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Moving from the seminal contribution of Aristotele--according to whom science is not concerned with the what, neither with the how of reality, but with the why--the article emphasizes some characteristic features of a science: it must be rational, methodologically grounded, and it must have a specific object, depending on which many different sciences can be distinguished. An historical sketch of science is offered, as well as some recent contributions in the field of epistemology, in particular those of Carl R. Popper and of Thomas S. Kuhn. The case of Glottodidactics (Language Teaching)--which has been considered as a proper science only since a few years ago, and which has, since then, regular university courses--is very useful to study the difference between "sciences to know" and "sciences to do", and to outline the structure of an interdisciplinary science; this case--this is the author's claim--is quite similar to that of Nursing Science.
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The authors propose a classification of knowledge that they call case, patient, and person and that reflects the content of the knowledge necessary to the conduct of nursing work. This classification represents an attempt to theorize from their respective empirical research data. Case knowledge is general knowledge of pathophysiology, disease processes, pharmacology, and other therapeutic protocols. Patient knowledge is that knowledge that defines the individual within the health care system, the knowledge expressed in the individual's response to therapeutics, and the knowledge that enables nurses to move the recipient of care through the health care system and along the illness trajectory. Person knowledge is knowledge of the individual as a subject with a personal biography who occupies a certain social space and who acts with his or her own desires and intentions for reasons that make sense to him or her. Two types of social knowledge serve as relational knowledge, or a bridge that links case knowledge to patient knowledge and patient knowledge to person knowledge. Each type of knowledge is accessed differently and the extent to which each is attained and used is determined by the circumstances of the patient's illness and his or her location in the health care system. The authors make a case for why this classification might be useful to the discipline.
A decision support system for artificial ventilation is being developed. One of the fundamental goals for this system is the application of the system when a domain expert is not present. Such a system requires a rich knowledge base. The knowledge acquisition process is often considered to be the bottleneck in acquiring such a complete knowledge base. Since no single available method, for example interviewing domain experts, is sufficient for removing this bottleneck, we have chosen a combination of different methods. The different backgrounds of knowledge engineers and domain experts could cause communication restrictions and difficulties between them, e.g. they might not understand each others knowledge domain and this will affect formulation of the knowledge. To solve this problem we needed a tool which supports both the knowledge engineer and the domain expert already from the initial phase of developing the knowledge base. We have developed a knowledge acquisition system called KAVE to elicit knowledge from domain experts and storing it in the knowledge base. KAVE is based on a domain specific conceptual model which is a result of cooperation between knowledge engineers and domain experts during identification, design and structuring of knowledge for this domain. KAVE includes a patient simulator to help validate knowledge in the knowledge base and a knowledge editor to facilitate refinement and maintenance of the knowledge base.
The right to clean air in public places (RCA) is a useful indicator of health consciousness. We surveyed the life style and consciousness towards RCA among employees working at the head office of a major company in Osaka, and examined the relationship between life style and knowledge aspect of RCA, one of the three aspects of consciousness towards RCA. Knowledge on laws concerning smoking regulations in public places was classified into two categories. One was knowledge on laws concerning general matters and the other was knowledge on laws concerning concrete and specific matters. Therefore, there are two kinds of relationship; the relationship between life style and knowledge on laws concerning general matters and the relationship between life style and knowledge on laws concerning concrete matters. These two relationships were examined with statistical procedures. Mean scores of knowledge on laws of subgroups divided by HPI score (POOR, MODERATE and GOOD) within groups divided by age and sex ("M. smoker," "M. nonsmoker" and "F. nonsmoker") were compared by t-test. Life style related to knowledge score was checked by correlation coefficient. The following results were obtained. (1) Relationship between life style and knowledge on laws concerning general matters Knowledge scores and their age-adjusted scores of MODERATE groups were the lowest among the 3 groups ("M. smoker," "M. nonsmoker," "F. nonsmoker"). This set of questions was designed to measure the knowledge level on laws concerning general matters. One would have abundant knowledge if one is health-conscious. In other words, those who do many things beneficial to physical health and have a high HPI have a wealth of knowledge on laws concerning smoking regulations on general matters. In the case of the employees, MODERATE groups were less health-oriented than others ("POOR," "GOOD") within the 3 groups ("M. smoker," "M. nonsmoker," "F. nonsmoker"). (2) Relationship between life style and knowledge on laws concerning concrete matters This set of questions was designed to measure the knowledge on laws concerning concrete and specific matters. To attain high scores, it is necessary to have more smoking experiences in various types of indoor places. POOR group of "M. smoker" and MODERATE groups of "M. nonsmoker" and "F. nonsmoker" had high knowledge scores. They were considered to have greater opportunities to visit public places where smoking is permitted (for example, bars) irrespective of their smoking status.
At the heart of organization-wide quality improvement in healthcare is the need to build knowledge for improvement that complements the subject matter knowledge of healthcare. Dr. W. Edwards Deming, the quality improvement pioneer, has suggested that "profound knowledge," or knowledge required for improvement, consists of four basic dimensions: Knowledge of the organization as a system. At its heart this knowledge is an understanding of the methods of production, the methods of improvement, and the aim of the entire enterprise. This concept was first presented by Deming at Mount Hakone, Japan, in 1950. In his book Out of the Crisis (1986), Deming illustrates the organization as a system. Knowledge of variation. This understanding comes from the awareness that a system of causes is at work producing any result. These sources of the variation, which can be observed in any process, are what must be acted upon to improve the results of the process. Studying the variation in a process can provide clues to the most economical actions that managers can take for improvement. It involves knowledge of the difference between common and special cause variation. Knowledge of psychology. The focus is on an awareness of the power of intrinsic motivation, a sense of self-worth and pride in what is done in the workplace. Theory of knowledge. How is new knowledge built? What is the purpose of knowledge? What is the nature of knowledge? Unless these issues are clear, it will not be easy to build useful knowledge. Deming has provided further insight into this framework in a recent unpublished essay and is currently working to further expand these concepts in additional publications in preparation. This framework helps build the knowledge necessary for the improvement of healthcare. As you work to build that knowledge, however, you will confront a wide variety of terms and a language that may in some ways be unfamiliar. In recognition of that, an introductory glossary is offered for your use and reference. With time, it can, should, and will be replaced by an expanded lexicon. Other sources that interested readers may wish to consult include the references listed at the end of the glossary.
OBJECTIVES: The authors discuss the usability of an automated tool that supports entry, by clinical experts, of the knowledge necessary for forming high-level concepts and patterns from raw time-oriented clinical data. DESIGN: Based on their previous work on the RESUME system for forming high-level concepts from raw time-oriented clinical data, the authors designed a graphical knowledge acquisition (KA) tool that acquires the knowledge required by RESUME. This tool was designed using Protégé, a general framework and set of tools for the construction of knowledge-based systems. The usability of the KA tool was evaluated by three expert physicians and three knowledge engineers in three domains-the monitoring of children's growth, the care of patients with diabetes, and protocol-based care in oncology and in experimental therapy for AIDS. The study evaluated the usability of the KA tool for the entry of previously elicited knowledge. MEASUREMENTS: The authors recorded the time required to understand the methodology and the KA tool and to enter the knowledge; they examined the subjects' qualitative comments; and they compared the output abstractions with benchmark abstractions computed from the same data and a version of the same knowledge entered manually by RESUME experts. RESULTS: Understanding RESUME required 6 to 20 hours (median, 15 to 20 hours); learning to use the KA tool required 2 to 6 hours (median, 3 to 4 hours). Entry times for physicians varied by domain-2 to 20 hours for growth monitoring (median, 3 hours), 6 and 12 hours for diabetes care, and 5 to 60 hours for protocol-based care (median, 10 hours). An increase in speed of up to 25 times (median, 3 times) was demonstrated for all participants when the KA process was repeated. On their first attempt at using the tool to enter the knowledge, the knowledge engineers recorded entry times similar to those of the expert physicians' second attempt at entering the same knowledge. In all cases RESUME, using knowledge entered by means of the KA tool, generated abstractions that were almost identical to those generated using the same knowledge entered manually. CONCLUSION: The authors demonstrate that the KA tool is usable and effective for expert physicians and knowledge engineers to enter clinical temporal-abstraction knowledge and that the resulting knowledge bases are as valid as those produced by manual entry.
OBJECTIVE: We assessed how consumption of a functional food relates to different combinations of nutritional knowledge. METHODS: American and Canadian subjects were asked by mail survey about their level of knowledge about soy and were assigned to one of four groups based on whether they had 1) no knowledge of soy, 2) attribute-related knowledge of soy, 3) consequence-related knowledge of consuming soy, or 4) both types of knowledge. Content analysis and analysis of variance were performed. RESULTS: The level of nutritional knowledge about soy did not necessarily influence how much people liked soy but was related to how much people consumed soy. In particular, consumers who were able to link attribute-related knowledge about soy to consequence-related knowledge about consuming soy were much more likely to consume soy than were those who only had one type of knowledge (average P < 0.007). CONCLUSIONS: Nutritional knowledge most likely correlates with consumption when people have attribute-related knowledge of the food and consequence-related knowledge of how it will benefit them. It is not the amount but the type of knowledge that matters. Educational strategies based only on attribute-related knowledge of functional foods and healthy products ("passing the nutrition quiz") may not effectively encourage the actual consumption of the food. Health care professionals and dietitians must link food attributes with personal health consequences when communicating to their patients.
OBJECTIVE: To determine whether women's global self-assessment of their knowledge about hormone replacement therapy (HRT) corresponds to their performance on an explicit knowledge test about HRT and to measure associations among knowledge, personal characteristics, decision conflict, and intention to use HRT. DESIGN: Preintervention telephone survey of 156 women enrolled in a randomized, placebo-controlled trial of HRT decision aids. RESULTS: The mean rating of menopause knowledge, on a scale from 1 to 10, with 10 indicating being "extremely knowledgeable," was 5.6 (range = 0-10) and of HRT was 4.2 (range = 0-9). The mean summary score for the explicit HRT knowledge test, on a 16-point scale, was 7.8 (range = 0-15). After adjustment for demographic characteristics and exposure to a provider conversation, higher income, white race, and the provider discussion were significant correlates of knowledge. Explicit knowledge was positively correlated with self-assessed menopause knowledge and HRT knowledge (Spearman's correlation coefficient = 0.39 and 0.52, respectively; p < 0.0001). Greater knowledge was not associated with intention to use HRT 1 year later. Women who had greater knowledge reported less conflict about the HRT decision (Spearman's correlation coefficient = -0.32; p < 0.0001). CONCLUSIONS: A global question about level of knowledge is an effective clinical tool for identifying patients who are in need of additional education about HRT and menopause in this managed care population. Increased knowledge may decrease women's conflict about the HRT decision. Having had a previous conversation about menopause with a primary care provider is associated with greater knowledge about HRT.
BACKGROUND: Contemporary nursing literature emphasises the desirability of clinical nurses being "knowledgeable". However, the need for nurses constantly to acquire more knowledge is reiterated. Lack of knowledge is seen to underlie an array of professional problems. Little is known of how nurses themselves understand what it means to practise knowledgeably. OBJECTIVE: To explore critical care nurses' understandings of knowledgeable practice and its relationship to being a "good nurse". METHODOLOGY: A poststructuralist framework informed the study. The study participants were 12 critical care nurses. Data were generated through three individual focused interviews with each participant. Data analysis involved deconstruction of the interview texts to reveal participants' discourses of knowledgeable practice and the implications of these discourses for their subjectivity and for their work. FINDINGS: A discourse of knowledgeable practice was revealed as central to participants' sense of identity as "good nurses". Participants believed their knowledge resided in their heads ("knowing why") and in their hands ("knowing how"). Fluency of action, which was achieved and maintained by frequent repetition of activities, contributed to their sense of being knowledgeable. Participants described being excluded from knowledge in some instances. In general, however, "actual" knowledge was of less importance than was being positioned, by themselves and others, as knowledgeable. This positioning was frequently undermined by other staff, both medical and nursing. Analysis revealed that the discourse of knowledgeable practice was underpinned by a dichotomy of ignorant/knowledgeable, in which "ignorant" was the dominant category; hence, nurses were assumed to be ignorant until they could "prove" otherwise. CONCLUSIONS: The findings contest the notion, espoused in nursing literature, that acquisition of knowledge can "empower" nurses, thus providing the solution to problems they may experience. Rather, strategies are required that challenge and disrupt relations of power that construct nurses as "ignorant".
BACKGROUND AND RESEARCH OBJECTIVE: Patients with mechanical heart valves must follow lifelong warfarin therapy. Warfarin, however, is a difficult drug to manage because it has a narrow therapeutic window and potentially serious side effects. Successful anticoagulation treatment is dependent upon the patient's knowledge of this drug; however, little is known regarding the determinants of such knowledge. Therefore, the purpose of this study was to determine the influence of both in-hospital teaching practices as well as socioeconomic status and demographic variables on patients' knowledge of warfarin therapy. SUBJECTS AND METHODS: A telephone survey was conducted among 100 patients 3 to 6 months after mechanical heart valve replacement. A previously validated 20-item questionnaire was used to measure the patient's knowledge of warfarin, its side effects, and vitamin K food sources. Demographic information, socioeconomic status data, and medical education information were also collected. Knowledge scores were compared using the Student t test or one-way analysis of variance. Variables with P < or = .2 on univariate analysis were entered in multiple stepwise regression analysis. RESULTS AND CONCLUSIONS: Sixty-one percent of participants had scores indicative of insufficient knowledge of warfarin therapy (score < or = 80%). Age was negatively related to warfarin knowledge scores (r = 0.27, P = .007). Patients with family incomes greater than $25,000, who had greater than a grade 8 education, and who were employed or self-employed had significantly higher warfarin knowledge scores (P = .007, P = .002, and P = .001, respectively). Gender, ethnicity, and warfarin therapy before surgery were not related to warfarin knowledge scores. Furthermore, none of the in-hospital teaching practices significantly influenced knowledge scores, whereas receiving postdischarge community counseling significantly improved knowledge scores (P = .001). Multivariate regression analysis revealed that understanding the concept of International Normalized Ratio, knowing the acronym, age, and receiving community counseling after discharge were the strongest predictors of warfarin knowledge. Accessing postdischarge counseling resulted in significantly improved warfarin knowledge scores. Because improved knowledge has been associated with improved compliance and control, our findings support the need to develop a comprehensive postdischarge education program or at least to ensure that patients have access to a community counselor to compliment the in-hospital education program.
The article describes how Finnish adults understand health. The data were collected by means of free-form thematic interviews and analyzed on the basis of an interpretive approach, representing the phenomenological research tradition. From the interviewees' responses, there emerged two different types of experiential health knowledge, namely institutional and individual health knowledge. Institutional health knowledge found expression in the following themes: knowledge about health as normalcy, knowledge about proper health care, knowledge about factors that may cause illness, knowledge about diseases observed in oneself, and knowledge about obtaining help. Individual health knowledge found expression in the following themes: knowledge about being healthy and feeling well, knowledge about how to produce well-being and how to deal with not feeling well, and knowledge about being ill and not feeling well. The results of the study provide conceptual tools for the further analysis of health knowledge from the perspective of people themselves and at the same time deeper knowledge about the ways in which people perceive health and in which they seek to maintain good health.