Summary Of Barbara Carper's Ways Of Knowing Concepts

“Code Blue, ER. Code Blue, ER”. I can still hear that calm, unalarmed voice over the intercom. Seconds later, John Doe, a 50-year-old male, is rushed in through the double doors of the Emergency Room with an EMT pounding on his lifeless chest. Although the medical staff had been preparing for some time, it still appeared like a scramble to resuscitate this man’s life. It was my first shift as a medical scribe; I had no idea what to expect. While paramedics shouted the jargon-filled report, the surrounding chaos was quieted by the physician who maintained the room's composure. The instant the pulse was obtained, I was overcome with a foreign feeling that can only be described as pure exhilaration as if the epinephrine injected into the patient manifested its effects on me.

This paper will discuss three theories of decision-making that can be adopted in nursing practice, additionally how decision-making theories are able to be implemented and used. Decision-making in nursing is adopted through the critical thinking process that provides each nurse a model to make the best choices, solve problems and to meet goals in clinical practice (Berman & Kozier 2018, pp. 199-200; Levett-Jones & Hoffman 2013, pp. 4-5). Effective decision-making in nursing is a vital component and part of the role of a registered nurse; each year a substantial number of patients die due to medical errors and poor decision-making (Levett-Jones & Hoffman 2013, pp. 4-5; Nibbelink & Brewer 2017, p. 3). Through the use of

The advanced practice nurse (APN) brings the combined training and experience received in school and the clinical practice to enhance patient care. Clinical decisions require problem solving, critical thinking, ethical judgment, and evidence-based practice to ensure patients receive the best care (Pearson, 2013). This unique set of skills allows the APN to determine areas needing further study to improve patient outcome. This paper will introduce the author’s phenomenon of interest and primary philosophic viewpoint for providing patient care, discuss an alternative or opposing philosophic viewpoint to patient care, and summarize the four patterns of knowing in nursing identified by Barbara Carper in 1978.

Standing (2011), defines clinical decision-making as a complex process that involves observation, gathering information, critical thinking, evaluating evidence, applying necessary knowledge, reflection and problem-solving skills. Every day nurses make important clinical decisions and these decisions have important implications for patient outcomes and deserve serious consideration. Therefore, it is important for nurses to have a better insight of the decision-making process, be able to deliver holistic care and meet essential and complex physical and mental health needs of the patient.

There are different types of knowledge and different ways of knowing. Four fundamental concepts of knowing in nursing highlighted by Caper (1978) are empirical, personal, ethical and aesthetic. He divided knowledge into two forms which are tacit and explicit. Tacit is insights and based on experience and not easily visible and expressible, difficult to share and communicate with others which is highly personal. Empirical sources of knowledge depend upon an individual’s manner of observing and responding to events in the outside world (Higgs et al, 2004). Whereas explicit is formal and based on rationality and easily can be expressed, shared, communicate which are highly universal principles. Rationalism comes from within the individual and

The first pattern of knowing in nursing presented is the Empirics: the science of nursing. Carper (1978) described this empirical knowing as factual evidence and proven medical research or documentation used for patient treatment. This empirical knowledge is vastly related explanations and predictions from facts and things that have been proven. This author believes that most of this scientific evidence or knowledge stems from books and clinical experiences gained in healthcare facilities under the leadership of trained educators or licensed medical providers. This author believes this because as a nursing student, she will learn nursing techniques such as inserting foley catheters, and doing injections first by observing the nursing

Carper’s ways of knowing provide a fundamental source of information regarding nursing knowledge and practice. Any professional field is built around a variety of knowledge tenets, which help to organize ideas, test those ideas, and then apply them. Carper’s ways of knowing outline fundamental patterns of deriving knowledge and building experience as far as teaching and the practice of nursing are concerned (Zander, 2007). These patterns are used to explain or develop theory in the teaching of nursing, besides helping practitioners to build more knowledge and to enhance their practice. Carper’s ways of knowing identifies four different patterns of knowledge, which are analyzed in this case within their syntactical and conceptual frameworks. They include empirical, personal, ethical, and aesthetic.

As the nurses who participated in a study (Jones & Cheek, 2003) overwhelmingly advised, there is no such thing as a typical day for a nurse. Nurses face new situations everyday and it is important that they can adjust their knowledge and skills accordingly. Critical thinking and reflection are essential skills because they can enhance nurses’ ability to solve problems and make sound decisions. Critical thinking skills enable nurses to identify multiple possibilities in clinical situations and alternatives to interventions; weigh the consequences of alternate actions; and make sound judgement and decisions (Brunt, 2005). Through reflection, nurses can examine their practice, explore feelings and reactions and connect new meanings to past experience (Brunt). Reflection can enhance self-awareness, foster professional satisfaction and growth and increase the possibility for change and improvement in nursing practice and therapeutic relationships (Thorne & Hayes, 1997).

Over the past 30 years nursing has evolved from a task-oriented to a logical and systematic approach to care, using theories and models to guide practice. According to Jasper (2007, p117) theories of decision making in medicine tend to favour logical, precise analytical models which are held to be testable, unambiguous and repeatable, therefore satisfying scientific principles. These represent important ideas of certainty and rationality that are intended to provide a sense of security and reliability. When used correctly a nursing model should give direction to nurses working in a particular area, as it should help them understand more fully the logic behind their actions. It should also act as a guide in decision-making and so reduce conflict within the team of nurses as a whole. This in turn should lead to continuity and consistency of the nursing care received by patients according to Pearson et al (1999,p ).

Within the practice of nursing, situations often arise where nurses are forced to make decisions regardless of their level of experience in the profession. Providing care and following the physician’s orders historically were the nurse’s sole responsibilities. However, social change, changes in health care finances, increasing international perspectives, and demographic population changes, have resulted in a significant evolution of the roles and responsibilities emplaced on today’s nurses (The National Association of Clinical Nurse Specialists (NACNS), 2007). Kelly and Crawford (2013) believe budget cuts, higher client acuity and clients with complex needs, mergers of hospital corporations as well as a general shortage of qualified nurses has made it necessary for nurses to play a role in decision making. Decision making is defined as “cognitive process leading to the selection of a course of action among alternatives” (Kelly & Crawford, 2013, p. 352).

Underlying both the clinical decision-making process and the nursing process is the skill of critical thinking. Critical thinking has been described as the ability to gather and process data in such a way as to arrive at the best conclusion using the filters of prior knowledge, experience and external resources to overcome personal emotions, biases, and assumptions. (This description was developed during NUR/300 class, University of Phoenix, S. Colorado, March 16, 2006) Note that critical thinking is described as a

The development of the nurse’s ability to clinically reason and take appropriate and timely action can, in time, become an instinctive and automatic process. Reflective practice by the nursing professional will highlight the areas in which further improvement is needed. Essentially, it is the responsibility of the individual nurse to identify the need to develop this ability, and the skill to effectively communicate the patient’s condition to the other members of the healthcare team to produce positive patient outcomes.

Critical thinking and clinical judgment are important skills that professional nurses use in every day clinical setting. In 2012, a mix method qualitative study by Dr. Jeanne Mann was done to evaluate the effectiveness of educational strategy to develop clinical judgment skills in nursing students. In this study, the population was identified as volunteered Level II baccalaureate nursing students from a Midwest nursing program. The variables identified in this article are the relation between critical thinking and clinical judgment. The title of the article clearly indicated the focus of the study and created an interest in reading the research due to nurses utilize their ability to critical think and

Clinical reasoning can be defined as, ‘the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient’s problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process’ (Levett-Jones & Hoffman 2013, p.4). It requires health professionals to be able to think critically and ensures better engagement and results for the patient (Tanner 2006, p.209). The Quality in Australian Healthcare Study (Wilson 1995, p.460) discovered that ‘cognitive failure’ resulted in approximately 57% of unfavourable clinical events involving the failure to produce and act correctly on clinical information. It also recognises that often nurse’s preconceptions and assumptions can greatly affect patient care and by going through such a process, one can take into account the holistic nature of the patient and provide the best, most appropriate care.

“Code blue in the emergency department, all personnel to room three.” These words droned over the loudspeaker, again and again, sending every trained staff member into a state of emergency. Code blue: the signal for an adult medical emergency. In a matter of seconds, the head nurse gave each staff member their orders and like an efficient machine, everyone went straight to work. My instinct was to run. Right in front of my eyes a patient’s heart had ceased to beat. The room filled with urgency as I filled with enough panic I nearly choked on it. With difficulty, I swallowed the lump in my throat containing all my fear and looked to my internship supervisor for instruction. It goes without questioning, nothing can prepare someone for what I