Running head: KNOWING IN NURSING
1
Fundamental Patterns of Knowing in Nursing
Jason E. Warshawsky
Nursing 101
Due: 03.11.2015
Instructor: Judy Crain
College of New Caledonia: Quesnel Campus
KNOWING IN NURSING
2
Within the field of nursing the fundamental patterns of knowing have developed over
time. The “patterns of knowing have been identified from an analysis of the conceptual and
syntactical structure of nursing knowledge” (Carper, 1978, p.14) and continue to evolve. These
patterns of knowing currently are: the science (empirics) of nursing; the art (aesthetics) of
nursing; ethical knowledge; personal knowledge, and socio-political knowledge. The purpose for
having the five ways of knowing is that “these different types of knowledge focus on the
meaning and value of nursing expertise” (Potter and Perry, 2014, p.70) in the nursing profession.
Understanding the fundamental patterns of knowing gives the nurse an increased awareness of
the complexity and diversity of nursing knowledge (Carper, 1978, p.21). This paper will discuss
the fundamental patterns of knowing through practice examples, current scholarly nursing
literature and how they may be integrated within the nursing practice.
The Science (Empirics) of Nursing
The science of nursing is empirical knowledge that generates explanations that are
systematic as well as controllable by factual evidence and has had exponential growth since the
1950’s (Carper, 1978, p.14). Nursing knowledge is specific to the nursing profession. Arnold and
Boggs (2011) stated that “nursing theory informs nursing practice by furnishing a distinct body
of nursing knowledge that nurses universally recognise as being unique to their discipline” (p.5).
Understanding why and how an outcome is reached is vital in the process of learning. An
empirical based quote written by Arnold and Boggs (2011) states that, “quality nursing practice,
implemented through the nurse-client relationship is theory guided and evidence based” (2011,
p.17). In 1985 Jean Watson defined theory as “an imaginative grouping of knowledge, ideas and
experiences that are represented symbolically and seek the illuminate a given phenomenon”
(Chinn and Kramer, 2008, p.181).
KNOWING IN NURSING
3
Having accurate information through scientific conduct is an integral part of building the
empirical knowledge of nursing. Not all information submitted is accurate. Scientific misconduct
compromises scientific integrity by distorting empirical evidence and in turn this could endanger
clients as well as nurses (Fierz et al 2014). To obtain useful and practical information the
research must be done correctly. Quality research involves having a non-biased viewpoint and
obtaining accurate information. The Manual of Nursing Diagnosis by Marjory Gordon is a
printed example of the science of nursing and a great resource in the nursing profession.
Without the empirics of nursing, nurses would have great difficulty competently
providing nursing care. The nursing process is an example of the empirics of nursing and “is the
primary framework used to structure and organize nursing care” (Arnold and Boggs 2011, p.30).
When nurses use the empirics of nursing correctly, it can aid them in explaining the basis of care
to patients, increase their confidence and also improve the relationships they have with
physicians (Halm, 2014). The science of nursing will continue to evolve as humanity discovers
new information and develops more advanced understanding of the human condition. Clearly
“the first fundamental pattern of knowing in nursing is empirical, factual, descriptive and
ultimately aimed at developing abstract and theoretical explanations. It is exemplary,
discursively formulated and publicly verifiable” (Carper, 1978, p.15).
The Art (Aesthetics) of Nursing
The art of nursing is generated through the tasks that a nurse performs on a daily basis.
Throughout a nurses “practice the art of nursing is expressed in transformative art/ acts” (Chinn
and Kramer, 2008, p.150). Orem described the art of nursing as being expressed by each nurse
through their stylish creativity in designing as well as providing satisfying and effective nursing
KNOWING IN NURSING
4
for the client (as cited by Carper, 1978, p.17). Four concepts within the art of nursing are care,
advocacy, respect and appreciation. These four concepts can be centred on the nurse or the client.
Sherring and Knight stated that “burnout in the helping professions is a state of physical,
emotional and spiritual fatigue caused by long-term exposure to demanding work Stressors” (as
cited in Breen and Sweeney, 2013). Nurses who maintain healthy physical and emotional states
will avoid burnout. Self-care through mindfulness is imperative for the nurse’s well-being
(White, 2013). Client care is paramount because “caring facilitates healing and improves patient
satisfaction with nursing care” (Potter and Perry, 2014, p.265). By developing a caring
relationship the nurse is able to choose the most appropriate nursing therapies (Potter and Perry,
2014, p.269). Advocacy for oneself is a highly beneficial practice and allows one to stay calmly
on the course they desire. Advocating for the clients is very important because the client’s wellbeing is in direct relationship to the nurse.
The nurse must understand that they are only in control of their own decisions; however
they must respect the clients’ decisions. Having autonomy means “that a capable and competent
individual is free to determine, and to act in accordance with, a plan chosen by” themselves
(Keatings and Smith, 1995, p.93). Respect for oneself is an honorable action in the art of nursing
and needs to be internalized constantly. Respect for all clients’ personal possessions, feelings and
space are an integral part of high quality nursing. Usually “respect is communicated principally
by the ways nurses orient themselves toward and work with clients” (Riley, 2012). Appreciation
for one’s body, mind, and spirit has a profound way of creating forward movement in the nursing
profession. Looking at nursing with “an individualized knowledge of the humanity of each client
as a unique individual with physical, cognitive, emotional, and spiritual needs” (Arnold + Boggs
KNOWING IN NURSING
5
2011, pp.5-6) is at the heart of nursing. Respect and appreciation for the clients in these areas
will help a nurse to gain a gratifying stance with the clients they encounter.
Ethical Knowledge
Ethical knowledge is a tool which allows nurses to decipher between right and wrong.
Clearly “in deontological theory, morals or rules are established to determine what is right or
wrong based on one’s obligations and duties” (Keatings and Smith, 1995, p.89). The more
sensitive a nurse is to the process of justification that govern their actions, the more ethical they
will be when assessing surrounding circumstances (Carper, 1978, p.21). In providing ethical
care, “the nurse promotes an environment in which the human rights, values, customs, and
spiritual beliefs of the individual patient, family and community are respected” and valued
(Potter and Perry, 2014, p.83). Sometimes there is no clear right or wrong in a situation which
makes some nursing choices very difficult. Decisions made by nurses are sometimes affected by
finances, personal values and may be time sensitive. Currently, global health systems face
constraints and challenges around patient safety and quality, lack of human resources, and rising
moral distress among nurses (Arries, 2014).
A nurse is wise to do the best job they can without causing themselves personal stress.
There are many difficult decisions for a nurse throughout their career because “nurses often face
ethical dilemmas when providing care to patients” (Hill, 2012) and a solid understanding of the
ways of knowing will help the nurse adapt to the situation. Deontology is a traditional ethical
theory that encompasses the system of ethics that is perhaps most familiar to practitioners in
health care (Perry and Potter, 2014, p.84). Within the context of modern health care, teachers and
individual practitioners are becoming increasingly aware of the personal choices that raise
fundamental questions about right and wrong action in connection with the care and treatment of
KNOWING IN NURSING
6
illness (Carper, 1978, p.20). We are currently going through a large scale change with a reliance
on ethics in the area of legalizing assisted suicide. Many “nurses hold strong views on one side
of the debate . . . regardless of their perspective, all nurses experience moral distress in these
situations” (Keatings and Smith, 1995, p.163) and “our individual values influence how we
respond to ethical issues” (Keatings and Smith, 1995, p.87).
Personal Knowledge
Personal knowledge is unique and individualized to every person. It is achieved through
living life and “the knowledge gleaned from experience belongs to this pattern” of knowing
(Potter and Perry, 2014, p.70) and there are no two people who have lived the same life. This
type of knowledge tends to be problematic due to the difficultly to master as well as to teach, but
is perhaps the most essential to understanding an individual’s well-being (Carper, 1978, p.18).
Communication is a vital component of personal knowledge and “intrapersonal communication
takes place within the self in the form of inner thoughts and beliefs that are colored by feelings
and influence behavior” (Arnold and Boggs 2011, p.13). Within nursing practice a nurse’s
personal knowledge of themselves is very important. A nurse will be in situations that will be
difficult to handle on many levels, and personal knowledge management can help to keep a nurse
balanced. Managing personal knowledge “can have an impact on organisational knowledge
management and productivity” (Jain, 2011).
It is the nurse’s duty to remain compassionate and focused while they use critical
thinking and empathy to perform nursing skills to the best of their ability. Being genuine and self
aware are two personal nursing qualities that fit together. Riley (2012) stated “being genuine
means that you send the other person a real picture of you” (p.101). If a nurse is not self- aware
and genuine they may offend clients, families, and co-workers. Our personal knowledge creates
KNOWING IN NURSING
7
our reality and this why the same event may be seen in countless different ways. Watson spoke
of multiple truths decades ago and now, clearly it is common knowledge that every individual
creates their own reality of truth. This is why protocol is set out by governing bodies and is vital
to guiding personal knowledge in a direction that benefits all involved. Personal knowledge can
assist humanity “toward growth and fulfillment of human potential” (Carper, 1978, p.19). The
quality and the depth of the interpersonal experience, as well as the nature of the relationship
formed with the client, are fundamental to the realm of personal knowledge (Potter and Perry,
2014, p.70).
Socio-Political Knowledge
Socio-political knowledge involves viewing information from the top down, starting with
the government and ending with the individual. All countries and communities are unique. It is
wise of a nurse to gain as much socio-political knowledge of the area they are to be working in
because it will allow them to understand the system in which they are involved. Nurses play an
important role in society. If there are an inadequate number of nurses, which is eighteen for
every ten thousand members of the population, this will lead to higher morbidity and mortality
rates (Parks, Longsworth, Espadas, 2013). Nurses are an integral part of society and create a
connection between many levels of society. Worldwide it is known that people of lower status
have substantially shorter life expectancies but “reducing health inequalities is a priority issue in
Canada and worldwide” (Reutter and Kushner 2010). Currently “Emancipatory knowing . . .
represents the ability to recognize social and political problems of injustice or inequality. . . and
to figure out how to change a difficult situation into one that improves the lives of people”
(Potter and Perry, 2014, p.71). Emancipatory knowing also “takes into account the power
dynamics that create knowledge, and the social and political contexts that shape and influence
KNOWING IN NURSING
8
knowledge and knowing” (Chinn and Kramer, 2008, p.78). Socio- political knowledge allows a
nurse to gain a greater view of the societal perspective, so that they can better perform nursing
care of the client and understand the client’s environment. Chinn and Kramer (2011) stated that
“emancipatory knowing requires the nurse to thoughtfully reflect and act in relation to a
treatment and its implications in a way that makes things better for the future, not just for” the
individual “but for society in general” (p.3). Socio-political knowledge will help the nurse to
understand the reality of a client’s world. Understanding about a client’s beliefs and values will
help a nurse to provide empathetic care. Empathy was defined by Dunne as “the act of
communicating to our fellow human beings that we understand something about their world” (as
cited in Riley, 2012, p.109).
Integration of the Fundamental Patterns of Knowing in Professional Nursing Practice
Nursing can be provided without the knowledge of the ways of knowing but this may put
the nurse, client, family members, and co-workers at risk. Risk can be divided into two areas,
physical and emotional. Physical risk is imminent if the nurse does not follow the science of
nursing. A simple wound on a patient may cause gangrenous poisoning if empirical protocol is
not followed. The simple task of washing one’s hands to prevent the transfer of micro-organisms
has shown a great influence on infection control. From Florence Nightingale to current sanitary
protocols the importance of high quality hand hygiene is undisputable. Many years ago “it was
Florence Nightingale who advocated and promoted the need for a uniformly high standard of
nursing care that required both education and certain personal characteristics” (Chinn and
Kramer, 2008, p.30).
If nursing was performed without any attention to the art of nursing, physical risk is
possible but emotional damage may occur. If the individual providing a service for a client does
KNOWING IN NURSING
9
not care, advocate, respect or appreciate the client they will become aware of this and be
emotionally affected. As humans we are generally very aware and will usually realize if someone
does not care about what they are doing. A nurse must understand the personal impact that they
have on their clients and no matter how menial the task, the act of caring makes a heartfelt
difference. Ethical knowledge is the most important category in the ways of knowing. Carper
(1978) stated “the moral code which guides the ethical conduct of nurses is based on the primary
principle of obligation embodied in the concepts of service to people and respect for human life”
(Carper, 1978, p.20). If a nurse does not have respect for life, they are a danger to themselves
and everyone within their environment. To be a safe, compassionate and effective nurse an
individual must have a grasp of the knowing referred to as personal knowledge. Being self aware
is a component that gives communication its quality and depth. Being aware of oneself and
maintaining well-being will allow a nurse the balance to provide quality nursing care. If one is
unable to maintain their own well-being, they will not be able to care for others adequately.
Socio-political knowledge allows the nurse to adapt to the society in which they are providing
nursing care. If a nurse is not aware of ethnic practices they could risk offending their clients and
disrupt them emotionally.
In the field of nursing the fundamental patterns of knowing have developed and continue
to evolve. The science (empirics) of nursing, the art (aesthetics) of nursing, ethical knowledge,
personal knowledge, and socio-political knowledge, all have a unique and valuable importance to
the nursing profession. Understanding the fundamental patterns of knowing increases the
awareness of the complexity and diversity of nursing knowledge (Carper, 1978, p.21). A nurse
will benefit from a greater understanding of the fundamental patterns of knowing in nursing.
KNOWING IN NURSING
10
References
Arnold, E. C., & Boggs, K. U. (2011). Interpersonal relationships: Professional communication
skills for nurses. St. Louis, MO: Elsevier Inc.
Arries, E. J. (2014). Patient safety and quality in healthcare: Nursing ethics for ethics quality.
Nursing Ethics, 21(1), 3-5. doi: http://dx.doi.org/10.1177/0969733013509042
Breen, M., & Sweeney, J. (2013). Burnout: The experiences of nurses who work in the inner
city areas. Mental Health Practice, 17(2), 12-20.
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing
Science, l (1), 13-23.
Chinn, P. L., & Kramer, M. K. (2011). Integrated theory and knowledge development in nursing
(8th ed.). Retrieved from http://books.google.ca/books?id=kdPsAwAAQBAJ&printsec=
frontcover#v=onepage&q&f=false
Chinn, P. L., & Kramer, M. K. (2008). Integrated theory and knowledge development in nursing
(7th ed.). St. Louis, MO: Mosby, Inc.
Fierz, K., Gennaro, S., Dierickx, K., Achterberg, T., Morin, K. H., Geest, S., William, F. (2014).
Scientific Misconduct: Also an issue in nursing science? Journal of Nursing Scholarship
46, 271-80. doi: 10.1111/jnu.12082
Halm, M. A. (2014). Science-driven care: can education alone get us there by 2020?
American Journal of Critical Care, 23(4), 339-343. doi:10.4037/ajcc2014997
KNOWING IN NURSING
11
Hill, J. (2012) Patient safety and ethics: A conflict of goods. Clinical Journal of Oncology
Nursing, 16 (6), 575-576. doi: 10.1188
Jain, P. (2011). Personal knowledge management: The foundation of organisational knowledge
management. South African Journal Of Libraries & Information Science, 77(1), 1-14.
Keatings, M., & Smith, O. B. (1995). Ethical & Legal Issues: In Canadian Nursing.
Toronto, ON: W.B. Saunders Canada.
Parks,M,E., Longsworth, T.,+ Espadas, L., Isidora. (2013) Harmonising Nursing Education.
Caribbean Quaterly,59(3/4), 76-97. Retrieved from
https://login.ezproxy.cnc.bc.ca:9443/login?url=http://search.ebscohost.com/login.aspx?di
rect=true&db=lfh&AN=94637900&site=ehost-live&scope=site
Potter, P. A., Perry, A. G., Stockert, P. A., Hall, A. M. (2014). Canadian fundamentals of
nursing (5th ed.). Toronto, ON: Mosby, Inc.
Reutter, L., & Kushner, K. (2010). Health equity through action on the social determinants of
health: taking up the challenge in nursing. Nursing Inquiry, 17(3), 269-280.
doi:10.1111/j.1440-1800.2010.00500.x
Riley, J. B. (2012). Communication in nursing (7th ed.). St. Louis, MO: Mosby, Inc.
White, L. (2014). Mindfulness in nursing: an evolutionary concept analysis. Journal of Advanced
Nursing, 70(2) 282-294. doi: 10.1111/12182