FOUR WAYS OF KNOWING

The art of knowing in nursing theory, more formerly known as the “FUNDAMENTAL
PATTERNS of KNOWING in NURSING”, describes four basic concepts, or patterns of knowledge,
as they relate to their advanced application in clinical practice.

Barbara Carper (1978) Identified four fundamental patterns of knowing that form the
conceptual syntactical (set of principles, according to rules) structure of nursing knowledge. The
rationale behind the establishment of “Carper’s ways of knowing” was to serve as a guide for
nursing practitioners toward the acknowledgement of experience as a valuable tool with which
to further the goals of patient management, education and research.

Knowledge and Development

The development of nursing knowledge reflects between Nursing Science and Research.
Its purpose is to improve nursing practice. The 3 facets include the Ontology which refers to
what exists, second is the Epistemology which refers to ways of knowing and the Methodology
which means of acquiring knowledge

Epistemology is the study of theory of knowledge which answers the questions: What
do we know? What is the extent of our knowledge? How do we decide whether we know?
What are the criteria of knowledge? It also provides a context in which to judge the
appropriateness of nursing knowledge and methods and refocus these methods for gaining
knowledge as well as establishing the legitimacy/quality of knowledge gained

Ways of Knowing

The Ways of Knowing are methods through which knowledge becomes apparent to us.
The term knowing means having inside information and knowledge means facts, information
and skills acquired by a person through experience or education. There are several ways
knowing and it includes the following:

a. Empirics– scientific form of knowledge

b. Personal knowledge – a priori knowledge that pertains to knowledge gain from thought
alone
c. Intuitive knowledge – includes feelings and hunches; not guessing but relies on non-
conscious pattern recognition and experience
d. Somatic knowledge – knowing of the body in relation to physical movement; includes
experimental use of muscles and balance to perform a physical task
e. Metaphysical knowledge – seeking the presence of a higher power; magic, miracles,
psycho kinesis, extrasensory perceptions and near-death experiences
 f. Aesthetics – related to beauty, harmony and expression; incorporates art, creativity, and
values
g. Moral/Ethical knowledge – knowledge of what is right and what is wrong

Nursing Epistemology

Nursing epistemology is the study of the origins of nursing knowledge, its structure and
methods, the patterns of knowing of its members and the criteria for validating its knowledge
claims

Example question: “What does he/she know that others don’t? What does it take to
become a Good Filipino Nurse?”

Answer: A good Filipino nurse is shown:

• Appropriate actions
• Good foundation in Knowledge
• Outcome of gathering and processing of information and experiences
• Knowing oneself in the area of nursing is important because without it, one cannot
fully know the patient
• Exemplary nurse consciously or subconsciously practices the Four Ways of Knowing

All the above answers are achieved and realized by harnessing the nurse’s collective stores
of knowledge, character, and profound experience through personal-knowledge or self-
knowledge.

The Four Fundamental Patterns for Nursing Knowledge (Carper) includes:

1. Empirical knowledge – the scientific discipline of nursing

2. Aesthetics or Esthetics knowledge – deals with the emphatic aspect of nursing.
3. Ethical knowledge – the moral directions of nursing
4. Personal knowledge – method by which nurses approach their parents

Empirical Knowledge:

• Principal form relating factual and descriptive knowing aimed at the expansion of
abstract and theoretical explanations
• First primary model of knowing; It is information source or base of knowing
• Factual knowledge from science or other external sources that can be empirically
verified; It includes empirical data
 • When verified through repeated testing over time, it is formulated into scientific
generalizations, laws, theories, and principles that explain and predict
• Most emphasized way of knowing in nursing because 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
• Focuses on evidenced-based research

Examples:

a. Stephen, a nursing student answer a question posed by the clinical instructor based on
what he learned from school.
b. Nurse Emmanuel practices nursing interventions based from accepted clinical practice.

Evidence Based Practice (EBP):

• EBP is recognized in nursing practice

• Uses a form of evidence in making clinical judgement
• Involves accurate and thoughtful decision making about health care delivery
• Based on the result of most relevant proofs derived from researches
• Can bridge the gap between nursing practice and research by providing basis for nurses
to transform research into quality care

Characteristics of Quality Health Care:

• Client-centered
• Scientifically based
• Population outcome based
• Developed through quality improvement and benchmarking
• Individualized to client’s need
• Attuned with system policies and resources

Evidenced Reports:

• Comprised of knowledge synthesis, review and documentation of how evidenced-based

practices are being implemented in the clinical area (Benefield)
• Application of EBP:
o Awareness of the need for information
o Development of a question – address the needs
o Conduction of a systematic review on research studies
o Determine what the research demonstrates
o Make recommendations
 • Analysis of the scientific data
o Review of a variety of published and unpublished research studies
o Details of the analysis
o Target population included in the study
o Types of clinical interventions investigated
o Strengths of individual and collective study results

AESTHETIC KNOWLEDGE

• From the Greek word “aisthanomai” meaning “I perceive, feel, sense.”

• Aesthetic: is used to mean “relating to the here and now”
• Awareness of the immediate situation, seated in immediate practical action; Sensing the
meaning of a moment
o Manifestation of the creative and expressive styles of the nurse
• Including awareness of the patient and their circumstances as uniquely individual, and
of the combined wholeness of the situation.
o Understanding what is of significance to particular patients such as feelings,
attitudes, points of view
o Evident through actions, conduct, attitudes, and interactions of the nurse in
response to another
• Focuses on Empathy – the ability for sharing or vividly understanding another’s feeling
(Primary form); Relies on perception; creative and incorporates empathy and
understanding
• Includes the nurse’s ability in changing ways and manner of rendering nursing care
based on the client’s individual needs and perception
o Interpretive, contextual, intuitive, and subjective; requires synthesis rather than
analysis
• Done by knowing the distinctive individual instead as atypical, stereotype whole

Examples:

a. Nurse Stephen places himself in the “patient’s shoes” when communicating, giving
judgment and providing care
b. Nurse Emmanuel shows compassion, mercy and understanding towards patients, co–
workers and supervisors
ETHICAL KNOWLEDGE

• Attitudes and knowledge derived from personal, including an awareness of moral

questions and choices.
• Requires knowledge of different philosophical positions regarding what is good and right
in making moral actions and decisions
• Refers to the moral code for nursing based on obligation to service and respect to
human life
• Deeply rooted in the concepts of human dignity, service and respect for life
• Lessening suffering, upholding and persevering health is one of the key elements
• Includes all deliberate nursing actions involving and under the jurisdiction of ethics and
professionalism

Examples:

a. Nurse Stephen presents himself as a patient advocate and defends his client’s right to
choose care.
b. Sir Emmanuel, a clinical instructor, reprimands a student who cheated on a quiz and
explains the consequences.

PERSONAL KNOWLEDGE

• Knowledge and attitudes derived from personal self-understanding and empathy,

including imagining one’s self in the patient’s position.
• Encompasses knowledge of the self in relation to others and to self
o Involves the entirety of the Nurse –Patient Relationship
• Refers to the way the nurses view themselves and the client
o Most difficult to master and to teach
• The key to comprehending health in terms of personal well–being
o Subjective and promotes the wholeness and integrity in personal encounters
• Involves Therapeutic use of self
• Takes a lot of time to fully know the nature of oneself in relation to the world around
o Human beings are constantly engaged in a dynamic state of changes

Examples:

a. Ruben, a nursing student, strives to promote a meaningful personal relationship with his
elderly patient.
b. Ruel, a nursing student, undergoes Psychological Counseling and Self –Awareness
sessions before his Psychiatric Nursing rotation.
Other Patterns of Knowledge in Nursing:

Clinical Knowledge

• Refers to the individual nurse’s personal knowledge

• Results from using multiple ways of knowing while solving problems during client care
provision
• Manifested in the acts of practicing nurses and results from combining personal
knowledge and empirical knowledge
• May also involve intuitive and subjective knowing
• Communicated retrospectively through publication in journals

Conceptual Knowledge

• Abstract and generalized beyond personal experience

• Explicates patterns revealed in multiple client experiences, which occur in multiple
situations and articulates them as models or theories
• Concepts are drafted and relational statements are formulated where the propositional
statements are supported by empirical or anecdotal evidence or defended by logical
reasoning
• Incorporates curiosity, imagination, persistence, and commitment in the accumulation
of facts and reliable generalizations that pertain to the discipline of nursing

The emphasis on Different Ways of Knowing is presented as a tool for generating clearer
and more complete thinking and learning about experiences and broader self-integration of
classroom education.

Moch (1990) expanded Carper’s pattern. He added the following knowledge:

o Experimental knowing – becoming aware of participation or being in the world
o Interpersonal knowing – increased awareness that occurs through intense
interactions with others
o Intuitive knowing – immediate knowing of something that does not appear to
involve conscious reasoning

White (1995) added the element “context” or the sociopolitical environment of the
persons and their interactions.

According to Kidd and Morrison (1998), in nursing, synthesis of theories derived from
different sources of knowledge will:
• Encourage the use of different types of knowledge in practice, education, theory
development and research
• Encourage the use of different methodologies in practice and research
• Make nursing education more relevant for nurses with different educational
backgrounds
• Accommodate nurses at different levels of clinical competence
• Ultimately promote high quality client care and client satisfaction

Prepared by: Charmaine Allaine E. Rocha, RN, MN