February 1, 2022

Reflect on your practice and select an experience that you had with a patient or family and explore the five fundamental patt

Reflect on your practice and select an experience that you had with a patient or family and explore the five fundamental patterns of knowing : ethical, personal, aesthetic, empirical, emancipatory

Patterns of Knowing in Nursing Practice Paper – Individual (15%): Limit of four pages plus title page and references. No abstract required. Upload the complete paper into Blackboard. Review the directions regarding Safe Assign on Blackboard. Minimum of four (4) references including the textbook, a journal article, the electronic version of the ANA Code of Ethics for Nurses (webpage), and Healthy People 2030 (government report). SEE EXEMPLAR for citation examples.

Reflect on your practice and select an experience that you had with a patient or family and explore the five fundamental patterns of knowing (ethical, personal, aesthetic, empirical, emancipatory) demonstrated with the experience. Try to choose a situation with all five patterns evident. Develop a paper that includes the following:

· Introduction (10% – 1 paragraph) – Briefly introduce the paper. End the paragraph with a purpose statement (The purpose of this paper is to…)

· Description of the Five Patterns of Knowing (10% – 1 paragraph) – Briefly explain each pattern of knowing in nursing

· Description of the Nursing Experience (10% 1-2 paragraphs) – Describe the experience including who was present, what was happening, who you were engaged with, and what you were thinking, doing, and saying. Include background information as appropriate to add context.

· Applying the Patterns of Knowing to Practice (50% – 5 short paragraphs) – Explain how each pattern was evident in the experience. If any of the patterns were not evident (usually only emancipatory knowing) state that it was not evident and propose what could have happened in the experience for it to be evident.

· Applying the Social Determinants of Health (10% – 1 paragraph) – Identify a Social Determinant of Health domain (from Healthy People 2030) that was evident in the experience and a proposed (brief) solution to it. https://health.gov/healthypeople/objectives-and-data/social-determinants-health

· Conclusion (10% – 1 paragraph) – Summarize the paper without introducing new content. Refer to the purpose statement – what was the purpose of the paper? Conclude that it was done.

Do not copy and paste content – plagiarism will result in a zero grade. Paraphrase using your own thoughts and words. Avoid quotations in academic writing – express your own interpretation of content you are learning. Use APA resources and exemplar in BB. Make an appointment with the Writing Center to review your paper before submission to avoid APA deductions.

APA – This paper must be presented in an organized and scholarly fashion following APA 7th edition guidelines. Up to seven (7) points can be deducted for the following:

1. Clarity – 3 points

2. References – 2 points

3. APA Format/In-Text citations – 2 points

Analysis of [Your Situation] Using the Patterns of Knowing

Student Name

Course

Nursing Program Name

University Name

Professor Name

Date

Analysis of [Your Situation] Using the Patterns of Knowing

Introduce the paper concisely with the Patterns of Knowing. First sentence indented and then align the rest of the paragraph at the left margin. Review full instructions in the syllabus and rubric. Cite Chinn & Kramer text throughout paper. End introduction with – The purpose of this paper is to…. (1 paragraph)

Description of the Patterns of Knowing

Explain each of the patterns of knowing briefly. Cite the text frequently. (1 paragraph)

Description of the Nursing Experience

Describe the experience as it happened to you. You can use “I” in this paper because it reflects your experience and analysis of it. Find a journal article that supports the problem/situation you were facing and cite it. (1-2 paragraphs)

Applying the Patterns of Knowing to Practice

Choose a situation that has all patterns present if possible. If one is missing, explain why. Five brief paragraphs total.

Describe/analyze your experience through a personal knowing lens. (1 paragraph)

Describe/analyze your experience through an ethical knowing lens. Support with one sentence statement from the ANA Code of Ethics (cite as webpage). (1 paragraph)

Describe/analyze your experience through an empiric knowing lens. Cite your reference about the problem/situation again. (1 paragraph)

Describe/analyze your experience through an aesthetic knowing lens. (1 paragraph)

Describe/analyze your experience through an emancipatory knowing lens. (1 paragraph)

Applying the Social Determinants of Health

Identify how your experience fits into one domain of the SDOH framework and a recommendation (simple, brief) to address it. Cite the Healthy People 2030 as a government report. (1 paragraph)

Conclusion

Summarize the paper. Refer to your purpose statement from the introduction. Don’t introduce any new information here. The paper should be 3-4 written pages plus title page and reference page (total 5-6 pages). No citations needed here. (1 paragraph)

References

You will cite a book, a journal article, a web page, and a government report (Healthy People 2030). This gives you experience in all types of citations used in the course. Do this correctly to avoid point loss. Use OWL at Purdue APA for support. Citations are alphabetical with a “hanging” indent.

NUR 620 The Theoretical Basis of Advanced Practice Nursing Patterns of Knowing Assignment Rubric

Student Name: Grade: out of 15 points Criteria Exceeds expectations

90-100% 13.5-15 points

Meets Expectations 83-89% 17.9-16.6

Partially Meets 80-82% 16.4-16

Does Not Meet 0-79% 15.8-0

1. Introduction 1.5 points (10%)

Introductory paragraph is complete and thorough. Ends in a purpose statement that accurately describes the purpose of the paper. 1.5 pts

Content of the introductory paragraph is adequate and ends in a purpose statement that accurately describes the purpose of the paper. 1.3 pts

Content of the introductory paragraph is incomplete and/or the purpose statement does not accurately describe the purpose of the paper or is missing. 1.2 pts

Does not address the requirements 1-0 pts

2. Description of Experience 3 points (20%)

Experience clearly and thoroughly described according to the criteria in the course outline. 3 pts

Experience is adequately described according to the criteria in the course outline. 2.55 pts

Experience is incompletely described according to the criteria in the course outline. 2.4 pts

Does not address the requirements 2.2 – 0 pts

3. Patterns of Knowing 7.5 points (50%)

Complete description of how all 5 patterns of knowing were evident in experience. Complete description if not evident. 7.5 pts

Adequate description of how all 5 patterns of knowing were evident in the experience. Incomplete description if not evidente. 6.4 pts

Incomplete description of how the patterns of knowing were evident in the experience. Missing description if not evident 6 pts

Does not address the requirements 5.9 – 0 pts

4. Social Determinants of Health 1.5 point (10%)

SDH problem was thoroughly identified and a solution proposed. 1.5 pt

SDH problem was adequately identified and/or an incomplete solution proposed. 1.3 pt

SDH problem was identified but a solution was not proposed. 1.2 pt

Does not address the requirements 1-0 pts

5. Conclusion 1.5 points (10%)

Conclusion completely summarizes key points without introducing new content. 1.5 pts

Conclusion summarizes key points without introducing new content. 1.3 pts

Conclusion incompletely summarizes key points or introduces new content. 1.2 pts

Does not address the requirements 1-0 pts

APA – This paper must be presented in an organized and scholarly fashion following APA 7th edition guidelines. Up to 7 points can be deducted for the following: Clarity up to – 3 points References page up to – 2 points APA Format/In-text citations up to – 2 points

Faculty comments

Fall 2021

CHAPTER 3

Fundamental Patterns of Knowing in Nursing

Barbara A. Carper, RN, EdD

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. The body of knowledge that serves as the rationale for nursing practice has patterns, forms, and structure that serve as horizons of expecta- tions and exemplify characteristic ways of thinking about phenomena. Understanding these patterns is essential for the teaching and learning of nursing. Such an understanding does not extend the range of knowledge, but rather involves critical attention to the ques- tion of what it means to know and what kinds of knowledge are held to be of most value in the discipline of nursing.

Identifying Patterns of Knowing

Four fundamental patterns of knowing have been identified from an analysis of the conceptual and syntactical structure of nurs- ing knowledge.

1 The four patterns are distin-

guished according to logical type of meaning and designated as (1) empirics, the science of nursing; (2) esthetics, the art of nursing; (3) the component of a personal knowledge in nursing; and (4) ethics, the component of moral knowledge in nursing.

Empirics: The Science of Nursing

The term nursing science was rarely used in the literature until the late 1950s. However,

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24 Chapter 3: Fundamental Patterns of Knowing in Nursing

since that time, there has been an increas- ing emphasis, one might even say a sense of urgency, regarding the development of a body of empirical knowledge specific to nursing. There seems to be general agree- ment that there is a critical need for knowl- edge about the empirical world, knowledge that is systematically organized into general laws and theories for the purpose of describ- ing, explaining, and predicting phenomena of special concern to the discipline of nurs- ing. Most theory development and research efforts are primarily engaged in seeking and generating explanations that are systematic and controllable by factual evidence and that can be used in the organization and classifica- tion of knowledge.

The pattern of knowing that is generally designated as “nursing science” does not presently exhibit the same degree of highly integrated abstract and systematic explana- tions characteristic of the more mature sci- ences, although nursing literature reflects this as an ideal form. Clearly, there are a number of coexisting, and in a few instances compet- ing, conceptual structures—none of which has achieved the status of what Kuhn calls a scientific paradigm. That is, no single con- ceptual structure is as yet generally accepted as an example of actual scientific practice “which include[s] law, theory, application, and instrumentation together . . . [and] . . . provide[s] models from which spring particular coherent traditions of scientific research.”

2(p10) It could be argued that some

of these conceptual structures seem to have greater potential than others for providing explanations that systematically account for

observed phenomena and may ultimately permit more accurate prediction and con- trol of them. However, this is a matter to be determined by research designed to test the validity of such explanatory concepts in the context of relevant empirical reality.

New Perspectives What seems to be of paramount importance, at least at this stage in the development of nursing science, is that these preparadigm conceptual structures and theoretical models present new perspectives for considering the familiar phenomena of health and illness in relation to the human life process; as such, they can and should be legitimately counted as discoveries in the discipline. The representation of health as more than the absence of disease is a crucial change; it permits health to be thought of as a dynamic state or process that changes over a given period of time and varies according to circumstances rather than a static either/or entity. The conceptual change in turn makes it possible to raise questions that previously would have been literally unintelligible.

The discovery that one can usefully con- ceptualize health as something that normally ranges along a continuum has led to attempts to observe, describe, and classify variations in health, or levels of wellness, as expressions of a human being’s relationship to the internal and external environments. Related research has sought to identify behavioral responses, both physiological and psychological, that may serve as cues by which one can infer the range of normal variations of health. It has also attempted to identify and categorize significant etiological factors that serve to promote or inhibit changes in health status.

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Identifying Patterns of Knowing 25

conditions for the normal development of an individual.

Thus, the first fundamental pattern of knowing in nursing is empirical, factual, descriptive, and ultimately aimed at devel- oping abstract and theoretical explanations. It is exemplary, discursively formulated, and publicly verifiable.

Esthetics: The Art of Nursing

Few, if indeed any, familiar with the pro- fessional literature would deny that primary emphasis is placed on the development of the science of nursing. One is almost led to believe that the only valid and reliable knowl- edge is that which is empirical, factual, objec- tively descriptive, and generalizable. There seems to be a self-conscious reluctance to extend the term knowledge to include those aspects of knowing in nursing that are not the result of empirical investigation. There is, nonetheless, what might be described as a tacit admission that nursing is, at least in part, an art. Not much effort is made to elaborate or to make explicit this esthetic pattern of knowing in nursing—other than to associate vaguely the “art” with the general category of manual and/or technical skills involved in nursing practice.

Perhaps this reluctance to acknowledge the esthetic component as a fundamental pattern of knowing in nursing originates in the vigor- ous efforts made in the not-so-distant past to exorcise the image of the apprentice-type educational system. Within the apprentice system, the art of nursing was closely associ- ated with an imitative learning style and the acquisition of knowledge by accumulation

Current Stages The science of nursing at present exhibits aspects of both the “natu- ral history stage of inquiry” and the “stage of deductively formulated theory.” The task of the natural history stage is primarily the description and classification of phenomena that are, generally speaking, ascertainable by direct observation and inspection,

3 but cur-

rent nursing literature clearly reflects a shift from this descriptive and classification form to increasingly theoretical analysis, which is directed toward seeking, or inventing, expla- nations to account for observed and classified empirical facts. This shift is reflected in the change from a largely observational vocabu- lary to a new, more theoretical vocabulary whose terms have a distinct meaning and definition only in the context of the corre- sponding explanatory theory.

Explanations in the several open-system conceptual models tend to take the form commonly labeled functional or teleological.

For example, the system models explain a person’s level of wellness at any particular point in time as a function of current and accumulated effects of interactions with his or her internal and external environments. The concept of adaptation is central to this type of explanation. Adaptation is seen as crucial in the process of responding to environmental demands (usually classi- fied as stressors) and enables an individual to maintain or reestablish the steady state, which is designated as the goal of the system. The developmental models often exhibit a more genetic type of explanation in that certain events, the developmental tasks, are believed to be causally relevant or necessary

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26 Chapter 3: Fundamental Patterns of Knowing in Nursing

exemplary and leads us to acknowledge that “knowledge—genuine knowledge, under- standing—is considerably wider than our discourse.”

7(p23)

For Wiedenbach, the art of nursing is made visible through the action taken to pro- vide whatever the patient requires to restore or extend his [sic] ability to cope with the demands of his [sic] situation,

8 but the action

taken, to have an esthetic quality, requires the active transformation of the immedi- ate object—the patient’s behavior—into a direct, nonmediated perception of what is significant in it—that is, what need is actu- ally being expressed by the behavior. This perception of the need expressed is not only responsible for the action taken by the nurse but reflected in it.

The esthetic process described by Wiedenbach resembles what Dewey refers to as the difference between recognition and perception.

9 According to Dewey, recog-

nition serves the purpose of identification and is satisfied when a name tag or label is attached according to some stereotype or previously formed scheme of classification. Perception, however, goes beyond recogni- tion in that it includes an active gathering together of details and scattered particulars into an experienced whole for the purpose of seeing what is there. It is perception rather than mere recognition that results in a unity of ends and means that gives the action taken an esthetic quality.

Orem speaks of the art of nursing as being “expressed by the individual nurse through her creativity and style in design- ing and providing nursing that is effective

of unrationalized experiences. Another likely source of reluctance is that the definition of the term art has been excessively and inap- propriately restricted.

Weitz suggests that art is too complex and variable to be reduced to a single definition.

To conceive the task of esthetic theory as defi- nition, he says, is logically doomed to failure in that what is called art has no common properties—only recognizable similarities. This fluid and open approach to the under- standing and application of the concept of art and esthetic meaning makes possible a wider consideration of conditions, situations, and experiences in nursing that may properly be called esthetic, including the creative pro- cess of discovery in the empirical pattern of knowing.

Esthetics Versus Scientific Meaning De- spite this open texture of the concept of art, esthetic meanings can be distinguished from those in science in several important aspects. The recognition “that art is expressive rather than merely formal or descriptive,” accord- ing to Rader, “is about as well established as any fact in the whole field of esthetics.”

6(p xvi)

An esthetic experience involves the creation and/or appreciation of a singular, particular, subjective expression of imagined possibili- ties or equivalent realities that “resists projec- tion into the discursive form of language.”

Knowledge gained by empirical description is discursively formulated and publicly veri- fiable. The knowledge gained by subjective acquaintance, the direct feeling of experience, defines discursive formulation. Although an esthetic expression required abstraction, it remains specific and unique rather than

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Identifying Patterns of Knowing 27

same time, increased awareness of the vari- ety of subjective experiences will heighten the complexity and difficulty of the decision making involved.

The design of nursing care must be accom- panied by what Langer refers to as sense of form, the sense of “structure, articulation, a whole resulting from the relation of mutually dependent factors, or more precisely, the way the whole is put together.”

7(p16) The design, if

it is to be esthetic, must be controlled by the perception of the balance, rhythm, propor- tion, and unity of what is done in relation to the dynamic integration and articulation of the whole. “The doing may be energetic, and the undergoing may be acute and intense,” Dewey says, but “unless they are related to each other to form a whole,” what is done becomes merely a matter of mechanical rou- tine or of caprice.

The esthetic pattern of knowing in nursing involves the perception of abstracted particu- lars as distinguished from the recognition of abstracted universals. It is the knowing of a unique particular rather than an exemplary class.

The Component of Personal Knowledge

Personal knowledge as a fundamental pattern of knowing in nursing is the most problematic, the most difficult to master and to teach. At the same time, it is perhaps the pattern most essential to understanding the meaning of health in terms of individual well- being. Nursing considered as an interpersonal process involves interactions, relationships, and transactions between the nurse and the

and satisfying.” 10(p155)

The art of nursing is creative in that it requires development of the ability to “envision valid modes of helping in relation to ‘results’ which are appropriate.”

10(p69) This again invokes

Dewey’s sense of a perceived unity between an action taken and its result—a perception of the means of the end as an organic whole.

The experience of helping must be perceived and designed as an integral component of its desired result rather than conceived sepa- rately as an independent action imposed on an independent subject. Perhaps this is what is meant by the concept of nursing the whole patient or total patient care. If so, what are the qualities that enable the creation of a design for nursing care that eliminate or would min- imize the fragmentation of means and ends?

Esthetic Pattern of Knowing

Empathy—that is, the capacity for par- ticipating in or vicariously experiencing another’s feelings—is an important mode in the esthetic pattern of knowing. One gains knowledge of another person’s singular, particular, felt experience through empathic acquaintance.

11,12 Empathy is controlled or

moderated by psychic distance or detach- ment in order to apprehend and abstract what we are attending to and in this sense is objective. The more skilled the nurse becomes in perceiving and empathizing with the lives of others, the more knowledge or understanding will be gained of alternate modes of perceiving reality. The nurse will thereby have available a larger repertoire of choices in designing and providing nursing care that is effective and satisfying. At the

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Reflect on your practice and select an experience that you had with a patient or family and explore the five fundamental patt

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