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"Carper's (1978) Discussion of Ways of Knowing NUR102

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julia gorelosheva

on 27 November 2014

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Transcript of "Carper's (1978) Discussion of Ways of Knowing NUR102

Ways of Knowing
"Carper's (1978) Fundamental Ways of Knowing ranks as one of the most influential pieces of nursing writing of the twentieth century" (Wainwright, 2000).

This theory was created by Barbara Carper: who discussed the integration of the four fundamental ways of knowing. (Clements & Averill, 2006)

Empirical Knowledge
"...based on the central idea that scientific knowledge can be derived only from sensory experience(i.e., seeing, feeling, hearing facts)"(Alligood, 2014, p. 16).
Esthetic Knowledge
Ethical Knowledge

safe
compassionate
competent
and ethical care

Applying The Ways of Knowing to a Clinical Case
Ways of Knowing

"as well as 2 additional patterns identified by J. Whilte, P. L, Munhall, H. Heath" (Clements & Averill, 2006)
Symbolic Knowledge
Sociopolitical Knowledge
Shar is a 24 year old young woman who is brought into the emergency room after having fainted in the washroom. She reports to the nurse that she was throwing up in the washroom and passed out because she saw some blood when she was vomiting.

Next thing she knew she was on the floor, with her boyfriend standing over her. Her boyfriend called 911 and the paramedics took Shar to the hospital. The paramedics reported to emergency room staff that there was a significant amount of undigested food in the toilet.
Marella, the emergency room nurse, makes sure that Shar is medically stable, hangs an IV, and then takes a more thorough health history.
Shar tells Marella that that she “has a problem with eating”. She also reports that her life has become very stressful lately – her father is chronically ill, her mother is becoming weak herself taking care of him, and they live 5 hours away. Also, Shar is in charge of a major project at work, which has increased her stress level.
Personal Knowledge
Symbolic Knowledge
Sociopolitical Knowledge
Miriam, Julia, Muna, Catherine, and Dionne
We know the information taken straight out of the situation that:

The Paramedics and/or Marella reported that:
Shar has admitted to experiencing high level of stress due to family issues
" there had been a significant amount of undigested food in the toilet"
Shar had a experienced vasovagal syncope upon the sight of blood
Shar had vomited up blood
Shar had been throwing up into the toilet
Shar has a "problem eating"
Shar is female
Shar is 24 years old
Empirical Knowledge
Esthetic Knowledge
Ethical Knowledge
Personal Knowledge

"Each moment is unique and a learning encounter unto itself. Based on that shared moment and perception of what is meaningful, the course of nursing action unfolds as a “transformative art/act,”one honoring “the art of nursing lived fully in relationship” and caring."

Marcella and Esthetic Knowledge:

"... this form of knowledge was conceptualized as developing over time. The nurse moves from being bound by rules and procedures, focused on the parts of a patient care situation rather than the whole, and somewhat inflexible to one who has more holistic, deeper understanding of the patient care encounter." (Schmidt, Nelson, & Godfery, 2003, p. 149)
Experience: from the meaning of the nurse's past experiences and applying it to her critical thinking
Pregnancy
Assumptions
Stress
Homesickness
Bulimia
Comes in 2 forms:
Intuition: based on intuition and that "hunch" or "gut feeling" that a nurse has.
The meaning of symbols and “the knowing by experience” through spoken words and gestures expressed (Kaakinen, Gedaly-Duff, Coehlo, & Hanson 2010, p.525).

Essentially:
• A type of dialogue

That reflects meaning to the person who interprets it.

o Helps to communicate / problem solves: it’s a form of language
o Abstract: takes on a different form
o Expressive: its deeply rooted within us
o Verbal: Spoken
o Non-Verbal: gestures, written
(N. Levy, personal communication, October 16, 2014).

"Art and music are forms of symbolic communication that nurses use to enhance understanding and promote healing” (Potter et al., 2014, p. 248).
Art v.s Music
v.s
Nurse - Client Relationship
By Shar talking to the nurse (Marella), she can interpret and formulate questions related to what the patient has:

Spoken
Food
Family
Work

Gestures
Body movement, facial expression

Questions

1) Can you describe what you were doing right before you fainted ?
2) Have you reached out to someone about your situation at home?
3) How do you feel about talking to someone here at the hospital?
4) Would you like something to read, watch or listen to ?




Also known as:
Emancipatory
knowing:

The ability to recognize social and political injustice, address and improve the health condition of a person (Snyder, 2014).

It’s about empowerment, rights and advocacy,

Nurses advocate but also create literacy that will empower and increase patient equality and improve care delivery (Snyder, 2014).

Bottom line:

• Nurses have to help and assist their patients who require advocacy for social justice and human rights (Snyder, 2014).

• Nurses become the patient's voice helping to address the inequalities of the patient through "reflection and action"(Snyder, 2014).


Through dialogue:

Marella provides a sense of care by "providing presence, a caring touch, and listening (Potter et al., 2014, p. 268).

This allows Shar to disclose to Marella the things she’s confronted with.

Issues such as:
Work related challenges, Concerns for her parents ill-health and travel fatigue
(she travels 5 hours to visit).

For this reason, explains why she was unable to provide adequate care for herself which lead to her to the hospital.

However, this process highlights the
determinants of health
that relates to Shar's current state.





Marella advocacy:

Speak to her about proper nutrition

Educate her on ways to manage time and stress

Provide referrals through pamphlets


With this dialogue it will give rise to Marella and Shar's point of view for effective communication. Addressing the "known and unknown" facilities and any misunderstanding of information, which will "influence thought and alter future actions"(Snyder, 2014).







Marella Advocates
Critical thinking of how to consider the implications and consequences concerning the ethical knowing about Dignity, Responsibility and confidentiality

Caring for Shar with dignity

Shar is taken care of with the most utter dignity as per nursing knowledge and professionalism by proving privacy and listening actively.

As a professional Meralla is Responsible for making sure that Shar health is sustained .

Merallara is responsible for making sure that Shar is in a stable condition in this case she take the vital signs and gives an IV to stabilize her health.

Confidentiality as an ethical way of knowing

Shar has a right to confidentiality and as mallera has the obligation to promise and maintain it. Only relevant information is shared with other members of the health care team who are also responsible to maintain confidentiality.


Nurse Perspective (Marcella)
1. Person 2. Patient
Trust
Empathy
Respect
Professional intimacy
Power

(N. Levy, personal communication, October 16, 2014)
College of Nurses of Ontario. (2006).
Therapeutic nurse-client relationship
. Toronto: Author. Available online:
www.cno.org
Appreciation of the meaning of the situation
“What does this mean?”
“How is this significant?”
not expressed through words or statistics
incomparable experience
moment of synchronous reality.
(Clements, PT., Averill, JB., 2006)

taking gathered Empirical Knowledge and taking it into consideration
Finding a meaning of all this data collected
primary roles?
daughter, employee,student etc
role overload?
clinical situation may not be always as them seem
I'm here to talk if you need me
May or may not open up
no loss
Possible Dignosis:
bulimia
problems with her GI tract
morning sickness
food poisoning
food allergies
Which DOH do you think applies to Shars situation?


health and well-being;
respecting informed decision-making
justice; and being accountable.
Provide
Promote
Perserve
dignity
Maintain

privacy and confidentiality
( College and association of registered nurses of Alberta 2013)
According to the code of ethics there are seven core values that are central to ethical nursing practice
Full transcript