It's not (just) about the evidence: the discourse of knowledge translation and nursing practice.

• Main Author: Newton, Lorelei Joyce
• Other Authors: Purkis, Mary Ellen
• Language: English; en
• Published: 2012
• Subjects: knowledge; nursing; practice
• Online Access: http://hdl.handle.net/1828/3891

This dissertation advances a reading of knowledge translation and the effects of such a discourse on nursing practice in one setting. Knowledge translation is often put forth as a solution to the ‘problems’ of contemporary Canadian healthcare. Yet to adopt the practices of knowledge translation does not necessarily reflect the inevitable progress of nursing professionalism or legitimacy but instead, is a process that is both engineered and unpredictable. In order to understand nursing practice in a different way, particularly in the era of ‘knowledge translation,’ an ethnographic methodology guided by a feminist poststructural perspective was chosen. Within the discursive frame of knowledge translation, accounts of nursing practice are narrowly described and often represented as a linear process of delivering particular knowledge (‘evidence’) from experts to users. This contradicts the knowledge translation practices observed in this study as such nursing practice requires a wide and varied knowledge base derived from multiple sources. Thus, it seems the work of successful knowledge translation is the capacity to “move within and between discourses” (Davies, 2000, p. 60) through contextualizing practices. Articulating these contextualizing practices provides an avenue to explain and understand aspects of nursing practice that are essential to sustain the discourse of knowledge translation yet are mostly unaccounted. The discourse of knowledge translation seems to focus on ‘outcomes’ and the creation of a particular kind of quantifiable evidence by the nurses themselves. Such outcomes not only become evidence of ‘good practice,’ the nurse is also positioned to ‘manage’ the subjective experiences of the patient (i.e. pain) by converting such experiences into quantifiable accounts. The production of such outcomes (evidence) also serves to bring nurses and patients into alignment with (made ‘subjects’ of) the discourse of knowledge translation. In this way, the discourse of knowledge translation does not seem to be just about the production of evidence (or knowledge); it is about the reorganization of knowledges. This ‘re-ordering’ is accomplished through (re)education and the concurrent use of chart audits that evaluate ‘good practice’ through the documented use of knowledge translation activities. It is self-referential: documentation of the outcomes of sanctioned knowledge translation activities becomes the evidence that these activities are effective. That is, the evidence is the evidence. While the effects of the discourse of knowledge translation seem to undermine professional judgment and position nurses as the vehicle for organizational surveillance in terms of patient safety (risk) and economic demands, it also serves as a point of resistance. The taken-for-granted contextualizing practices required to enact the discourse of knowledge translation positions the nurse to be influential in expanding the notions of both evidence and knowledge translation. It is the articulation of the multi-dimensional recursive contextualizing practices in concert with the nurses’ ability to move between discursive frames that simultaneously allows for and creates knowledge to be translated. In this way, nurses are also being responsive to a new kind of patient who, while rarely discussed in the knowledge translation process, also has an unaccounted for potential to influence and reshape the discursive field of healthcare. === Graduate