Carper’s Patterns of Knowing: Fostering Nursing Wisdom

Our current featured article will be of great interest to ANS readers, in that the concept of “nursing’s patterns of knowing” is among the top search terms for the journal!  The article  is titled “Expert Nurses’ Perceptions of the Relevance of Carper’s Patterns of Knowing to Junior Nurses” authored by Louise Terry, PhD, SFHEA, LLB(Hons), FIBMS; Graham Carr, MSc, RNT, RN and Joan Curzio, PhD, RN.  The authors have provided this description of their work, and also included the video at the conclusion!

As the nursing profession ages, many are concerned at how to capture the wisdom and expert knowledge of those

Louise Terry

who are retiring. This provided the impetus for our study and underpinned the decision to provide funding by the General Nursing Council for England and Wales which was the regulatory body for nurses in England and Wales for over 60 years. Their mission now is to promote the development of the science and art of nursing for the benefit of society.

Through studying how expert nurses foster and develop nursing wisdom in new and junior nurses we have been encouraged and inspired by the vision, dedication and quality of the nurses who participated. This countered the media rhetoric at the time in the UK which suggested that nursing was a profession that had lost its ability to care and care well. We worked with expert nurses in a variety of ways as explained in our article to draw out and develop their insights. As part of exploring ethical knowing, we had a simple activity where participants placed colored

Graham Carr

glass tiles according to how they felt they weighted ethical values during their daily practice (see the photo on this blog). This visual metaphor formed the basis of some of the discussion around how ethical knowing is shaped, influenced and, at times, challenged by issues such as limited resources or poor nurse-patient ratios.

In our paper, we mention that one of our participants brought in her hand-drawn version of a Picasso painting (see the photo on this blog) and as she discussed its depth, angles, hidden aspects, she explained how it exemplified nursing to her. She spoke of how it had taken her hours to complete the drawing but the physical activity of drawing was essential to her reflections on nursing. Perhaps this is typical of nurses as reflective practitioners – through doing they reflect and through reflection they develop their doing [practice].

The study design allowed for co-construction of ideas relating to the development of nursing wisdom. Our article shows the finished concept map. This blog shows for the first time, a photograph taken of the preliminary concept map as developed by participants at the end of the second cycle in

Joan Curzio

phase 1 of the study. As explained, based on our study, we have proposed that a new pattern of knowing, Organizational knowing, should be recognized.

Post-qualifying, nurses gain experience but do not necessarily learn from it. Good nurses were identified through our research as sharing certain qualities and knowledge which were consistent with Organizational, Socio-political and Emancipatory knowing.  We all know good or wise nurses who are able to influence and improve patient care (praxis) as expert, fluid practitioners. In order to facilitate the transition from new nurse to expert to wise nurse attention, we believe that foundations for this need laying in the undergraduate, pre-registration nursing stage. Nursing curricula need to ensure that students develop the qualities and knowledge identified in Carper’s four fundamental patterns of knowing: Personal, Empirical, Aesthetic and Ethical and the importance of fundamental care needs to be reaffirmed. Students should be introduced to the concept of Organizational knowing and taught how to help themselves to ensure they gain this knowledge effectively in any organization in which they work or move to as junior nurses. As someone who teaches over 500 nursing students a year, I encourage each of them to keep an eye out in clinical practice for the wonderful nurse that they want to be like. Sadly, many of them tell me that they have yet to see that nurse even though they are half-way through their training. I tell them that when they do find that nurse, to ensure they work with them as often as they can and to absorb as much as they can from them.

In addition, employing organizations have a role to play in ensuring that newly qualified or newly appointed nurses are supported to develop fully the qualities identified within the Organizational pattern of knowing. As Graham and I discuss in our short film, this is now beginning to happen as practice educators are incorporating the essential aspects for developing organizational knowing into their preceptorship and induction programs for newly qualified or newly appointed junior staff. Also, role modeling of good nursing should be recognized and valued by employers. We would also like to see universities/nursing schools do more to develop socio-political and emancipatory patterns of knowing, particularly in qualified nurses. Through this, nurses will benefit society.

Finally, we hope that others will be excited by our ideas and further develop our concept of organization knowing. It would be wonderful if suggestions could be shared for developing organizational knowing and moving nurses through the hegemonic barriers that prevent the development of praxis and wisdom.