What do we know about nursing? To what extent do we understand nursing? How can we decide if we do “know” what nursing is? These are questions asked when we are developing knowledge about Nursing as both an Art and Science. The word we use to refer to the questions above is “Epistemology.” Its formal definition 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.” Epistemology within Nursing includes several different kinds of “knowledge.”
- Empirics: Scientific. “Science of Nursing” Observation, testing, replication
- Personal Knowledge: “Therapeutic use of self.” Knowledge gained from thought alone
- Intuitive Knowledge: feelings and hunches
- Somatic Knowledge: knowing of the body in relation to physical movement
- Metaphysical Knowledge: Spiritual
- Esthetics: “Art of Nursing” Knowledge related to beauty, harmony, expression…Art, creativity, values
- Moral or Ethical Knowledge: “Moral Component of Nursing.” Knowledge of what is right and wrong
It is important to use–and be aware you are using– all of these “ways of knowing” in your daily practice as a nurse. Not just because it is best practice and encourages better caregiving, but because it’s exclusive to our discipline—it’s what sets us apart as a profession—it’s one of the things that separates nursing from simply being a “job.” Besides the fact that several of the “ways” overlap, it’s prudent to consider them all together so that we as nurses aren’t always focused on purely the empirical (science) piece of our profession—or purely the “Art” of Nursing. What we know about the human experience has changed and expanded, new ways of obtaining knowledge have been discovered, and technology’s impact on lengthening patient’s lives have produced the necessity to incorporate new and innovative areas of knowledge to help us provide the best care to patients and to grow our profession to fit the current ever changing complex patient care environment…Chinn and Kramer added “emancipatory knowing,” Schultz and Meleis identified the need add “practical knowledge” to epistemology, and White folded in the need to be aware of the “sociopolitical environment” in addition to the traditional epistemology components. Carper’s “Ways” are an excellent foundation that guides us in how we can “begin” our journey in obtaining knowledge unique to our profession—but it’s just that, a foundation. As our profession has evolved so has the need to continue discovering and adding to the original components of epistemology. Nursing knowledge should include other patterns of knowing in addition to the empirical pattern because…The blending of patterns is a critical part of “what nurses do” that seems to be getting lost in technology, health care policy, cost containment, and resource utilization……demonstrating the use of these “ways” in my opinion, is probably one of the most important contributions we advance practice nurses will pass on as a legacy to our younger newer colleagues.
We would all love to have a beautiful mansion by the sea, with many themed, artistic rooms and halls, laced with the latest in technology—but careful, that mansion will not stay upright if there aren’t proper building materials or a solid foundation for it to stand on. Empirics provides that “hard structure.” What I see as a practitioner right now is nursing’s mansion sitting on a wet sandy beach—and as each tide comes in—were losing bits and pieces. Those bits and pieces are the other patterns of knowing that are – and should be—center to our interactions with patients. Humans are not robots; they aren’t machines, vital signs, test tubes, petri dishes, or heart rhythms—nor are they “p” values or bell curves.
I’m often teased for focusing and taking my time to take in the “holistic picture” of the patient and how I will design/add to the patient’s healing process. My colleagues think it’s funny that I am hypersensitive to energies they can’t feel and that I use that as a tool to help guide my interactions and relationships with the patient and family. Being empathic (an empath)—I’m now learning, is a “way of knowing” that I have incorporated into my own personal practice and it has yielded me a much more therapeutic and trusting relationship with my clients. The hypersensitivity to energies and intuition are my primary guides and they dictate how I utilize the other ways of knowing—Empirics actually comes second in many cases; with the use of Esthetics, Metaphysical, and Moral/ethical knowledge folded in later as I go along. Humans are multifaceted beings interacting with their environment, their illness, or wellness, or their final hours of life thus it only makes sense that nursing “reflect” that as much as it can. When I use my sensitivity to the energies around me my goal is to be as “in sync” or the best “reflection” of that patient – but in a nursing perspective.
Solely focusing on Empirics not only disregards the human experience, but it also diminishes the art of what we do, thus dimming the gleam of what makes our profession so bright, therapeutic—and healing. All of us have preferences for how “we nurse”—our own unique “ways” of critical thinking or using theory (sadly, theory use is rare these days). In my opinion the most important pattern of knowing is “Empirical.” It’s a sturdy foundation! I’ve begun to appreciate that my own personal practice has been to “blend” the ways of knowing in my daily nursing care of recovering heart transplant patients, or in guiding a patient and family to end of life. If I had to make Empirics the “winner” over the other “ways of knowing”—I’d have to say that Empirics edges all the others out by just a millisecond over the finish line. I say this because when I spoke of the mansion earlier I compared empirics to the building materials used to build the mansion and the foundation upon which it sits—the complete and finished mansion is the combination of all the “ways” together and what I view as nursing as “a whole” or the perfect balance of art and science.
Empirics as a frame wouldn’t mean much or be as valuable to me without all the other stuff that makes up the mansion. Empirics are the things we know for sure. Hard and fast knowledge, book smarts, evidence based practice,– how we categorize things to explain them better or make sense of them—thus developing frameworks. We as nurses can’t use the rest of the patterns of knowing if we don’t have the main frame of the nursing house—it would be messy, disorganized, and we wouldn’t really know when or how to use them. The frame of the house should always validate our profession to others as one of substance, strength, and depth. If people were to take apart the mansion and go backward—they would be able to see, piece by piece, what nursing “is”—but again, that is subject to individual perception—our own metaparadigm of what nursing is and what it is not.
Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13-23.
Fawcett, J., Watson, J., Neuman, B., Hinton Walker, P., & Fitzpatrick, J.J. (2001). On nursing theories and evidence. Journal of Nursing Scholarship, 33(2), 115-119.
McEwen, M. & Wills, E. (2011) Theoretical basis for nursing. Philadelphia, PA: Wolters Kluwer Health.