Page 37 - Encyclopedia of Nursing Research

4 n ACTivE SURvEiLLANCE FoR PRoSTATE CANCER

science generates knowledge regarding the may be entrenched with routinization or fro-
process involved in self-awareness and the zen within Model 1 theories in use.
A learning of new theories in use through The general aim of action science for
reflective practice and practice design. nursing is then to improve nursing practice
Research process in action science calls by freeing nurses from self-sealing practices
for the cooperative participation of practi- and by engaging them in the process of learn-
tioner and researcher through the phases of ing and participatory research. An extended
description, discovery of theories in use, and model of inquiry based on action science
intervention. The core process in this inquiry such as critical reflective inquiry (Kim, 1999)
is the cooperative offline reflection (Rudolph, can be applied to develop knowledge for
Taylor, & Foldy, 2001). Transcriptions of actual improving nursing practice.
practice by the researcher or narratives of
actual practice by the practitioner are ana- Hesook Suzie Kim
lyzed together to describe and inform reflec-
tively the nature of practice and theories in
use. Action Design (1996) suggested the use
of the ladder of inference as a tool to discover Active SurveillAnce for
practitioners’ modes of thinking and action
as revealed in transcripts or narratives. The ProStAte cAncer
research process is not oriented to the anal-
ysis of action transcripts or narratives by a
researcher independent of the practitioner. Active surveillance for early stage pros-
it involves a postpractice face-to-face discus- tate cancer is defined as a period of intense
sion (interview) between the researcher and monitoring for the purpose of delaying
the practitioner. Such sessions are used to traditional therapy within a timeframe
get at the reconstructed reasoning of prac- that allows for cure if disease progression
titioners regarding critical moments of the is detected. This approach can be offered
practice and to provide opportunities for to men with low or very low risk cancers
reflection on the thinking and doing that and may reduce overtreatment of clinically
were involved in the practice. Through such insignificant disease and the subsequent
sessions, the researcher also acts as an inter- side effects that include urinary incon-
ventionist by engaging the practitioner to tinence and impotence. Men who select
move toward new learning. active surveillance are usually monitored
Nursing practice is a human-to-human every 3 to 6 months by their health care pro-
service that occurs in the context of health vider. Monitoring may include digital rec-
care. Nursing practice occurs within online tal examination, repeat biopsy to evaluate
conditions that are complex not only with Gleason score, estimate of tumor volume,
respect to clients’ problems but also in terms and prostate-specific antigen (PSA) testing
of organizational elements of the health care to include PSA density (Dall’Era & Kane,
environment. Nursing practice is not based 2008). PSA levels provide the most useful
simply on linear translations of relevant the- information for monitoring disease progres-
oretical knowledge that governs the situation sion. However, evidence-based selection cri-
of practice but has to be derived and designed teria, monitoring schedules, and confirmed
from the nurse’s knowledge of and responses methods to monitor disease activity have
to the competing and complex demands of not been established and at this time; there-
the situation (Kim, 2010). in addition, as the fore, active surveillance protocols remain
action scientists suggest, nursing practice in institution and practitioner specific. Given
general as well as particular nursing actions the lack of an established approach for