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An Interview With
Dr Barbara A. Carper
Elizabeth R. Eisenhauer, RN, BSN, MLS
In 1978, Dr Barbara A. Carper’s foundational work, “Fundamental Patterns of Knowing in
Nursing,” arguably created a paradigm shift in nursing. However, her voice has been absent
from the nursing literature in recent years. I was privileged to conduct a personal interview
with Dr Carper in 2014. The edited interview includes a synopsis of her background, career
trajectory, sources of inspiration, and her perspective on the current state of nursing. She
reaffirmed her passion for reflective nursing practice, the importance incorporating the arts
and humanities into nursing education, and using an integrated approach with the patterns of
knowing in nursing. Key words: caring, Carper, epistemology, nursing practice, nursing
theory, patterns of knowing, technology, ways of knowing
73
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ANS1010 April 22, 2015 6:32
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
ANS1010 April 22, 2015 6:32
our 55th class reunion. The College of Nurs- miles north of Dallas, but they had a clini-
ing there was 1 of the very earliest 4-year pro- cal campus in Dallas and a clinical campus in
grams in Texas. I think I was in either the first Houston. They had expanded tremendously
or second class. I deliberately chose Texas since I had graduated. I was there for quite
Women’s University because I wanted to go some time. My last position there, I was a di-
to a women’s college. In the 1950s that was rector of their PhD program.
sort of against the grain. Most people my age EE: And then you went to New Hampshire
after high school wanted to go to the larger after that?
coed university but I just thought there would BC: Yes, my husband and I decided to make
be more opportunity at a women’s college that move for family reasons. We moved to a
to make choices that you might not other- small town in New Hampshire and for the
wise have made; to concentrate on what you first 2 years we were there I commuted to
were really interested in and I was able to take Maine—to Portland—the University of South-
advantage of some of those things—the mu- ern Maine. Two very good friends of mine
sic, some of the athletics, however, limited (we had been classmates at Columbia), one
because the nursing program was extremely was the dean [Audrey Conley] and one was
time consuming. We went 12, well 11 months the associate dean [Carla Mariano], somehow
a year, for 4 years. or other persuaded me to make that commute
Then I did some clinical nursing and from every week from New Hampshire to Maine.
my experience there I became very interested The University of Southern Maine had a fairly
in being a nurse anesthetist. So I did go to the young graduate program, a master’s degree
University of Michigan, to the Medical School program, and so I went there for 2 years to be
there in Ann Arbor. It was either an 18-month director of the graduate program—the mas-
or a 2-year program certification (in those ter’s degree program—and particularly en-
days, it wasn’t a degree program but a certifi- joyed it, but the commute particularly in New
cation program) and finished there and took Hampshire winters was stressful.
my certifying exams as a nurse anesthetist. I I decided the commuting was too much.
did that for quite a few years and I liked it very There was a small, private, liberal arts col-
much, but quite frankly, after several years I lege Colby-Sawyer in the town where I was
missed the patient contact. You had very brief living—New London, New Hampshire. They
contact, you spent hours with them but they had just started a nursing program—I think it
were unconscious and then they were gone. I was 2 years previously—and the person who
always wondered, “how did they do?” “What had started that program was resigning. So
happened to them after we took them out I took that job. That was almost building it
of the recovery room?” So I decided then to from the ground up. They hadn’t even got-
go back and get a master’s degree. I went ten to the point where they’d gotten the state
to Teachers College at Columbia University board of nursing approval so that was an enor-
in New York and obtained my master’s de- mous challenge and extremely time consum-
gree. Then I went from New York to New ing, but it was a wonderful setting! Nursing
Mexico to teach! Well, I wanted to see some- in the middle of this liberal arts college was
thing different. I loved New York. I just took [something] they didn’t quite understand. So
to Manhattan like a duck to water but thought I set about making connections with the lib-
I’d try something different. eral arts people, the humanities people, and
EE: And then did you teach in Texas? they were a wonderful group of people and
BC: Yes, after I finished my doctorate I very soon I felt at home and at place there.
went back to Texas Women’s University to And the nursing faculty! If I had hand-picked
the faculty there. By then it was quite a large them I could not have gotten a better group.
program; they had not only the program on So that was a wonderful experience, working
the main campus, which was in Denton few with all of those people, the nursing faculty
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ANS1010 April 22, 2015 6:32
and people particularly in the sciences that that I became aware of some of the personal
were so critically important for the nursing concerns I had about what the curriculum fo-
program. cused on, what we went about emphasizing,
I was there until ‘89. Once our daughter fin- and in some aspects what we ignored or paid
ished college, again, for personal reasons, my little attention to or placed little importance
husband and I decided to go further south and on from a practice perspective. Science, and
after some exploration and looking around— the science of nursing, had become the focus
we came to the University of North Carolina at at that point in time. I think it would be a bit
Charlotte, which had a very good undergrad- of an exaggeration to say that there was such
uate program and had, a few years before, a strong focus on the science that there was
established a graduate program master’s de- an exclusion of everything else, but science,
gree. They needed some experienced faculty the science of nursing, became “the elephant
and I saw a wonderful opportunity! I love to in the room.” But in my mind everything that
go into programs that are growing and chang- surrounded nursing, that I thought was im-
ing rather than those that have reached the portant to the practice of nursing, seemed to
point where they think they are perfect and have become less important to the students,
nothing needs to be altered. So, again, this almost to the point where they thought, “it
was just like me going to New Mexico, when doesn’t count” or “if I don’t have time for
I came to the University of North Carolina at that it doesn’t matter” and that bothered me
Charlotte, and I stayed there until I retired in very much because I thought there was more
1999. to nursing practice than the way we were
approaching it at that point in time. After a
while, I decided, “there is something miss-
INSPIRATION AND INFLUENCE ing here I would like to explore some more.”
So that’s when I decided to go back and get
EE: It is fascinating to hear about you, my doctorate from Columbia, again, Teachers
Dr Carper. The fact that you were working College, Columbia.
with unconscious patients, I wonder how EE: You mentioned something was “miss-
you think that influenced the “patterns of ing.” What was missing? Can you please pro-
knowing”? vide an example?
BC: Well, I’d never thought about it that BC: A lack of consideration of ethics was
way. I could say, certainly, spending so many missing from both education and practice.
hours with an unconscious patient constantly There was no real time devoted to the teach-
monitoring and caring for in a way but with- ing of ethics. In nursing education, ethics was
out any communication between us, it prob- frequently restricted to teaching the Nightin-
ably did lead to why I decided to go back gale pledge. It was more rule-oriented than
[to school]. That was for me a very important principle-oriented, in terms of the morality of
missing link—the patient. I decided it really [one’s] actions. Very few people were pre-
was important enough to do something differ- pared to address ethics at that time. But there
ently. As I said, I enjoyed the nursing; being were very real, ethical, and moral concerns
a nurse anesthetist, it was also very demand- that I observed in practice.
ing but again, it was just that missing link. For example, it was common, accepted
I wanted to be conscious and present with practice—not fully informing patients about
another conscious and present human being their condition or their treatment. Informa-
who I was caring for. tion was frequently omitted. I can recall sev-
EE: So what do you think inspired you to eral instances of patients not being informed
write about the “ways of knowing”? that they had a terminal illness, and their fam-
BC: It was at the University of New Mexico, ilies were not informed either! That was very
when I was teaching there [mid to late 1960s] disturbing to me, and it wasn’t just a few
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ANS1010 April 22, 2015 6:32
patients, that was the standard at the time. So, yes there have been a lot of people and
Most health care workers at that time did not books and ideas that have influenced me—
see it as an ethical issue. Of course, clinicians that, as we all do, I just sort of . . . I thought
varied; some provided more information than about them sometimes over a period of sev-
others. Some providers omitted information eral years, and it became incorporated in
that would have been very important about my perspective without stopping to cite the
making choices in terms of treatment. source, so to speak.
So, for me, developing the patterns of There were several people too, after I
knowing was a response to intellectual and wrote my dissertation. There have been some
personal concerns to clarify and express that people, too, writing independently of me but
nursing practice was more than science; nurs- I think they were very often on the same track.
ing practice was not limited to that. One of them in nursing is Pat Benner. When I
EE: Did other fields or theorists impact or read her book9 I thought, “Oh she got it. She
influence your work? got it!”
BC: In college, I became interested in phi- EE: Yes. I was wondering what other nurs-
losophy and I did a considerable amount of ing theorists you favor. You were a contem-
reading just because I liked it. And over time, porary of people like Watson and Leininger.
history, too, became something I very much Did they influence your work at all or did you
enjoyed reading and learning about. I don’t know each other?
mean dates, but intellectual history, cultural BC: Oh, yes in fact in the early days most
history, and there were some professors at of us knew each other! It was a small group
Columbia who influenced me. I took more so most of us knew each other one way or
courses than I had to because it intrigued me. the other. And it was amazing . . . some of the
I took some philosophy courses, and at the discussions we’d have. You know, we’d go
time there was a wonderful professor of phi- to a conference or a meeting and there’d al-
losophy who did, I think, enormously influ- ways be some of the others there and the con-
ence me in my dissertation6 —Phil Phenix.7 versations we’d have over the dinner table!
He’s deceased now but I took his course, Yes, yes. Peggy Chinn and I were colleagues
which probably had a major influence on for quite some time. She is one of those peo-
what I decided I was going to do with my ple that we could, you know, sit down over
dissertation.6 There was another professor at lunch or whatever and have the most won-
Columbia that taught a course in cultural his- derful conversations!
tory, which I thoroughly enjoyed. I took 2 or 3 EE: I often think your views are much in
philosophy courses at Columbia and enjoyed line with Dr Peplau’s work.
every one of them. I particularly remember BC: Oh, yes, I knew her. Not as well as I
Dr Phenix.7 knew some of the others but she was a re-
History reinforced the notion in my mind markable woman. In fact they all were; we
of context, how important context is. One were all remarkable in our day and time! The
professor that I took a course from wrote an whole army of us!
article called “Meaning in Context: Is there EE: I’m sure that was fascinating. What do
any other kind?”8 And that really made me you think was going on in the late 1970s or
stop and think because, of course, there re- early 1980s that generated so much new nurs-
ally isn’t, particularly when you are talking ing theory at the time?
about relationships with human communica- BC: This was when nurses started getting
tion. Anything in which one has to relate to an- interested in going back for graduate degrees.
other, context becomes critically important. That was probably a large part of it. Also,
But context is also important in science. You in my mind, what accounted for such a fo-
don’t disregard the context in terms of inter- cus, almost a laser focus, in some regard, for
preting the data. several years on developing the science of
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ANS1010 April 22, 2015 6:32
nursing was because quite frankly, in those BC: Yes. I had several phone calls from
days, science was what had the status. If it other universities from the ethics professors.
wasn’t science you didn’t get money for re- He said, “I’ve heard this, do you really do this?”
search. No one paid attention in so many ways And I said, “Yes, I do!” And it engaged stu-
if it wasn’t science, if it wasn’t data based. dents because it was interesting, these were
In many ways, this wasn’t bad because it did doctoral students; almost none of them had
help in the beginning to get the momentum read Frankenstein.10 And they couldn’t imag-
going, but it excluded everything else. Who ine why I would require that. So, it really got
knows what other people might have done their attention. It worked!
at that time that would have been of value EE: I’m sure it did. I find that fascinating.
that wasn’t science. So, like most other things BC: That was one of the joys of teaching
in life, it was a blessing but it also had its that I could have interaction with many more
limitations in that it excluded a lot of other people than I would have had in other circum-
things that may have developed earlier than stances, to get them to stop and think. What
they did. does being a nurse mean to you? What do you
EE: We’ve talked about who inspired you, think you need to know to be a nurse? And it’s
you sound very inspired by the humanities not just science and it’s just not the technol-
and liberal arts . . . . ogy. You need to know that, but if you stop
BC: And that’s still very much a part of my at that you will never be a very good nurse.
life. I think it continues to inform how I live
my life. I very much enjoy music. I listen to
music a great deal. I have expanded my lis- THEORY AND PRACTICE
tening repertoire over the last several years,
as well as my reading; I still manage to read EE: Some authors consider your patterns of
quite a bit in a variety of areas—history, cul- knowing a theory [see, eg, reference #4].
tural and intellectual philosophy, philosophy Do you consider that a theory?
itself, and I have encountered some biogra- BC: Absolutely not.
phies. I love biographies; it’s actually fascinat- EE: No? Okay. Can you talk a little bit about
ing, some of these biographies, like Einstein— the difference?
I was just fascinated with that one. Some fic- BC: Well, to me it’s, shall we say a cultural
tion, too, I have found interesting. I always or intellectual philosophy of nursing, not a
used literature in my teaching because litera- theory. It was never intended to be that way.
ture and prose, as well as poetry, can distill It was never an expectation of mine. I was sim-
a certain kind of experience and context that ply, at that point in my life, saying to myself—
most of us would never experience. And to “What is nursing? What is the practice of nurs-
me, that is then expanding your skills and un- ing? And what is required to be a skillful prac-
derstanding of other people’s lives, you know, titioner?” And a lot of that in my immediate
[being] able to interpret how you might re- past came out that the way we were teach-
spond and what they would find most helpful ing nurses in those days it was the science—
from you. I have found literature very, very period—and of course some of the clinical
helpful. skills. But I think that’s what I was ultimately
In fact, I had several phone calls from fac- resisting. I was saying—the science, yes, it is
ulty when I went back to teach at Texas important, but that isn’t nursing, period.
Women’s University. I was teaching in the EE: Do you feel like your work has been
doctoral program and developed a course in incorporated into curriculums to the fullest
ethics, and one of the required readings in extent that it can be?
there was Frankenstein!10 BC: Well, I don’t know. I know certainly
EE: Oh. In fact, you write about that in one it has been incorporated into several cur-
of your papers, I believe3 . . . . riculums. I’m not in a position to say how
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ANS1010 April 22, 2015 6:32
successful they have been in how they have that has to be taught, but again you have to
integrated it. Once you publish something begin with the basics. If you are going to learn
it’s a matter of someone else’s interpretation. an instrument you have to learn the notes, you
And how do you go about using it, which have to learn how to read written music. Then
is fine, I have no objection. I think one of you have to learn the particular instrument
the things, though, a couple of curriculums and you have to put them together. It’s a mat-
I had knowledge of in the past—how they ter of integrating everything you’ve learned
have gone about incorporating it is the art of before into what you’ve learned now and I
nursing—which in my mind is the practice— think a practice is like that too. That’s why,
which incorporates all of the other parts. It’s once you take music lessons or if you take art
something you can only introduce a student lessons, after 2, or 3, or 4, years you’re not a
to, because I think to become an effective Rembrandt or a Picasso.
practitioner and to develop the art of your Once you finish an undergraduate or even
practice take years and years of conscious at- a master’s program, that doesn’t make you a
tention. Not just years of going to work, but master necessarily. Now some people manage
years of looking at your practice, in all aspects. to move faster than others, I think, in terms
And that’s something that doesn’t just happen of developing their own set of artful skills and
by the time you finish an undergraduate pro- combinations in their practice. And with oth-
gram or even for many even when they finish a ers, it takes longer and some, I can testify,
graduate program. And I think I became very, never, never get to that point.
very conscious of that in terms of what they EE: You must have opinions about the 2
were attempting in some of these programs year degree programs.
in terms of the art. Now I think you have to BC: Well, they are really, in terms of what I
introduce a student; in a sense, it’s like learn- see as an accomplished and experienced prac-
ing any other art as a beginner. Either painting titioner, they are real beginners, in terms of
or learning how to play a musical instrument, the practice. For many people, it’s the only
you have to begin with the very basics as you opportunity they have to get started. It’s what
do in nursing—the science, the social aspects. they do to develop their own practice after
The liberal arts, the literature, supporting hu- that that really counts.
manities become critically important later. I
think most undergraduate students see that
as, “well this is something we have to do be- TECHNOLOGY AND THE CURRENT
cause they say we have to do it, but I don’t STATE OF NURSING
know what it has to do with nursing,” and that
disturbs me because often we don’t make it EE: When you wrote “The Ethics of
apparent to them. Caring”3 you talked about caring decreasing
What does it have to do with nursing? First when technology increases, and I wonder
of all, it has to do with you as a person, as what your perspective is on the current state
a human being. As a practitioner, you are a of affairs in that regard? Do you see that pre-
very critical element in the environment, in diction having come true?
the context, and are very different from the BC: I do, unfortunately, to a very large ex-
person next to you or the other person next tent. The last several years I have spent 24/7
to them or from the patient you are providing looking after my husband and on several oc-
care for, and that becomes a very, very impor- casions he did require hospitalization. I did
tant aspect. I think we don’t make that as evi- get to observe some of the nursing and there
dent as we might possibly be able to do with was certainly more than 1 nurse—he was in 2
an undergraduate because, again, we are try- different hospitals, so it wasn’t just a particu-
ing to educate on so many things and 4 years lar environment—with their computers, their
is not a long time when you look at everything portable computers on wheels. They would
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ANS1010 April 22, 2015 6:32
come in the room and would be there maybe doctors—nurses should be a little more tuned
3, or 4, or 5 minutes before they ever looked in about what has happened [to the patient]
at him. I would just sit there and observe and in the hospital. The changes that have been
say to myself, “I don’t believe this!” Then they made or the expectations and how are they
would give the medications, or the injections, [patients] going to manage? Are they going
or check his IV, and that was it, out the door. to be able to manage? Do they really under-
I was personally, as a nurse, very disturbed stand what that means? What will that mean
about that. to the patient once they get home? What kind
I found some of the nurses’ aides much of help will they have?
more tuned in to the human being in the One of the things I accomplished when I
bed than the nurses were . . . about being com- came to the University of North Carolina was
fortable, making observations, or listening to to negotiate clinical placement at a small hos-
what he was saying. Particularly in hospi- pice in Charlotte for some of the students. I
tals now very few people actually listen to thought that kind of experience, when you
what the patient is saying. You know, they are caring for someone you know cannot be
say, “well we’ve got your medical history.” cured, what then does nursing practice re-
That disturbs me too—that so very often quire? For me, that was an enormous learning
medical professional people do not listen, experience. The students were self-selected
do not allow the patient to tell their story, and I thought that would work best, that they
about their illness. You can learn an awful would benefit the most from that kind of a
lot by listening to the patient’s story of their practice environment.
illness. EE: Yes. So what is your answer to that
In response to your question about tech- question?
nology in medical and nursing practice, it has BC: It depends on the context and the per-
made an enormous difference. Even going to son and who you are, because everyone, even
the doctor’s office, they’re sitting there with when they are dying, dies in their own way.
their back turned, with their fingers on the The only easy answer is if they’re unrespon-
keyboard, looking at the computer, with few sive and unconscious, then it’s clear that it’s
exceptions, and if that happens more than about comfort, comfort measures, and then
twice, I find another doctor. Turn around and you turn your attention to the family—what
look at me! Listen to me! do they need?
EE: Yes. It’s very difficult. Going to the doc- The more I have informed myself in
tor, that was one of my questions for you—in terms of practice and the more experience I
your experience as a patient is nursing care acquired—and this is going to sound strange,
what you think it ought to be? And what I’m but—the less able I am to give a direct and
hearing is no, it’s not. simple answer to a question that involves an-
BC: For the most part it isn’t. But it could other human being.
be! I have encountered excellent, excellent, So I do think [nursing] could be [what it
what I would call artists in the practice of ought to be]. But technology is very alluring,
nursing. For the most part they have been particularly now that some of the younger
nurse practitioners. I don’t know if that kind nurses grew up with it. It’s just part of their
of person is attracted to the nurse practitioner lives. It’s kind of like when I saw some of
program or as a result of their experience and these nurses in the hospital come in and stare
their set of skills they become much a differ- at their computer screens for 5 minutes be-
ent kind of nurses. They do listen; sometimes fore looking up to see the human being in
they are the only one to listen. They let the the bed. It reminded of some of these—well,
patient tell their story. I say teenagers, but some of them are even
And one of the other things about nurses younger—that tweet each other when they
in hospitals—doctors too, but doctors are are in the same room!
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ANS1010 April 22, 2015 6:32
EE: Yes. I have a question here about that about 6 months ago I unplugged my com-
how you feel texting, for example, has af- puter! If I really, really need one, if it would
fected human relationships because I know make a big difference, I go to the library and
a lot of people think that has sorely impacted use theirs.
nursing.
BC: This is my personal opinion—I think,
and I’m certainly not antitechnology, I think CONTRIBUTION
it’s an extremely critical thing, very impor-
tant in many regard, but as far as substitut- EE: Your paper “Fundamental Patterns of
ing e-mail and texting [for face-to-face com- Knowing in Nursing”1 has been cited over
munication] if that constitutes 90% of your 1800 times according to Google Scholar as of
communication with other human beings, I yesterday.2
think that has an enormous impact because BC: My goodness!
“the other” becomes a faceless entity. And EE: I don’t know if you are aware of that,
yes, particularly when you start doing that but it’s phenomenal. So talk to me about what
when you are 12 years old, I think that has you feel is your most enduring contribution to
an enormous impact on how children that nursing science at this point.
age growing up in terms of how they relate BC: I would say my major contribution was
to other people and the skills they develop not just to nursing science but was to the
in relating to other people or that they don’t practice of nursing, and that contribution was
develop in relating to other people, I’ll put it to get nurses, and those who taught nurses, to
that way. think about something more than the science,
EE: What is your vision for nursing at this in terms of what is the practice of nursing.
point? That was always my end point, the practice.
BC: Learning to nurse in a totally different When you make the practice of your profes-
environment and context is one of the things sion the focus, then that informs everything
I think is a challenge to nursing today. How else. It informs the science—okay, given this
to incorporate and utilize existing and yet [to practice, what do we need to be doing re-
be] invented technologies without losing the search about? Not the other way around. Not,
critical elements of the practice; without for- “we are doing this research” then “how do
getting that the end point for all of this is a hu- we change the practice to fit it?” To me that’s
man being, a patient. The technology doesn’t the wrong way around.
exist in and for itself. It’s a tool to use in the EE: Do you have any other comments about
assistance, diagnosis, treatment, and the sup- the patterns of knowing or your other schol-
port of a human being. arly work?
EE: So it sounds to me like, instead of staring BC: Regarding the patterns of knowing, I
at the computer screen, you’d like someone was surprised and gratified that it received
to come in and look someone in the eye and the attention that it did. I had certainty not
greet them and listen to their story and go expected that! I thought it would disappear
from there. into the archives and accumulate dust like so
BC: Well, yes. What I’m saying is, they many dissertations do. I think one reason for
should do it all! Don’t get rid of the computer, the attention is that it demonstrated that we
definitely not, but just incorporate into the are not limited to one kind of knowledge or
context so that it becomes one piece of the way of knowing. I think that resonated with
furniture, so to speak; one of the aids or tools. experienced clinicians in their practice, but it
One of the things I find very interesting is that probably wasn’t discussed much. They agreed
computers were supposed to be time saving. that we do require different kinds of know-
I don’t find that. My experience has been ex- ing . . . all of value but different ways . . . it’s
actly the opposite. In fact, so time consuming not “either or,” but all of them.
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ANS1010 April 22, 2015 6:32
EE: Talking to you certainly is fascinating, about you and I think your point of view is
Dr Carper. I think there are an awful lot of still very relevant and very important. Thank
people who would like to know something you for allowing me to do this interview.
REFERENCES
1. Carper BA. Fundamental patterns of knowing in nurs- Columbia University Teachers College; 1975:176.
ing. Adv Nurs Sci. 1978;1(1):13-24. http://pocketknowledge.tc.columbia.edu/home.
2. Google Scholar. http://scholar.google.com/. Ac- php. Accessed October 13, 2014.
cessed July 27, 2014. 7. Phenix PH. Realms of Meaning. New York, NY: Mc-
3. Carper BA. The ethics of caring. Adv Nurs Sci. Graw Hill; 1964.
1979;1(3):11-20. 8. Mishler EG. Meaning in context: is there any other
4. Fawcett J, Watson J, Neuman B, Walker PH, Fitz- kind? Harv Educ Rev. 1979;49(1):1-19.
patrick JJ. On nursing theories and evidence. J Nurs 9. Benner P. From Novice to Expert: Promoting Excel-
Scholarsh. 2001;33(2):115-119. lence and Career Development in Clinical Nurs-
5. Hart CW. Biography as an art form: the story of Helen ing Practice. Menlo Park, CA: Addison-Wesley;
Flanders Dunbar, M.D., Ph.D., B.D., and Med. Sci. D. 1984.
J Relig Health. 2014;53(3):778-788. 10. Shelley MW. Frankenstein; or, The Modern
6. Carper BA. Fundamental Patterns of Knowing Prometheus. London, England: Lackington, Hughes,
in Nursing. [EdD dissertation]. New York, NY: Harding, Mavor, & Jones; 1818.
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