Carper (1978) Carper (1978) Fundamental patterns of Fundamental patterns of knowingknowing

Knowledge development for a practice discipline

The problem of Nursing as a The problem of Nursing as a practice discipline 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 Why develop patterns of knowingknowing

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 knowledgeKnowing 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 Nursing’s fundamental patterns of knowingpatterns of knowing

Carper (1978)◦ Ethics◦ Personal knowing◦ Aesthetics◦ Empirics

Chinn and Kramer (2008)◦ Emancipatory

Knowing The praxis of

nursing

Ethics: Ethics: the component of moral the component of moral knowledge in nursing 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 Sources of Ethical knowingknowingNursing’s ethical codes and

professional standardsAn understanding of different

philosophical positions ◦Consequentialism◦Deontology ◦Duty◦Social justice

Personal knowing: Personal knowing: acceptance of self acceptance of self that is grounded in self-knowledge and that is grounded in self-knowledge and confidence 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 knowingPersonal 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: Aesthetic knowing: the art of the art of nursing 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 knowingAesthetic knowingPerceiving 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: Empirics: the science of nursingthe 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

understoodA pattern of knowing that draws on traditional

ideas of scienceExpressed 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 knowingEmpirical knowingPositivist science

◦Knowledge is systematically organised into general laws and theories

Source of this knowledge◦Research◦Theory

Emancipatory knowing Emancipatory knowing (Chinn and Kramer)(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 Fundamental patterns of knowing knowing

Emancipatory Ethical

Empiric

Personal

Aesthetic

Methods of turning knowing Methods of turning knowing into knowledgeinto knowledgeProblem 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