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Nursing 101: Fundamental Patterns of Knowing in Nursing Colette JarvisCollege of New Caledonia – Quesnel CampusJudy Crain 11 March 2015Nursing 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 NursingRashid (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 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 NursingAesthetics, 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). 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 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 KnowledgeTo 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).Personal KnowledgePersonal 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)Socio-Political KnowledgeNursing is a moral practice that takes place within a social, economic, cultural, and political context. Community Health Nurses Association of Canada (2008) stated, " Socio-political 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 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 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). ReferencesAvolio,?C.?D. (2014). Political advocacy: Beliefs and practices of registered nurses. 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Contemporary nursing wisdom in the UK and ethical knowing: difficulties in conceptualising the ethics of nursing. Nursing Philosophy, 15(1), 50-56. doi:10.1111/nup.12028Potter,?P.?A., Perry, A.G., & Kerr,?J.?C. (Eds.).(2014). Canadian fundamentals of nursing (5th ed.). Toronto: Elsevier Canada. Portillo, M. C., & Cowley, S. (2011). Working the way up in neurological rehabilitation: the holistic approach of nursing care. Journal Of Clinical Nursing, 20(11/12), 1731-1743. doi:10.1111/j.1365-2702.2010.03379.xRashid, M. (2013). The Question of Knowledge in Evidence-Based Design for Healthcare Facilities: Limitations and Suggestions. Health Environments Research & Design Journal (HERD) (Vendome Group LLC), 6(4), 101-126.Sumner II, W., Schootman, M., Asaro, P., Yan, Y., & Hagen, M. D. (2008). Measurement of nursing’s complex health care work: Evolution of the science for determining the required staffing for safe and effective patient care. Nursing Economic$, 28(4), 197-204. doi:10.10020chp.186Watson, 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. White, S., & Siebold, C. (2008). Walk a mile in my shoes: An auto-ethnographic study. Contemporary Nurse: A Journal For The Australian Nursing Profession, 30(1), 57-68. ................
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