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The Use of Ways of Knowing in a Clinical Scenario

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The use of ways of knowing is assumed to be a valid and necessary strategy in providing adequate care in the nursing field. Carper has developed four ways of knowing that has become essential in a nurses every day practice. Carper’s four fundamental patterns of knowing are defined as empirical, ethical, personal and aesthetic. Empirical knowledge is defined as the science of nursing. Aesthetic knowledge is reflected as the art of nursing and the use of empathy. Personal Knowledge is the knowledge we contain from our personal experiences. And ethical knowledge is described as the ethical codes of nursing; what is our matter of obligation. In the 1990s a major modification to Carpers pattern of knowing was suggested. Jill wright suggested the addition of a fifth pattern of, sociopolitical knowing. Sociopolitical knowing defines the cultural aspect of knowing and how it influences each person’s understanding of health and disease. This paper will focus on a clinical scenario I encountered in my nursing career, and I will integrate how the ways of knowing can change ones way of being.

The Use Ways of Knowing in a Clinical Scenario
Nursing professionals are often faced with challenges in our clinical practice. They seek different methods that can be effective in providing adequate care for their patient’s. Carper’s patterns of knowing in nursing have influenced many nurses. The emphasis of different ways of knowing represents a tool for generating clearer thinking and learning about our experiences. This paper will incorporate a scenario and how empirical, aesthetic, ethical, sociopolitical, unknowing and personal knowledge changed its way of being. On August 20th, 2014 I received a phone call from my staffing coordinator to fill in for a nurse. She stated that this was a very simple case and the patient, a child, only had a gastrostomy tube. I had been working for this agency for a couple of weeks, and the two patients I had been working with prior to this case also had gastrostomy tubes. I had become comfortable with the procedures of gastrostomy tubes. My supervisor emailed me the patient’s plan of care, as I read this plan of care I noticed that this child had several diagnoses.

She was diagnosed with microcephaly, scoliosis, cerebral palsy, seizure disorder, and chronic lung disease. I also noticed that this patient was on multiple medications; I decided to research these medications uses and adverse effects. As a new nurse I always want to be two steps ahead and be sure to gather as much information as possible before caring for my patients. I arrived at the home and the patient was asleep. The mother’s chief complaint was that the patient was congested. I looked in the patient’s plan of care and I saw that the patient had albuterol PRN via nebulizer. I provided the patient with some albuterol, there were no signs of discomfort observed and the oxygen level was normal. The mother oriented me where I could find things in the home (medications, oxygen, and formula); she then went off to work. Twenty minutes after the mother left, the pulse oximetry began to sound. When I entered the living room and assessed the patient, she was attempting to cough, and her oxygen had decreased to about 89%. In her chart it stated her oxygen should not go below 92%; if it remained below 92% for longer than 2 minutes, give oxygen.

I realized that she was just given albuterol about twenty minutes ago. So the albuterol had done its job, the mucus has loosened and was ready to be expelled. I intervened by providing her with chest physiotherapy. While I was providing her with these percussions, no secretions were being expelled and her oxygen levels steadily began to decrease. I decided to reposition her in High Fowler’s position, her oxygen levels went back up to 92%, but the patient was still in distress. Once again her oxygen levels decreased and the patient remained in distress. I had tried chest physiotherapy for about fifteen minutes and that was not working, I had tried to reposition her several different times and that method was inconsistent. It was about 10:45 am and the patient had not yet received her medications; she is on seizure precautions and MD orders stated to give her medications on time. I quickly placed the child on her high chair with her head slightly tilted behind, expanding her lungs.

The patient’s oxygen levels began to increase and went back up to 97%, with no signs of discomfort and distress. The patient’s condition was stable for about ten minutes, and then the oxygen levels began to decrease again. I concluded this was not an issue of positioning, this child could not solely breathe, and required supplemental oxygen. I provided her with two liters of oxygen; the patient became stable for the rest of the day, with frequent repositioning. I discovered the position she was most comfortable in, lying on a mat, on the floor, with her body in a semi-inclined position. To the more seasoned nurse this may have been an easy fix, and they would have known the immediate interventions to carry out. However for me it was a learning experience, comfort was provided to my patient. The application of empirical knowledge can be applied in this clinical situation through my nursing interventions. My patient was diagnosed with chronic lung disease, she showed signs of congestion.

In the article “Fundamental Patterns of Knowing in Nursing,” Carper (1975) speaks on empirical knowledge: There seems to be general agreement that there is critical need for knowledge about the empirical world, knowledge that is systematically organized into general laws and theories for the purpose of describing, explaining and predicting phenomena of special concern to the discipline of nursing. (p. 14) In my initial assessment I auscultated rhonchi bilaterally on my patients lungs, as a result I administered albuterol via nebulizer. Throughout the first couple of hours I observed distress in my patient, so I frequently repositioned my patient, to promote better gas exchange. When these methods were deemed insufficient, supplemental oxygen was then given to this patient, and as a result she became stable. Personal knowledge is something that we can all apply in our daily lives; we can also appropriately integrate this form of knowledge in our careers. As an adolescent I was diagnosed with scoliosis, which is the result of a lateral spinal curvature.

As a child, this was very painful, especially depending on my posture and how I was positioned. It was so painful at times that I could not properly breathe. So when I read in this patients chart that she had scoliosis and chronic lung disease; I knew repositioning would play a major role in providing comfort for this patient. According to Farley et al. (2003), “Postural management is not a clinical specialty. It touches many different client groups and may produce benefits for them in different ways” (p. 454). Aesthetic knowledge was demonstrated throughout my interaction between my patient and the patient’s mother. When the mother complained about her daughter’s congestion, I searched for a method that would relieve the mother’s anxiety. I provided the patient with her PRN albuterol. Although my patient could not speak and verbalize how she felt I was able to intervene by frequently repositioning her, providing comfort. I was able to empathize due to my personal experience as an individual who had also suffered from the disease scoliosis. Ethical knowledge is one of the first things acquired in nursing school, the “code of ethics”.

However it can easily be neglected and dismissed depending on an individual’s moral values. The minute I accepted to be the nurse to care for this patient, I immediately became this patient’s advocate. It was my responsibility to seek methods to provide the most optimum care. This is essentially why I researched the patient’s medication, I wanted to be aware of what I should and should not expect. I applied the nursing process through my assessments and provided appropriate interventions. Before any intervention was carried out, I weighed the pros and cons, trying various methods to receive the best outcomes. According to White (1995), “The sociopolitical context of the nurse-patient relationship fundamentally concerns cultural identity, for it is in culture that ‘self’ is intrinsically located” (p. 84). I was able to incorporate this way of knowing into this situation because this family was of a Haitian culture and so am I. There seemed to be a lot of discrepancies between the previous nurses and the mother because of a language barrier, which subsequently provided inadequate care for the patient.

I was able to communicate with the mother and understood the concerns she had for her child and provided the care she wanted for her daughter. Unknowing knowledge can definitely be integrated in this clinical situation. I contained the empirical knowledge in the aspect that I had her diagnoses and was able to research her conditions. I was able to integrate personal knowledge because I knew the patient would potentially be in pain due to her scoliosis. However, I truly did not know how this patient would respond to the medications and the interventions I would provide. But I was open to providing this patient with whatever the mother told me best worked for her. I was open to changing my methods and discovering alternate methods in providing care for this patient.

With my openness in unknowing knowledge, I was able to find a position that provided comfort to the patient. In conclusion, as I reflect, the various ways of knowing has a tremendous impact in changing ones way of being a nurse. It is the key to providing better nurses in today’s society. We are trained and have brainwashed ourselves with the everyday technicalities of nursing. However, there is far much more to nursing then just its technicalities. These various ways allows us to use personal experiences, empathy, morals, culture, education, and ignorance to provide optimum care for our patients. This allowed me to realize that nursing is not just a career or profession; it is a way of life. Now when I tell someone I am their nurse for the day, I do not just consider it a job, it is my desire. When we desire to be nurses who provide care, we will truly be in synced with the “ways of knowing”.

Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Aspens Systems Corporation, 13-23.
Farley R., Clark J., Davidson C., Evans G., MacLennan K., Michael S., Morrow M., & Thorpe S. (2003). What is the evidence for the effectiveness of postural management? International Journal of Therapy & Rehabilitation, 10(10), 449-55. White, J. (1995). Patterns of knowing: Review, critique, and update. Advances in Nursing Science, 17(4), 73-86.

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