Patterns Of Knowing In Nursing Practice: Understanding Carper's Four Knowledge Patterns

Jean Watson's influence on nursing practice is significant. As all theorists do, she has a perspective through which she views nursing care and practice. This activity will help frame the guiding principles of University of Phoenix curriculum through the application of theory-based thinking.

Describe the five patterns of knowledge and how they can be applied in nursing practice.
Summarize the main points of Jean Watson's theory of human caring, including the 10 carative factors.
Determine how Jean Watson views the following patterns of knowledge:
Empirical knowledge (the science)
Esthetic knowledge (the art)
Ethical knowing (what constitutes good actions for that patient)
Personal knowing (nurse-patient relationship)
Explain which pattern(s) are more evident or easier to apply in Watson's theory of human caring, citing specific examples to support your explanation.
Reflect on how you may (or do) use caring science in practice and cite a practice scenario in which you could or do apply the theory to patient care

Empirics: The Science of Nursing Knowing

Numerous ways of knowing are being used in the field of nursing. Conventionally, four knowledge patterns in nursing have been employed in the nursing field. The four knowledge patterns include empirics (the science of nursing knowing), esthetics (the art of nursing), ethics as well as personal knowledge. Through the combination of these knowledge patterns, a physician or a nurse can develop prudent clinical knowledge that can guide his or her nursing practice and actions in various situations (Jackson, et al 2009; Hyejung, et al 2017). The four basic concepts of knowledge patterns were pinpointed by Caper in 1978 and placed them into two types, that is, explicit and tacit. Tacit types are insights and are anchored on one’s experience and most of the times are not easily expressible as well as visible, cannot be easily shared and communicate with other people and the communication is normally personal. Sources of knowledge which are considered as empirical depend on a person’s patterns of responding and observation to situations which are considered to be not in the world. on the other hand, explicit is described as formal and anchored an individual’s rationality. Explicit forms are normally easily shared, expressed and communication is based on universal principles.

Five ways of knowing Carper and how they can be applied in nursing practice

Mostly the four knowledge patterns were established by Barbara. A. Carper in 1978. The four ways of knowing include personal knowledge, ethics, aesthetics and empirics. The four knowledge were proposed in order to characterize the intricate knowledge phenomenon applied by physicians when offering care to their clients.

Empirics which is also referred to as nursing science is was proposed by Carper and is concerned with the general knowledge, abstract and objective which can be verified and quantified through continuous testing and analysis over a given period of time (Averill & Clements, 2007). In nursing empirical knowledge is considered as vital and significant in the clinical practice and providing of care to the patients. Empirical knowledge is quantifiable, objective and scientific knowledge which can be applied so as to explain situations that are verifiable and observable. For instance, empirical knowledge enables nurses and physicians to prudently know and ascertain that an oxygen saturation of about 77% is considered dangerous to a patient who is whose oxygen saturation through pulse oximetry is recorded to be 95% at room temperature. Another application of empirical knowledge for clinicians and nurses is when a positive D-dimer result is recorded which can mean and signify the blood clot presence that normally poses a harm to the safety and health of a patient.

Ethical Way of Knowing: The Moral Component of Patterns of Knowledge

Ethical way of knowing; this a moral component of patterns of knowledge that was proposed by Carper and is concerned with judging, justifying and choosing actions which are involving obligations, rights and moral duty. It should be noted that ethical nursing practice demands philosophical basis having concepts of oughts, rights, good and duties (Heath, 1998; Lee, Deana & Leah, 2003). Therefore, an array of numerous ethical contexts can be applied to aid in clarification of ethical issues. Carper (1992) continued to describe ethical knowing as abstract and normative, particular and singular.  According to McGovern, et al (2013), Ethical knowledge can be shown through the choices that physicians and nurses make as well as nursing judgements upon which actions can be taken at any given event or circumstance. Through ethical knowledge should ensure timely delivery of patient care in order to limit the risk of permanent damage or death of the patient since it is the morally right to undertake that even though he or she may have any personal relation with the patient.

Esthetics; also known as the skills of nursing demands a nurse to discern and interpret the behavior of the patient in relation to the wholes and associations instead of different discrete parts (Schaefer, 2002). Nursing practice depends on the empirical knowledge of the human character in illness and in health, the esthetic view of vital human experiences.

Personal knowledge; this one of the patterns of knowledge that entails self-awareness and the awareness of others in an association which is existential, concrete, subjective and normally do not need mediation via language (Zander, 2007). Personal knowledge needs engagement instead of detachment, an individual who is empathic as well as active in the field of nursing practice and it can be realized through intricate interpersonal associations. For instance, a mother brought her two old girl needed palate and cleft lip. The mother of the child stayed with the child while the father went to look for money for surgery. After sometime, the physician saw that the mother and daughter did not have food. The nurse decided to provide food for the daughter and the patient out of empathy. After discharge the mother went and thanked the nurse for the candid gesture she demonstrated.

Experience; experience can be described as knowing through continued circumstances resulting to refinement of previous thoughts and ideas. For instance, is expected to use her previous experiences in order to offer solutions that are required in the nursing practice.

Esthetics: The Art of Nursing

The main components of Watson theory are carative factors, caring moment or occasion and the transpersonal caring associations (Watson, 2009). Carative factors consist of ten elements; sensitivity to others and self, trusting and helping, human beings care associations, expressing negative and positive feelings, transpersonal learning and teaching, assistance of human needs, protective, supportive, and/ or corrective spiritual, societal (Lachman, 2012(, physical and mental environment, hope and faith, altruistic and humanistic value system, problem-solving and creative caring process and the phenomenological, spiritual and existential forces.

Watsons on the four knowledge patterns

In the esthetic knowledge, Watson states that connectedness requires that for the nurse to care for the patient, he or she must feel connected or attached with the patient.

Watson viewed personal knowledge as important in the esthetic knowledge through the alteration of the situation to one which is unique as well as meaningful not only to the nurse but also to the patient.

Watson view on empirical knowledge was that nurses should the available scientific data and information in order to improve the health of the patient.

Watson view on ethical knowledge was that nurses must use ethical considerations in delivering and practicing nursing.

The patterns that are more applicable in Watson theory of caring are personal knowledge and esthetic knowledge (Joseph, 2014). Watson recognized and identified the significance of making environment and the room of the patient a healing, soothing and sacred place which can be achieved with personal knowledge. Watson viewed nursing as an art and science, thus, being an artist, according to Watson is part of nurse’s role and caring for patients as well as their relatives and families.

References:

Averill, J. B., & Clements, P. T. (2007). Patterns of Knowing as a Foundation for Action-Sensitive Pedagogy. Qualitative Health Research, 17(3), 386–399. 

Heath, H. (1998). Reflection and patterns of knowing in nursing. Journal of Advanced Nursing, 27(5), 1054–1059. 

Hyejung, L., Anna, K., Anna, M., & Minjeong, S. (2017). Pediatric nurse practitioner’s clinical competencies and knowing patterns in nursing: Focus group interviews. Contemporary Nurse: A Journal for the Australian Nursing Profession, 53(5), 515–523. https://doi.org/10.1080/10376178.2017.1315827

Jackson, J. P., Clements, P. T., Averill, J. B., & Zimbro, K. (2009). Patterns of Knowing: Proposing A Theory for Nursing Leadership. Nursing Economic$, 27(3), 149–159.

Joseph, C. B. (2014). Caring Science, Mindful Practice: Implementing Watson’s Human Caring Theory by Kathleen Sitzman and Jean Watson. Journal of Hospital Librarianship, 14(4), 410. https://doi.org/10.1080/15323269.2014.950916

Lachman, V. D. (2012). Applying the Ethics of Care to Your Nursing Practice. MEDSURG Nursing, 21(2), 112–116.

Lee, A., S., Deana, N., & Leah, G. (2003). A Clinical Ladder Program Based on Carper’s Fundamental Patterns of Knowing in Nursing. Journal of Nursing Administration, 33(3), 146–152. 

McGovern, B., Lapum, J., and Schindel-Martin, L. (2013). Theoretical framing of high-fidelity simulation with Carpers’s fundamental patterns of knowing in nursing. Jouranl of nursing education, 52(1), 46-9.

Schaefer, K. M. (2002). Reflections On Caring Narratives: Enhancing Patterns of Knowing. Nursing Education Perspectives (National League for Nursing), 23(6), 286.

Watson, J. (2009). Caring Science and Human Caring Theory: Transforming Personal and Professional Practices of Nursing and Health Care. Journal of Health & Human Services Administration, 31(4), 466–482.

Zander, P. E. (2007). Ways of Knowing in Nursing: The Historical Evolution of a Concept. Journal of Theory Construction & Testing, 11(1), 7–11.