2. 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
3. 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
4. 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
5. Nursing’s fundamental patterns
of knowing
Carper (1978) Chinn and Kramer
◦ Ethics (2008)
◦ Personal knowing ◦ Emancipatory
◦ Aesthetics Knowing
The praxis of nursing
◦ Empirics
6. 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
7. Sources of Ethical knowing
Nursing’s ethical codes and
professional standards
An understanding of different
philosophical positions
◦ Consequentialism
◦ Deontology
◦ Duty
◦ Social justice
8. 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
9. 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
10. 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
11. 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
12. 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
13. Empirical knowing
Positivist science
◦ Knowledge is systematically organised
into general laws and theories
Source of this knowledge
◦ Research
◦ Theory
14. 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
16. 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
