Unit 4: Knowledge, Theory and Reasoning in Nursing Practice

Responses to Learning Activities

List and define the four patterns of knowing in nursing.
Give an example of how you use each of the four patterns of knowing in nursing.
- Empirics (Science of Nursing): facts, laws, principles and descriptions used to explain, describe and predict phenomena of relevance to nursing.
  
  Examples include using specific practice-related nursing theories.
- Esthetics (The Art of Nursing): the expressive aspect of nursing as evidenced in caring. Also includes skillful practice. Examples include establishing interpersonal relationships and the skillful performance of psychomotor tasks.
- Ethics (The Moral Imperative of Nursing): the moral component of nursing.
  Examples include ethical decision-making in practice.
- Personal Knowledge (Self-Understanding): use of self in nursing.
  Examples include self-awareness and the ability to use self therapeutically in interaction with clients.
What other four ways of knowing does Zander address in her article? Define these ways of knowing and give examples of how you might use each of these additional ways of knowing in your nursing practice.

Experience is defined "...as knowing through repeated exposure to situations leading to refinement of earlier thoughts and ideas" (Benner and Wrubel 1982, as cited in Zander 2007, p 9). Examples include learning how to provide care to critically ill patients through the experience of caring for them over time.

Intuition is a "...process whereby the nurse knows something that cannot be verbalized, that is verbalized with difficulty, or for which the source cannot be determined" (Young 1987, as cited in Zander 2007, p 9). Intuition is sometimes considered a "sixth sense" (Zander, 2007, p 9). Examples include that feeling you may get when you sense something is "wrong" with a patient, but you cannot specifically say what it is. You may have heard nurses say, "I knew that patient was getting worse, but I just couldn't put my finger on what was happening. The vital signs were normal, but I felt something was wrong."

Unknowing is a position of "openness" that "...is necessary in order to understand the complex realities of people and their world-view" (Zander, 2007, p 9). Examples include being open to what a patient has to say, even though it may not make sense to you. Being open can allow you to truly empathize with the patient and gain a deeper understanding of their situation.

Sociopolitical knowing encompasses the contexts of the nurse-patient relationship and nursing as a practice profession (Zander, 2007). "There would be an understanding of nursing by society and an understanding of society and its politics by the nurse" (Zander, 2007, p 9).

Do you believe that the sociopolitical pattern of knowing is important in nursing? Why or why not?
- Personal response required; state your opinion. You may want to consider how nurses work together to improve the health of their patients by taking political action, such as lobbying for clean drinking water or clean air.

How is the sociopolitical pattern of knowing consistent with (or inconsistent with) the principles of primary health care?

Five principles underlying primary health care are accessibility of health services, use of appropriate technology, individual and community participation, increased health promotion and disease prevention, and inter-sectoral cooperation (WHO, 1978). Practicing from a primary health care perspective demands that all stakeholders, including nurses, develop a clear understanding of the social-political factors that influence health.