Of Mary TMCCA Patterns of Knowing and Knowledge It is suggested that there are five patterns of knowing and knowledge in nursing. A nurse must develop and balance all of these patterns of knowledge in order to be effective. As in all of nursing, nurses refine these patterns with experience and reflection throughout his or her career. This knowledge is interrelated, interdependent and overlapping.
Nurse, as any other profession develop their own pattern of knowledge as part of their profession, nursing being a unique profession with a unique pattern of knowledge because it requires intellectual knowledge, technical skill and is considered an art (Rutty, J. E. 1998). The first pattern of knowledge is emancipatory knowledge. This concept challenges the nurse to recognize the sometimes-subtle social and political ramifications influencing his or her practice and patient care.
The nurse must first recognize that something is wrong, and then have the courage to meet the challenge to attempt to change the status quo (Chinn & Kramer, 2011). Hegemony is the ability of a certain group or dominant class to influence or control another population or group and influence them to accept their view. The hospital environment and relationships within them can be considered hegemonic, therefore, nurses learn early in their education that is conflict is common between hierarchies within institutions. Nurses learn early in their careers that hegemony can cause disharmony in their practice (Clare, 1993).
In order to utilize this practice or pattern of knowing the nurse must question not only what is wrong with the picture but also who is benefiting from the status quo. It is assumed that the disadvantaged population or individual is not free to choose from the options that more advantage persons would be able to choose. The nurse must ask critical questions such as what is wrong with this picture and who is benefiting by keeping the status quo (Chinn & Kramer, 2011). Ethical knowledge in nursing has to do with doing no harm and doing what is right. Ethics asks what is right and who is responsible?
Nurses are challenges daily in clarifying their values and exploring their alternatives when ethical dilemma’s occur in practice. Various techniques that can be utilized for this process, however the nurse must be aware that this process is likely to be emotionally charged, as it will challenge his or her deeply held values and belief system. The nurse must also explore other avenues of resolution to the problem from the viewpoint of facts and logic. The use of an ethical decision tree is often useful when making an ethical decision, as it add clarity to the situation.
Ethical knowledge in nursing operates within fundamental principal and codes. These include such principles of autonomy and benevolence. These are guides to our practice of what the right thing to do (Chinn & Kramer, 2011). Griepp’s model of ethical decision making suggests that the nurse has personal belief systems and values however through education and knowledge development has the ability to change his or her beliefs or values. The nurse has the responsibility to always be aware of outside influences on his or her decision-making and carry out right behavior and knowledge (Griepp, 1992).
Ethical and Moral Comportment is a term that refers to how nurses or individual behaves or acts morally relative to what they know ethically. This requires the nurse to integrate all patterns of knowledge into the decision-making process. Ethics being the knowledge of what is right, morality being the behavior or heart of what is right and is based on values. An individual has moral integrity when they behave in a manner that is consistent with their ethics. When nurses are unable or unwilling to maintain moral integrity they get moral distress. There are four types common ethical perspective in nursing.
Teleology refers to what is right produces good. This concept often refers to the justification for the greatest good for the greatest number of people. Deontology refers to the principle that what is right may not necessarily produce a good outcome. When this principle is followed, it may be the right thing to do in the circumstance, but may cause harm. These two principles are often in conflict. The principle of relativism suggests that what is right in one culture or society may be different on another. This suggest that depending on time and place in history, what is right may change.
Virtue ethics suggests that the person involved is important in the decision- making. The character and values or virtues of the person determines the ethical decisions made. The definition of virtue can be troubling when utilizing this principle, especially when referring to nurses as it is comprised of a high percentage of women, whose virtues tend to be obedience, submissiveness and self-sacrificing (Chinn & Kramer, 2011). Personal knowledge is the most difficult knowledge for nurses to describe and develop as it takes much introspection, interaction and experience.
It is complex and unique to each person yet fundamentally one of the most important patterns of knowing (Rutty, 1998). Personal knowing is rooted in the central questions of; do I know what I do? And Do I do what I know? This concept is spiritual in nature as ones values, attitude and hopes are linked to what they know about themselves and how they view the world, joy and suffering, realities, and how each person learns to be authentic and genuine. Personal knowledge is guided and learned by self-reflection, personal stories and being ones genuine self. The creative process of opening and centering guides it.
This process allows the nurse to be present fully with other individuals, and develop the strength and character to be authentic and genuine with others. This allows the nurse to give meaning to the experiences he or she has lived (Chinn & Kramer, 2011). Once knowledge is obtained, it becomes personal knowledge; this is part of our humanness. At times, the nurse must become uncomfortable in order to seek out personal knowledge as he or she explores and reflects (Sweeney, 1994). Personal knowing is how a nurse just knows something is about to happen or about a situation or another person.
Personal knowing is the experience of the situation without conscious reason (Chinn & Kramer, 2011). Personal knowing is what leads the nurse to intuitive thinking. He or she cannot tell you why she has this feeling that this will happen, he or she just knows (Sweeney, 1994). When the nurse has a strong sense of personal knowing it is empowering and gives the nurse a sense of community. The nurse values human life more fully and is more giving to others as he or she is more authentic and genuine both with him or herself and with others as they must attempt to view the perception of others (Chinn & Kramer, 2011).
Aesthetic knowledge is the art of nursing and how nurses find meaning and significance in each situation. This pattern of knowledge provides the nurse with insight into the human condition. This insight gives the nurse appreciation and inspiration for the practice of nursing. This pattern of knowing and insight allows the nurse to know the unique meaning to unique situations and transform problematic situations into therapeutic situations instantaneously. As in other patterns of knowing this pattern utilizes creativity by the nurse.
The nurse must envision the possibility of the best outcome for a given situation and design through experience of past knowledge and present relationship and state as the situation takes place. This must integrate all patterns of knowing in order to be effective. While this is underemphasized in nursing practice, it is and integral part of nursing history. It is the heart of nursing excellence as it embodies mind, body and spirit to form the art and caring of nursing. This pattern of knowing takes discipline on the part of the nurse, as he or she must rehearse situations in advance (Chinn & Kramer, 2011).
This pattern of knowing requires the nurse to be fully engaged and he or she must interpret each situation by looking beyond what is happening at the moment and envisioning various possibilities. One cannot fully explain in the form of language the art of nursing, however the nurse shows the art through interactions and skills (Mantzorou & Mastrogiannis, 2011). This pattern of knowing requires the nurse to know what it means to experience health as well as illness. Synchronous movements with ones language are important in this knowledge.
The art of body language and touch is embodied with language skills. Eye contact, touch, facial expressions, tone and language skills are all important. When the nurse’s body language and tone matches what he or she is saying and he or she engages in therapeutic touch, language skills and body language skills a therapeutic environment is created. This therapeutic environment translates to aesthetic nursing (Chinn & Kramer, 2011). Empiric knowledge can be viewed as the science of nursing. This is the knowledge that is based on the senses.
What can the nurse see, hear, touch, smell and possibly taste. They are the facts, figures, graphs, descriptions, and predictive relationships. Empirics can be validated and are viewed the same by all individuals, they are concrete (Mantzorou & Mastrogiannis, 2011). This being said, there are several dimensions to empiric knowledge as one must define the conceptual meaning of any given word or concept as it may have different meaning dependent on culture, the situation it is used, or past experience of the person imagining that word. Some concepts are based n continuums. The concepts of cardio-vascular health can be defined in many ways along the continuum. It would need to be more specifically defined along the continuum in order to be valid and clarifies an empiric concept. This creates identifies assumptions, clarifies context for theories, and designs relationship statements. Empiric theory can be defined in a number of ways. Chinn and Kramer (2011) describe empiric theory as “A creative and rigorous structuring of ideas that projects a tentative, purposeful and systematic view of phenomena”.
This process requires creativity, rigor, structure, purpose and tentativeness on the part of the nurse (Chinn & Kramer, 2011). The fundamental concept of the servant leadership is relationship. One must have relationship with self and with others. This relationship relates to nursing as relationships and personal knowledge and self-reflection is an integral function of all patterns of knowledge. Listening, self- awareness, empathy, foresight and personal and professional growth all contribute to healing of self and others by a servant leader.