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Patterns of knowing: Review, critique, and update
Abstract
Carper's patterns of knowing in nursing have been consistently cited in the nursing literature since they appeared in 1978. The degree to which they represent nursing knowledge in the mid-1990s is explored, and a major modification is suggested--the addition of a fifth pattern, sociopolitical knowing. The article also suggests modifications to the model for nursing knowledge put forward by Jacobs-Kramer and Chinn to enable this model to be used more effectively as a framework for exploring processes of inquiry into nursing knowledge and practice.
... Para entender qué es enfermería y la naturaleza de sus fundamentos filosóficos, se requiere un amplio ámbito de conocimiento que procede de las perspectivas humanísticas y científicas (White, 1995). El cuerpo de saberes que sirve de fundamento para la práctica tiene patrones, formas y estructuras que dan expectativas a los horizontes de la disciplina, entenderlos es esencial para la enseñanza y el aprendizaje de enfermería, este entendimiento no proyecta la amplitud del conocimiento, pero llama la atención sobre la cuestión relativa al significado de conocer y sobre las clases de conocimiento que se pueden determinar y que aportan de manera, más significativa, al conocimiento de enfermería (Velandia-Mora, 1998). ...
... Esta autora propone que el conocimiento de enfermería puede ser organizado a partir de lo personal, estético, ético y moral. Por consiguiente, la profesión de enfermería se interesa en las actividades que desarrollan y canalizan sus practicantes para lograr la promoción y el mejoramiento de la salud y el bienestar de los seres humanos (White, 1995). Desde la perspectiva de la disciplina, el cuerpo de conocimientos y su experiencia en la interacción con las necesidades del ser humano, permiten orientar sus esfuerzos a desarrollar una profesión con posiciones críticas hacia lo social. ...
... Sin embargo, se señala como práctica profesional incluyendo el entendimiento de la sociedad de enfermería y sus políticas. Este patrón no se considera tan inmediato en la relación enfermerapaciente, en tanto va más allá de su espacio institucional (White, 1995). ...
El objetivo de la investigación se basó en analizar los patrones de conocimiento sociopolítico asociados a la disciplina y práctica de la profesión en enfermería. Basado en una metodología de corte bibliográfico – documental; donde la hermenéutica se constituyó en la principal fuente de generación de información y con un diseño fue no-experimental. El corpus del estudio lo constituyeron las lecturas relacionadas a teorías en enfermería, contenidas en diferentes textos, artículos científicos y de opinión disponibles en la web. Se pudo evidenciar transversalidad en el patrón de conocimiento socio-político, dado que permite conocer y reconocer el contexto desde una perspectiva holística, permitiendo trasformar sus políticas y leyes en materia legislativa propias de la salud y el ejercicio de la profesión de la enfermería.
... Historically, the patterns of knowing have been applied within the context of client care, and some have argued that the introspective focus has limited the profession's ability to attend to the social, political, and economic forces and structures required to improve health. 9,27 However, given that the patterns of knowing within a discipline are in constant evolution and subject to be transformed, 32 situating them within the policy advocacy context is possible. While sociopolitical knowing and emancipatory knowing seem to be more relevant to policy advocacy, I suggest that Carper's 28 original patterns of knowing can also be applied to this domain of practice to illustrate the unique and distinct perspectives that nurses bring to frame policy content. ...
... Sociopolitical knowing, introduced by White, 27 illustrates the importance of knowledge about the contexts and environments in which nurses and clients exist, and the influence of power on health and well-being. White 27 suggests that this type of knowing not only involves understanding the sociopolitical context of persons, but also of nursing, the profession's understanding of society and politics, and society's understanding of nursing. ...
... Applied to policy advocacy, this involves examining how power and politics impact society's structures. 27 Emancipatory knowing, on the other hand, involves the ability to be aware of social injustices and inequities, and engage in critical reflection and action to address the historical, social, cultural, and political determinants of health that contribute to inequities. 29 Within nursing, emancipatory knowledge has been emphasized by theorists, as it provides nursing with the ability to answer questions of "what ought to be" in addition to "what is." 39(pp119) Applied to policy advocacy, nurses who enact this knowledge pattern can address the structural determinants of health and wellbeing and influence the framing of policy issues and solutions by raising consciousness, shining a light on health inequities and social injustices, and connecting elements of experience and context to change the status quo. ...
Nursing policy advocacy continues to be recognized as a key part of a nurse’s role by
educators, professional associations, and regulators. Despite normative calls on nurses to
engage in political action and advocacy, limited theories, models, and frameworks exist to
support this practice within nursing. Using Walt and Gilson’s Health Policy Triangle Framework, this article explores the theoretical underpinnings of policy advocacy to enhance nursing’s contemporary role in advancing social justice. Specific consideration is placed on the type of nursing and policy knowledge and perspectives required to understand policy content, contexts, processes, and actors.
... Com maior ou menor formalismo, o conhecimento de enfermagem tem sido submetido a descrições e classificações das quais as mais difundidas são os padrões de conhecimento propostos, em 1978, por Carper, e posteriormente atualizados por White (4)(5) . Os próprios escritos de Nightingale foram submetidos à análise para se verificar se os padrões de conhecimento teriam validade como um sistema de descrição e classificação do material (6) . ...
... Formaram a base categórica referencial os modelos históricos da formação de enfermagem e os padrões de conhecimento da enfermagem propostos por Carper (4) e atualizados por White (5) . No modelo histórico, foi utilizada a concepção da implantação de um modelo nightingaleano de formação, específico para enfermeiras brasileiras no Brasil, a partir da década de 1920, com a reforma sanitária. ...
... No modelo histórico, foi utilizada a concepção da implantação de um modelo nightingaleano de formação, específico para enfermeiras brasileiras no Brasil, a partir da década de 1920, com a reforma sanitária. No modelo epistemológico de categorização do conhecimento de enfermagem, foram usados os cinco padrões de conhecimento, segundo a classificação de Carper (4) , atualizada por White (5) : empírico, ético, pessoal, estético e sociopolítico (4)(5)9) . ...
Objective:
to identify evidence of nursing patterns of knowing disseminated by the Brazilian press before the implementation of Florence Nightingale’s model in Brazil and categorize topics of journalistic articles according to Carper’s and White’s patterns of knowing.
Methods:
categorical content analysis of materials related to Florence Nightingale, published in Brazil between 1850 and 1919, collected at Hemeroteca Digital. Four analysts identified themes of journalistic article, performing classification in patterns of knowing.
Results:
there was a predominance of evidence of the sociopolitical pattern followed by the empirical pattern. In the analyses per decade, ethical and aesthetic patterns showed predominance between 1860 and 1870, respectively.
Conclusion:
White’s classification by nursing patterns of knowing was useful in understanding precursor themes of professional/disciplinary knowledge that spread in Brazil, linked to Nightingale’s character, in addition to the repercussions of her actions and her expanded sociopolitical perspective.
... After reviewing the titles and abstracts of these studies, 51 additional studies were excluded. Of the remaining 196, 91 were eliminated for not being original studies since they did not include the subject of study (cultural competence/students), reflect cultural awareness and Train and avoid discrimination Clark et al., 2011;Lenburg, 1995;Lipson and Desantis, 2007;Meleis and Trangenstein, 1994;Meleis, 2010Chiarenza, 2012Ingleby, 2012;Sealey et al., 2006;Purnell, 2005; Ibarra Mendoza and González, 2006Taylor et al., 2011Maddalena, 2009;White, 2006;Atxotegui, 2000;Repo et al., 2017;Garneau, 2016;Meydanlioglu et al., 2015;Flood and Commendador, 2016;Bohman and Borglin, 2014;Jeffreys and Dogan, 2012;Bentley and Ellison, 2007;Allen, 2010 Cultural knowledge ...
... In North American contexts, to promote cultural competence, it has been developed specific teaching modules, such as the Culturally Competent Nursing Modules, proposed by the Office of Minority Health, and became a standard criterion of the Joint Commission for the accreditation of hospitals (White, 2006;Govere et al., 2016). Due to the increase of the immigrant population, with the consequent effects on the society, a similar module has been used in Spain, specifically in the city of Barcelona, in university training (Master), to promote the acquisition of cultural competence (Atxotegui, 2000). ...
When assessing the fragility that characterizes the health of an immigrant person, a culturally competent transformation of the nurse–patient teaching-learning process is necessary. Therefore, it is considered essential to incorporate cultural competence and intercultural communication in higher nursing education.
Objective
To determine the content and knowledge of cultural competence and intercultural communication offered in higher education in nursing courses.
Design
The Campinha-Bacote model of cultural competence was used as the primary reference.
Method
A scoping review was conducted about studies published in the period 2003 and 2020. The research was conducted between May and October 2020. More than a hundred documents (books, chapters, articles, conference proceedings) have been consulted.
Results
Undergraduate nursing courses and postgraduate education move toward promoting cultural competence and sensitivity through teaching strategies.
Conclusions
Teaching projects that combine multiple competencies are more effective, including teacher training. A predominant element is a need for continuous and transversal projects. University nursing education must adapt culturally competent curricula.
... Las tablas, a su vez se presentan como una propuesta de estructura y organización de datos para el análisis de narrativas de estudiantes y profesionales que deseen hacer uso de ellas. Cabe resaltar, desde la propuesta de estos autores que pueden ser contemplados más patrones del conocimiento, por ejemplo, el sociopolítico 21 ¿Cómo funciona? Mediante la aplicación del conocimiento en el protocolo de atención y la colaboración con otros profesionales de la salud. ...
... Carper [13] described four fundamental patterns of knowing in nursing: empirics (i.e. the science of nursing), aesthetics (i.e. the art of nursing), ethics (i.e. the moral component of nursing), and personal knowing (i.e. the self and other in nursing). White [14] reexamined the four patterns of knowing and proposed the fifth pattern: sociopolitical knowing, which focused nursing knowing on the sociopolitical context of persons and nursing. Chinn and Kramer [15] further developed the knowing and came up with emancipatory knowing with the aim to challenge and change social and political injustice or inequity. ...
... Philosophically, we refer to this as our patterns of knowing, which originally included empirics, aesthetics, personal, and ethical knowing. 2 Other patterns of knowing, such as emancipatory, sociopolitical, and unknowing, have since been described in our discipline. 3,47,48 To date, there has been much debate on the value of one pattern over another, specifically among the patterns of empirics and aesthetics. 49 This essay is guided by the * Essay author: Chole Littzen assumption that not one pattern of knowing is of greater value in itself, but that in unity there is strength. ...
The crucible of the COVIDicene distills critical issues for nursing knowledge as we navigate our dystopian present while unpacking our oppressive past and reimagining a radical future. Using Barbara Carper's patterns of knowing as a jumping-off point, the authors instigate provocations around traditional disciplinary theorizing for how to value, ground, develop, and position knowledge as nurses. The pandemic has presented nurses with opportunities to shift toward creating a more inclusive and just epistemology. Moving forward, we propose an unfettering of the patterns of knowing, centering emancipatory knowing, ultimately resulting in liberating the patterns from siloization, cocreating justice for praxis.
How advanced practice nursing is defined primarily emanates from nurses’ basic functions and responsibilities, where traditional nursing tasks are preserved, but also includes some functions and responsibility areas that have been expanded to an advanced level. To facilitate recognition of the role, its practice, and its implementation in a country’s health system as a whole, each country should clearly define what an advanced practice nursing role entails. Through definitions it is possible to identify new roles, including new areas of responsibility and limitations, in clinical practice. Definitions provide an overview of the type of nursing, care, treatment and services that can be expected from the person engaging in a certain practice. In this chapter, the concept “advanced practice nursing” is described and defined from an international perspective. Thereafter follows a brief introduction to the Caring advanced practice nursing model and how it and its central concepts can be defined, as well as a reflection on the difference between the specialist and advanced levels.KeywordsDefinitionAdvanced practice nursingCharacteristicsCaring advanced practice nursing model
The view of knowledge that is taken in a discipline and professional domain is determinative for its research, practice, and education. In this chapter, a three-dimensional view of knowledge related to the development of advanced practice nursing is presented, as an area of research in nursing science, nursing professional practice, and higher education. The three dimensions part of this view of knowledge are epistêmê, which is theoretical-scientific knowledge; technê, which is practical knowledge; and phronesis, which is practical wisdom. A nurse’s advanced clinical skills are a synthesis of these various forms of knowledge and are revealed through his/her approach to a patient or the patient’s family and through concrete nursing and care for the patient’s best. The three-dimensional view of knowledge is related to Kim’s view of knowledge domains and related to nurses’ advanced clinical competence as knowledge in action.KeywordsView of knowledgeEpistemologyAristotle
Epistêmê
Technê
PhronesisKnowledge in actionKnowledge synthesis
Comparing the practice of nurse practitioners to medical practice began almost 50 years ago and continues to this day. This comparison is curious since the founders of this movement did not indicate that these advanced practice nurses were to be interchangeable with physicians. Nevertheless, substantial literature indicates that nurse practitioners perform equally or better when measured against physician practice standards. This paper compares the ontology and epistemology of both professions and concludes that the philosophical foundations are so different that comparisons are illogical.
Background:
The Covid-19 pandemic has significantly impacted organizational life for nurses, with known physical and psychological impacts. New graduate nurses are a subset of nurses with unique needs and challenges as they transition into their registered nurse roles. However, this subset of nurses has yet to be explored in the context of the Covid-19 pandemic.
Purpose:
To explore the experiences of new graduate nurses entering the profession in Ontario, Canada, during the Covid-19 pandemic approximately one year after entering the profession.
Methods:
Thorne's interpretive description method was utilized.
Findings:
All participants identified as completing second entry nursing programs, offering a unique perspective on new graduate nurse transition. Four themes emerged in the data: 'Virtual Didn't Cut It,' 'Go Where You Know,' 'Picking Up the Pieces,' and 'Learning When to Say No and Let Go.' Participants felt ill prepared to enter the profession and were cognizant of the various challenges facing the nursing profession, and how these pre-existing challenges were exacerbated by the pandemic. They acknowledged the need to protect themselves against burnout and poor mental health, and as such, made calculated early career decisions - demonstrating strong socio-political knowing. Half of the participants had already left their first nursing job; citing unmet orientation, mental health, and wellbeing needs. However, all participants were steadfast in remaining in the nursing profession.
Conclusions:
Second entry new graduate nurses remain a unique subset of nurses that require more scholarly attention as their transition experiences may differ from the traditional trajectory of new graduate nurses.
PurposeThe purpose of this synthesis of qualitative studies is to explore manifestations of ambiguous loss within the lived experiences of family caregivers (FCG) of loved ones with cancer. Grief and loss are familiar companions to the family caregivers of loved ones with cancer. Anticipatory loss, pre-loss grief, complicated grief, and bereavement loss have been studied in this caregiver population. It is unknown if family caregivers also experience ambiguous loss while caring for their loved ones along the uncertain landscape of the cancer illness and survivorship trajectory.Methods
We conducted a four-step qualitative meta-synthesis of primary qualitative literature published in three databases between 2008 and 2021. Fourteen manuscripts were analyzed using a qualitative appraisal tool and interpreted through thematic synthesis and reciprocal translation.ResultsFive themes were derived, revealing FCGs appreciate change in their primary relationship with their loved ones with cancer, uncertainty reconciling losses, an existence that is static in time, living with paradox, and disenfranchised grief. The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous research.Conclusions
The
results of this synthesis of qualitative studies complement the
descriptors of ambiguous loss presented in previous theoretical and
clinical research. By understanding ambiguous loss as a complex and
normal human experience of cancer FCGs, oncology and palliative care
healthcare providers can introduce interventions and therapeutics to
facilitate caring-healing and resiliency.Implications
for Cancer SurvivorsUntreated
ambiguous loss can result in a decrease in wellbeing, loss of hope,
and loss of meaning in life. It is imperative that cancer FCGs
experiencing ambiguous loss are recognized and supported so that they
may live well in the family disease of cancer.
Objetivo: Analizar las preguntas, metodologías y tendencias en investigaciones realizadas por enfermeras/os, con el fin de identificar los intereses disciplinares y posibles derivaciones en el desarrollo del conocimiento y las prácticas de cuidado. Metodología: Revisión panorámica en las bases de datos: Scielo, BVS, PubMed y Redalyc, con una ventana de búsqueda de 2008 a 2020, en idiomas español, inglés y portugués. Se incluyeron 33 artículos, producto de la búsqueda con términos de: MeSH, Nursing Care, Abortion, Abortion Applicants. Además, se emplearon expresiones en español sobre: cuidado de enfermería; la enfermería; el aborto; el aborto y cuidado de la enfermería en la salud pública; aborto inducido y cuidado de la enfermería sobre salud mental; aborto criminal y salud mental; y, cuidado de la enfermería frente a solicitantes de aborto. Análisis: Se observó una relación entre el tipo de estudios y el contexto jurídico de los países en que se realizaron. Son relevantes los estudios respecto de las actitudes, creencias y prácticas de la enfermería en torno al aborto, poniendo el foco en la subjetividad de los profesionales de la disciplina. Resaltan los estudios cualitativos, haciendo acopio de teorías y conceptos de procedencia multidisciplinar y solo marginalmente de aquella producida por la disciplina de la enfermería. Conclusiones: Las preguntas más frecuentes que se hacen las enfermeras/os sobre el aborto se dirigen especialmente a examinar las formas en que se provee el cuidado de la enfermería a las mujeres que pasan por esta experiencia; del mismo modo se evidencia el correlato en las experiencias emocionales y dilemas éticos para el personal de la enfermería, constituyéndose en un fenómeno controversial. Lo expuesto anteriormente implica para la disciplina sobre enfermería ampliar el repertorio para el abordaje epistemológico de este fenómeno, con miradas críticas transdisciplinares, que consideren el contexto social, cultural y normativo, con el fin de enriquecer la investigación disciplinar, que tenga efectos sobre la práctica profesional y los procesos de formación.
Chapter 2 presents what will be ‘theoretical resources’ and explains why the term ‘resources’ is used. The chapter presents a selection of socio-cultural and psycho-social theories that represent different knowledges that underpin the perspectives in the book. This chapter is designed to be deliberately jarring for the reader to reflect the authors experience of discomfort in presenting and interrogating theories that are pathologizing alongside theories that offer emancipatory potential. This chapter presents the role of research in the construction, representation and critical understandings of ‘race’.KeywordsDecolonisationIntersectionalityEpistemology
Objectives:
to analyze the expression of sociopolitical-emancipatory knowledge, based on the participation of women-nurses in social movements, and the implications for nursing care.
Methods:
a research-interference, whose data were obtained from narrative interviews with six women-nurses inserted in social movements and with political representation. Data were submitted to discourse analysis, based on Michel Foucault.
Results:
women-nurses' social and political involvement is driven by the contexts of life and work, marked by gender inequalities. Ability to criticize oneself, the profession and health policies and practices are presented as expressions of sociopolitical-emancipatory knowledge. Nursing care is conceived as a political practice that, influenced by learning from social movements, must go through a denial of the historically performed form.
Final considerations:
participation in social movements triggers sociopolitical-emancipatory knowledge, resulting in differentiated care, a way of acting oriented towards reducing inequalities.
La douleur est un phénomène auquel l’infirmière est fréquemment confrontée dans son activité clinique. Si les ressources disponibles pour en réaliser l’évaluation et le traitement sont désormais nombreuses, leur mise en œuvre se trouve parfois entravée par les contextes de pratique parfois difficiles. La recherche en sciences infirmières produit un volume de connaissances conséquent et évolutif que l’infirmière peut mobiliser dans son raisonnement clinique afin de chercher à comprendre la situation du patient dans sa singularité pour mieux agir dans un double objectif de pertinence et d’efficacité des interventions de soins.
The emancipatory theory of compassion, created by Dr Jane Georges, assumes the universality of suffering (physical, psychoemotional, socioeconomic, or biopolitical), and the means by which suffering can be alleviated: compassion. The theory also assumes that nurses can knowingly or unknowingly create environments in which suffering is perpetuated. Through critical review of Georges' work and major caring theories, an operationalized model was developed with which nurses may frame inquiry and practice focused on compassion, the alleviation of suffering through the deconstruction of power relations, and the promotion of health equity, social justice, and human rights.
Understanding the social contexts of health and healthcare delivery from a multilevel thinking perspective offers nurses an opportunity to prioritize research and interventions that address communicable and noncommunicable diseases across the care continuum. The content of this paper explains the development of a multilevel theory of family health for Sub-Saharan families affected by the burden of breast cancer guided by Neuman’s Systems Model. Implications for knowledge development in family nursing practice and research in the region are discussed.
Arts-based pedagogy (ABP) helps nursing students attain affective domain outcomes that are linked to ethical and moral development and professional value acquisition. This literature review identifies theoretical foundations of ABP, examples of art-inspired strategies that helps students achieve affective domain outcomes, and recommendations for using ABP to enrich nursing education. ABP enhanced student engagement, group connectivity, social-emotional learning, and critical thinking. Educators using ABP need to be sensitive to possible student vulnerability and emotional distress.
Background:
Providing holistic and humanistic care to patients requires a variety of factors. A care solely based on objective knowledge might be unsafe and of low quality. Using the patterns of knowing in an integrated manner and relative to the context of caring is one of the necessities for proving a holistic and efficient nursing care. This study aimed to explore the role of patterns of knowing in the formation of uncaring behaviors.
Materials and methods:
The researchers used a qualitative research design for this study. Participants included 19 clinical nurses who attended semi-structured and in-depth interviews. In addition, theoretical and purposeful sampling methods were used in this research. Observation of caring processes in different hospital wards was another method used for collecting data. The data analysis was carried out according to conventional content analysis technique.
Results:
The study findings revealed five categories for the theme of "omission of some patterns of knowing" including omission of scientific principles, omission of therapeutic relationship, omission of ethics, omission of social justice, and omission of flexibility.
Conclusions:
The omission of some patterns of knowing creates an ugly image of nursing and a negative outcome of caring as well.
Résumé
But de l’étude
Explorer comment s’inscrit l’analyse de la pratique professionnelle dans la pratique des infirmières cliniciennes spécialisées comme dispositif d’accompagnement des équipes soignantes et de développement des savoirs.
Méthode
Étude qualitative exploratoire descriptive dont les données ont été recueillies lors d’un entretien de groupe auprès de neuf infirmières cliniciennes spécialisées et lors d’entretiens individuels auprès de quatre experts. Une analyse de contenu déductive a été utilisée pour catégoriser les données.
Résultats
Les entretiens révèlent que l’analyse de la pratique professionnelle permet d’accompagner les équipes soignantes face à la complexité des soins. Cependant, cette pratique reste méconnue et confuse auprès des équipes soignantes et des cadres de santé.
Conclusion
L’analyse de la pratique professionnelle permet le développement des connaissances personnelles et professionnelles, et contribue ainsi au développement des savoirs des infirmières. De par leur expertise, les infirmières cliniciennes spécialisées peuvent promouvoir la posture réflexive nécessaire à cette pratique.
Résumé
Introduction
La conception dominante de la pratique infirmière d’éducation pour la santé (PIES) met l’accent sur la responsabilité individuelle de personnes considérées à risque et sur des modèles de changement qui abordent peu les déterminants sociaux de la santé.
But de l’étude
En cohérence avec des orientations contemporaines de la discipline infirmière qui évoquent un mode de savoir émancipatoire et la légitimation de savoirs occultés, cette revue critique des écrits a pour but l’élaboration d’une conception de la PIES qui soit inclusive d’une diversité de connaissances et perspectives.
Méthode
La sélection et l’analyse de 56 articles selon la méthode de Wuest fut conjuguée à la modélisation systémique. Une conception inclusive de la PIES comporte trois tendances complémentaires – technique, pratique, émancipatoire – qui se distinguent au plan relationnel et spatiotemporel.
Conclusion
La reliance de différentes rationalités donne à penser le potentiel de transformation de la PIES, au-delà de la transmission d’informations.
© 2021
Context : The current COVID-19 context has placed nurses at the heart of the pandemic, due to the critical role they play within the population. However, media and professional discourses are influencing the identity and clinical practice of nurses.Objective : Review the literature on the construction of the popular identity of nurses and their roles during the COVID-19 pandemic.Method : Several data sources were consulted : Eureka, Google News, Education Resources Information Center (ERIC), Sociological Abstracts, Cumulative Index to Nursing Information and Allied Health Literature (CINAHL), MEDLINE, and Social Sciences Abstracts. Manual searches of government and professional sites were also conducted.Results : Of a total of 281 papers indexed, 73 were retained. The literature analysis identified the following themes : 1) identity images of nurses during this pandemic and their professional roles ; 2) the sometimes paradoxical nature of media and political discourse ; and 3) the fact that this discourse seems to influence clinical nursing practice, which is being assigned new roles.Conclusion : This article raises awareness among decision-makers about the multiple roles of nurses and the public image of nurses during a pandemic, and takes a critical look at popular discourses related to nurses' identity and how this identity changes during a pandemic.
Every academic discipline nurturing its own science draws on the development and dissemination of a knowledge. In pursuit of this project, the nursing discipline has proposed various conceptualizations of knowledge. The one developed by Chinn and Kramer, following Carper's work, is without doubt the most prominent and most often borrowed concept in discussing the epistemological foundations of the discipline. This thoughtful article proposes an in-depth critical analysis of this theoretical development by focusing on "personal" and "esthetic" knowledge. As part of the analysis, the author scrutinizes the inherent logics that support these patterns of knowing. Finally, the author highlights some overinterpretations and discrepancies with regard to nursing practice.
Introduction : Historically, it is accepted that women caregivers have always had care-giving roles. Care is expressed in various ways in professional acts.Background : A context where nursing activity is more centered on technical and cure-related acts raises questions about the role of care-related professional knowledge in nursing.Objective : To present the results of a study looking at the identification of care-related professional acts in the activity of nurses in care-providing situations and their links to nursing knowledge.Method : The study was conducted in the context of clinical activity using simple self-confrontation and lookalike instruction methods. Data were collected from independent nurses through recordings and note-taking and then analyzed to categorize them using the frames of reference of lexical analysis, enunciative topics and the typology of nursing knowledge.Results : Four types of care-related professional acts were identified : acts of atmosphere, acts of solicitude, acts of evaluation, and acts of regulation. The results made it possible to design a tool for analyzing these care-related professional acts.Discussion : Care-related professional acts exist and can be identified. Analysis of the results confirms that experience transforms knowledge of various kinds into practical knowledge.Conclusion : The confrontation between professional practice and the various types of knowledge acquired enables the construction of professional knowledge.
In the operating conditions of the 21st century it is impossible to be competent alone’ (O’Hara & Leicester, 2019, p. 16). Competence in leading and managing, as in any professional practice, is best understood as the ability to work with others to meet important challenges in complex human systems (Rychen & Salganik, 2003). Systems thinkers such as Oshry (1999, 2007, 2018, 2019, 2020) recognise that competence is a function of systems and culture; that is, of relationships. This insight acknowledges the importance of being able to work effectively in group settings but goes further in recognising that our lives are always lived in complex patterns of relationships with others (O’Hara & Leicester, 2019).
Mentoring in academia has traditionally and currently been prescriptive and institutionally driven. The purpose of this paper is to deconstruct these current mentoring practices with a critical feminist stance. New understandings are shared and gained through dialogue, relevant literature, and performativity to (re)create and name a caring and relational partnership. This caring and relational partnership is grown through a process of mutuality and reciprocity, and based on relational ethics, authenticity, and solidarity. By embracing ideologies of caring and relational ethics, mentoring blurs the lines of mentor/mentee to a perpetual state of walking beside each other in equity to learn and strengthen each other’s insights into our worlds. Material realities become illuminated through our shared journeys growing an appreciation and gift of the other. In turn, engaging in meaningful dialogue informs scholarship increasing our understandings of the human condition.
Objective
For the past 30 years there has been a growing emphasis on evidence as the primary or exclusive basis for nursing practice.
Methods
Critical examination of literature related to evidence-based practice from the 1990s to the present.
Results
This review of the nursing literature from the 1990s to the present reveals that in the midst of the movement to promote evidence-based practice as the gold standard, there have been persistent expressions of concern. These concerns are (a) lack of alignment of evidence-based practice with nursing's disciplinary perspective; (b) wrongful privileging of empirical knowledge over other sources of knowledge; (c) underappreciation of the complexity of practice and practice wisdom;(d) possibilities of evidence-based practice thwarting innovation and creativity;(e) vulnerabilities of empirical evidence to be flawed, inconsistent, and influenced by competing interests; (f) situational realities that limit access to and critical appraisal of evidence that access to and critical appraisal of evidence is not feasible or practical; and (g) lack of relationship of evidence-based practice to theory.
Conclusions
We call for a recalibrated practice epistemology that promotes a greater appreciation for the myriad sources of knowledge for nursing practice, and offer recommendations for international change in education, literature, scholarship, and public media.
The purpose of this article is to identify the commonalities in nursing perspectives among 6 countries/regions (United States, South Korea, Taiwan, Japan, Hong Kong, and Thailand). Nine leaders from the 6 countries/regions reflected on what nursing perspectives were in their own countries/regions and provided exemplars/cases from their own experiences and literature reviews. The data were analyzed using a content analysis. Seven themes were extracted: (a) "embedded in cultural and historical contexts"; (b) "based on philosophical pluralism"; (c) "women-centered perspectives"; (d) "care-oriented holistic views"; (e) "ethical and humane views"; (f) "respecting and advocating"; and (g) "considering diversities."
Background
Patterns of knowing in nursing are the epistemological foundation of the discipline and are necessary for achieving nursing competence. Although knowing in nursing has received critical attention in developed countries, the notion has not been explored in developing countries like Malawi where the context is different to that studied by other researchers. The aim of the study reported in this paper was to identify nurses’ perceived ways of knowing and their learning needs in the critical care environment. The study was part of a larger body of research on the planning, development and evaluation of a training programme for critical care nurses in Malawi.
Methods
Thorne’s interpretive descriptive design was used to analyse the qualitative data collected using two focus groups with nurses (n = 13), and one-on-one interviews with nurse leaders (n = 8) and anaesthetists (n = 2) in critical care units (CCU) at two tertiary hospitals in Malawi.
Results
The dimensions of knowing which are expected to be demonstrated by an effective nurse are theoretical knowing, practical knowing, managerial knowing, ethical and professional knowing, and ability to interpret and act. Critical care nurses who demonstrate these dimensions of knowing are confident with delivering the required standard of care for critically ill patients and in managing the complexities of working in the critical care units.
Conclusion
The findings illustrate the need to be cognizant of patterns of knowing in resource limited settings and the importance of incorporating these into the development of training programmes.
Objectives:
To reflect on the scope of the working process in nurse participation political activities as a possibility for expanding its performance.
Methods:
this is a reflective study, supported by the discursive elaboration on the nursing participation political activities and work process, structured through concepts, theoretical perspectives and practices based on the experiences described in references.
Results:
studies on this process demonstrate that nurses need sensitivity to understand the complexity of their social practice.
Final Considerations:
in their professional actions, nurses must mobilize political resources, making their knowledge, skills and attitudes available to their practices, aiming at power and improvement of conditions for the work of Nursing.
Objective:
to analyze the knowledge standards that found nursing practices in the home care setting.
Method:
qualitative study using a single case study strategy, supported by the dialectical methodological framework. Thirteen nurses who work in home care services from two municipalities in Minas Gerais, Brazil, participated. The data were obtained in 266.5 hours of participant observation and 8 hours and 58 minutes of interview and submitted to Critical Discourse Analysis.
Results:
empirical knowledge was revealed to be fundamental for clinical, managerial and educational care at home. The adaptations specific to this environment require aesthetic knowledge. The relational and educational actions, the decisions responsible for benefiting the individual and his family, the doubt and willingness to learn when dealing with unpredictable cases and the assessment of the socioeconomic conditions of the family, represent, respectively, personal, ethical, lack of knowledge and sociopolitical aspects present in the practice of nurses in home care.
Conclusion:
the particularities of home care trigger different patterns of knowledge to ensure creative, sensitive, human and responsible care. Innovation and availability to learn are part of nurses' performance in home care. The need for differentiated training is reinforced in order to respond to the increasing complexity in this field.
The chapter addresses the normative analysis of the value-based aspects of nursing. Values are commonly distinguished into: (a) epistemic, when related to the goals of truth and objectivity; (b) non-epistemic, when related to social, cultural or political aspects. Furthermore, values can be called constitutive when necessary for a scientific enterprise, or contextual when contingently associated with science. Analysing the roles of the various forms of values and models of knowledge translation helps us understand the specific role of values in nursing. A conceptual framework has been built to classify some of the classical perspectives on nursing knowledge and to examine the relationships between values and different forms of knowledge in nursing. Adopting a normative perspective in the analysis of nursing knowledge provides in fact key-elements to identify its proper dimension.
This article discusses how different forms of autoethnographic production prompted by diverse forms of academic self-expression can lead to different types of knowing. Utilizing five examples from the Massive_Microscopic project, where participants responded to 21 different prompts inviting autoethnographic reflections about COVID-19 global pandemic, the article explores the responses from the perspective of alternative ways of knowing, reflecting on questions of motherhood, self-care, and performance in academia. Whether visual, rhythmic, or text produced from the perspective of things, the different modalities of the prompts allowed unexpected knowledge to emerge and supported deeper and more colorful reflections. Exploring the personal experience with the pandemic is expanded by the qualitative inquiry supported by different (self-)expression formats.
Within the discipline of nursing, two main areas of philosophical inquiry include ontology and epistemology. The purpose of this article is to examine nursing ontology and epistemology and to encourage further philosophical discussion within the discipline, in particular, to describe, distinguish between, and provide not only further philosophical discussion but an argument for nursing ontology and epistemology, respectively. The author's argument for nursing ontology is nursing is caring, while the epistemological argument is esthetic knowing is the knowledge of nursing practice.
The journey through the history of nursing, and its philosophical and political influ-ences of the moment, contextualizes the interest that arose about the nurse–patient relationship after World War II. The concept has always been defined as a relationship but, from a phenomenological approach based on a historical, philosophical, psycho-logical and sociological cosmology, it is possible to re-conceptualize it as ‘caring inter-action’. Under the vision of aesthetics and sociopoetics, the object of nursing care is the most delicate, vulnerable and unrepeatable raw material: the person, whose feel-ings and reciprocity, which must be considered. In addition, it involves the adoption of the socio-critical paradigm, as it considers the importance of actively involving the person, not just patient anymore, or their family in the nursing cares, optimizing the reciprocity inherent to this interactivity. In short, our philosophical and epistemologi-cal approach to the concept of nurse–patient relationship proposes a new conceptu-alization of it as a caring interaction.
epistemology, interpersonal relation, nurse, patient relation
Nursing history is firmly rooted in social and political activism; however, both the word activism and its defined actions have been minimized in modern nursing practice. This paper seeks to define activism, its uses, and importance to the nursing discipline. A concept analysis using the Walker and Avant (2019) method was conducted. Literature sources were identified through a search of PubMed, CINAHL, and PsycINFO along with hand searches of reference lists. Nursing activism is a concept that extends from within the discipline's ethical responsibilities and social contract with humanity. Activism differs from advocacy or engagement as it requires the expenditure of energy including personal, social, and/or political capital. Nursing activism is a necessary response to health inequities, social accountability, and advancement of the nursing profession.
In 1978, Barbara Carper named personal knowing as a fundamental way of knowing in our discipline. By that, she meant the discovery of self‐and‐other, arrived at through reflection, synthesis of perceptions and connecting with what is known. Along with empirics, aesthetics and ethics, personal knowing was understood as an essential attribute of nursing knowledge evolution, setting the context for the nurse to become receptively attentive to and engaged within the interpersonal processes of practice. Although much has been done over the 40 years since Carper described these ways of knowing, and we have seen enormous advances in empirics and ethics, and I would argue even in aesthetics (understanding the subtle craft of nursing in action), personal knowing may not have attracted its fair share of critical unpacking. Further, we see increasing evidence of a distortion on how forms of personal knowledge, including beliefs and attitudes, are being taken up within segments of the profession; these include legitimizing idiosyncratic positionings and, most worrisome, challenges to the idea that there are and ought to be fundamental truths within nursing that stand as central to disciplinary knowledge. In this paper, the author reflects on the confusion that a continued uncritical deference to personal knowing may be creating and the evolving interests it seems to serve.
Background: The older population is growing. One particular group among this population, LGBTQ+ [1] older adults, are sometimes discriminated against by health care professionals. In this context, this scoping review sought to describe the extent of knowledge about nursing practice among LGBTQ+ older adults and to summarize the implications for clinical nursing practice.
Method: The scoping review method that uses the framework set out by Peters et al. from the Joanna Briggs Institute was adopted.
Results: The recommendations for nursing LGBTQ+ older adults were grouped into five key areas: raise awareness of the existence of LGBTQ+ older adults, their historical context, and their experiences of health care; refrain from heterocissexist and heterocisnormative preconceptions by adopting inclusive language and an open-minded attitude; support LGBTQ+ older adults and their caregivers or family of choice; create a safe and confidential environment; and finally, promote the inclusion of LGBTQ+ older adults in the health care system.
Conclusion: The results could be used by nurses and other health care professionals to optimize the quality of care for LGBTQ+ older adults and to promote their inclusion.
This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted a literature search and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse–patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge.
Objectives:
To evaluate the implementation of a regular Nursing Round as an educational strategy for workplace learning in an intensive care unit with a single room environment.
Research design:
A multiple methods design was used. Fifty-four Nursing Rounds were observed and nurses (n = 40) completed bespoke evaluative surveys. Structured observational data and open-ended survey responses were submitted to content analysis and descriptive statistics were used to analyse survey findings.
Results:
Nursing Rounds involved a diverse range of participants, most frequently nurses. The content most frequently discussed included empirical clinical issues where nurses decided on nursing care actions to address these issues. The most frequently observed outcome of Nursing Rounds was knowledge translation. Nursing Rounds were perceived to positively influence application of evidence in practise, identification of areas for practise improvement and ability to communicate clinical information. Two categories emerged from analysis of open-ended survey questions; (1) 'Positive learning environment', where nurses described Nursing Rounds as a social learning experience; and (2) 'Impediments to Nursing Rounds', including difficulty attending Nursing Rounds due to competing priorities.
Conclusion:
Nursing Rounds enabled evidence-based learning that enhanced inter-disciplinary collaboration. Further investigation may be required to understand how to enable nurses to attend more frequently, and generate a more holistic, evidence-based discussion.
Compassionate knowing is the practice of intentional presence to relieve suffering. Inspired by Carper’s patterns of knowing, it is an additional form of knowing grounded in caring science. Likewise, the concept of compassionate knowing is framed by tenets of Buddhist philosophy and George’s emancipatory theory of compassion. Intentional presence is defined as a conscious and altruistic choice, born of moral virtue and selflessness, to act in a thoughtful, empathetic, and humanistic way that honors and gives meaning to the uniqueness of each patient and caring-healing nurse-client interaction. Relieving suffering is defined as the nurse responding to the needs of the patient with loving-kindness to alleviate a perceived or real threat to self-integrity.
Confusion remains about the concept “nursing science.” Definitions vary, depending on country, context and setting. Even among nurse scholars and scientists there is disagreement about the content and boundaries of nursing science. There is an urgent need for an acceptable definition that can guide nursing knowledge development, education, and practice. In this article, we highlight the problems for the profession of this sort of conceptual ambiguity, arguing that it is an ethical responsibility for the profession to gain clarity about the meaning and apt focus of our knowledge development initiatives. We parse out nursing and science as separate concepts and synthesize from this analysis a simple yet comprehensive definition of nursing science. We propose that this definition is capable of unifying ongoing nursing endeavors and should serve as the basis for evaluating nursing's knowledge development and educational initiatives.
By combining clinical reasoning and evidence-based practice, nurses can create a virtuous circle which can in turn increase the probability of obtaining satisfactory clinical results for patients. Nursing research must thereby benefit practice by producing scientific knowledge which can be used in day-to-day care.
Intersubjectivity or the ability to understand and work with others is essential in healthcare. Intersubjective processes include workplace relationships where clinicians seek to make sense of and identify stakeholders’ interests. Students may develop intersubjectivity through group work, structured around classroom activities. However, less well established is how the types of skills required for the temporary, fleeting and partial everyday healthcare collaborations amongst nurses, patients, families, doctors and allied health professionals are developed. The study discussed here aimed to evaluate the feasibility of, and learning experienced by students who participated in, learning circles conducted in health workplaces.
Fundamental patterns of knowing in nursing have historically served to clarify the substance and structure of the discipline, significantly contributing to nursing's body of knowledge. In this article, we continue the scholarly conversation on patterns of knowing in nursing by advancing spiritual knowing as a pattern of knowing that helps advance nursing's agenda toward universal well-being and critical during this time toward interdisciplinarity. Implications for nursing are explored in relation to enduring and new questions that require our attention related to human beings, their environments, and healing.
Higher Education in the development of future professionals requires consideration of the types of knowledge on which professional practice is predicated and the art of communicating that knowledge to the next generation of professionals. Although not all students will have a practical application to their university studies this chapter concentrates on those that do. It is therefore pertinent to a range of professionals, the continuum spanning accountants and architects through nurses and midwives to technical engineers and veterinarians. Each of these groups and many more, have a unique body of knowledge with a direct application to their particular professional behaviour. Knowledge consists of pieces of information that are explicitly stored in the brain and are constructed by individual scholars to support their experiences or practice, and by association the complex decision making that may be required in that context. The construction of such knowledge is therefore of paramount consideration to all educators within the context of Higher Education. Viable Knowledge is a concept that addresses the use of such information or knowledge as a unique and personal way of thinking that supports individual experience. This chapter is written in the context of Nurse Education and sets out to consider the particular experience of a student nurse. It addresses the unique experience of a student within this particular discipline and how the theoretical component of the program can best support the practical application necessary for professional practice. The different types of knowledge within the curriculum are appraised and a theoretical model supporting the inter-relationship between theory and practice constructed. Finally, an example of how this has been applied to the delivery of a nursing program will be considered, along with the general implications for practice within Higher Education.
Purpose:
The purpose of this article was to discuss barriers and potential solutions for strengthening inter- and intraprofessional collaborations that will advance biobehavioral symptom science.
Organizing construct:
General and team-based barriers and solutions for advancing biobehavioral symptom science are reviewed with an exemplar discussion that is guided by Carper's patterns of knowing.
Conclusions:
Strategic partnerships across nursing associations and organization can help to build collaborations that are focused on symptom science in a specific population, disease, or setting. Additional strategies to build collaborations include supporting interprofessional workgroups, data sharing, and dissemination of research findings across associations. Prioritization of funding opportunities and resources devoted to building inter- and intraprofessional collaborations focused on advancing biobehavioral symptom science will benefit nursing science, the membership, and patients and families.
Clinical relevance:
Nursing associations and organizations can play an integral role in building inter- and intraprofessional teams dedicated to advancing biobehavioral symptom science via multiple ways of knowing that nurses use to generate new knowledge, develop innovations, and apply them in practice.
While for decades nursing has advocated for theory‐informed practice, more recent attention has tended to focus on mid‐range theory rather than the earlier focus on developing grand theory to encompass all of nursing practice. However, there has been continued interest in the holistic nursing community on grand theory and, in particular, on Integral Theory. Although Integral Theory's four‐quadrant (AQAL) perspective is familiar in nursing, little is known about how it is being used by nurses in direct practice. The purpose of this interpretive descriptive study was to provide a practice‐based perspective on Ken Wilber's Integral Theory in professional nursing practice. The following research question was investigated: How does Integral Theory assist nurses in describing and understanding their professional work? Nurses participating in this study used Integral Theory as a map or heuristic that gave structure to an inquiry process in professional nursing practice and in nursing education in a manner that was holonic, multiperspectival, and self‐reflective. Challenges constraining nurses’ use of Integral Theory included its intricacy, as well as contextual factors in practice environments. Implications for nursing practice and education for the use of Integral Theory's meta‐framework are described.
In this paper, a model describing nurses' responses to patients who are suffering is presented. The nurse's level of engagement with the patient is affected by whether the caregiver is focused on him-/herself or on the sufferer (i.e. embodied with the patient) and whether the caregiver is responding reflexively or with a learned response. Four types of communication patterns are identified: engaged responses (first-level) are used in a connected relationship; when the nurse responses reflexively and is focused on him-/herself, the response is reflected; when the caregiver is patient-focused, a learned response is labelled a professional response; and a self-focused, learned response is labelled detached. Examples of each type of response are provided.
As theories of developmental psychology continue to define educational goals and practice, it has become imperative for educators and researchers to scrutinize not only the underlying assumptions of such theories but also the model of adulthood toward which they point. Carol Gilligan examines the limitations of several theories, most notably Kohlberg's stage theory of moral development, and concludes that developmental theory has not given adequate expression to the concerns and experience of women. Through a review of psychological and literary sources, she illustrates the feminine construction of reality. From her own research data, interviews with women contemplating abortion, she then derives an alternative sequence for the development of women's moral judgments. Finally, she argues for an expanded conception of adulthood that would result from the integration of the "feminine voice" into developmental theory.
The purpose of this research was to explore intuitive experiences of nurses in critical care and home care settings. Fifty-six nurses were interviewed and transcriptions of interviews were analyzed for emergent themes. Nurses described their experiences in terms of feeling and knowledge and gave examples of types of intuition. Further analysis showed themes consistent with three attributes of intuition found in the nursing literature. Recognition of intuitive experiences has consequences for communication and decision making in clinical practice.
The relationship that is established between the nurse and the patient is the result of interplay or covert negotiations until a mutually satisfying relationship is reached. Depending on the duration of the contact between the nurse and the patient, the needs of the patient, the commitment of the nurse and the patient's willingness to trust the nurse, one of four types of mutual relationship will emerge: a clinical relationship, a therapeutic relationship, a connected relationship or an over-involved relationship. If the nurse is unwilling or unable to be committed to the patient, a unilateral relationship will develop, with the patient continuing to use manipulative or coercive behaviours, attempting to increase the nursing involvement in the relationship. If the patient is unwilling to trust the nurse and accept his or her illness situation, she or he will manifest 'difficult' behaviours, be withdrawn or elope. The changing nature of the relationship, and the conditions and consequences of each type of relationship are discussed.