FOUR WAYS OF KNOWING

FOUR WAYS OF KNOWING

Barbara Carper ( 1978 )

 Identified four fundamental patterns of knowing
that form the conceptual syntactical ( set of
principles , according to rules )structure of
nursing knowledge.

 The Ways of Knowing

- Are methods through which knowledge becomes
apparent to us .
KNOWING / KNOWLEDGE

Knowing : having inside information

Knowledge : facts , information and skills

acquired
by a person through experience or
education
 FOUR WAYS OF KNOWING
 “What does he/she know that others don’t? What does it
take to become a Good Filipino Nurse?”
A good Filipino nurse is shown:
 Appropriate actions
 Good foundation in Knowledge

 Outcome of gathering and processing of information

and experiences
 Knowing oneself in the area of nursing is important
because without it, one cannot fully know the patient
 exemplary nurse consciously or subconsciously practices
– Four Ways of Knowing
 FOUR WAYS OF KNOWING
 Achieved and realized by harnessing the nurse’s collective
stores of knowledge, character, and profound experience –
Personal – Knowledge or Self – Knowledge
 The Four Ways of Knowing includes:

1. EmpiricaL knowledge – the scientific discipline of

nursing
2. Ethical knowledge – the moral directions of nursing
3. Personal knowledge– method by which nurses
approach their parents
4. Aesthetics or Esthetics knowledge – deals with the
emphatic aspect of nursing.
FOUR WAYS OF KNOWING

1. Empirical Knowledge

 Factual knowledge from science or other

external sources that can be empirically
verified.
 Empirical data
 FOUR WAYS OF KNOWING
EMPIRICAL KNOWledge
 Principal form relating factual and descriptive knowing
aimed at the expansion of abstract and theoretical
explanations
 First primary model of knowing

 It is information source or base of knowing

 It emphasize scientific research is important to nursing

knowledge
 As a part of empirics, clinical and conceptual knowledge
are the keys to nursing practice
 FOUR WAYS OF KNOWING
EMPIRICAL Knowledge
 Empirical knowing focuses on evidence – based research
for effective and accurate nursing practice
 Most theory and research development is concentrated
and some conceptual forms have better capacity to
explain
Examples:
 David, a nursing student answer a question posed by the
clinical instructor based on what he learned from school.
 Nurse Michael practices nursing interventions based from
accepted clinical practice.
2. AESTHETIC KNOWLEDGE
 Set of principles

 Awareness of the immediate situation ,

seated in immediate practical action;

 Including awareness of the patient and

their circumstances as uniquely individual ,
and of the combined wholeness of the
situation.

 Aesthetic : is used to mean “relating to the

here and now “
 From the Greek word (aisthanomal ) ,
meaning “I perceive , feel , sense.”
 FOUR WAYS OF KNOWING
AESTHETIC /ESTHETICS KNOWledge
 Related to understanding what is of significance to
particular patients such as feelings, attitudes, points of
view
 Also the manifestation of the creative and expressive styles
of the nurse
 Focuses on Empathy – the ability for sharing or vividly
understanding another’s feeling (Primary form)
 Includes the nurse’s ability in changing ways and manner
of rendering nursing care based on the client’s individual
needs and perception
 FOUR WAYS OF KNOWING
AESTHETIC/ESTHETICS Knowedge
 Done by knowing the distinctive individual instead as a
typical, stereotype whole
Examples:
 Nurse Moses places himself in the “patient’s shoes” when
communicating, giving judgment and providing care
 Nurse Ace shows compassion, mercy and understanding
towards patients, co – workers and supervisors
3. ETHICAL KNOWLEDGE

 Attitudes and knowledge derived from

personal , including an awareness of moral
questions and choices.
 FOUR WAYS OF KNOWING
ETHICAL KNOWledge
 Requires knowledge of different philosophical positions
regarding what is good and right in making moral
actions and decisions
 Code of Morals or Code of Ethics
 Deeply rooted in the concepts of human dignity, service
and respect for life
 Lessening suffering, upholding and persevering health is
one of the key elements
 Includes all deliberate nursing actions involving and
under the jurisdiction of ethics and professionalism
 FOUR WAYS OF KNOWING
ETHICAL KNOWLEDGE
Examples:
 Nurse Carl presents himself as a patient advocate and
defends his client’s right to choose care.
 Sir Kevin, a clinical instructor, reprimands a student who
cheated on a quiz and explains the consequences.
4. PERSONAL KNOWLEDGE

 Knowledge and attitudes derived from

personal self understanding and empathy ,
including imagining one’s self in the
patient’s position.
 FOUR WAYS OF KNOWING
PERSONAL KNOWLEDGE
 Encompasses knowledge of the self in relation to others and
to self
 Involves the entirety of the Nurse – Patient Relationship
 Most difficult to master and to teach
 The key to comprehending health in terms of personal well –
being
 Involves Therapeutic use of self
 Takes a lot of time to fully know the nature of oneself in
relation to the world around
 Human beings are constantly engaged in a dynamic state of
changes
 FOUR WAYS OF KNOWING
PERSONAL KNOWLEDGE
Examples:
 Ruben, a nursing student, strives to promote a
meaningful personal relationship with his elderly
patient.
 Ruel, a nursing student, undergoes Psychological
Counseling and Self – Awareness sessions before his
Psychiatric Nursing rotation.
EMPHASIS ON DIFFERENT WAYS OF
KNOWING

 Is presented as a tool for generating clearer and

more complete thinking and learning about
experiences and broader self- integration of
classroom education.
MODULE I
NURSING THEORIES : AN OVERVIEW
A.THEORY

 Set of concepts , definitions , relationships ,

and assumptions or propositions that
project a purposive , systematic view of
phenomena by designing specific
interrelationships among concepts for the
purposes of describing , explaining ,
predicting and / or prescribing.

 They provide a foundation of knowledge for

the direction and delivery of nursing care.
1. NURSING THEORY
A. Definition of nursing theory
 Is a conceptualization of some aspect of nursing
communicated for the purpose of describing ,
explaining , predicting,and /or prescribing
nursing care .
 Example :

- Orem’s ( 1991 ) self – care deficit theory

- can be used to explain the factors within a
client’s living situation that with the client’s
self- care ability.
- theory provides nurses with a perspective to
view client situations.
NURSING THEORY
 Theory allow nurses to :
a. Organize data
b. Analyze and interpret information
c. Plan and implement care purposely and
proactively.

 Why nursing theory ?

 Why is there a need for theoretical models as basis
for practice ?
- Theoretical thinking is integral to all roles of the
discipline : the clinician, the researcher, the
administrator , and the consultant.
B. COMPONENTS OF A THEORY

1. Concept
2 Definition
3. Assumptions
4. Phenomena
COMPONENTS OF THEORY

Concepts Definition

Phenomena

Assumptions /
Propositions
1. CONCEPT
 Defined as general idea of somthing
 Are mental formulations of an object or event
that comes from individual perceptual
experience.
 It is an idea, a mental image

 An abstract idea

 Idea formed mentally

 It helps to describe or label phenomena

 Are words that describe objects , properties, or

events .
 Basic component of theory
CONCEPT
Example :
Neuman’s systems model are concepts that affect the
client system .
 These concepts are :
- physiological (normal functions of a living thing)
- psychological (mental, emotional state )
- sociocultural (social and cultural factors )
- environmental ( relating to person’s
surroundings)
- health and wellness
- prevention
- stressors ( factors that cause stress to a person)
and defense mechanisms( mental process
initiated to avoid conscious conflict or anxiety )
2. DEFINITION
 Conveys the general meaning that fits the
theory
 Also describe the activity necessary to measure
the constructs , relationships , or variables with
in a theory.

 Example :
 Newman’s systems model defines clients as
people who are anticipating stress or who are
dealing with stress.
 Nurses focus their care on responses that could
be labeled stressful, and this responses are
within the domain of nursing.
3. ASSUMPTIONS
 Statements that describe concepts or connect two
concepts that are factual and are accepted as
truths.
 Determine the nature of the concepts ,
definitions , purpose , relationships and structure
of the theory.
 Example : the assumptions in Neuman’s systems
model are that clients are dynamic ; the
relationships between the concepts influence a
client’s protective mechanisms and determine a
client’s response; clients have a normal range of
responses ;nurses actions are focused on primary
, secondary and tertiary prevention.
4. PHENOMENA

 Are aspects of reality that can be consciously

sensed or experienced.
 In nursing it reflect the domain (a specified
sphere of activity or knowledge ) of nursing
practice .
 In Neuman’s system model ( 1972 ) phenomena
include all client responses , environmental
factors and nursing actions.
TYPES OF THEORIES
1. Grand theories
 Are broad in scope and complex.
 Requires further specification through research
before they can be fully tested.

2. Middle –Range Theories

 More limited in scope and less abstract ( existing in
thought not having a physical or concrete existence )
 Addresses specific nursing phenomena ( uncertainty ,
social support , incontinence )
 Example : Mishel’s theory of uncertainty in illness
focuses on client’s experiences while living with
continual uncertainty. The nurse assists client in
appraisal of and adaptation to the uncertainty and
illness response.
EXAMPLE OF GRAND THEORIES

 Parse’s theory of becoming (1989 )

 In this theory , the person is unitary , an
indivisible being who interrelates with the
environment while co – creating health.
3. DESCRIPTIVE THEORIES

 Delineate phenomena ,
 Speculate on why phenomena occur, and

 describe the consequences of phenomena,

 Have the ability to explain , relate , predict

nursing phenomena .
 Examples of this theories are those that
describe the life processes of a client, such as
developmental theories.
 They do not direct specific nursing activities in
specific clinical situations but they have the
potential for guiding future nursing research to
refine the theory.
4. PRESCRIPTIVE THEORIES

 Address nursing therapeutics and the

consequences of interventions.
 Predict the consequences of a specific nursing
intervention.
 In nursing ; prescriptive theory should
designate the prescription ( nursing
Interventions ), the conditions under which the
prescription should occur, and the consequences.
 Are action oriented, which tests the validity and
predictability of a nursing intervention.
THEORETICAL MODELS

 Refers to global ideas about the individuals ,

groups , situations or events of interest to a
specific discipline.
COMPONENTS OF NURSING THEORETICAL
MODELS
Definitions :
1. Domain – is the perspective and territory of the
discipline.
 It contains the subject , central concepts, values and
beliefs , phenomena of interest , and the central
problems of discipline.
 Components od a discipline’s domain are described in
a paradigm.

2. Paradigm – term used to denote the

linkages(connection ) of
science , philosophy, and theory accepted by
a discipline.
COMPONENTS OF NURSING THEORETICAL
MODEL

1. Nursing’s paradigm
 It directs the activity of the nursing profession ,
including knowledge , philosophy, theory ,
educational experience , practice , orientation,
research methodology and literature identified
with the profession.
a. Person

 Refers to the recipient of care , including

individual clients, families, and the community.
 Is central to care being provided because the
person’s needs are multidimensional .
 Care should be individualized.
NURSING’S PARADIGM

b. Health
 Defined by ANA as a dynamic state of being in
which the developmental and behavioral
potential of the individual is realized to the
fullest extent possible.
 Is dynamic, changing

 Nurse must provide invidualized care based on

the patients level of health and health care needs
at the time of delivery.
NURSING PARADIGM
3, Environment / situation
 Involve all conditions affecting the client and the
setting in which health care need is needed .
 Example;

Clients level of health and health care needs can be

influenced by factors in the home, school,
workplace, or community .
NURSING PARADIGM

4. Nursing
 Is the diagnoses and treatment of human responses to
actual or potential health problems.
 Example :
- A nurse does not diagnose the client’s heart
condition but instead develops nursing diagnoses
of fatigue, change in body image and altered
coping.
 From this nursing diagnoses, the nurse creates an
individualized plan of care.
 Nurses use critical thinking , skills and integrate
knowledge , experience , attitudes , and standards into
the individualized plan of care for each client.
IMPORTANCE OF NURSING THEORIES
1. Offer conceptual bases for nursing practice.
2. Serve as framework for specific
schools of nursing.
3. Health care facilities adopt a nursing theory for
its staff where in nursing clinical decisions are
made through a particular theory.
4. Utilize a logical structure of ideas , hypotheses
and asssumptions that can be applied to a
variety of situations.
5. Serve as basis for nursing practice, patient
care , professional development , education ,
nursing research, or administrative decision making.
SOME WELL- KNOWN NURSING THEORIES
AND THEORISTS :

DR. jean Watson , “caring model “

 Emphasizes the humanistic aspects of nursing
with scientific knowledge.
 This theory sees the patient as a holistic being (

(body, mind, and spirit ), and recommends

treating the patient with positive regard and
unconditional acceptance.
WELL - KNOWN NURSING THEORIES

Dorothea Orem
 Popularized a theory of centered on the notion
that nursing interventions are geared towards
assisting patients in re-establishing their ability
to provide their own self - care and recover their
health from a place of deficit.
WELL KNOWN THEORIES

Callista Roy
 Propagated the adaptation theory of nursing
in which the patient is seen as a “ biopsychosocial
being” who is constantly adapting to a changing
environment.
END…