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 Carper’s 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

Nursing’s 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

  Nursing’s 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 Self–awareness 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 given situation

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 ◦ Nursing theory

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 John’s (1994) model of structured reflection used Carper’s 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