University of Nottingham, Derby, UK.
Nurs Inq. 2012 Mar;19(1):6-17. doi: 10.1111/j.1440-1800.2011.00566.x. Epub 2011 Aug 1.
This paper will identify some of the key conceptual tools of a critical realist approach to knowledge. I will then apply these principles to some of the competing epistemologies that are prevalent within nursing. There are broadly two approaches which are sometimes distinct from each other and sometimes inter-related. On one side, there is the view that all healthcare interventions should be judged on the principles of randomised controlled trials and the other is a preoccupation with language in which healthcare interventions are subjected to a discursive interrogation. These debates are configured through the idea of a hierarchy of knowledge that is accorded uncritical acceptance by some and virulent distaste by others. I will argue that the notion of hierarchy is problematic and is largely argued for in unproductive epistemological terms. What is required is a shift towards a theory that emphasises the contextual nature of the ways that knowledge is produced and disseminated. In other words, there is no single hierarchy of knowledge, but there are multiple hierarchies of knowledge.
本文将确定一些关键的概念工具，以批判性现实主义的方法来了解知识。然后，我将把这些原则应用于一些在护理领域中普遍存在的相互竞争的认识论。通常有两种方法，有时彼此截然不同，有时又相互关联。一方面，有一种观点认为，所有的医疗干预措施都应该根据随机对照试验的原则来判断，另一种观点则关注语言，认为医疗干预措施应该受到话语的质疑。这些争论是通过知识的层次结构的概念来构建的，这种层次结构的概念被一些人不假思索地接受，而被另一些人强烈反感。我将论证等级制度的概念是有问题的，而且在很大程度上是用无益的认识论术语来论证的。所需要的是一种转向强调知识产生和传播的语境性质的理论。换句话说，不存在单一的知识层次结构，而是存在多种知识层次结构。
