Sturmberg Joachim P, Martin Carmel M
Monash University and Newcastle University, Australia.
J Eval Clin Pract. 2008 Oct;14(5):767-70. doi: 10.1111/j.1365-2753.2008.01011.x.
In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains - the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning.
在本文中，我们认为，与将知识视为一种客观状态的主流观点相反，医疗保健中的知识是一个多维动态结构。波兰尼证明，知识是个人的，知识是被发现的，知识具有显性和隐性维度。复杂适应系统科学将知识同时视为一种事物和一种流动，既是构建而成的，又是不断变化的。辛芬框架是一个有助于我们理解知识是通过意义建构实现的个人建构的模型。特定的知识方面暂时存在于四个领域之一——已知、可知、复杂或混沌，但新知识只能通过将已知知识移入并循环通过其他领域来挑战已知知识而创造出来。医学知识同时具有显性和隐性，某些方面已经广为人知且易于传播，而其他方面尚未完全知晓，仍需学习。同时，某些知识方面主要涉及内容，而其他方面则涉及背景。尽管在临床护理中我们可能主要在一个知识领域运作，但我们有时也会在其他领域运作。医学知识本质上是不确定的，在临床实践以及卫生服务规划中，我们需要一种由背景驱动的灵活方法来进行知识发现和应用。
