Four ways of Knowing

Femy, a nurse in a provincial hospital in Bacolod goes on her rounds. She carefully reads the
client’s chart, noting that the medications prescribed require precise monitoring and observation due to
its potency . She greets her clients with a welcoming and caring attitude, and understands the client’s
needs, showing much compassion. Her advice was sought by a novice nurse over a moral delimma. She
told her to be firm clients advocate while upholding her moral beliefs.

How did the nurse accomplish this?. What does she know that others don’t? What does it take
to become a good Filipino nurse?.

A good Filipino Nurse is shown by her appropriate actions. The proper nursing actions are the
result of a good foundation in knowledge in which is an outcome of gathering and processing of
information and experiences. Therefore, knowing oneself in the area Of Nursing is important because of
it, one cannot fully know the client, which hinders provision of total care. The saying “ Know thyself” or
“kilalanin muna ang sarili bago ang iba” should be taken by a Filipino nursing student seriously as early
as possible.

Indeed, it can be said that an exemplary nurse consciously or subconsciously practices what is
called the Four ways of Knowing identified by Barbara Carper in 1978. This is achieved and realized by
harnessing the nurse’s collective stores of knowledge, character and profound experience. A concept
nursing theorists call Personal Knowledge or Self Knowledge.

EMPIRICAL KNOWING

Empirical Knowing is the principal form relating factual and descriptive knowing aimed at the
expansion of abstract and theoretical explanations. Empirical knowing focuses on evidenced-based
research for effective and accurate nursing practice, making it the “Science of Nursing “. It is where
most theory and research development is concentrated and some conceptual forms have better
capacity to explain nursing phenomena that others. Chronologically, empiric ways of knowing has
dominated the nursing profession since Nightingale’s era. Nurses are inclined to believe that only valid
and reliable knowledge is factual, objective and generalizable.

Notes: Any scientific, research-based, theoretical and factual information that the nurse makes use of
are under empirical knowing. Such as knowledge obtained from lectures, textbooks, journals and online
resources.

EVIDENCED-BASED PRACTICE as part of Empirical knowing.

Nurses of today are active in creating, publishing and applying research in order to enhance
client care and broaden nursing scientific knowledge base. Recently, use of evidenced basedpractice
gained recognition in the nursing practice. It uses a form of evidence in making clinical judgement. This
evidence or support may stem from tradition, authority, experience, trial and error, logic or reason and
research.

Evidenced- Based Nursing Practice involves accurate and thoughtful decision making about
health care delivery for clients. This is based on the result of the most relevant and supported evidence
derived from research in response to client’s preferences and expectations. An institution will benefit if
evidenced-based practice is effectively implemented and significantly translated into nursing practice.
Practice founded in EBP can bridge the gap of nursing practice and research to provide basis for nurses
to transform research into quality care.

Characteristics of quality health care that reinforces aspects of EBP

 Client- centered
 Scientifically-Based
 Population outcome based
 Developed through quality improvement and benchmarking
 Individualized to client’s needs
 Attuned with system policies and resources

Evidenced reports

According to Benefield(2002), evidence report is compromised of knowledge synthesis, review,

amd documentation of how evidence- based practices are being implemented in the clinical area. He
added that it can also include discussion of the clinical significance and usefulness of such practices.

In the application of EBP, the nurse should first become aware of the need for information.
Development of a question or problem statement to address the need is the next step in the process.
Once the question is defined, the nurse should conduct systematic review on research studies that has
been done on the particular topic.

Take note that systematic review is different from literature review in the sense that the former
utilizes all relevant literature from multiple sources which later undergoes rigorous and systematic
evaluation, while a literature review provides a qualitative summary of evidences on a topic using
informal or subjective methods to collect and interpret studies. After the review and analysis of data,
the nurse must now determine what the research demonstrated and must decide the level of evidence
in order to make recommendations to promote EBP. A structured research summary statement should
briefly describe the evidence reports.
The level of evidence ranks the strength and the quality of the study results. The research findings
should also be evaluated within context of actual or potential usefulness in the practice. If the evidence
gathered is appropriate it will now result to a recommendation in the form of a practice focused
guidelines or clinical intervention.

E videnced-based practice promotes quality care that has been demonstrated to be effective. If practice
guidelines do not exist for a specific problem, the nurse should look for relevant evidence in studies,
integrate reviews and analysis and assess the quality of evidence.

Statement or Question

Analysis or systematic review

Evidence

Recommendations
AESTHETIC KNOWING

Aesthetics or esthetics knowing- is related to understanding what is significant to particular

patients such as feelings, attitudes, points of view. Simply put, aesthetic knowing is the comprehension
of meaning of singular, particular, subjective expression that we call the art of nursing. Aesthetic
knowing focuses on empathy- the ability for sharing or vividly understanding another’s feeling. This is
the primary form aesthetic knowing. It also includes the nurse’s ability in changing ways and manner of
rendering nursing care based on the client’s individual needs and perceptions.

Examples of aesthetic knowing

 Nurse Moses places himself in the “client’s shoes” when communicating, giving judgement and
proving care.
 Nurse Miguel uses layman terms in explaining the needs of the client with right sided heart
failure.

ETHICAL KNOWING

Ethical knowing- requires knowledge of different philosophical positions regarding what is good
and right in making moral actions and decisions, particularly in the theoretical and clinical components
of nursing. The CODE OF MORALS or CODE OF ETHICS that leads the conduct of nurses is the main basis
for ethical knowing. It is deeply rooted in concepts of human dignity, service and respect for life.
Ethical knowing leads one to seek an answer to the question: “ is this right or wrong”?.

Examples of ethical knowing:

 Nurse Carl presents himself as a client advocate and defends his clients rights to choose care.
 Sir Kevin, a clinical instructor, reprimands a student who cheated on a quiz and explains the
consequences.

PERSONAL KNOWING

Personal Knowing- encompasess knowledge of the self in relation to others and self. It involves
the entirely of the Nurse-Client relationship, as stted by Khuan(2006) reflection and response are the
processes of personal knowing that contribute to an understanding. It is the key to comprehending
health in terms of personal well-being and it involves the therapeutic use of self.

Examples of Personal Knowing

 Ruben, a nursing student, strives to promote a meaningful personal relationship with his elderly
pt.
 Ruel, a nursing student, undergoes Psychological counselling and self awareness sessions before
his physchiatric nursing rotation.