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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 


How do we know?

So how do nurses know how to take care of patients? And how do nursing instructors evaluate that students are safe to take care of patients?

In 1978 Barbara Carper published her doctoral thesis titled, “Fundamental Patterns of Knowing in Nursing”. Her contention was that there are four ways nurses learn knowledge and practice nursing in any practice setting.

The four ways of knowing are:

1. Empirics: the science of nursing

2. Esthetics: the art of nursing,

3. Personal knowing: both patient and nurse

4. Ethics: the moral component

  1. Empirics

Empirics or the science of nursing relates to the empirical, factual, descriptive, theories, concepts, principles and research findings that guide a nurses’ actions with a patient (Carper, 1978). Empirics are the fundamental ways of dealing with and treating patients by the nurse and are able to be quantified and described by nurses. If you think back to nursing school think about the clinical skills, you had to master to take care of a patient. Then multiply that by 1,0000! You are expected to know how to DO everything, and it is a major focus for nurses while in nursing school. Nurses have to know a little bit about everything in school and then focus their knowledge and learning in their jobs. And this brings up an excellent point, you have to keep learning when you leave school. Just because you got that diploma and get to put initials behind your name does not mean you were endowed with all the knowledge you will need when you start working. When you get your first job in the hospital or skilled nursing facility, or clinic and your patient has a medical diagnosis that you know nothing about, you should be taking some time at the beginning of your shift to learn about that diagnosis. And also look at common medications that would be given for the diagnosis. Then see if your patient is taking those and if they have any symptoms "outside" of the diagnosis. If you practice this every day and try to learn something new every day you will acquire so much valuable information to help you in your career.

2. Esthetics

The second way of knowing is the art of nursing or esthetics. Carper (1978) says “...the action taken to provide whatever the patient requires to restore or extend his ability to cope with the demands of the situation.” (p. 26). Carper (1978) also contends that esthetics requires the nurse to use their perception and empathy to understand how to treat and care for the patient. This also requires that the patient is seen as a whole and not just as the sum of their parts and does take time and experience to cultivate in the nurse. For example, my interaction with a dying patient will be different than how I interact with a patient admitted 3 days ago for an exacerbation of asthma or COPD who is stable and waiting for discharge orders. I would initially spend more time with the dying patient to ensure that he/she is comfortable, and I would find out what is most important for the patient and the family. Maybe the patient is waiting for a son to arrive from out of town and they want to be awake and alert for the visit. Patient-centered care involves asking questions and figuring out what is most important to the patient. The best part of being a nurse, in my opinion is the art of nursing which takes time and experience to learn. One of the hardest skills to learn is how to connect to the patient in a short amount of time so trust is built. Without trust anything you teach or communicate to the patient may not be heard or understood. Another important skill is learning when to allow the patient to perform a task and when the nurse should step in and help. I was so thankful to my early rehabilitation training because it taught me that you let patients do as much as they can by themselves and step in when help is truly needed.

3. Personal Knowing

The third way of knowing is personal knowing. This involves the interpersonal relationship that is established between the patient and the nurse. According to Carper (1978) “...the quality of interpersonal contacts has an influence on a person’s becoming ill, coping with illness and becoming well.” (p.28) This, according to Carper (1078) is the therapeutic use of self and is difficult to teach and quantify in nurses. This way of knowing rejects the idea that the patient is just his diagnosis or condition and takes offense when patients are called by their room numbers and not by their names. Smith & Parker (2015) contend that the nurse is continually growing and learning as a person and as a practitioner and knowing self is essential in establishing the relationship with the patient by the nurse. Personal knowing helps nurses in choosing appropriate nursing theories that guides their practice. By knowing your patients' wants, wishes and desires you can tailor your care plans, interventions and outcomes to that particular patient. But as I have said in other posts, you have to know yourself. There is a saying, take your pulse before you take a patient's pulse. If you are upset about a disagreement you had with another nurse, you won't be able to concentrate on what your patient is telling you.

4. Ethics

The fourth way of knowing is ethics or the moral component of nursing. “The moral code that guides the ethical conduct of nurses is based on the primary principle of obligation embodied in the concepts of service to people and respect for human life.” (Carper, 1978, p.29) As technology has changed medicine there is a greater need for nurses to respect a patient’s wishes and to be nonjudgmental in carrying out those wishes. Smith & Parker (2015) contend that ethics is essential in every nurse action with a patient and should inform their care daily. In my current position in forensics nursing, I have to be careful in thinking that everyone is lying, and every inmate has a secret agenda. But I cannot take everyone at their word and must understand the boundaries of my role versus the role of the custody officers. Ethically, I have to be able to back up my decisions with the story from the inmate and the facts presented to me in terms of vitals and other identifiable parameters.

Carper, B.A. (1978). Fundamental patterns of knowing in nursing. ANS, 1(1): 13-24

Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). F.A. Davis Company.

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