Transcript Nursing`s fundamental patterns of knowing

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
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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
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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
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Carper (1978)
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Ethics
Personal knowing
Aesthetics
Empirics
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Chinn and Kramer
(2008)
◦ Emancipatory
Knowing
 The praxis of nursing
Ethics: the component of moral knowledge
in nursing
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Guides and directs how nurses conduct
their practice
Requires
◦ Experiential knowledge of social values
◦ Ethical reasoning
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Focus is on:
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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
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Consequentialism
Deontology
Duty
Social justice
Personal knowing: acceptance of self that is
grounded in self-knowledge and confidence
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Concerned with becoming self-aware
◦ Self–awareness that grows over time through
interactions with others
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Used when nurses engage in the
therapeutic use of self in practice
◦ Scientific competence, moral/ethical practice, insight
and experience of personal knowing
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Personal reflection
◦ Informed by the response of others
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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
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◦ Perceiving self feelings, and prejudices within
the situation
Aesthetic knowing: the art of nursing
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Expressed through:
◦ Actions, bearing, conduct, attitudes, narrative and
interaction
◦ Knowing what to do without conscious deliberation
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Involves:
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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
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Perceiving the nature of a clinical situation
and interpreting this information
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To respond with skilled action
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It uses the nurses intuition and empathy
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Is based on the skill of the nurse in a
given situation
Empirics: the science of nursing
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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
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◦ Competent action grounded in scientific knowledge
including theories and formal description
◦ Involves conscious problem solving and logical
reasoning
◦ Nursing theory
Empirical knowing
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Positivist science
◦ Knowledge is systematically organised into
general laws and theories
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Source of this knowledge
◦ Research
◦ Theory
Emancipatory knowing (Chinn and
Kramer)
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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
Aesthetic
Personal
Methods of turning knowing into
knowledge
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Problem based learning
◦ An instructional method in which students work in small groups
◦ Used to gain knowledge and acquire problem-solving skills.
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Clinical Supervision
◦ An exchange between practicing professionals to enable the
development of professional knowledge and skills
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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