Fundamental Patterns of Knowing in Nursing

Fundamental Patterns of Knowing in Nursing

Fundamental Patterns of Knowing in Nursing

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It is the general conception of any field of inquiry that ultimately determines the kind of knowledge the field aims to develop as well as the manner in which that knowledge is to be organized, tested, and applied. The body of knowledge that serves as the rationale for nursing practice has patterns, forms, and structure that serve as horizons of expecta- tions and exemplify characteristic ways of thinking about phenomena. Understanding these patterns is essential for the teaching and learning of nursing. Such an understanding does not extend the range of knowledge, but rather involves critical attention to the ques- tion of what it means to know and what kinds of knowledge are held to be of most value in the discipline of nursing.

Identifying Patterns of Knowing

Four fundamental patterns of knowing have been identified from an analysis of the conceptual and syntactical structure of nurs- ing knowledge.1 The four patterns are distin- guished according to logical type of meaning and designated as (1) empirics, the science of nursing; (2) esthetics, the art of nursing; (3) the component of a personal knowledge in nursing; and (4) ethics, the component of moral knowledge in nursing.

Empirics: The Science of Nursing

The term nursing science was rarely used in the literature until the late 1950s. However,

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24 Chapter 3: Fundamental Patterns of Knowing in Nursing

since that time, there has been an increas- ing emphasis, one might even say a sense of urgency, regarding the development of a body of empirical knowledge specific to nursing. There seems to be general agree- ment that there is a critical need for knowl- edge about the empirical world, knowledge that is systematically organized into general laws and theories for the purpose of describ- ing, explaining, and predicting phenomena of special concern to the discipline of nurs- ing. Most theory development and research efforts are primarily engaged in seeking and generating explanations that are systematic and controllable by factual evidence and that can be used in the organization and classifica- tion of knowledge.

The pattern of knowing that is generally designated as “nursing science” does not presently exhibit the same degree of highly integrated abstract and systematic explana- tions characteristic of the more mature sci- ences, although nursing literature reflects this as an ideal form. Clearly, there are a number of coexisting, and in a few instances compet- ing, conceptual structures—none of which has achieved the status of what Kuhn calls a scientific paradigm. That is, no single con- ceptual structure is as yet generally accepted as an example of actual scientific practice “which include[s] law, theory, application, and instrumentation together . . . [and] . . . provide[s] models from which spring particular coherent traditions of scientific research.”2(p10) It could be argued that some of these conceptual structures seem to have greater potential than others for providing explanations that systematically account for

observed phenomena and may ultimately permit more accurate prediction and con- trol of them. However, this is a matter to be determined by research designed to test the validity of such explanatory concepts in the context of relevant empirical reality.

New Perspectives What seems to be of paramount importance, at least at this stage in the development of nursing science, is that these preparadigm conceptual structures and theoretical models present new perspectives for considering the familiar phenomena of health and illness in relation to the human life process; as such, they can and should be legitimately counted as discoveries in the discipline. The representation of health as more than the absence of disease is a crucial change; it permits health to be thought of as a dynamic state or process that changes over a given period of time and varies according to circumstances rather than a static either/or entity. The conceptual change in turn makes it possible to raise questions that previously would have been literally unintelligible.

The discovery that one can usefully con- ceptualize health as something that normally ranges along a continuum has led to attempts to observe, describe, and classify variations in health, or levels of wellness, as expressions of a human being’s relationship to the internal and external environments. Related research has sought to identify behavioral responses, both physiological and psychological, that may serve as cues by which one can infer the range of normal variations of health. It has also attempted to identify and categorize significant etiological factors that serve to promote or inhibit changes in health status.

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Identifying Patterns of Knowing 25

conditions for the normal development of an individual.

Thus, the first fundamental pattern of knowing in nursing is empirical, factual, descriptive, and ultimately aimed at devel- oping abstract and theoretical explanations. It is exemplary, discursively formulated, and publicly verifiable.

Esthetics: The Art of Nursing

Few, if indeed any, familiar with the pro- fessional literature would deny that primary emphasis is placed on the development of the science of nursing. One is almost led to believe that the only valid and reliable knowl- edge is that which is empirical, factual, objec- tively descriptive, and generalizable. There seems to be a self-conscious reluctance to extend the term knowledge to include those aspects of knowing in nursing that are not the result of empirical investigation. There is, nonetheless, what might be described as a tacit admission that nursing is, at least in part, an art. Not much effort is made to elaborate or to make explicit this esthetic pattern of knowing in nursing—other than to associate vaguely the “art” with the general category of manual and/or technical skills involved in nursing practice.

Perhaps this reluctance to acknowledge the esthetic component as a fundamental pattern of knowing in nursing originates in the vigor- ous efforts made in the not-so-distant past to exorcise the image of the apprentice-type educational system. Within the apprentice system, the art of nursing was closely associ- ated with an imitative learning style and the acquisition of knowledge by accumulation

Current Stages The science of nursing at present exhibits aspects of both the “natu- ral history stage of inquiry” and the “stage of deductively formulated theory.” The task of the natural history stage is primarily the description and classification of phenomena that are, generally speaking, ascertainable by direct observation and inspection,3 but cur- rent nursing literature clearly reflects a shift from this descriptive and classification form to increasingly theoretical analysis, which is directed toward seeking, or inventing, expla- nations to account for observed and classified empirical facts. This shift is reflected in the change from a largely observational vocabu- lary to a new, more theoretical vocabulary whose terms have a distinct meaning and definition only in the context of the corre- sponding explanatory theory.

Explanations in the several open-system conceptual models tend to take the form commonly labeled functional or teleological.4 For example, the system models explain a person’s level of wellness at any particular point in time as a function of current and accumulated effects of interactions with his or her internal and external environments. The concept of adaptation is central to this type of explanation. Adaptation is seen as crucial in the process of responding to environmental demands (usually classi- fied as stressors) and enables an individual to maintain or reestablish the steady state, which is designated as the goal of the system. The developmental models often exhibit a more genetic type of explanation in that certain events, the developmental tasks, are believed to be causally relevant or necessary

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