Ways of Knowing

LECTURE OBJECTIVES

  • Define and compare Carper's fundamental ways of knowing.

  • Comprehend importance in nursing and practice.

  • Understand significance of praxis and its relationship to emancipatory knowing.

THEORIZING YOUR OWN NURSING PRACTICE

  • Importance of pragmatic theory in nursing:

    • Theories guide the focus, attention, and actions during nursing practice.

    • Nurses should consider the following when evaluating theories:

    • How does it change their approach in nursing situations?

    • How do they perceive and engage with others?

    • What is essential in their nursing practice?

    • How do they relate to themselves and their working environment?

    • What are the experiential values of the theory?

  • Reference: (Doane & Varcoe, 2020)

ALL WAYS OF KNOWING IN NURSING

  • Nursing knowledge encompasses multiple dimensions:

    • Helps deeper understanding of self and practice.

    • Balances nursing as an art and science.

  • Concept of Praxis:

    • Integrated expression of emancipatory knowing.

    • Involves recognizing and addressing injustices in nursing practice.

    • Individual praxis involves identifying injustices and taking action to ameliorate conditions affecting lives.

  • Reference: Chinn & Kramer (2020)

CARPER'S FOUR PATTERNS OF KNOWING

  • Identified by Carper (1978), later adapted by Chinn & Kramer:

    • Empiric

    • Emancipatory

    • Ethical

    • Personal

    • Aesthetic

  • Original patterns (Empiric, Aesthetic, Ethical, Personal) supported by Chinn & Kramer’s adaptation which integrates Emancipatory knowing into nursing.

EMPIRICAL WAYS OF KNOWING

  • Empirical understanding in nursing is based on sensory experiences:

    • Touch, sight, hearing as means of acquiring knowledge.

  • Rooted in scientific methodology:

    • Logical reasoning

    • Systematic hypothesis testing.

  • Assumes an objective reality is accessible and measurable.

  • Reference: Chinn & Kramer (2020)

EMPIRICAL KNOWING EXAMPLE

  • Graduate nurse Chelsea employs empirical knowing:

    • Reviews procedural guidelines for catheter insertion prior to undertaking the task in practice.

  • Reference: Chinn & Kramer (2020)

ETHICAL KNOWING

  • Definition and Importance:

    • Involves clarifying conflicting values and exploring alternatives.

    • Ethical dilemmas may not have satisfactory resolutions, leading to moral distress.

    • Requires experiential knowledge of social values.

  • Key patterns of knowing in nursing are:

    • Empiric

    • Emancipatory

    • Ethical

    • Personal

    • Aesthetic

  • Reference: Chinn & Kramer (2020) adapted from Carper (1978)

ETHICAL KNOWING IMPORTANCE

  • Core of nursing ethics:

    • Focus on obligations and moral judgments.

    • Moves beyond knowledge of codes to active ethical engagement in practice.

    • Shapes moral behavior, defines loyalties, and prioritizes advocacy.

  • Key patterns of knowing in nursing:

    • Ethical

    • Empiric

    • Emancipatory

    • Personal

    • Aesthetic

  • Reference: Chinn & Kramer (2020) adapted from Carper (1978)

ETHICAL EXAMPLE

  • Scenario involving ethical knowing:

    • Nurse Juan in rehabilitation discovers a patient uses legally obtained marijuana for pain control in a state where it is illegal.

    • Ethical dilemma arises whether to report or remain uninformed.

  • Considerations:

    • Engage with the healthcare team

    • Have a conversation with the patient

    • Document findings about the patient's prescription and potential alternatives (e.g., medication-based pain control)

  • Reference: Chinn & Kramer (2020)

AESTHETIC KNOWING DEFINED

  • Fundamental aspects of aesthetic knowledge:

    • Grasping meaning of experiences.

    • Establishing human connections.

    • Performing morally and appropriately (focusing on 'how' rather than 'what').

    • Spontaneous, intuitive response to unpredictable circumstances.

    • Reflection enables growth and understanding of situations.

  • Key patterns of knowing in nursing include:

    • Empiric

    • Emancipatory

    • Ethical

    • Personal

    • Aesthetic

  • Reference: Chinn & Kramer (2020) adapted from Carper (1978)

AESTHETIC KNOWING CONCEPT

  • Significance in nursing:

    • Enables appreciation of the meaning behind experiences.

    • Uses inner strengths to transform care practices into meaningful outcomes.

    • Involves a focus on how care is provided, emphasizing connection to patient experiences.

    • Necessarily involves reflection on health practices:

    • Recognizing the uniqueness of human experiences (sickness, recovery, etc.).

    • Drawing on multiple ways of knowing effectively to inform care processes.

  • Reference: Chinn & Kramer (2020) adapted from Carper (1978)

AESTHETIC KNOWING EXAMPLE

  • Nurse Presley’s approach in the orthopedic clinic:

    • Uses aesthetic knowing to minimize distress when removing casts from children.

    • Understands children see tools as threatening.

    • Employs distraction, humor, and careful timing to ease the process.

    • Importance of handling procedures artfully to ensure children's comfort.

  • Reference: Chinn & Kramer (2020)

PERSONAL KNOWING EXAMPLE

  • Nurse-midwife Luella experiences bias:

    • Holds negative feelings toward young, single mothers due to her background.

    • Acknowledges her bias and strives to accept and empathize with clients.

  • Importance of self-awareness in nursing practice:

    • Impacting patient care positively or negatively.

    • Essential for building therapeutic relationships and minimizing biases

  • Reference: Chinn & Kramer (2020)

EMANCIPATORY KNOWING EXPLANATION

  • Defined as the capacity to critically reflect on societal norms and injustices tied to social, cultural, and political spheres.

  • Focus on benefits and barriers affecting equality in health.

  • Questions posed for analysis:

    • What barriers exist?

    • Needed changes?

    • Who benefits from the current situation?

    • Importance in nursing practice?

  • Reference: Chinn & Kramer (2020)

EMANCIPATORY KNOWING EXAMPLE

  • Nurse practitioner Cherise's realization:

    • Observes a high prevalence of childhood obesity in her practice.

    • Emancipatory knowing leads to understanding the social-political factors affecting health, including market regulations on food targeting children.

    • Engage parents to lobby for better food regulation laws.

  • Reference: Chinn & Kramer (2020)

GROUP WORK DISCUSSION

  • Task: Reflect on addiction and inform knowledge on substance use.

  • Consider different sources that / a nurse's understanding:

    • Empirical

    • Personal

    • Ethical

    • Aesthetic

    • Emancipatory

  • Reflect on challenges faced in the patterns of knowing, particularly in scientific competence or therapeutic use of self.

REFLECTION PROMPT

  • Consider what knowledge is essential for nurses beyond textbooks:

    • Explore sources for this knowledge and its grounding in personal values versus professional values.