Running head: FUNDAMENTAL PATTERNS OF KNOWING
Nursing 101: Fundamental Patterns of Knowing in Nursing
Colette Jarvis
College of New Caledonia – Quesnel Campus
Judy Crain
11 March 2015
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Nursing knowledge is hard to define because it is dynamic, evolving, and associated with
a wide range of theoretical and practical knowledge. The different types of knowing nurses come
in contact with are science (empirics), art (aesthetics), personal, ethical, and socio-political
understandings. These types of awareness's are the means by which the whole purpose of caring
for patients is achieved. It is what defines a nurse, and differentiates them from doctors, lay
workers or other support staff. Defining a profession in a society is outlined by the unique body
of information one has gathered and accumulated throughout multiple experiences. Carper
(1978) declared that "the body of knowledge that serves as the rationale for nursing practice has
patterns, forms and structure that serve as horizons of expectations and exemplify characteristic
ways of thinking about phenomena" (p.13). The following pages, will discuss the meaning of the
five fundamental patterns of knowing by analysing and giving examples of how nurses can, and
do apply these particular wisdoms.
Science (Empirics) of Nursing
Rashid (2013) noted that empirical knowledge, also referred to as empiricism,
emphasizes evidence that is based on experimental design and hypothesis testing (p. 107). Carper
(1978) stated that "there is a critical need for knowledge about the empirical world, knowledge
that is systematically organized into general laws and theories for the purpose of describing,
explaining and predicting phenomena of special concern to the discipline of nursing" (p.14).
Nursing knowledge has been reduced to Carper’s (1978) empirical knowing by the focus on
quantitative data and measurable outcomes which can be made a goal to achieve and also done
within a certain time frame (as cited in Newham, Curzio, Carr, & Terry, 2014, p.51). This type of
knowledge is vital to patient care and links nursing theory to nursing practice. By applying
empirical knowledge, nurses are equipped with the ability to interpret undefined clinical
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situations and respond appropriately. An example of using empirics when nursing is stated by
Potter and Perry (2014), wiping from the perineum to the rectum reduces the chance of
transmitting fecal organisms to the urinary meatus (p.847).
Art (Aesthetics) of Nursing
Aesthetics, often defined as the art of nursing, is the ability to connect with patients.
Chang, Lu, Lin & Chen (2013) suggested that much like art, nursing can be inspirational,
comforting, creative, dramatic, and even sorrowful (p. 108). According to Carper (1978), "the art
of nursing was closely associated with an imitative learning style and the acquisition of
knowledge by accumulation of unrationalized experiences" (p.17). This component is what can
primarily attract persons to become educated and pursue a degree in this particular profession.
Nursing requires therapeutic communication that conveys a message of respect, empathy and
understanding. It is a holistic practice meant to enhance the lives of individuals, families, and
their communities through their physical health and emotional well being. The powerful
connection between the nurse and patient creates an environment conducive to healing if fostered
through aesthetics. The art of nursing is different from the science of nursing. For example, we
can physically examine the heart because the heart is something we can touch. The art of nursing
is not something that can be physically touched or examined. A person is able to develop
abilities with practice and time, just like an artist and the art of nursing. Greveson (2013) stressed
the importance of conveying information in a meaningful way without manipulating the
message; for example, ensuring clients are fully counselled regarding treatment options to
provide informed consent, and managing their expectations by providing a realistic idea of
outcomes (p.2).
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Caring can be described as having the passion and desire to serve those in need. To care
is to create a spirit of healing by sharing personal gifts and talents and to make the effort to do
the little things for your patients. Hujala & Rissanen (2011) stated that "aesthetic dimensions of
care are constructed by management practices which, in their turn, influence the nature of
management" (p.439). The practice of nursing requires a higher level of knowledge and skill, but
it is still built upon the fundamental moral commitment of caring in nursing (Sumner,
Schootman, Asaro, Yan, & Hagen, 2008, p.197). Communication also plays a key role in the
caring in nursing as it is the interaction that exists between the nurse and the patient. In a nursing
field, advocacy means that the nurse acts for and on behalf of the client. To be an advocate for a
client the nurse must ensure that the client is provided with adequate and accurate information
relating to his care and support the client in any informed decisions he makes about his care
(Koutoukidis, 2009, p.10). Two other concepts that are related to the art of nursing that are
essential in a professional practicing nurse are Empathy and warmth.
Empathy is the role of recognition and perception in aesthetic knowing. Archibald (2012)
stated that "empathy is commonly regarded as central to the provision of ‘good’, ‘expert’, or
‘caring’ nursing practice, and hence has been the focus of inquiry for numerous nursing scholars"
(p.183). Empathy in nursing is convincing your clients and colleagues that you understand their
feelings. Carper (1978) stated that "one gains knowledge of another person's singular, particular,
felt experience through empathetic acquaintance" (p.17).
Warmth demonstrates to your clients in concrete ways that you are concerned about and
interested in them. In agreement with Balzer-Riley (2012), "warmth is the glue in the bonding
between people and the magnetism that draws us to a closer intimacy with others" (p. 84). An
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expression of warmth toward another person almost always brings a response of acceptance,
trust, and the desire for a closer relationship. Sharing feelings of warmth is a powerful tool in
building and maintaining relationships.
Ethical Knowledge
To influence patient care through ethical knowledge, nurses need the understanding of
ethical principles such as beneficence, confidentiality, autonomy, privacy, advocacy. These
principles should be applied in an atmosphere of respect and trust while being sensitive to the
values and morals of others. Carper (1978) declared that "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" (p. 20). Essentially, ethics are moral
principles governing relationships between patient and nurse. Also, nurses must have an
understanding of ethics in order to remain professional and subsequently make the correct choice
for a particular scenario. Watson’s, theory of human caring, establishes the concepts that nurses
must be aware of any judgments and look at the uniqueness of each patient in order to preserve
his or her dignity (Watson, 2009, p.471). An example of applying ethics to the nursing practice is
demonstrated on CRNBC's website when a nurse notices bruises on her patients arms and legs. A
nurses patient is a 20 year old male with cerebral palsy, and the nurse believes he may have been
physically abused. The nurse makes an ethical decision by factoring in if there is a risk of harm,
if the client is capable of making decisions or has the information to make informed choices and
if the client has consented to disclosure (CRNBC).
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Personal Knowledge
Personal knowledge involves the process of self-reflection and authenticity. Carper
(1978) explained that "personal knowledge is concerned with the knowing, encountering and
actualizing of the concrete, individual self" (p. 18). Personal knowledge stems from reflection on
personal experience; that is, reflection on the integration of scientific knowledge and the personal
application of that knowledge. By repeated reflection of the proverb “walk a mile in another
man’s shoes” nurses are able to grasp the concept of a person’s actions and emotions (White &
Siebold, 2008, p. 57). This awareness to the sensitivity of others helps address the physical,
emotional, social, and spiritual needs of the patient - a holistic approach (Portillo & Cowley,
2011, p. 1739). Gourlay (2004) stated that "Florence Nightingale believed that health and well
being depended on people's circumstances, and that both personal and environmental situations
contribute to good health" (p.14). Nightingale's work contains the core values to holistic nursing
practice. Although the face of modern health care has changed dramatically, Nightingale’s
message of self-care, self-responsibility, and reflection has led nurses to a greater awareness of
their connection to others and to the universe. An example of applying personal knowledge to the
nursing practice is shown by Mallik (2009) when she stated, "working with people who are
approaching the end of life, or caring for the dying and the bereaved, raises significant personal
questions about the meaning of life, and may at times raise fundamental anxieties about illness,
dying and death" (p. 308). She also declared that this is especially the case when something in
one’s personal life intersects with work life or when there are organizational problems which
mean that you cannot provide the best care possible (Mallik, 2009, p.308)
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Socio-Political Knowledge
Nursing is a moral practice that takes place within a social, economic, cultural, and
political context. Community Health Nurses Association of Canada (2008) stated, " Sociopolitical knowledge, or emancipatory knowing, goes beyond personal knowing and nurse-client
introspection. It places nursing within the broader social, political and economic context where
nursing and health care happen. It equips the nurse to question the status quo and structures of
domination in society that affect the health of individuals and communities" (p.7) Rains &
Barton-Kriese's stated that political competence is our legacy and mandate, and needs to be
stressed as a means to addressing the continuous health-related needs of society (as cited in
Avolio, 2014, p. 2). An example of how socio-political knowing can be applied to nursing
practice is by focusing on micro sociological aspects such as labeling, and by gaining an
understanding of the sociology of nursing and organisations.
Integration of the Patterns of Knowing
Nursing is a profession that constitutes both art and science. Carper (1978) described
empirical, ethical, personal, and esthetic designs of nursing knowing to complete the framework
of nursing knowledge (as cited in Chinn & Kramer, 2011, p.36). A nurse should aspire to provide
optimal care to patients by utilizing evidenced-based practice and a creative means of putting
evidence-based practice into action. Carper (1978) declared that "nursing depends on the
scientific knowledge of human behaviour in health and illness, the aesthetic perception of
significant human experience, a personal understanding of the unique individuality of the self
and the capacity to make choices within concrete situations" (p. 22). It is essential that nurses use
the nursing knowledge in evidence-based practice, to provide better patient care, improve
communication between nurses, and as a guide for nursing research and education. The
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community Health Nurses Association of Canada (2008) rationalised that "each way of knowing
is necessary to understand the complexity and diversity of nursing in the community and by
integrating multiple ways of knowing into the practice of community health nursing, the
individual nurse becomes a co-creator of nursing knowledge" (p. 7). They also concluded that
critical examination of this nursing knowledge contributes to evidence-based community health
nursing practice (p. 7). The art or aesthetics of nursing seems to stick out from the rest of the
fundamental patterns of knowing because it promotes adapting knowledge and practice to
particular rather than universal circumstances and brings out a nurses intuition and empathy.
Aesthetic knowledge is knowing what to do without conscious deliberation, and moves beyond
the surface of a situation (Carper, 1978, p. 17). It also encourages nurses to explore possibilities,
and encourages individual creativity and style. Since it is associated with the ability to connect
with patients, it is extremely important that a strong connection between the nurse and patient
creates an atmosphere that manipulates healing. Aesthetic knowledge brings together all the
elements of a nursing care situation to create a meaningful whole (Carper, 1978, p. 17).
The different types of knowing nurses come in contact with are science (empirics), art
(aesthetics), personal, ethical, and socio-political understandings. An understanding of different
types of education, professional mission statements, conceptual frameworks and paradigms will
enhance a deeper understanding and greater knowledge base for the desired role in nursing
practice. McEwen & Will (2011)stated "the study of the origins of nursing knowledge, its
structure and methods, the patterns of knowing of its members, and the criteria for validating its
knowledge claims is what is regarded as nursing epistemology" (p. 238). As nurses, we can
acquire knowledge base from numerous sources and this knowledge is what we can apply in our
ways of knowing as we practice our profession in many contexts. Carper (1978) proposed an
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epistemological structure to the different ways in which this knowledge may be acquired and
used, referred to as the ways of knowing. The meanings of the five fundamental patterns of
knowing were discussed by analysing and giving examples of how nurses can, and do apply
these particular wisdoms. Carper (1978) stated that for each of these separate but interrelated and
independent fundamental patterns of knowing should be taught and understood according to its
distinctive logic, the restricted circumstances in which it is valid, the kinds of data it subsumes
and the methods by which each particular kind of truth is distinguished and warranted (p. 22).
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