Theory of profound knowing: A study of nurse-midwifery knowledge

The substantive theory of profound knowing represents the nature of nurse-midwifery knowledge within a unique rural setting, Frontier Nursing Service (FNS), Hyden, Kentucky, between the years 1925 through 1965. The structure, conditions, and fundamental patterns of knowing found in expert clinical practice intimately tied to its social community of service were examined. Interviews, autobiographical documents, and historical materials relating to nurse-midwifery practice at FNS were analyzed using grounded theory method.;The phenomenon under investigation was the nature of nurse-midwifery knowledge. The analysis was guided using formal research questions: (a) what was the nature of nurse-midwifery knowledge underlying nurse-midwifery practice in this isolated environment, Frontier Nursing Service, between the years 1925 through 1965? (b) what were the patterns of knowing discoverable from social action and interaction? and (c) what accounted for most of the variation in the patterns of knowing?;The integrity of the research was maintained through audit trails using coded groupings and theoretical development templates. Trustworthiness and confirmability of the developing theoretical model was ensured through participant validation during and after the interviews.;Symbolic interactionism, the philosophic underpinning of grounded theory, states that the nature of a phenomenon is derived from the meaning given by the participants experiencing the phenomenon. The meaning is derived from how individuals "act" in relating to the phenomenon. The nature of nurse-midwifery knowledge was derived from how the participants acted during the acquisition and application of their nurse-midwifery knowledge. The substantive theory of profound knowing represents the contexts of knowing within which their professional lives were conducted. The theory reflects the integration and synthesis of the dimensions of environmental knowing, community knowing, family knowing, and "knowing the woman". The theory represents their actions in professional practice and conceptualizes the recurring theme in their narratives, "They really knew their women".