The Five Patterns of Knowing
There are five patterns of knowing that attempt to describe how we learn, focus, identify issues, and make changes within our society. These patterns are emancipatory knowing, ethical knowing, personal knowing, aesthetic knowing and empiric knowing. Each one is an intrinsic part of nursing practice and invaluable to nursing's future. Each represents a facet of required skills needed for the successful deployment of nursing's vast knowledge base and the advancement of the nursing profession. Each one can be seen on a daily basis through the actions of nurses in every level of nursing. It is imperative that nurses understand the importance of knowledge development for the advancement of our future, the betterment of society and the movement toward social justice.
Emancipatory knowing is "the capacity not only to notice injustices in a social order, but also to critically examine why injustices seem not to be noticed or remain invisible, and to identify social and structural changes that are required to right social and institutional wrongs" (Chinn & Kramer, pg. 78). Emancipatory knowledge development is done through a very humanistic, qualitative and interpretive ability to analyze the social context of the world around us and determine social inequalities and why they exist. This type of analysis occurs through reflection of our "own experience, assumptions, and actions" (Chinn & Kramer, pg. 81) and allows us to examine "the contexts within which your experience is situated" (Chinn & Kramer, pg 81). Applied properly and with enough force, emancipatory knowing will allow us to correct the social injustices of the world.
Ethical knowing is a bit more difficult to quantify as it is demonstrated more through practice than words. Each of us determines what we consider to be morally right based on our views and experiences but "nurses who practice using ethical knowledge that has been strengthened through disciplinary processes of dialogue and justification can be expected to increasingly practice with moral/ethical comportment" (Chinn & Kramer, g. 109). In other words, when what we believe to be morally right and demonstrate in our practice is further reinforced through discussion with colleagues and positive outcomes our resolve to continue to perform ethically will be strengthened.
Personal knowing describes an intangible awareness of oneself and ones value of others. "Personal knowing is the dynamic process of becoming a whole, aware self and of knowing the other as valued and whole" (Chinn & Kramer, pg 133). This personal knowing is what allows us as nurses to unconsciously demonstrate a genuinely caring manner which is perceived as authentic by our patients. It is a process that takes a lifetime of experiences and learning but through which we begin to know our selves, reflect inwardly upon our thoughts and actions, and allows us to express ourselves without words. It is the "cornerstone on which wholistic practice is based, making possible wholeness of self and other in a context of relational experience" (Chinn & Kramer, pg. 135).
Aesthetic knowledge is the fourth type of knowledge examined here and can be described as follows:
...That aspect of knowing that connects with deep meanings of a situation and calls forth inner creative resources that transform experience into what is not yet real, but possible. It is the dimension of knowing that connects with human experiences that are common but expressed and experienced uniquely in each instance (Chinn & Kramer, pg. 151).
With an acquired aesthetic knowledge, a nurse can perform their duties in a manner that is both intuitive and artful by assessing the patient's needs or simply that there is an unidentified need and fulfilling it without the context or boundaries of words in a manner which is ultimately satisfying to the patient. The art of caring is one where the act of caring is done in a manner which creates beauty through human interaction from nothing more than the thin thread that initially connects the nurse to the patient. Once the artwork is begun by the nurse that thread is woven into a beautiful blanket under which the patient can comfortably rest in the knowledge they are genuinely cared for. That blanket is our artwork; the skillful interaction is the beauty.
Empiric knowledge in nursing is based on what has worked in the past as presented through validated research with quantified results. "Theory is a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena" (Chinn & Kramer, pg. 182). This empiric knowledge is not limited by the positivist's view that "the goal of knowledge is simply to describe the phenomena that we experience" (Trochim, 2006) but is bound more by the post-positivist view that "the post-positivist critical realist recognizes that all observation is fallible and has error and that all theory is revisable" (Trochim, 2006). This means we can observe all data in a study and come to a logical conclusion but we must remain critical of that conclusion as phenomena and reality are ever-changing. "The goal of science is to hold steadfastly to the goal of getting it right about reality, even though we can never achieve that goal" (Trochim, 2006). We must constantly revise our theories to fit current context and remain applicable to current empiric knowledge if nursing is to remain a relevant art and science-if we are to "get it right". "There are phenomena in the world that can be discovered and known, albeit imperfectly" (Routledge, 2007).
After thorough review of the material discussing the patterns of knowledge it is my belief the Chinn & Kramer have an accurate description of these patterns with few exceptions. Their descriptions are accurate and understandable even though the subject material is ethereal at best. Much of the knowledge discussed consists of intangibles extremely difficult to describe but applicable in our every-day practice. In terms of knowledge development and its application into practice, (as cited by Routledge, 2007) "Grounding research in specific philosophical perspectives allows for careful consideration of ideas and issues as well as encourages nurses to set their own directions for research and knowledge development" (Rodgers, 2005). The only shortcoming I have found in Chinn & Kramer's discourse on patterns of knowledge is in the discussion of empiric knowledge development in that I believe that while we must develop the intangibles, we must also rely on science as it can isolate, identify and predict research when objectivity and distance from the problem being studied is observed (Young, 2008). While their discussions on all other patterns of knowledge were, in my opinion, complete, accurate and comprehensive, I believe that their discussion of empiric knowledge should have included more of a grounded, scientific aspect without excluding the philosophical and perceptual aspects.
Of all patterns of knowing, I believe that emancipatory knowledge is most important. As nurses we bear witness to many injustices through a unique perspective. We have the ability to be the lens through which society views these injustices and the voice of those previously unheard. Through emancipatory knowing we can affect change in a pre-emptive fashion, helping members of society before they require access to medical care. In the words of Lao Tzu, the founder of Taoism, "Give a man a fish; feed him for a day. Teach a man to fish; feed him for a lifetime". Emancipatory knowledge allows us to analyze these issues, eliminate social inequities and move toward social justice for all-in short, emancipatory knowledge provides the knowledge that will feed us for a lifetime.
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