The current ANS featured article presents a new way of structuring nursing knowledge. It is title “The Nursing Knowledge Pyramid: A Theory of the Structure of Nursing Knowledge” by Veronica B. Decker, DNP, PMHCNS-BC, MBA and Roger M. Hamilton, PhD. This article is available to download at no cost while it is featured, and I join the authors in inviting you to post your comments here, and to join in a discussion of their work! Dr. Decker shared this message about the evolution of this work:
The idea for the Nursing Knowledge Pyramid started in the fall of 2012 when I was in my first semester of a Doctor of Nursing Practice (DNP) program at Wayne State University. I was going to school full time and working full time. I was (and still am) living in Orlando Florida and I attended my courses synchronously on-line. The internal visual I maintain from this time includes seeing my cohort in their classroom seats in downtown Detroit, while I was in front of my lap top video cam in the den of my home, in sunny Florida. Most of the time, my fellow classmates would instant message me that they were a little jealous of the weather.
I was taking a course on foundations in nursing from doctors Nancy George and Rosalyn Peters when my work on knowledge development started. I was trying to get my head around integrating philosophical and theoretical perspectives of nursing to create a solid foundation for nursing practice and meet the requirements of an assignment for the course, which included a very detailed rubric. The paper I submitted to my professors was titled Toward a Theory of Cancer Coping. I titled it after Imogene King’s 1971 – Toward a Theory for Nursing: General Concepts of Human Behavior in mind. It made sense to me because I realized my ideas weren’t fully established yet, but I had made a solid start. This first document included a concept map that aligned King’s conceptual system with my own nursing system model, which included the Nursing Knowledge Pyramid. Over the next two years, nearly every assignment even remotely asking for use of theory, I would continue to enhance and better define this work.
As many of you know, DNPs are required to complete projects rather than the traditional PhD dissertation. To meet the requirements of my program, I completed two projects. A clinical performance improvement project (Decker, Howard, G.S., Holdread, H., Decker, B.D., Hamilton, R.M. 2016). and a theoretical application by developing a practice theory called Substructing a Cancer Coping Rule-base, which included the Nursing Knowledge Pyramid.
The Nursing Knowledge Pyramid (NKP) is a practical approach to support nursing practice. In my DNP program I was able to use the pyramid as a means of bridging the gap between theory and practice. As an experienced psychiatric mental health advanced practice nurse (APRN), I could operationalize the research project by methodically going from abstract knowledge (bottom of the NKP) to the concrete knowledge (top). The abstract level of the project was my knowledge as an APRN developed over my 30 years of experience. The middle tiers indicate the theoretical underpinnings and evidence-based practice. The most concrete knowledge at the top of the pyramid was the rule-base used to offer my patients coping strategies to handle their distress. Most recently we utilized the NKP to help develop the key conceptual relationships and theoretical foundation for a case study where the patient had an unrealistic fall risk appraisal. The patient was treated with a feedback strategy to reframe her perception of risk of falling. I’m interested in feedback from others who are considering using the NKP in their research.
Decker, V.B., Howard, G.S., Holdread, H., Decker, B.D., Hamilton, R.M. (2016). Effects of an Automated Distress Management Program in an Oncology Practice. Clinical Journal of Oncology Nursing, 20(1), e9-15.
King, I.M. (1971). Toward a Theory for Nursing: General Concepts of Human Behavior. New York, NY: Wiley.