Patterns of Knowing in Nursing

Nursing education has evolved greatly over the years, in the mid-19th century, nursing was seen as a mothering and homemaking role; today nursing has a more scientific base (Peplau, 1986). Nursing is much more than following doctors’ orders and performing comfort care. Nurses must be able to apply different aspects of knowledge into their care in order to provide quality care to their patients. According to the American Nurses Association (2014), nursing is the protection, promotion and optimization of health and abilities; nursing includes the prevention of injury and alleviation of suffering through diagnosis and treatment, and advocate in the care of the individual, families and community.

The purpose of this paper is to identify the four patterns of knowing and the importance of implementing them into patient care.

According to Carper (1978), there are four fundamental patterns of knowing in nursing which are essential for the teaching and learning of nursing which involve critical analysis of what it means to know, and the type of knowledge that is most valuable in the discipline of nursing.

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The four patterns of knowing are empirics, ethics, personal knowledge, and esthetics. Carper (1978) defines empirical knowledge as being factual, descriptive and ultimately aimed at developing abstract and theoretical explanations. This type of knowledge would include the knowledge learned through theory and application of scientific evidence which is learned through textbooks and classroom settings. Knowledge that is gained through empirical description can by formulated and publically verifiable. The ethical pattern of knowing focuses on matters of moral obligation which goes beyond the knowing of norms or ethical codes of discipline; it includes voluntary actions which are deliberate and subject to judgment of right or wrong (Carper, 1978).

Ethical knowledge guides how nurses confront and resolve conflicting issues and requires application of ethical reasoning.

Personal knowledge is the pattern of knowing which is concerned with encountering and actualizing of the individual self. Personal knowing is concerned with becoming self-aware and having personal reflection when caring for the patient (Carper, 1978). Personal knowing is the most problematic and difficult pattern to master since it requires having the ability to analyze an event from the perspective of another through the use of reflection (Nursing Pedagogy, n.d.). Esthetic knowledge involves application of empathy, perception, and acknowledgement of the value of everyday experiences lived by individuals. Esthetic knowledge involves the “art” in nursing. Esthetic knowledge is gained through experience and includes the use of intuitions (Berragan, 1998).

Application of the four patterns of knowledge is essential to the professional nurse in order to provide quality care. Empirical knowledge in nursing theory refines and enhances the structural foundation in the nursing curriculum thus enhancing the viewpoint of the science of nursing in a global perspective (Kalofissudis, 2007). Ethical knowledge for the professional nurse involves matters of moral obligation, the use of the ethical code of nursing, and application of social justice when caring for their patients. Nurses apply personal knowledge through personal reflection and are able to demonstrate to patients that the nurse understands what they may be going through and can help interpret some of their decisions and experiences in such a way that can aid in the patients understanding of a difficult situation (Nursing Pedagogy, n.d.). The aesthetic pattern of knowledge is considered the art in nursing as it is based on the skill of the nurse in a given situation and transpires in the effectiveness of the nurse-client relationship (Peplau, 1988). Without a positive nurse-client relationship the nurse may face many barriers in attempting to care for their clients.

Reflecting on how the use of aesthetic knowledge was used in my nursing experience I am able to realize how important having a positive nurse-client relationship is. I had a patient who was newly diagnosed with diabetes and according to his chart he was noncompliant with his diet and medications. In interviewing he patient I learned that he did not have a good understanding of what the diabetic diet entailed, he mentioned that he didn’t understand why his sugar would be elevated if he was not eating that much and avoided candy. I sat down with the patient and we made a food log of what he had consumed over the last two days, he mentioned he would have a small breakfast which included bacon and white toast, he stated he usually would not have lunch and his dinner included fried chicken with macaroni and cheese. I explained to the patient how managing his blood sugar was not only avoiding sugar, but also balancing proteins and carbs and eating throughout the day.

I gave him a booklet with diet recommendations and encouraged him to keep a log of what he ate. This patient mentioned how I was the first one to take the time to sit with him and explain how diabetes works. From then on his treatment was more effective and his hemoglobin A1c had decreased from eight to six within three months. I was able to use my intuition in acknowledging that this patient was not purposely being noncompliant but rather had knowledge deficit on how to manage his new disease. As nursing continues to evolve into a more autonomous field, nurses must be aware of, and be able to apply all four patterns of knowing into their practice. As mentioned by Idczak (2007), science provides the nurse with knowledge on which to base decisions but it remains for the arts and humanities to direct the nurse to examine the value of his or her practice. .

References
American Nurses Association (2013). What is nursing. Retrieved from
http://www.nursingworld.org/especialyforyou/what-is-nursing Berragan, L (1998). Nursing practice draws upon several different ways of knowing. Journal Of
Clinical Nursing,7(3), 209-217
Carper, B. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing

Science, 1(1), 13-23.
Idczak, S. E. (2007). I am a nurse: Nursing students learn the art and science of nursing. Nursing Education Perspectives, 28(2), 66-71. Kalofissudis, I. (2007). The theory of nursing knowledge. Health Science Journal, 1(4) Retrieved from http://www.hsj.gr/volume1/issue4/editorialkalof.pdf Nursing Pedagogy.
(n.d.). Introduction to nursing pedagogy. Retrieved from http://nursingpedagogy.com/intro.html

Peplau, H. E. (1988). The art and science of nursing: Similarities, differences, and relations. Nursing Science Quarterly, 1(1) 8-15.

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