Public defence: Hanna Marie Ihlebæk

This thesis is an ethnographic study of nursing knowledge from the perspective of its use, exploring how professional knowledge evolves in work by taking clinical cancer nursing as its case. Cancer nursing requires a complex interplay between biomedical, clinical and patient knowledge in caring for patients’ acute and prolonged physical and mental problems. It thus provides a case that reveals the heterogeneous body of theoretical knowledge and complex practical skills that comprise clinical nursing. The nature and status of these different forms of knowledge and their usefulness for clinical practice in modern healthcare contexts have been discussed in great detail in the nursing literature, more recently related to questions of academisation and evidence-based practice. These discussions reflect the essential role ascribed to knowledge in defining and exploring what professions are, and what they do, in the sociology of professions and the literature on expertise. 

Despite this interest in understanding what knowledge is, and what role different forms of knowledge play in professional practice, few studies have aimed to envision and explore how different types of knowledge and modes of knowing are interconnected in professional decision-making at a micro-level, and how knowledge thus develops through use.

Methods

These questions are explored in this thesis by analysing data from five months of fieldwork followed by formal interviews with registered nurses in a cancer ward in a Norwegian hospital. Observations revealed how nurses’ professional knowledge and clinical expertise emerged in clinical decision-making through practices of sensing, sharing and caring, as they aimed to evaluate, define and meet cancer patients’ overall care needs. These practices were further explored and analysed by combining perspectives from the sociology of professions and knowledge in policy with sociological and anthropological notions on embodiment, translation and temporality. On this basis the thesis addresses the question of how knowledge is acquired, shared and structured in nurses’ clinical practice and how it is moulded in its circulation through enactments in an organisational context.

Findings

Based on the three empirical articles, the thesis demonstrates, firstly, how nursing knowledge develops through the building of sensory knowledge in nurses’ continuous, embodied and intersubjective interaction with individual patients and a specific patient group. Secondly, it illustrates how the embodied knowledge of individual nurses is transformed through acts of translation as knowledge is shared, and hence moves in interaction. Thus, nursing knowledge emerges as a third space in the nurses’ interpretative and creative effort to fill the gap between knowledge as embodied and inscribed and the languages and lifeworlds of patients, practitioners and managers. Finally, it displays how nurses’ professional knowledge is produced and reproduced through temporal structuring of caring practices in clinical work, potentially emphasising particular modes of accomplishing care and forms of knowing at the expense of others. In sum, the thesis thus sheds light on how nurses’ heterogeneous body of theoretical knowledge and practical skills is put to use and made useful in a particular organisational context. In this way, the study identifies topics for reflection by clinical practitioners, managers and policy-makers in the field of knowledge management in contemporary healthcare contexts and other professional settings.

Discussion

Beyond providing an in-depth ethnography on aspects of clinical work and knowledge that are little studied in the existing nursing literature and often rendered invisible in a modern hospital context, the thesis contributes to the literature on professions more generally. It does so by demonstrating how acts of diagnosis and treatment are accomplished in the continuous mobilisation and synthesis of theoretical and practical forms of knowledge through inference as an embodied, interactional and situated achievement. The thesis thereby nuances a notion on professional knowledge as a given, illuminating its potential heterogeneous nature, the complex ways in which various forms of knowledge are connected in the solving of particular tasks, and how it circulates and evolves in enactments at the workplace. Overall, the thesis demonstrates the fruitfulness of broadening out theoretical and methodological approaches to the understanding of professional knowledge in future research. It is to be hoped that the thesis can inspire further exploration and new revelations of the knowing body and the body of knowledge in professional practice.