If you are a BSN or doctorate nursing student or a practicing nurse, having a great deal of knowledge is a vital part of nursing as it guides decision-making and clinical practices. Carper’s way of knowing was developed in 1978 by Barbara Carper to help nurses acquire this knowledge. Understanding these ways of knowing is essential in bringing nursing knowledge and practice together.
In this article, we will explain how nurses come to know something by exploring Carper’s way of knowing and how they apply it in caring for patients.
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Carper analyzed the conceptual structure of nursing knowledge and how, within it, nurses can come to know things about their profession and anything within their practice. Carper identified the following ways of knowing: “(1) empirical knowing, the science of nursing; (2) aesthetics knowing, the art of nursing; (3) personal knowledge in nursing; and (4) ethical knowing, the component of moral knowledge of nursing.
The science of knowing is the most common form of knowing in nursing. It is based on scientific research and utilizes evidence-based practices to understand different concepts and solve nursing issues. It is expressed through facts, models, theories, and descriptive themes,
The following is an example of empirical knowing in nursing.
A nurse is attending to a person with diabetes and notices that their blood sugar level is not dropping despite following the right medical procedures. Immediately, the nurse recognizes the essence of the science of nursing and investigates the issue further. They review the current research students and evidence-based guidelines on how to manage diabetes.
Through the research, they come across a study that identifies a link between high blood sugar levels and increased stress. The nurse then suggests some stress management techniques to lower stress levels and, consequently, blood sugar. They incorporate this into the patient's comprehensive plan, which also involves educating the patient and their family about how dangerous it is for a person with diabetes to be stressed.
Thus, from this example, it is clear how empirical knowledge is crucial in identifying a health factor in a patient that can also help guide nursing interventions.
The primary objective for empirical knowing is the development of nursing theories. It involves the creation and refinement of conceptual frameworks that guide nursing practice. Here are ways in which empirical knowing contributes to nursing practice:
Empirical knowing relies on scientific inquiry and objective data to generate evidence that serves as a foundation for the development of theory. “Objective,” here means that it can be observed, measured, and analyzed.
Empirical knowledge provides the right validation and support that are necessary for supporting a theory. Through empirical research, nursing professionals can gather evidence about the effectiveness of clinical interventions and treatments. This is essential in ensuring all clinical practices are grounded on sound empirical knowledge.
Through empirical knowing, there can be validation and refinement of theories through research studies. Scientistic, collects objective data, designs experiments and analyzes them to determine whether the provided evidence is effective in supporting or refuting nursing theories. Thus, through this process, theories are validated and refined, creating the foundation for more theory development.
Through empirical knowing, researchers can review real-world situations through careful observation and analysis. Through this, they can identify patterns of behavior and trends that lead to the formulation of the hypotheses necessary for predicting future phenomena.
Remember that nursing theories are crucial in identifying the phenomena nurses experience in day-to-day life while caring for a patient, describing the phenomena, and explaining how they can help improve a patient's health.
In essence, empirical knowing is explained through the following skills:
The art of knowing relates to the senses, that is, to feeling and perceiving something. It differs from empirical knowing in that it is expressive rather than descriptive.
Carper identified the esthetics pattern of knowing as a key component in understanding and caring for patients. She suggested that esthetic knowledge includes both motor and intellectual skills necessary for understanding, planning, and intervening in case of any clinical situation. Nurses can form the needs and wants of patients and act on their behalf.
Consider the following example of esthetic knowing in nursing: a child with cancer is admitted for chemotherapy and radiation treatment. The attending nurses notice that the child is visibly agitated and anxious, and on asking, they reveal that they had negative medical procedures in the past. The nurse then immediately understands that the environment significantly influences the child's well-being and could affect the overall treatment.
Through Carper's art of knowing, the nurse takes actions such as creating a soothing environment for the child and developing creative and imaginative way communication and distraction techniques to allow for the treatment to be administered.
Esthetics way of knowing emphasizes nurses having empathy — the capacity to feel what another person is feeling. Nurses can put themselves in their patient's shoes and gain knowledge of what the patient is going through. They can then act on that knowledge to improve the health and wellbeing of the patient. Through an esthetic way of knowing, nurses assess social cues and vital patient signs to understand the best possible ways of caring for patients.
According to Carper, esthetic knowledge is action-oriented and cannot be semantically described. In other words, esthetic knowing is behavioural, but it can be either overt (active behaviour) or covert (cognitive processing). She emphasized esthetic knowledge going beyond observing behaviour and actively gathering information to see something as a whole instead of what there is.
The understanding of self is important in nursing practice. Personal knowledge is concerned with the knowing, understanding and actualizing of a person. It acknowledges that personal knowing is not about knowing about the self but striving to continuously know the self.
Carper described personal knowledge through the following characteristics: (1) subjective, (2) concrete, and (3) existential. Subjective means that knowledge is personal and is based on the perspective of the perceiver. She borrows from Polanyi’s knowledge: Towards a post-critical philosophy, the idea of personate participation to explain that the perceiver plus her moods, attitudes, ideas and opinions form the personal knowledge.
Carper identified knowledge as a result of an "i-though" encounter. Personal knowing is the understanding derived from putting oneself in the standing of another and viewing oneself as a human. In other words, people are who they are in relation to others. The relationship between nurses and patients reflects four dynamics in the nature of personal knowing:
In personal knowing, relationships don't mean intimate relationships. Rather, it includes interactions that nurses have every day with patients. In addition, one can also have relationships with themselves. One can only arrive at personal knowledge through self-reflection and analysis and synthesizing what has been perceived.
According to Carper, nursing is an interpersonal process through interactions and transactions between nurses and patients. Research has shown that patient-nurse relationships can influence how a patient can cope with an illness and become well. Personal knowing states that how nurses view themselves and their patients is crucial in establishing a working nurse-patient relationship.
By understanding the self, nurses can recognize biases and weaknesses that could impact patient care. Personal knowing emphasizes nurses taking time to know their patients and families through difficult health situations. This will give them the sensitivity to address their physical, emotional, and psychological needs.
Consider the following example of personal knowing in nursing:
In a routine checkup, a nurse notices that their patient, who is always bubbly, is withdrawn and becomes restless with each passing time. Through personal knowledge, the nurse realizes that something could be bothering the patient. They then initiate a conversation to understand what the patient is going through. Based on that understanding, the nurse provides emotional support, significantly improving the patient's mood.
From this example, it is evident that the nurse can understand a change in someone's behavior, which they experience in their lives, as an indication of a problem.
Personal knowledge describes an authentic relationship between a nurse and a patient, which can only be achieved when nurses accept others for who they are. Nurses should also understand that an individual is not a fixed entity, but rather one is constantly engaged in the development process.
This fourth way of knowing identifies nurses as superheroes without a moral compass. They are responsible for taking good care of patients and nursing them through recovery while making certain ethical decisions. Nurses and other medical practitioners face ethical dilemmas daily and must make difficult personal choices that could affect a patient. These choices raise questions on what is morally right and wrong about caring for and treating patients.
Carper defines ethical knowing based on the content of knowledge necessary for developing explanations, executing behavioral responses, making inferences, and predicting behavior. She further explains that it concerns matters of obligations and what ought to be done in a given situation. In other words, ethical knowledge is concerned with distinguishing right from wrong. This can be achieved when nurses have the following skills:
Carper further argues that ethical knowing is consciously accessible knowledge crucial for ethical judgments. Examining the codes of conduct to which we determine what is right and wrong must result in awareness of what it takes to make moral choices and be responsible for the choices made. Nurses become distressed if there are no apparent "right choices" in nursing practice.
This knowledge is the fifth pattern of knowing, added to Carper’s 4 ways of knowing. Emancipatory knowledge prepares nurses for the profession by helping them advocate for social justice and human rights for their patients. Nurses should be able to identify injustice or inequity within their community and strive to change the situation by engaging in social and political movements that improve people's lives.
Emancipatory knowing originated from a Nursing Manifesto development that critiqued traditional approaches to nursing. The aim is to ensure healthcare is reformed to promote quality healthcare. Emnaciparoty knowledge encourages the acquisition of the following skills:
Introduced by Chinn and Kramer, emancipatory knowing is described by the characteristics behind the manifestos, like ideas, values, worldviews, and nurse's activism. Through this, nurses are encouraged to do the following:
Furthermore, nurses are encouraged to incorporate ethics, holistic care, and critical thinking in their practices to challenge traditional practice, allowing for a more socially just healthcare system. In other words, the knowing calls for nurses to be social activities.
According to a study by the Ethiopian Journal of Science, Nurses apply patterns of knowing in the following ways:
Based on the results of this study, cohesion of patterns of knowing was identified as the key variable.
When patterns of knowing are integrated with flexibility, it results in the right treatment of patients.
The results showed that in some situations, for example, when helping patients shave their groin, some nurses' inflexibility becomes more evident. In those situations, nurse argues that they cannot do something because of their values, timing, and scope of the tasks.
In critical situations, nurses have been observed applying all of Carper's ways of knowing and emancipatory knowledge appropriately in patient care. On the other hand, there have been situations where nurses don't apply all ways of knowing. In those situations, nurses are not flexible and only insist on their knowledge, scope, and timing.
Nurses may also eliminate some patterns of knowing, thereby providing unethical and unscientific care without therapeutic communication.
The above is evidence that flexibility is the main component of cohesion in patterns of knowing.
Carper's way of knowing has significantly contributed to nursing practice. Thus, every nurse needs to understand these patterns of knowing for the following reasons:
Acknowledge the importance of learning that occurs outside the classroom.
Carper's way of knowing provides a framework that enables continuous professional development. When nurses identify the different dimensions of knowledge, they can look for learning opportunities to enhance their skills and knowledge. This ensures that they stay up to date with clinical practices.
According to research, the relationship that nurses build with patients is highly critical in fostering patient autonomy. By understanding their values and biases and actively listening to patients’ issues and concerns, they can correctly tailor their care and treat them empathetically. Treating patients with empathy allows for mutual collaboration and open communication that allows patients to take an active role in their well-being.
Holistic care is a crucial approach in nursing that addresses the physical, emotional, spiritual, and psychological health of patients. Carper's way of knowing allows nurses to view patients as whole individuals rather than ill segments that need treatment and cure. Following this approach, nurses can promote healing and significantly improve patient outcomes.
Nursing education is essential and dynamic. The ways of knowing discussed above are crucial in helping nursing students and practicing nurses acquire the formal knowledge necessary for clinical practice. Through these, students acquire clinical reasoning skills to help them provide safe, effective patient care. Failing to master Carper’s ways of knowing means that a nursing student’s education is incomplete.
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