There are four main ways of knowing in nursing practice: empirical, personal, esthetic, and ethical. Empirical knowledge is based on evidence and scientific research. This type of knowledge is important for understanding how the human body works and for developing effective treatments. Personal knowledge is based on our own experiences and observations. This type of knowledge is important for providing care that is tailored to the individual needs of each patient.
Esthetic knowledge is based on our appreciation of beauty and art. This type of knowledge can be used to create a healing environment that helps patients feel more comfortable and relaxed. Ethical knowledge is based on our system of morality and values. This type of knowledge guides us in making decisions about what is right and wrong in healthcare.
In nursing, there are several ways of knowing. Traditionally, four patterns of nursing knowledge, or ways of knowing, have been utilized in the field of nursing. Empirics, or the science of nursing, esthetics, or the art of nursing, personal knowledge, and ethics are examples (McEwen & Wills, 2011). A nurse may use these methods to construct clinical knowledge that guides her decisions in various circumstances by combining them. The following case illustrates how multiple types of knowledge can be applied in a clinical setting.
A patient comes to the emergency department complaining of chest pain. The nurse begins by taking a history and performing a physical assessment. This is an example of empirics, or the science of nursing. The nurse uses her knowledge of anatomy and physiology to determine the cause of the chest pain. She also uses her Nursing Processes skills to gather data and make a plan of care.
The next step is to establish rapport with the patient. The nurse uses her interpersonal skills to put the patient at ease and build trust. This is an example of esthetics, or the art of nursing. The nurse uses her intuition and empathy to understand the patient’s needs.
After gathering all the necessary information, the nurse must make a decision about the best course of treatment. This is where personal knowledge comes into play. The nurse uses her own values and beliefs to make a decision about the best way to care for the patient.
Finally, the nurse must consider the ethical implications of her actions. She must weigh the benefits and risks of each potential course of action and make a decision that is in the best interest of the patient.
On a medical/surgical ward, a 62-year-old patient is being treated by a nurse. The patient has been in the hospital for 11 days, far longer than the usual duration of stay for this diagnosis. This patient also has a seizure disorder comorbidity. He has not complied with daily ambulation instructions, and when asked to accomplish activities of daily living on his own, he becomes largely uncooperative.
The nurse has noticed that the patient’s family is constantly at the bedside, and they seem to be very involved in his care. The nurse wonders if the family is “enabling” the patient by doing too much for him.
The patient is awake and oriented at the start of the shift. He has no pain symptoms. His respiratory sounds are clear but shallow in the bases. At this time, his breathing is even and regular. On room air, his oxygen saturation via pulse oximetry is 94%. The patient is wearing sequential compression devices on his bed, but they are not utilized at this time.
He has a Foley catheter in place with no drainage. His abdomen is soft and nontender to palpation. He has an IV of 0.9% NaCl solution at 125 mL/hr infusing in his left antecubital fossa. The patient reports that he has not had anything by mouth since 1800 last night because of his procedure today.
The patient’s chart indicates that he is scheduled for an upper endoscopy with biopsies today. Nursing interventions prior to the procedure will include administration of medications as ordered, monitoring of vital signs, and providing emotional support to the patient and family members. Nursing interventions during the procedure will include monitoring of the patient’s vital signs, providing emotional support, and ensuring that the patient is comfortable.
When the patient is questioned as to why they aren’t wearing them, he claims that they were getting on his nerves and so he took them off early in the day. They are reapplied at this time. The patient has no further complaints and goes about his night without incident. His regular seizure medicine regimen includes 30 mg of Phenobarbital, 100 mg of Dilantin, and 10 mg of Valium, which is given at bedtime.
The patient is asked about his day and he states that it was good. He also reports that he has been having some headaches and has been feeling dizzy when he stands up too fast. When asked about these complaints, the patient says that they are not severe and have only been occurring sporadically throughout the day. The patient’s vital signs are taken and found to be within normal limits. The patient is placed in a supine position on the bed and told to relax while the nurse assesses his level of consciousness using the Glasgow Coma Scale. The patient scores a 15 on the scale, which is indicative of a normal level of consciousness.
The nurse then proceeds to perform a physical assessment of the patient. Upon inspection, the patient is noted to have a well-healed surgical scar on his forehead from a previous craniotomy. Upon palpation of the patient’s scalp, no evidence of tenderness or masses is found. The patient’s eyes are noted to be clear and without discharge.
His pupils are equal in size and reactive to light. The patient’s ears are noted to be clear, with no evidence of discharge or trauma. The patient’s mouth is noted to be moist and without lesions. His teeth are in good repair and he has no dental caries. The patient’s neck is supple and without lesions. Upon auscultation of the patient’s chest, clear lung sounds are heard bilaterally. Cardiac sounds are regular and without murmur.
