Chapter Two

Nursing Fundamental Patterns of Knowing

By Sisay Shewasinad

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• By the end of this session, you will:

– Understand the concept of "Patterns of Knowing" in nursing.

– Explore the four fundamental patterns: Empirical, Ethical,

Personal, and Aesthetic.
– Discuss their application in nursing education, practice, and
research.
– Reflect on how to integrate these patterns into professional
nursing roles.

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 Outline
• Knowing and Knowledge
• Knowledge development and Patterns of
Knowing in Nursing
• Overall process of knowledge development in
nursing

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 Introduction
Definition: "Patterns of Knowing" describe the different ways

nurses understand and apply knowledge in their practice, by

Barbara Carper in 1978

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 Knowing and Knowledge…

• The study of the theory of knowledge is known as Epistemology

• Epistemologic questions include:

– What do we know?

– What is the extent of our knowledge?

– How do we decide whether we know? and

– What are the criteria of knowledge?

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 Knowing and Knowledge
 What is Knowing in Nursing?
– The process of understanding and being aware of phenomena
relevant to nursing.
– knowing refers to the way of perceiving and understanding
self and the world
 Characteristics:
– Dynamic, experiential, and contextual.
 What is Knowledge in Nursing?
– Information, understanding, and skills that nurses acquire
through experience, education, and practice.
– Knowledge refers to knowing that is expressed in a form that
can be shared and communicated to others
 Sources:
– Evidence-based research.
– Clinical experience.
– Interdisciplinary insights.

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 Ways of Knowing in Nursing….
 Varying views of reality lead to different nursing beliefs,

theories, and educational approaches

 Core beliefs affect how you practice nursing

 Your practice must be in harmony with your beliefs about what

is real and true

 Important to know your core beliefs

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 Knowing and Knowledge…

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 Knowing and Knowledge…
Knowledge
Awareness of reality acquired through insight, learning, or
investigation
– Intelligence: Capacity to acquire & apply knowledge;
thinking & reasoning; ability to understand and use language
• Memory: Ability to store & retrieve relevant experience;
part of intelligence
– Learning: Knowledge acquired by instruction or study;
consequence of intelligent problem solving
– Experience: Relates to what we’ve done; It leads to expertise
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 Knowing and Knowledge…
• Data: Unorganized and unprocessed facts; static; a set of discrete
facts about events
• Information: Aggregation of data that makes decision making
easier
– Becomes knowledge with questions like “what implications
does this information have for my final decision?”
– Therefore, knowledge is understanding of information based
on its perceived importance

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 Knowing and Knowledge…
Basic types of knowledge includes:
– Empirical knowledge : scientific knowing, comes from
observation & testing.
– Personal knowledge (a priori knowledge) : pertains to
knowledge gained from thought alone.
– Intuitive knowledge : relies on non-conscious pattern
recognition & experience.
• Includes feelings, hunches
– Somatic knowledge : knowledge of the body in relation to
physical movement.

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 Knowing and Knowledge…
Knowing
• Four ways of acquiring knowledge about the
world:
1. Perception,
2. Language,
3. Reason and
4. Emotion.

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 How do you learn things?

Nobody knows how people learn, but there are many

theories:
• Behaviorism
• Cognitivism
• Social Learning Theory
• Social Constructivism
• Multiple Intelligences

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 How do you learn things?...
Behaviorism
•Learning is defined by the outward expression of new behaviors

•Focuses on observable behaviors, biological basis for learning

Cognitivism
•Knowledge is stored cognitively as symbols

•Learning is the process of connecting symbols in a meaningful &

memorable way.
•Studies focused on the mental processes that facilitate symbol
connection
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 How do you learn things?...
Social Learning Theory
•Learning takes place through observation and sensorial
experiences(Learning from Models)
•Imitation is the sincerest form of knowledge development
•Is the basis of movement against violence in media & video games

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 How do you learn things?...

Social Constructivism
•Framed around metacognition(knowing who you are as a learner,
and developing the capacity to leverage your strengths to your
advantage while purposefully addressing your weaknesses)
•Knowledge is actively constructed by individuals in relation to
past experiences, motivation & our beliefs/attitudes/prior
knowledge
•Learning is a search for meaning by the learner and is the
responsibility of the learner

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 How do you learn things?...
Multiple Intelligences
•Framed around metacognition
•All people are born with eight intelligences:

1. Verbal-Linguistic 5. Musical
2. Visual-Spatial 6. Naturalist
3. Logical-Mathematical 7. Interpersonal
4. Kinesthetic 8. Intrapersonal

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 How do you learn things?...
Generally, Learning occurs in one of three ways:
• By experience: a function of time and talent
• By example: more efficient than learning by experience
• By discovery: undirected approach in which humans explore a
problem area with no advance knowledge of what their
objective is.

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 Nursing Epistemology
• Study of the origins of nursing knowledge, its structure &
methods, patterns of knowing & the criteria for validating its
knowledge claims.
• Social & behavioral sciences and arts rely on other methods to
establish knowledge since scientific processes are not suitable for
creating and describing all types of knowledge.
– Because nursing has characteristics of social and behavioral
sciences, as well as biologic sciences, it must rely on multiple
ways of knowing & has both scientific knowledge &
conventional wisdom.

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 Epistemology
 Epistemology is the branch of philosophy that deals with the
nature, scope, and sources of knowledge.
 Focuses on questions like: What is knowledge? How do we know
what we know?
Key Elements
 Belief
 Truth
 Justification

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Epistemological Approaches in Nursing
•Empiricism:
– Knowledge derived from sensory experience and
observation.
– Strong influence on evidence-based practice.
•Rationalism:
– Knowledge derived from reasoning and logic.
– Important in developing nursing theories and frameworks.
•Constructivism:
– Knowledge is constructed through experiences and
interactions.
– Applied in nursing education and clinical practice.

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 Importance of Knowledge in Nursing

• Enhances patient care quality.

• Promotes critical thinking and decision-making.

• Encourages professional growth and lifelong learning.

• Builds the foundation for evidence-based practice.

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 Integrating Knowledge into Practice

• Reflective Practice: Regularly assess and learn from experiences.

• Evidence-Based Practice: Use current research to inform care.

• Continuous Education: Participate in workshops, seminars, and

higher studies.
• Interdisciplinary Collaboration: Learn from other healthcare
professionals.

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 Challenges in Utilizing Knowledge
• Barriers to accessing evidence-based resources.

• Resistance to change in practice.

• Time constraints in clinical settings.

• Balancing theory with practical application.

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 Role of Technology in Nursing Knowledge

• mHealth applications for patient education and

care.
• Online databases for evidence-based resources.
• Virtual simulations for skill enhancement.

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 Nursing Epistemology…
• Carper (1978) identified 4 fundamental patterns for nursing
knowledge:
– Empirics: the science of nursing, Scientific, evidence-based

– Esthetics: the art of nursing, creativity in care.

– Personal knowledge in nursing, Understanding oneself and

patient relationships.
– Ethics: moral knowledge in nursing, Moral principles guiding
care.

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Sources of Knowledge in Nursing
•Empirical Knowledge (Scientific Evidence):
– Based on research, experiments, and clinical trials.
– E.g., clinical guidelines, systematic reviews.
•Personal Knowledge:
– Based on nurses’ lived experiences and intuition.
– Guides individualized care.
•Ethical Knowledge:
– Derived from values, ethics, and moral reasoning in practice.
– Influences decision-making, especially in complex cases.
•Aesthetic Knowledge:
– The art of nursing—knowing through compassion and
empathy.
– Affects the emotional and relational aspects of care.

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 Patterns of Knowing
Patterns of Knowing: Framework introduced by Barbara Carper in 1978 to categorize
nursing knowledge.
Empirical (The Science of Nursing): Evidence-based guidelines for administering
medication, Systematic, evidence-based, Research, Theory, textbooks, and clinical
guidelines, and scientific knowledge. Application: Evidence-based practice and
clinical decision-making.
Aesthetic (The Art of Nursing): Using creativity to comfort a distressed patient. The
art and creativity of nursing, focusing on empathy and patient-centered care. Sources:
Experience, observation, and intuition. Application: Understanding and addressing
patient emotions and needs.
•Personal (The Self in Nursing): Building trust through empathetic interactions. Self-
awareness and interpersonal connections in nursing. Sources: Reflection and
therapeutic relationships. Application: Building trust and rapport with patients.
Ethical: Upholding patient confidentiality.
•Emancipatory (Social and Political Contexts of Nursing)--- Chinn and kramer (2008)

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 Nursing Epistemology…
Empirical knowledge
•Most emphasized way of knowing since there is a need to know
how knowledge can be organized into laws and theories for the
purpose of describing, explaining, and predicting phenomena of
concern to nurses.
•Is objective, abstract, generally quantifiable, exemplary &
verifiable.
•It draws on traditional ideas that can be verified through
observation and proved by hypothesis testing.
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 Nursing Epistemology…
Esthetic knowledge
•Is subjective, unique & experiential rather than formal or
descriptive.
•It is evident through actions, conduct, attitudes, and interactions
of the nurse in response to another(not expressed in language)
•It relies on perception, is creative and incorporates empathy and
understanding.

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 Nursing Epistemology…
Personal knowledge
•The way in which nurses view themselves and the client.

•Incorporates experience, knowing, encountering, and

actualizing the self within the practice.
•Since it is difficult to express linguistically, it is largely expressed
in personality.

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 Nursing Epistemology…
Ethics
•The moral code for nursing and is based on obligation to
service and respect for human life.
•Ethics must address conflicting norms, interests, and
principles and provide insight into areas that cannot be tested.
•Requires rational & deliberate examination & evaluation of
what is good, valuable & desirable as goals, motives, or
characteristics.

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 3.Process of knowledge development in
nursing

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 Process of knowledge development in nursing
…
Hierarchical structure of knowledge development includes:

A. Metaparadigm

B. Philosophy

C. Conceptual models

D. Nursing theory and

E. Empirical indicators

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 Hierarchies of Nursing Knowledge …
A. Metaparadigms for nursing
•The most abstract & closely mirrors beliefs held about nursing.
•Offers a context for developing conceptual models & theories but
no direct guidance for research & practice since the term may not
be familiar.
•Historically, it described concepts of person, environment, health,
& nursing but alternative concepts are being explored (E.g Kim sets
4 domains focusing on client, client-nurse encounters, practice,
and environment. )

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 Hierarchies of Nursing Knowledge …
B. Nursing philosophy
•Comprises statements of enduring values and beliefs that
address
– The major concepts of the discipline,
– Setting beliefs about what nursing is,
– How to think about and do nursing,
– The relationships of nursing, and
– The environment of nursing.

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 Hierarchies of Nursing Knowledge …
C. Conceptual models (frameworks/ systems) of nursing
•Sets of general concepts & propositions that provide perspectives
on major concepts of the metaparadigm.
•Also reflect sets of values & beliefs, as in philosophical statements
& preferences for practice & research approaches.
•Less abstract than metaparadigm & more abstract than
theories, offering guidance (not distinct direction) to nursing
endeavors.

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 Hierarchies of Nursing Knowledge …
D. Nursing theories
•Describes & explains phenomena of interest to nursing in a
systematic way in order to provide understanding for use in
nursing practice & research.
•Are less abstract than conceptual models, although they vary in
scope and levels of abstraction.

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 Hierarchies of Nursing Knowledge …
E. Empirical indicators
•Very specific and concrete identifiers of concepts.

•Are actual instructions, experimental conditions and procedures

used to observe or measure the concept(s) of a theory.

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 Research Methodology and Nursing Science
• In mid-1900s, quantitative methods were used almost
exclusively in research.
• In the 1980s; when some nurse scholars asserted that nursing’s
ontology (what nursing is) was not being sufficiently explored
using only quantitative methods, qualitative methods began
to be put into use.
• Currently evidence-based practice emerged in response to many
concerns.

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 Discussion Questions
What type of knowledge is used in the following
activities?
– Tying a shoelace
– IM medication administration
– Installing a computer program
– Negotiating to change a schedule with a hostile boss

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 Validity of Knowledge

• Corresponding Theory
• Coherence Theory
• Pragmatic Theory

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Validity of Knowledge - Tests of Truths
• Correspondence Theory:
– theory fits the data collected & analyzed through
research
– if the judgement corresponds with the facts it is true
– method most often used by those working in the sciences
• Coherence Theory:
– places its trust in the consistency of harmony of all ones’
judgments
– a judgment is true if it is consistent with other judgments
that have previously been accepted as true
– there is an agreement on the boundaries, logic &
phenomenon of the theory

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Validity of Knowledge - Tests of Truths

Pragmatic Theory:
– there is NO such thing as static or absolute truth

– people know only their own experiences

– the test of truth is in its utility, workability, or satisfactory

consequences

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 Worldviews (paradigms)

• Explanations given for life events

• All beliefs and values regarding health care are derived from a
person’s basic worldview
• 3 Major Worldviews:
1. Magicoreligious
2. Scientific
3. Holistic

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 Magicoreligious Worldview

• The fate of the world depends on God, gods, or supernatural

forces
• Events can be responsible for illnesses (sorcery, breach of
taboo, disease-causing spirits, loss of soul).
• Relates to a psychic or metaphysical need of humanity for
integration and harmony

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 Holistic Worldview

• The forces of nature must be kept in harmony or balance

• All is connected, inter-related, separate and yet part of a
Whole

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 Axiology, Ethics, Aesthetics
• Axiology: asks “what is of value?”
• Ethics: the study of moral values & conduct
– “what should I do?”
– “what is the best for all?”
– “what is good conduct?”
• Aesthetics: searches for the principle governing the creation of
beauty and art
– imagination & creativity
– the art of nursing

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Application of Epistemology in Nursing Practice
Evidence-Based Practice (EBP): Empirical knowledge guides
clinical decisions and ensures safe, effective care.
Clinical Judgment: Nurses integrate personal knowledge and
reasoning to assess patients and make decisions.
Ethical Decision Making: Epistemology influences how nurses
justify their actions based on ethical considerations and patient rights.

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Epistemology in Nursing Education
•Critical Thinking Skills:
– Educators encourage students to question the nature and
sources of knowledge to develop clinical reasoning.
•Reflective Practice:
– Encourages students to reflect on their experiences to build
personal and professional knowledge.
•Curriculum Development:
– Incorporating epistemological perspectives into nursing
curricula helps students understand the different ways of
knowing and their application.

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Epistemology in Nursing Research
•Research Methodology:
– Epistemological perspectives guide the choice of research
methods (qualitative vs. quantitative).
•Paradigms in Nursing Research:
– Positivist paradigm (empirical evidence) vs. Interpretivist
paradigm (subjective experiences).
•Ethical Considerations:
– Understanding the epistemological underpinnings of nursing
research helps in addressing issues of informed consent,
confidentiality, and the role of the researcher.

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Challenges in Epistemology in Nursing
•Balancing Different Ways of Knowing: Nurses may struggle to
integrate empirical knowledge with personal or ethical knowledge.
•Cultural Influences on Knowledge: Different cultural backgrounds
may affect how nurses perceive and apply knowledge.
•Over-reliance on Scientific Knowledge: There may be a tendency to
prioritize empirical knowledge at the expense of the emotional or
relational aspects of care.
Discussion Points
•How does your personal experience as a nurse shape your
understanding of epistemology?
•What challenges do you face when trying to integrate different types
of knowledge in practice?
•How can we ensure a balance between empirical knowledge and
personal, ethical, or aesthetic knowledge?

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