Running head: UTILIZING BARBARA CARPER’S “WAYS OF KNOWING” 1

Utilizing Barbara Carper’s “Ways of Knowing” Attributes in the Hospital

Gary A. Parker

Jacksonville State University

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Abstract

In this paper we will explore Barbara Carper’s “Ways of Knowing,” an alternative model of

practice for the nursing profession as a whole. We will discuss a personal example, and then we

will look at Carper’s “Ways of Knowing” and discover how this philosophy is used to guide our

interventions. We will also look into Carper’s concept and focus on how it could be used to

encourage critical thinking with all patient situations we encounter on a daily basis at the

hospital.
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Utilizing Barbara Carper’s “Ways of Knowing” Attributes in the Hospital Attributes in the

Hospital

At Gadsden Regional Medical Center, we focus attention everyday on safety of our

patients while they are in the hospital. It has been 1014 days since our last serious safety event

and this is credited to our staff and our leadership team. Today, we will talk about how our staff

and I know to take the appropriate actions in order to keep our patients safe. We will discuss an

example that happened recently on our unit, and then we will look at Carper’s “Ways of

Knowing” and see how they guided our interventions. We will also look into Carper’s concept

and focus on how that could be used to guide our critical thinking.

Practice Exemplar

Safety has always been at the forefront of nursing care, it is a general understanding that

we are to do no harm to the patient and strive to give them the best treatment while they are at

our facility. On the seventh floor at Gadsden Regional Medical Center, we have several rooms

that are dedicated to patients that have psychiatric conditions, but they need medical treatment

before they can be moved to inpatient psychiatric units. We recently had a situation in which an

elderly patient was admitted to our unit and while doing my leadership rounds, this particular

patient had several risk factors that concerned me. She scored a 100 on the Morse Fall Risk

Scale, she was pulling at her Foley catheter, trying to unwrap her intravenous catheter, and also

had a history of dementia. If proper action didn’t take place, this particular patient was going to

end up falling or hurting herself or others.

The critical actions that were taken to assess the situation were as follows: A complete set

of vital signs were taken, the patient’s blood sugar tested, we addressed sensory needs, we

checked with the multi-skilled technicians to see when the last time the patient had urinated or
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had a bowel movement, we assessed to see if the patient was potentially in pain or discomfort,

we reviewed medications to see if there were potentially any medications that could be causing

the confusion, and then we looked at the patient’s most recent labs to see if she potentially had a

source of infection or is the patient’s sodium was out of normal range. Taking the time to assess

this patient was crucial as to there were several items that we could treat to help decrease some

of the patient’s confusion. The patient had an elevated white blood cell count so we started

intravenous antibiotics, her oxygen saturation rate was low so we placed her on two liters of

oxygen, and her sodium level was low so we placed her on a fluid restriction diet temporarily.

Because we acted promptly, the patient was able to get the treatment necessary to speed up her

healing process and eventually transferred to the inpatient geriatric-psychiatric unit.

Ways of Knowing

In retrospect, acting in the manner that I did to properly care for the patient, a few of Barbara

Carper’s foundational patterns came to mind. First, it was important to look at the esthetics. I

believe that it is imperative to look at the whole patient to properly interpret their behavior

instead of looking at one system. There were seven different assessments completed to attempt to

diagnose the patient’s issues. Second, the actions that were used to help treat the patient were

ethically based and sound decisions. For a confused patient that was attempting to get out of the

bed, restraints could have been a measure that some would have taken, but in my opinion for this

particular case, it would have caused more confusion and frustration for her. We collaborated to

find a solution to allow the patient to have a safe and comfortable recovery. Third, personal

knowledge was used to help care for this patient. This patient was admitted to our unit because

the nurses on our unit are familiar with taking care of this particular population. Our staff is

comprised of specially trained individuals that have patience and can deal with situations like
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this one correctly. They were able to draw from past experiences to know what to look for and

what works well for this population. Our nurses also drew knowledge from the empirics. Our

nurses are aware that 28-35% of adults ages 65 and older fall every year and that number

increases when they are admitted into the hospital due to the fact that they are out of their

comfortable environment and they have contributing illnesses that alter their mental status.

(World Health Organization, 1) Each month we discuss the falls that occur throughout the

hospital and we use this quantifiable information to base our nursing care. Taking care of this

particular individual required us to use the knowledge to think in these four aspects.

Understanding Carper’s concepts to explain interventions.

I believe that it is important to have a foundation of Barbara Carper’s principles to

critically think and be able to explain why we choose to do certain actions pertaining to patient

care and safety. Having the foundation of knowledge helps base our recommendations on sound

ideas that have been proven on our own and through others past experiences. In each situation

that we encounter, Carper’s “Ways of Knowing” impacts our decision in how to proceed. Taking

into account Carper’s focus on personal knowledge, esthetics, the ethically and moral treatment

of a patient as well as the quantifiable data empowers our staff to feel confident in the

interventions concerning patient care.

In conclusion, Carper’s attributes not only guided our interventions as we were dealing

with the patient’s situation that we discussed; it is also important to note that we relied on the

core values with all aspects of the case that we encountered. While it is true that the evidence

presented for all individual cases should base our decisions in every action; it is also important to

stress that we should critically dwell on the core values in Carper’s “Ways of Knowing” to

provide patients with the best quality care. Critical thinking is essential to understanding the
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reasoning behind the knowledge that has been presented to us and we should seek each day to

further our thinking and align it with Barbara Carper’s “Ways of Knowing.”
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References

World Health Organization. (2007). WHO Global Report on Falls Prevention in Older Age, 1.

Zander, P. (2007). Ways of Knowing in Nursing: The Historical Evolution of a Concept. The

Journal of Theory Construction and Testing, 11(1), 7-11.