examples: how medical innovations, renal transplantation and hemodialysis, developed and disseminated in the health care sector, how youngsters find out and internalize that they are "mature for sex", or what happens to older womens health competence when a society changes and becomes more modern.
A third cluster, of great importance in a new scientific domain, concerns theoretical development and attempts to define its basic concepts and scholarly critique of nursing as a science. Researchers have investigated, compared and defined concepts such as pain-ache-hurt, trust or biophile. As is the case in all sciences, the nursing science must devote itself to theoretical contemplation supported by empirical studies and logical reasoning. Of course, many of the other theses have contributed to the theoretical development, even if the thesis as a whole can not be considered as directed towards theory. Many authors have, on the other hand, contributed to the development of methodology through their work on the construction of instruments.
The two clusters of theses, mentioned last, have in common that they can be seen as texts on nursing as opposed to texts in nursing, to paraphrase Ulf P. Lundgrens vocabulary. Their purposes are not focused on improving practice but on influencing, for example, our conceptions of health, illness, nursing, caring, learning, teaching, research, and science. The philosophical orientation is often relativistic and has aspects from constructive empirism, i.e. the researchers view all knowledge as a construction of human minds.
Needless to say, the representations may have had another appearance, if non-nurse-researchers also had been included in the analyses. In what way is hard to say without further investigations.
Findings from my empirical examinations support the idea that a field or maybe several fields in the sense of Bourdieu, is emerging.
The authors of theses in nursing, have entered the academic world via different routes and, because of varying backgrounds, experiences and knowledge, have contributed in different ways to the 28 departments or combinations of departments at three faculties: medicine, social science and the humanities. Results from a correspondence analysis of their social origin show differences in their capital of education, in the work and education of their fathers, mothers and husbands, in growing up in cities or in a rural areas, etc. The analyses of scientific capital and the kind of capital that renders you academic power, reveal a polarity between those with high values in distinguishing qualities and those with low values. Authors with a high amount of scientific prestige and academic power tend to be professors, members of editorial boards, members of research granting institutions, and also members of several scientific associations. Other distinctive features are that they often have written many books and articles in English and Swedish , attended several conferences in Sweden and abroad and have doctoral students of their own.
On the other hand, authors with a low amount of scientific prestige and academic power tend to have been working as nurses during their doctoral studies and afterwards as well. In their present work, there is little time for either research or teaching. For most of them, it holds that they have not written any articles and, by no means, a book or contributed to an anthology. They also agree to a sentence like: "It was accidental that I entered doctoral studies." In other words, the idea that developed into the question studied in a doctoral thesis, emanated from their supervisor.
The second factor in this particular correspondence analysis unveil an opposition between an interest for nursing and caring on the one hand and, on the other, an interest for research in general, not specialized in the caring area.
When an extensive correspondences analysis was carried out with variables and modalities from the theses as well as from the questionnaire, the most distinguishing features still adhere to two different kinds of scientific traditions a biomedical one and some interpretative traditions inside social science. Social factors like education and occupations of mothers, fathers and husbands, growing up in the countryside or in town, etc. seem insignificant. The second factor uncovered the opposition between work oriented towards nursing and caring on the one hand and, on the other, on non-nursing and non-caring. This is now a well known pattern recognized from an earlier presented correspondence analysis. However, this new analysis brought to light an opposition between research and teaching. In the pole most oriented towards nursing, there was no room for research, only teaching, probably for the upbringing of a new generation of nurse researchers. This, I think, is a memento: is research in nursing mainly carried out by doctoral students? Are the appointments for research too few altogether? In this group of researchers under study, only eight out of sixty had their work mainly devoted to research after their dissertation.
The third factor, unmasks once again the polarity between positions of high or low amount of scientific prestige and academic power.
Summa summarum, the stands the researchers have taken in scientific questions the method of writing thesis, the choice of research question and theory, methodology, technique, etc. as well as the mode of thinking with a word of Dr. Ludwig Fleck: Denkstil in the research group where the doctoral student ended up, meant much more than most of the social factors in our large, amalgamated correspondence analysis. But, the authors of theses found within social science, with interests in interpretation of texts and analyses of qualitative data, were characterised by a high amount of educational capital bachelor or master of social science, studies abroad before the doctoral education and many courses during the education. This was the only social features of dignity in our extensive correspondence analysis.
In this emerging scientific domain of nursing, many sciences have contributed in different ways. But the most central contribution is reflected by the link to the medical field. From a social point of view, this relationship has long traditions with a given hierarchical order, in which the doctor always is the superior one. Medical doctors were earlier teachers in nursing schools and wrote the majority of the nursing textbooks. The former schools of nursing were institutions where the students not only trained and learned how to nurse but also their place in the hierarchy of health care as well.
When nurses took their first tentative steps on the scientific path, support and help was offered from the Swedish Council of Medical Research (SCMR) in the form of seminars, conferences, working groups, academic appointments and, last but not least, financial support. Some reports were published in the name of SCMR with focus on methodology in nursing research rather than on theory.
The most concrete and personal support from medical researchers to nurses have been given by supervisors. Forty-two out of 65 nurse researchers were supervised by physicians. Even some of the researchers within the social sciences have obtained support and advice from medical doctors. It goes without saying, that in situations of supervision, a medical perspective, medical knowledge and a medical use of language is intermediated. Thus, a vital share of inheritance in the new scientific domain comes from the medical field. When the former doctoral students later are to act as supervisors, there is a reason to believe that the medical inheritance pass on to the next generation. This situation can be seen as a possible deterrent in the development of theories, methods and techniques in research on nursing and caring.
Also significant is that medical researchers have acted as opponents in more than half of the dissertations, 35 out of 65, while nurse researchers have acted as opponents only in thirteen cases. When positions of authority are held by agents representing other scientific fields than nursing, it is a clear sign of weak autonomy in the new domain.
The positive support of the new domain of nursing research by medical researchers, indicates inclusion rather than exclusion, an aspect that assimilates some nurse researchers into the field of medicine. However, after concluding this present study, I became aware of two incidents showing the opposite. In the first incident, a nurses doctoral thesis was failed by the faculty of medicine, i.e. its thesis committee. The nurse revised her thesis according to the recommendations of the committee and passed through the eye of the needle the second time. In the second situation, a nurses thesis was not approved of by her faculty, and discouraged by this, the nurse chose to have her thesis put forward at a university in another country. My conclusion is that the establishment of medicine is so stable and entrenched that nurse researchers cannot possibly alter its frames of reference. There is a norm, a doxa, from which one cannot deviate too much without negative consequences.
Two of the three clusters of theses that have been identified in the first correspondence analysis, have received strong scientific and social support from the medical establishment. Clinical investigations are what counts in the medical field and, of course, such enterprises are applauded when they occur, even outside the medical field.
If the terms nursing, caring, nursing research and science, etc. in the future are to be defined in a more stringent manner than at present, some scholars need to monopolize nursing as their research focus and to devote themselves to theory building, which will identify and define concepts in the new emerging discipline. To be dominated by researchers inside other scientific fields and only be marginally accepted there is no future for a new domain. Nurses need to develop a discipline of their own.
According to Bourdieu, no single field in a society can be totally autonomous if that were the case, then the field per definition could not be an integral part of the society. But the field can be more or less autonomous depending on the type of contacts with the dominating field. A scientific field is always dependent on the financiers who support the research to be done. Although external support limits autonomy in the field, it is at present the only way of existence for scientific fields. Furthermore, a scientific field like nursing, with research interests focused on persons in need of health and medical care, has a political and an ideological component. The way in which the needs of vulnerable patient groups, such as the very old and children, are attended to, depend on political decisions concerning health care delivery.
Nursing research can produce empirical data useful in dealing with political issues within the health care sector. This is the main reason why nursing research cannot be value-free. As long as the problems of interest are derived from the clinical area, as long as the research aims at improving the very same practice, then it is impossible to vindicate the autonomy of nursing science.
Secondly, a new scientific domain threatens the established order of the scientific community merely by its emergence. Example of threat against the orthodoxy inside the medical establishment could be theses not approved of by medical faculties.
As my study has shown, there is no consensus on the object of research in this new nursing domain. The question is, is it possible to determine its boundaries? In my point of view, the territory is shared with other agents in the health care sector, for example medical doctors, physiotherapist and occupational therapists. When this is the case, some scientists believe that it is important to have different perspectives within the scientific field as a whole. My analyses have shown that this is not the case as far as nurse researchers are concerned. There are, for example, a variety of perspectives, designs, theories and ways of writing a thesis. In other words, one could say that there is a low degree of cognitive legitimacy.
The idea of strong connections between nursing research and clinical work plays an important role as a social strategy of legitimacy. My analyses support such an idea, since the main part of the nursing theses are about problems in the clinical area. Thus, there are empirically strong bonds between research and clinical and health care settings. I hold the hypothesis that the more institutionalised the research, the more difficult it becomes to maintain the ties to the clinical settings. The distance between the two is also due to epistemological questions, for example, what kind of knowledge the researchers are trying to produce. If knowledge in nursing is the aim of research then the distance is probably smaller than if knowledge on nursing is at stake.
Society could possibly benefit from the knowledge gained by nurse researchers. This utilitarian attitude is also an idea of social legitimacy. The knowledge can also be of use to increase the status of nurses, in their process of specialisation and professionalisation.
Professionalisation is not of primary interest in this work, but it is related. I have noticed that many writers confuse, or at least do not distinguish clearly, between the concepts of professionalisation and scientification. For many decades, it appears that the sociological concept of professionalisation has been interpreted in different ways in everyday language. Professionalisation as a sociological concept is manifested by the aspiration of a certain occupational group to gain more status, strength and social authority in competition with other occupational groups. This must be distinguished from professionalism which means the quality and competence of the practising persons. The competence has to do with the occupational group as a whole as well as with individuals. These two meanings are usually not differentiated.
In order for nursing to be recognized as a profession, a unique body of knowledge, relevant to the specific occupation, must be identified. Nursing research contributes to this process by naming phenomena and identifying basic concepts and their interrelationships. The results of this scientific endeavour then needs to be communicated and understood by practitioners. This also bring to surface a unique personal and experiential knowledge in an authoritative manner.
The knowledge, used in professionalisation, "belongs" to a certain occupational group and therefore excludes others, for example non-registered nurses. This phenomena has been looked upon as the reverse of the coin of professionalisation. In relation to patients, there are also some disadvantages. Some nurse researcher cautioned, as early as 1979, that the sickest patients may be forgotten in the process of nurse professionalisation. The aim of care is to help patients to get well and healthy. The risk is that only curable patients are taken into consideration, neglecting the very old patients or the ones with incurable illnesses.
Another issue is related to patient education. The promotion of self-care means that the patient has to have access to the same knowledge as the professionals. If the nurse shares her knowledge with everyone, she can no longer claim to have unique knowledge, thus weakening the professional status of nursing. This can be looked upon as a paradox. Embedded in this paradoxical view, is the prerequisite of an epistemological perspective of knowledge as additive and mechanistic. In other words, small pieces of knowledge can be placed here and there, leaving a hole when removed. If we, on the contrary, look upon knowledge as based upon situations and contexts, a nurse incorporates and integrates new "pieces of knowledge" with all her previous knowledge and experiences. In a scientific context, the meaning of a term, i.e. pain, may be given a rather unambiguous expression, but when it is introduced in other sociocultural areas, it could have other meanings. In patient education, the nurse can choose and integrate knowledge from many sources. She reformulates and adjusts the content to the specific patients ability to grasp the information. The professionalism of the nurse increases by experience from different patient situations, if knowledge is regarded as relativistic. This brings me to the conclusion that objective knowledge can not be transferred to another individual without change.
On the other hand, according to my analyses, science can be used in two different ways. The first is the practical use of knowledge, including an ambition to change or develop practical attainments in nursing. This kind of research is practical theory, according to mile Durkheim, or research in nursing. The other type of research is aimed at influencing ideas on caring and nursing, what I earlier called research on nursing. The workload is equally demanding, irrespective of how the results will be used. Practical theories can, of course, give insights which in time can contribute to theory development. The function of a theory is cognitive, i.e. aims at helping us better understand phenomena inside nursing. When we understand something better, we also are better prepared to improve practice.
Thus, I agree with the opinion that scientific knowledge can not be applied directly, but has to be transformed and recontexualised before using it.
The relationship between professional and scientific knowledge depends on how to interpret the two parts. There are no simple connections. I think it is of importance to reflect upon if the development of theoretical knowledge in and on nursing, is carried out at the sacrifice of other kinds of knowledge ethical, aesthetic, practical, etc. Demands are raised on the nursing science from at least two directions: from the practice give us knowledge so that we can develop our work! and from the academic world make use of recognized methods, keep the banner of science flying! The practice of nursing actions and research actions places different demands on the new domain of nursing research, which has to balance between the seemingly contradictory demands.
My study has illuminated what nurses in Sweden actually have done when they have written their doctoral theses, what the theses are about, what choices they appear to have made in relation to science. This is the most obvious part of their work. Another level has to do with what symbolic systems they have made use of. The traditions they have chosen to join, the supervisors they have chosen, been encouraged by or have been allotted to, not only has a concrete or materialistic meaning but also a symbolic one: what is the meaning of having a medical doctor or a nurse researcher as supervisor? What significance can they themselves and others ascribe to such facts as lacking literature references to nursing or a majority of nurse researchers on an examination board? Behaviour and action have both material and symbolic dimensions, a phenomena I have tried to shed light upon in this study.
Ingrid Heyman <ingrid.heyman@ped.uu.se>
Postal address: Forskningsgruppen för utbildnings- och
kultursociologi.
Institutionen för pedagogik, Lärarhögskolan
Box 34103, S-100 26 Stockholm
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