The four patterns of knowing as identify by Carper, are empirics, esthetics, personal knowledge

and ethics. More recently, Chin & Kramer (2008) added the fifth, emancipatory knowing
(Jackson, 2009). As stated by Carper (1978), these patterns represented the complex
phenomenon of knowing that nurses use when caring for their patients. Chin & Kramer added
emancipatory knowing to address the issue of equality, justice, and transformation in all areas of
practice to include nursing leadership. The five patterns of knowing when used together are
beneficial to nursing leadership theory, specifically because they were developed by nurses and
for nurses.

Empirics: According to Carper (1978); Fawcett et al (2001), empirics leadership knowing is

based on the science of nursing and includes a body of empirical knowledge that is based on
research and systematically organized. They noted that empirical knowing is factual, objective
and can be verified by “outcome measures” (Jackson, 2009). The postpositivist and interpretive
paradigms have attained a welcoming approach in nursing as paradigms for guiding knowledge
development (Alligood & Tomey, 2010). For Carper (1978), empirical knowing is how we came
to understand the science of nursing and other disciplines that are used in the practice of nursing
(Jackson, 2009).

Esthetics: Carper (1978), defines the esthetic knowing as the art of nursing. It is the creative and
imaginative use of nursing knowledge in practice as stated in Jackson (2009). This pattern of
knowing encompasses non-verbal expressions, therapeutic actions, unconditional presence, and
empathy. As stated by Parker & Smith (2010), each nurse is an artist, expressing and interpreting
the guiding theory uniquely in his or her practice. One needs to reflect on the experience of
nursing to enhance the understanding of esthetic knowing. Only through such reflection, the
nurse understands that each instance of nursing is unique, and that outcomes of nursing cannot be
precisely predicted (Parker & Smith, 2010). Esthetic knowing gives meaning to the wholeness of
experience.

Ethical Knowing: As stated by Parker (2010), ethical knowing is increasingly important to the
discipline and practice of nursing today. According to Carper (1978), ethics in nursing is the
moral component providing guidance for choices within the complex structure of health care.
Ethical knowing guides and direct nurses in doing what’s right, doing what’s ask of them, and
what a prudent nurse should or most under any circumstances. Ethical nursing plays a pivotal
role in every action taken by the nurse in his/her daily undertaking. Nurses are expected to
maintain a high level of professionalism and to maintain their ethical standards at all times.
Respect for human dignity, right to self-determination, relationships with peers, accountability
and responsibility for own actions, self-respect, influence of environment on nurses,
advancement of the profession and assertion of values are all included in the code of nursing
ethics (Jackson, 2009).

Personal Knowing: Carper (1978), describes personal knowing as striving to know the self and to
actualize authentic relationship between the nurse and the one nursed. By applying this pattern of
knowing in nursing, the nurse sees the patient as a person heading toward attainment of potential,
rather than viewing the individual as an object (Jackson, 2009). As stated by Jackson (2009),
personal knowing encompasses consistency between what one knows and what he/she does.
Reflecting on a person as a client and a person as a nurse in the nursing situation can foster
understanding of nursing practice and can centrality of relationships in nursing.

that outlines four guidelines to help nurses meet patients' needs

to help nurses gain a more holistic approach to assessing, understanding and treating patients.
Carper's theories have made a widespread impact and are still used in medical facilities across
the world.

Aes Awareness of the immediate situation, seated in immediate practical action; including
awareness of the patient and their circumstances as uniquely individual, and of the combined
wholeness of the situation.
Professionals define themselves in terms of what knowledge they possess and seek to acquire.
Have you ever considered how nurses add to their knowledge base? Barbara Carper (1978)
identified four fundamental patterns of knowing that form the conceptual and syntactical
structure of nursing knowledge. These four patterns include: personal, empirical, ethical, and
aesthetic knowing. Let’s look at how these ways of knowing can assist you in your pursuit of
knowledge as a nursing student.

PERSONAL knowing refers to the knowledge we have of ourselves and what we have seen and
experienced. This type of knowledge comes to us through the process of observation, reflection,
and self-actualization. It is through knowledge of ourselves that we are able to establish
authentic, therapeutic relationships as it propels us towards wholeness and integrity (Chinn &
Kramer, 2015). When you began to study nursing, what knowledge did you possess? Consider
what you have learned since–in your personal life, in school, and through practice.

We gain EMPIRICAL knowledge from research and objective facts. This knowledge is
systematically organized into general laws and theories. One of the ways we employ this
knowledge is through the use of evidenced-based practice (EBP). This way of knowing is often
referred to as the “science” of nursing (Chinn & Kramer, 2015). Can you relate how study
findings have changed your nursing practice?

ETHICAL knowing helps one develop our own moral code; our sense of knowing what is right
and wrong. For nurses, our personal ethics is based on our obligation to protect and respect
human life. Our deliberate personal actions are guided by ethical knowing . The “Code of Ethics
for Nurses” (American Nurses Association, 2015) can guide us as we develop and refine our
moral code. Can you think of an occasion that you needed to make an ethical decision? If you are
like many practicing nurses, you make several every single day.

The final way of knowing identified by Carper (1978) is AESTHETIC Knowing. Aesthetic
knowing makes nursing an “art.” It takes all of the other ways of knowing and through it creates
new understanding of a phenomena. Aesthetic knowing is that “aha” moment that we have when
we uncovered something new; and just as an artist creates a painting, you are afforded the
opportunity of new perspective. Consider a time when you had an “aha” moment. How did you
come to that discovery?

The practice of nursing is a holistic, human discipline. The ways of knowing allow us to
understand ourselves and nursing practice at a much deeper level; to appreciate nursing as both
an art and a science. Consider how the ways of knowing can assist you in being a better person, a
better student, and a better nurse.
arper's first principle, "Empirical," focuses on factual scientific evidence and proven medical
documentation used to treat patients. Most of this scientific knowledge comes from textbooks, training
and practical experience gained in hospitals and medical facilities, under the leadership of educators and
licensed nurses or doctors. For example, through observation and practice, nurses learn how to find
veins, insert intravenous fluids or medications, check vital signs, give immunizations and aid doctors in
medical procedures. Empirical knowing encourages nurses to use fact-based approaches to address
patient needs.

he second principle, "Personal," takes nursing to a whole new level. Nurses must learn to empathize
with patients and their families as they face difficult illnesses or injuries. Carper encourages nurses to
put themselves in their patients' shoes, so they will have the sensitivity and awareness to address not
only physical needs, but mental and emotional ones too. Personal knowing is the "understanding and
actualization of a relationship between a nurse and patient," says registered nurse Pamela Cipriano,
PhD, in "American Nurse Today."

The third principle, "Ethical," is one of the most difficult to incorporate into a medical setting because
people hold different values and expectations. Moral and ethical decisions are made on a daily basis in
most hospitals, and Carper realized that these influences couldn't be overlooked. Family members often
have to make difficult decisions, such as when to end life support, whether the side effects of
chemotherapy are worth the risk, if surgery is the right choice or if they want the doctor to try to save
the mother or the baby in a difficult delivery. Nurses must learn to be sensitive to the moral values of
others, especially if patients and family members hold values different from their own.

Carper's fourth topic, "Aesthetic," is often the most difficult to apply to the nursing field because there
are so many factors at play. This principle deals with a nurse's ability to effectively perceive a patient's
needs. Nurses must be able to evaluate and assess patient needs at any specific point in time, without
looking solely to future hopes or goals. For example, a nurse must be empathetic to a patient's pain
tolerance level even when she knows the person isn't in any immediate danger and will soon recover.
Or, a nurse must sympathize with a patient's fears and anxieties about getting inoculations or local
anesthetics, even when she knows the short-lived pain is well worth the long-term benefits. Nurses
must be patient with each person's individual recovery process and create personalized plans to help
them get through it.