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Custom Fundamental Patterns of Knowing Essay

There are four basic patterns of knowing: empirical, esthetics, personal and ethical. Empirics is the process of constructing theory through research in order to produce objective, evidence-based explanations for nursing phenomena which can be generalized such as when these become the basis of future actions. Esthetics is knowledge gained from practice and the subjective experience of perceiving a patient’s need and appropriately, creatively responding to it resulting in positive outcomes. Personal knowledge is self awareness and being comfortable with oneself. This allows acceptance of others for who they are and a capacity to engage in meaningful helping relationships. Finally, ethics is knowledge of what is right and good based on moral, ethical or clinical standards and the ability to apply these principles using critical thinking.

On reflection, a previous clinical experience allowed me to apply the four patterns of knowing. I was once assigned in the medical ward and an admission was made of a bed-bound elderly patient who had multiple stage IV pressure ulcers and a fever from presumed sepsis. She was brought in by her daughter who was her primary caregiver. On day 3 post admission, the daughter requested for the patient’s discharge to home. The physician berated the family member for neglecting the patient and bringing her in so late into the disease process, stating that discharge was not possible as she would probably not be taken care of at home anyway.

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I knew I needed to intervene since patient advocacy is an ethical role of a nurse. Discharge was not in the patient’s best interest based on empiric knowledge that pressure sores need acute management to include wound care, medications, dietary and other interventions. Through personal knowledge, I knew I had the capacity and the desire to engage the patient’s daughter in a conversation to explore the context of her decision for a discharge against medical advice. I was conscious to be nonjudgmental in view of the physician’s opinion of the caregiver’s presumed neglect of her mother. I did my best to listen and be emphatic.

The daughter then expressed that she was divorced and had sole custody of her children. Her former husband was noncompliant with financial obligations. She lived with her mother and juggled two jobs. Ever since her mother suffered a stroke, things became more difficult. She had a limited social support system and her multiple roles left her exhausted. Though she had a sister living in the state, they were not in good terms for the past 10 years. There was no one to take care of her kids at home and so having her mother discharged was, for her, the best option.

Drawing from prior clinical and personal experiences (esthetic knowledge), I realized that the patient’s daughter was experiencing caregiver role strain. I proceeded to explore with her how to expand her support system. We looked at a list of support groups whose services were accessible and applicable to the patient and family’s case. We studied how those services can be accessed. I also encouraged her to enlist the support of her sister. I further told her that I would be referring her to social services for assistance. Lastly, I explained other options for her mother including home-based nursing care or transfer to a nursing home. From there, we were able to work out ways of coping with the problems which improved the patient and family situation. It was also a fulfilling experience for me.

Theoretical Foundations of Practice: Views on Theory-Driven Evidence-Based Practice

Evidence-based practice has become a central concept in defining quality in nursing practice. Clinical judgments regarding the adoption of one intervention over another are often guided by the results of research. When scientific study yields hard evidence of the higher efficacy of one intervention, that intervention is subsequently given greater weight during decision making. However, there are different views on what constitutes sound evidence. This DQ response discusses the medical theorist’s view and a nursing theorist’s view of the issue.

Evidence is often defined in terms of the degree that it is scientific. From a medical standpoint, this connotes quantitative measurements and a high degree of research control as exemplified in randomized controlled trials. RCTs are associated with a class A category or a high level of evidence. For example, to find out the presurgical body hair intervention  least associated with postoperative infection, the various methods, namely shaving body hair, clipping it, using depilatory cream or just leaving it alone are subjected to RCT. Only then would the recommended intervention be promoted as a standard.

This medical perspective has diffused into nursing practice in that there is strong reliance on empirical knowledge when establishing evidence-based practice. Thus, in initiating changes in operating room practice to decrease postsurgical infections, nurses would conduct a meta-analysis of prior studies, often screening them to include only those that used methods approximating RCT standards. Despite a greater emphasis on the empiric pattern of knowing manifested in more active research efforts using the medical approach, nursing knowledge however still maintains a marginal status of scientific credibility as compared to medicine.

Nursing theorists such as Jean Watson and Betty Neuman contend that there is a need to veer away from the overreliance on empirics to developing other patterns of knowing in nursing. Because of the nature of nursing as a caring profession, not all facets of nursing care are amenable to explanation using solely a traditional scientific approach. Nursing practice deals with the therapeutic use of self, helping relationships, empathy and the resolution of various ethical dilemmas where intuition, experience and other forms of subjective knowledge from non-empirical patterns of knowing are indispensable resources.

What this means is that there are alternative perspectives besides the medical approach and redefining the meaning of theory and evidence as they apply to nursing is entirely possible. Utilizing the patterns of knowing as a framework for research and theory building will advance nursing knowledge in all fronts, not just nursing science. Consequently, a theory-driven evidence-based practice developed by nurses for nurses can emerge. Therefore, it is necessary for nurses to correct their dominant assumption that empirical knowledge derived using the traditional framework is the foremost or only key to theory and evidence.

Custom Fundamental Patterns of Knowing Essay

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