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Posts tagged ‘Miriam Bender’

Understanding Esthetic Knowing

The new featured article from the current ANS issue is titled “Reorienting Esthetic Knowing as an Appropriate “Object” of Scientific Inquiry to Advance Understanding of a Critical Pattern of Nursing Knowledge in Practice” by Miriam Bender, PhD, RN and Dina Elias, MSN, RN, CCSN.  Download your copy of this article at no charge while it is featured, and share your responses here!  Both authors have provided messages for ANS readers about their work:

Dina Elias: The act of providing nursing care, or the act of nursing, depends heavily on the nurse knowing the right action to take. Knowing, in and of itself, can manifest itself in many different ways depending on the context in which it is needed. In my first year of my PhD studies I took a Philosophy of Science class and it was in that class that I realized I had known so

Dina Elias

Dina Elias

little about what it means to really ‘know’. Foreign words like ‘epistemology’ and ‘ontology’ began to take on a whole new life of their own in my mind. I began asking and wondering about the ontology of nursing, and the type of knowledge that is necessary to make nursing the science that it is. But then to my dismay, I realized that nursing and its ways of knowing were not always ‘scientific’ enough for the positivistic worldview of healthcare science in which it belongs to. Yes, it is true that there are empirical and ethical ways of knowing that nursing draws from, but it was the aesthetic way of knowing that fascinated me the most. My naivety led me to believe that others would understand that the world cannot be possibly explained empirically; that the positivistic view of the world would not suffice. Einstein once said “Not everything that counts can be counted, and not everything that can be counted counts”, yet here I was being told that aesthetic knowing, since it cannot be counted and measured, must not count. I struggled with my inability to explain and objectify aesthetic knowing…that intuition that is so close and near to a clinician’s heart. It is in aesthetic knowing that a critical way of knowing emerges and manifests itself. But how do we objectify something that cannot be objectified or observed in the first place? Do I just relinquish the fight and submit to the idea that aesthetic knowing is nothing more than a ‘gut’ feeling that has no merit? I could not be convinced of that. It was here that the debates and discourse be,tween my professor and mentor began…how do we reorient aesthetic knowing so that it reveals itself as an object of scientific inquiry? When we can do that, we can begin giving aesthetic knowing the rightful scientific place it deserves. When we understand how aesthetic knowing is acquired and expressed, we can begin articulating it in an objective manner that can be translated into practice.

Miriam Bender: This article was born in a Philosophy of Science course that all University of California Irvine (UCI) nursing doctoral students must take in year one, as part of their core curriculum. I started as junior faculty at UCI in November 2014, and was slated to teach the course starting Fall quarter 2015. To ensure I was adequately prepared, I began a scholarly journey that I am still passionately engaged with. I created a syllabus based on 10 months of reading and

Miriam Bender

Miriam Bender

reaching out to esteemed faculty across the world. I am especially indebted to Janice Morse and Sally Thorne, to whom I reached out asking for guidance, and who gave me great feedback and insights. In this course the students read Susan Gortner, Mark Risjord, Jacqueline Fawcett, Thomas Kuhn, Larry Laudan, Donna Haraway, Paul Thagard, Sally Thorne, Janice Morse, and Patricia Benner, to name just a very small sample. We discussed the history of nursing science; the evolution of philosophy of science; prediction, explanation and the appropriate claims of science; and what it all means for nursing science and practice. Luckily for me, the students were as passionate as I was about the readings. Dina had a series of insights throughout the course that inspired this paper. She was truly engaged in identifying a philosophical orientation that “allowed” for what she began calling “prediction in practice.” As the weeks went by, Dina was able to synthesize the readings into a nascent argument for a philosophy of science that entailed systematic inquiry into the phenomenon of esthetic knowing. We took her final paper for the course and shaped it into the paper that is published. Dina took the lead in writing a thorough treatise on esthetic knowing, and allowed me to strengthen the philosophical section and develop the section outlining an esthetic knowing program of research. Dina set the bar in terms of the level of engagement and scholarship I now expect in the course, and I am excited to see what other articles will come from future students as they synthesize their learning into insights that influence the ongoing philosophy of nursing science discourse.


Producing Environments of Care

The current featured ANS article is titled “A Practice Theory Approach to Understanding the Interdependency of Nursing Practice and the Environment: Implications for Nurse-Led Care Delivery Models” by Miriam Bender, PhD, RN and Martha S. Feldman, PhD.  The article is available for free download while it is featured on the ANS web site.  Dr. Bender has shared this story of how this work evolved, and the importance of networks in the evolution of theoretical ideas:

This article is the product of more than two years’ immersion in a multi-disciplinary practice theory reading group created by Martha S. Feldman at the University of California, Irvine (UCI). Martha is an organization theorist best known for her work on organizational routines, and routine dynamics

Dr. Miriam Bender

Dr. Miriam Bender

in particular.

In 2012, I was working on my doctoral research, which focused (and still does) on a care delivery model that integrates a new nursing role, the clinical nurse leader. I wanted to understand the mechanisms by which this reorganization and implementation of nursing care delivery produced documented improvements in care quality and outcomes.

I chanced upon Martha’s and Brian T. Pentland’s article Organizational Routines As A Unit Of Analysis (2005) via an exploratory Google Scholar search. Fascinated, I found and read more of her articles, which opened my eyes to a theoretical lens and body of work on organization dynamics that I felt could be leveraged to better understand and explain the complexity of multi-disciplinary healthcare delivery.

I gathered my courage to contact Martha (with a supportive push from Dr. Ann M. Mayo, one of my outstanding doctoral committee members), and she very graciously met with me and even invited me to join the practice theory reading group, which had its first meeting January 2013. The reading

Dr. Martha Feldman

Dr. Martha Feldman

group includes nursing, social ecology, business, education, informatics, and many other interdisciplinary scholars who meet every month for a couple of hours to engage with practice theory and empirical research that uses a practice theory lens.

As I am learning, practice theory offers a new way of understanding and explaining social phenomena such as contemporary organizing, which is increasingly understood to be complex, dynamic and distributed. A philosophical premise of practice theory is that there are no boundaries separating subject and object, mind and body, or structure and action, but rather they only exist in a recursive relationship of mutual constitution. Mutual constitution means social orders (structures, institutions, routines, etc.) cannot be conceived without understanding the role of actions in producing them, and similarly, human actions should be understood as always already configured by structural conditions. This continuous co-production of action and structure in practice means neither is static or stable, but rather they are continuously refreshed, adapted or perpetuated.

The more I became immersed in this strange new world of mutual constitution, the more I began to think about nursing practice in relation to the spaces where nurses practice. Current theory and research on nurse practice environments focus on the ‘things’ necessary to create environments that nurses then populate and practice within. Bad environments make nursing practice difficult, good environments make nursing practice easy. Partial or thwarted nursing practice negatively influences patient health outcomes, while fully engaged nursing practice positively influences patient health outcomes.

I slowly began to realize that in this conceptualization, no meaning is ascribed to nursing practice contributing to the environment where all this occurs. Using a practice lens, I began to understand that nurses, along with patients and everyone else on the healthcare team, through their practices, are always meaningfully constituting their environments of care and conditions for practice. There is in fact no externally defined environment that nurses and others populate and act within, but rather the environment is embedded in their activities.

Once that became clear to me, I made another realization; there is currently no proposition explicitly linking nursing practice and the environment in the nursing metaparadigm, which I believe has led conceptually and methodologically to nursing knowledge that is also preconfigured and separate. In other words, because we have not linked nursing practice and the environment theoretically, we have not considered the ways they are linked empirically and have instead studied them in isolation from each other.

Once that became clear to me, I felt challenged to address this theoretical gap as a first step towards creating awareness of nurses’ critical role in shaping environments through their practices. Hence the published article, which argues that a refined conceptualization of the interdependency of nursing practice and environment is necessary to identify, theorize and promote nursing practices that are beneficial to the environment of care as part of an explicitly proposed domain of nursing knowledge and practice.

The significance of a focus on the mutual constitution of nursing practice and environment is that it enables the conceptualization and development of holistic models of care that better integrate the dynamics of practice and the conditions for health into the organization of healthcare delivery. Implications include healthcare practice patterns that patients, nurses and the multi-professional healthcare team consider healing and health promoting.

This has been a long, long journey that really is only just beginning. Over the last few years I have transitioned from doctoral student to assistant professor at UCI, which allows me to continue my engagement in this incredibly generative cross-disciplinary practice theory forum that Martha initiated and which continues to flourish. I am grateful to Martha and all participants of the reading group, who challenge me to further explore practice and the duality of structure and action in relation to nursing and healthcare delivery, and to better understand how healthcare practice patterns are produced, reinforced and/or adapted, and how they generate both expected and unexpected outcomes and the conditions for further practice.








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