Ways of Knowing in Nursing

Introduction

Nursing involves the application of a wide range of theoretical and practical knowledge to assess, diagnose, and provide the appropriate level of care for patients. Historically, nursing has been regarded as a vocation and seen as a calling or duty. Nursing is knowing what the patient needs even before he or she explains it (Critical Care Nurse Training Standards Task Group Final Report, 2010). Nursing also can be termed as a profound knowledge of the heart (Jasper, 2003).

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Over the years, the nursing sphere has experienced many changes. Nursing practice is based on the best knowledge evidence available at the moment with nurses regularly reviewing their professionalism. Nursing as a profession focuses on the wellbeing of the members of the society. According to the International Council of Nurses (2015), nursing as a profession includes autonomous and collaborative care for individuals of all ages ranging from families, groups to communities in any setting.

Nurses' approach to patient care, training, and scope of their practice are some of the features that can be used to differentiate nurses from other health care providers (Bishop & Scudder, 1990). This paper reviews different patterns of knowing in nursing and various improvements that should be made in a traditional care plan to ensure better health care service delivery to the patients.

Depiction of the Patterns of Knowing

The portrait above is “Self-portrait with Dr. Arrieta” by Spanish artist Francisco Goya, where the artist depicted himself during his severe illness. The portrait clearly portrays the doctor-patient relationship. The manifestations of the four patterns of knowing in the portrait, including the empirical pattern of knowing, the ethical pattern of knowing, the personal pattern of knowing, and the aesthetic pattern of knowing, are discussed below.

Empirical Pattern of Knowing

The empirical pattern of knowing refers to the factual knowledge obtained from external sources that are empirically verifiable (Jasper, 2003). In this regard, the portrait represents the nursing proficiency and skills of the medical practitioner in dealing with the complexity of the patient’s case. The doctor in the picture is using the acquired knowledge to examine the patient. The empirical knowledge that the doctor acquired through education and training in the medical school enables him to examine the patient accordingly. Thus, in the portrait above, the doctor's specialization is manifested in the actions he is performing towards the patient.

Personal Pattern of Knowing

The knowledge and the attitude derived from the doctor's personal understanding are the main aspects of the personal pattern of knowing (Carper, 1978). As it appears from the portrait, the doctor is building a personal understanding with the client so as to provide the client with the freedom of expression. Although the doctor and the patient might be strangers, the doctor remains keen on the patient's position to get to know the situation of the patient. Thus, the doctor listens to the patient, and a real relationship of working together is established.

Ethical Pattern of Knowing

The ethical pattern of knowing refers to the attitude and the knowledge within the ethical framework and moral behavior in the line of living (Jasper, 2003). According to Bishop & Scudder (1990), good ethics and moral practices are the key factors to good doctor –patient's relationships, that are leading to better service delivery. In the portrait, the doctor is showing respect to the patient as he attends to him. The medical practitioner is manifesting the required ethical standards when assisting the patient. Concisely, the portrait shows how the communication between the doctor and the patient has brought about friendship. This is clearly shown when the doctor assists the patient with a glass of drinking water to take some pills. Therefore, the doctor has created an enabling environment that adheres to the ethical standards so as to execute his duties satisfactorily.

Aesthetic Pattern of Knowing

The aesthetic pattern of knowing in nursing refers to the awareness of the immediate situation at hand and the ability to outreach all the possible outcomes of any situation at any given time (Carper, 1978). The nurse should engage the patients in a live conversation so as to understand the situation of the patients more. As shown in the portrait, the doctor is interacting with the patient so that he can get to know his patient better. The doctor is helping the ailing patient to swallow the pills in a way that suggests he really feels for the patient. The doctor keenly observes the patient as he touches him on the forehead carefully to provide support and sympathy to the patient. The mutual understanding of the doctor and the patient shown in the portrait will enhance the quality of health care provided to the patient.

Nursing Plan Improvement

The nursing program refers to a schedule of content that illustrates various processes that are adhered to when providing health care to an individual, a family, or a community by medical personnel (Carper, 1978). In the process of attending the patients in a healthcare setting, medical practitioners are supposed to adhere to the processes as indicated in the nursing plan. The care plan enhances the monitoring of the patients and thus leads to better service delivery. The traditional nursing program has six columns which include assessment, planning, diagnosis, rationale, intervention, and evaluation. Each column briefly describes the desired actions that the medical practitioner has to offer to the client. An example of a traditional care plan is shown below.

Traditional Nursing Care Plan

Problem List

  1. Inflammation of bowels Colon mucosa ulceration Fecal impaction.
  2. Gastric bypass Infant – breastfed.
  3. Decreased sphincter reflexes.
  4. Allergies.

Goals and Outcome Criteria

The patient will have:

  • stool elimination;
  • verbalized methods of treating diarrhea.

Nursing Orders

  • assess abdomen for distention bowel sound and pain;
  • record color, odor, amount, and frequency of stool.

Evaluation

Instruct patient on:

  • diet;
  • medication usage;
  • discontinuing solid;
  • offer clear liquids.

Empirical Know-How Improvement

According to Park & Park (2004), the medical industry, just like any other large sector, is prone to changes and improvement. Thus, a modified and more detailed nursing care plan is appropriate. Medical practitioners need to fetch more information from the clients; thus, the plan should be more accommodated for the medical practitioners to gather all the necessary information. The empirical expertise of the nurses can be adequately accommodated in this plan by adding more columns that will create room for information.

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Apart from collecting the information from patients comprehensively, the plan will help nurses to provide better care to the patients. A more comprehensive care plan will also reflect the personal attributes of the doctor diagnosing the patients. The modified care plan will adhere to the initial columns, but it will be more detailed than the initial one. The modified care plan will have concrete steps that the nurses will follow when attending to their clients, that is, the assessment of the case, diagnosis, then planning, implementation, and then evaluation.

Personal Know-How Improvement

Traditional nursing care units do not explicitly cover the knowledge and attitude derived from doctor's or patient's self-understanding and empathy. The care units should be improved to provide room for imagination as well as self-reflection to provide better service delivery. For instance, the assessment section, which contains both objective and subjective data of the patient, should be clearly outlined to give room for more information. First, the primary source of data, which is the patients’ complaints, should include the patients’ reflections on the developmental, psychological, spiritual, physical as well as the socio-cultural issues facing them.

Therefore, with all these factors being discussed, nurses will be able to capture as much information as they need for the successful attendance of the patients. Besides, nurses can take the patients’ records that involve the medical history, therapeutic information as well as the laboratory report (Critical Care Nurse Training Standards Task Group Final Report, 2010). Having all these records, a nurse or a doctor will understand the patient's problem better, which will lead to better health care service delivery. All the information provided will give the care providers insight into all the possible aspects of the problem.

Ethical Know-How Improvement

To ensure that quality services are delivered to the patients, the nursing care plan should be modified to accommodate more information. However, apart from promoting quality service delivery, it should enhance good ethical practices. Nurses should treat the patient with due respect, making sure that the patient still needs their intervention. Again, nurses should encourage their patients to participate in these moves to have a successful intervention. This step assesses the knowledge the nurses have toward the interventions done to the patients. They should create a good rapport to ensure that this phase is completed successfully.

Aesthetic Know-How Improvement

Traditional nursing plan narrowly addresses the attitudes and knowledge emanating from the ethical framework, which includes the awareness of moral questions and choices of both the doctor and the patient. This improvement will fall under the evaluation section. The aim of the evaluation process is to determine the progress of the patient regarding the goals as well as the expected outcomes based on the criteria outlined in the nursing care plan. It seeks to check whether the problem was resolved and what more can be done to the patient.

The evaluation will be done through data collection using the stated and measurable outcomes. By so doing, the nurse will determine whether the intervention achieved the set goals. Again, the data gathered from the evaluation of the patients’ responses will be compared with the outcomes (Wade, 2012).

The stated goals will be met if the patient’s responses correspond with the expected results. The goal will not be met if the patient’s responses correspond partially with the expected outcomes, so the result will be partial. Again, the goals may be barely met, so the nurse will seek to determine why the activities have not led to the expected results. Therefore, if the patient’s responses do not correspond to the desired outcomes, then the nurse will be able to know what needs to be improved.

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