Theoretical Framework for Study 91 

It seems clear that that nursing students find science difficult. Nursing science courses are traditionally taught using didactic methods, and are in isolation from nursing practice and in particular, clinical decision-making. Yet, supporting clinical decision-making appears to be the main reason that science content is in the curriculum – so that patient outcomes can be enhanced by scientific knowledge that a nurse can apply to an individual patient. This includes biological knowledge of patient’s health, knowledge of how the body responds to illness or

altered health states in that patient’s particular stage of life and hence, an understanding of what may influence positive patient outcomes (in terms of biological care) under a particular set of circumstances. Paramount to this is the ability of the nurse to detect changes in the physiology of the patient. All nurses, no matter what level of care is being provided (assistant, enrolled, registered or practitioner) have a responsibility to observe and interpret changes in the patient’s state. Registered nurses have the responsibility to undertake a nursing assessment and make decisions on nursing care that is based on the change of status. This establishes then that all levels of nursing require enough scientific knowledge to be able to observe basic human physiology and report it. Nursing science appears to relate to the ability of the nurse to recognise patterns and to respond appropriately to those patterns, to the benefit of the patient.

Expert clinical decision-makers appear to have knowledge, confidence in their own judgements and experience (recognising patterns and responses that worked before). However I suggest that experience (either self experienced or by proxy via recommendations from other more experienced nurses) appears to be the most value to new nurses as they attempt to negotiate the workplace which is in reality, very protocol driven, and hence does not make much room for innovative practice. Innovations in nursing care are most likely to occur from independent minded practitioners who are capable of independent thought and have enough knowledge to challenge protocols. Currently, the biological science behind nursing decisions may either by unrecognised (not considered to be based in science) or unvalued (not considered to be important to nursing).

Confidence in terms of acknowledging and using science based knowledge has also been established as an issue for many nurses. Many nursing students have issues when it comes to studying science and these may be quite deep seated and hard to influence. It is not established if nurses with higher levels of self-efficacy for using-science-in-practice (hence confidence) use scientific knowledge more (than those with lower levels of self-efficacy) to inform their clinical decision- making and hence inform their practice. Changing the name of science courses to something more acceptable or integrating the science into nursing topics has been suggested as one way of ‘hiding’ the science and so ensuring that students attempt

to engage in it without realising that they are learning scientific concepts. However, when confronted with the realities of basic biology, chemistry or physics, some students will still evoke a negative response, no matter what heading it is taught under. Examination of nurses’ clinical practice, and in particular, the knowledge that is accessed for clinical decision making (the depth and breadth) is required. Alongside this, an examination of confidence levels (self-efficacy) should occur to see if it influences the type of knowledge used when making clinical decisions. Understanding how this knowledge is applied will also inform curriculum development and will contribute to answering the research question.

The research question “What is the role of science in nursing practice?” can be further developed into:

R1: Is science required for clinical practice?

R2: In what ways, if any, do registered nurses use science in their clinical practice?

R3: What is the role of science education in nursing education? R4: What is the role of science educators in nursing education?

Finally, the following table consists of exploratory questions/ statements (E) or ideas that underpin this thesis as derived from the research questions (R) and objectives. These exploratory statements are to guide specific areas of focus for the research and are not testable statements. They also provide a framework for the next chapter which discusses the methodology used in this thesis.

Table 3.4: Research and Exploratory Questions What is the role of science in nursing practice? R1: Is science required for clinical practice?

Exploratory questions:

E1: Do all levels of nursing clinical practice require patient observation? E2: Is science knowledge required for patient observation?

E3: Do nurses need science knowledge in order to practice competently? E4: Is science knowledge required for clinical decision-making?

E5: Do registered nurses carry responsibility for clinical decision making? E6: Does Nursing Council of New Zealand require all levels of nurses to

have scientific knowledge?

E7: What are the perceptions of nurse educators about the relevance of science to nursing?

E8: What are the perceptions of nurses in clinical practice about the relevance of science to nursing?

E9: Will future nursing practice require nurses to be involved in more autonomous clinical decision making?

R2: In what ways, if any, do registered nurses use science in their clinical practice?

E10: What science knowledge, if any, is required for patient observation? E11: What science knowledge, if any, is required for competent clinical practice?

E12: What science knowledge, if any, is required for clinical decision- making?

E13: How is science recognised and validated in the clinical setting? E14: Do nurses in practice recognise the science behind their clinical practice?

E15: Are nurses in clinical practice confident with their ability to use scientific knowledge in practice?

scientific knowledge in practice?

E17: Does the science used in clinical practice align with conventional constructs?

E18: Does the science required to inform clinical practice align with conventional science nursing curricula?

R3: What is the role of science education in nursing education? E19: What is the basic requirement (depth, breadth of content) to support patient observation?

E20: What is the depth and breadth of content required for competent practice?

E21: What depth/breadth of content is required for clinical decision-making? R4: What is the role of science educators in nursing education?

E22: Establish appropriate authentic experiences for active learning. E23: Establish an appropriate method of curriculum design.

E24: To provide structure, scaffolding and appropriate challenges to the learner.

CHAPTER FOUR METHODOLOGY  

Overview of the Chapter

This chapter consists of a description of the methodology employed in this inquiry. It begins with an overview of the methodological approaches that are common in science education inquiries then follows with a discussion on approaches used in this study. Next is a discussion on the appropriateness of the methods and protocols that were used in the investigation including document analysis, surveys, observations and interviews. Then a description follows of the procedures and measures taken to ensure that the data is dependable and that the inquiry is trustworthy, followed by a discussion of ethical implications.