Barbara Carper says, “It is the general conception of any field of inquiry that ultimately determines the kind of knowledge the field aims to develop as well as the manner in which that knowledge is to be organized, tested and applied” (Carper, 1978). It is Barbara Carper who developed the four fundamental patterns of knowing in nursing and they are; empirics, esthetics, personal knowledge and ethics (Carper, 1978). In this paper I will provide clinical interventions that I have used for my patients and explain how they are relevant. Empirics; the science of nursing (Carper, 1978).
According to Merriam-Webster online, “empirical is 1. Originating in or based on observation or experience, 2. Relying on experience or observation alone often without due regard for system and theory, 3. Capable of being verified or disproved by observation or experiment. ” (Merriam-Webster, 2013) I believe this to be congruent with evidenced based practice (EBP). For example, ventilator associated pneumonia or foley catheter associated urinary tract infections. Both of these are preventable if we use EBP. For ventilator patients in ICU, it is important to do oral care every 2 hours and endo-tracheal suctioning when necessary.
Patients with foley catheters need to have the necessity of the catheter evaluated daily and discontinue as soon as possible. Also, sterile technique is important upon insertion as is daily perineal care. In the ICU I worked in, we would track these infections on a monthly basis. This was a good indicator if we were effective in our patient care. I believe these to be a demonstration of empirical knowledge because they are proven by evidence based practice. According to Carper, Esthetics is the art of nursing (Carper 1978). Aesthetic knowledge is subjective and intuition based.
It is recognizing and appreciating the unique qualities of individual patients, as well as responding with compassion and understanding to help both patients and their families. For example, I had a patient of was a rape victim who did not want to be medically examined. Every time I walked into the room she was sitting on the floor in the corner crying. She said she didn’t remember what happened and she just wanted to go home. I took time to talk with her and explain to her the importance of doing an exam so we could determine what happened and she finally agreed.
I spent over 9 hours with her, gathering evidence, listening to her, talking with her and allowing her to just sit there and cry. I was compassionate, non judgmental and protective. After that night, I believed my profession truly was an art. The component of personal knowledge in nursing is the most problematic, the most difficult to master and to teach, according to Carper. (Carper 1978). This means drawing on first-hand experience and self awareness. Giving a diabetic short acting insulin when he or she comes into the ER for an elevated blood glucose is a good example.
Medical research has shown this to be an effective form of treatment. If the patient, doesn’t have congestive heart failure (CHF) or kidney disease, then we usually give them one to two liters of 0. 9% normal saline which is proven effective even without insulin in certain circumstances. If a hyperglycemic patient comes into the ER, I will start a peripheral IV and hang IV fluids (after reviewing their history) before the physician sees the patient. This is a good example of personal knowledge because I’m relying on past experience to treat my patient’s hyperglycemia.
Lastly, ethics; the component of moral knowledge in nursing (Carper 1978). This knowledge refers operating within a framework of ethical standards and to be able to recognize or judge what is correct when there is no textbook answer. An example of this is when I was working in the ICU and my patient was in multi organ failure with a very poor prognosis. I had to discuss the possibility of a DNR order with the family. Unfortunately, the family did not see that the risks outweighed the benefits and would not sign a DNR. I had to uphold my ethical duty of treating the patient as if he had a good prognosis.
I did everything I would have done on any other patient; draw labs, draw ABGs and call the physician with the results and carry out new orders. Even though the effort on my part was futile, I upheld my ethical responsibility of doing what I could for him. The family did finally sign the DNR after the patient coded twice. In situations like that, it’s very challenging to get the family to understand our views as medical professionals. I hope my personal experiences have been clear examples of each of the, Fundamental Patterns of Knowing in Nursing.