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Carper (1978) Fundamental patterns of knowing

Knowledge development for a practice discipline

The problem of Nursing as a practice discipline


Nursing involves processes of dynamic interactions Nurses in practice know more than they can communicate to others Historically what nurses know has not been communicated well Empirical knowledge only partially reflects nursing knowledge This can be improved when all forms of knowing are integrated and valued

Why develop patterns of knowing

The aim of Carpers theory was to:


Formally express nursing knowledge Provide a professional and discipline identity Convey to others what nursing contributes to healthcare Create expert and effective nursing practice

Knowing and knowledge

Knowing and knowledge


Knowing refers to the way of perceiving and understanding self and the world Knowledge refers to knowing that is expressed in a form that can be shared and communicated to others

Nursings fundamental patterns of knowing

Carper (1978)
Ethics Personal knowing Aesthetics Empirics

Chinn and Kramer (2008)


Emancipatory Knowing
The praxis of nursing

Ethics: the component of moral


knowledge in nursing

Guides and directs how nurses conduct their practice Requires


Experiential knowledge of social values Ethical reasoning

Focus is on:
Matters of obligation, what ought to be done Right , wrong and responsibility Ethical codes of nursing Confronting and resolving conflicting values, norms, interests or principles

Sources of Ethical knowing


Nursings ethical codes and professional standards An understanding of different philosophical positions

Consequentialism Deontology Duty Social justice

Personal knowing: acceptance of self that


is grounded in self-knowledge and confidence

Concerned with becoming self-aware


Selfawareness that grows over time through interactions with others

Used when nurses engage in the therapeutic use of self in practice


Scientific competence, moral/ethical practice, insight and experience of personal knowing

Personal reflection
Informed by the response of others

Openness to experience

Personal knowing
Personal knowing needs to be integrated or reconciled with professional responsibilities Personal Knowing is the basis of the therapeutic use of self in the nurse patient relationship

Perceiving self feelings, and prejudices within the situation

Aesthetic knowing: the art of


nursing

Expressed through:
Actions, bearing, conduct, attitudes, narrative and interaction Knowing what to do without conscious deliberation

Involves:
Deep appreciation of the meaning of a situation Moves beyond the surface of a situation Often shared without conscious exchange of words Transformative art/acts Brings together all the elements of a nursing care situation to create a meaningful whole

Aesthetic knowing

Perceiving the nature of a clinical situation and interpreting this information

To respond with skilled action


It uses the nurses intuition and empathy

Is based on the skill of the nurse in a

Empirics: the science of nursing

Based on the assumption that what is known is accessible through the physical senses: seeing, touching and hearing.
Reality exists and truths about it can be understood

A pattern of knowing that draws on traditional ideas of science Expressed in practice as scientific competence
Competent action grounded in scientific knowledge including theories and formal description Involves conscious problem solving and logical reasoning

Empirical knowing

Positivist science
Knowledge is systematically organised into general laws and theories

Source of this knowledge


Research Theory

Emancipatory knowing (Chinn and Kramer)

Emancipatory knowing addresses the social and political context of nursing and healthcare and critiques the four fundamental patterns of knowing It recognises serious social barriers to health and well-being Emancipatory knowing requires an understanding of the nature of knowledge Praxis is the process of emancipatory knowing. It requires both critical reflection and action

Fundamental patterns of knowing


Empiric

Ethical

Emancipatory

Personal

Aesthetic

Methods of turning knowing into knowledge

Problem based learning


An instructional method in which students work in small groups Used to gain knowledge and acquire problem-solving skills.

Clinical Supervision
An exchange between practicing professionals to enable the development of professional knowledge and skills

Structured reflection on practice


Johns (1994) model of structured reflection used Carpers fundamental patterns of knowing Section 5 of the model considers learning gained from the experience. It asks how has this experience changed my ways of knowing?
Empirics/ Aesthetics/Ethics/Personal