Carper’s ways of knowing essay examples

Carper’s ways of knowing essay examples

Instructions:

For this assignment, consider Carper’s Ways of Knowing: empirical, personal, ethical, and aesthetic. For each way of knowing, describe a clinical situation including a nursing intervention you implemented while caring for a patient, family, group, or community. In your description, explain how the particular way of knowing informed the decision to implement the intervention.

Use one scholarly reference for each of your four explanations in order to provide support for your reasons that a particular intervention is an example of the selected way of knowing. Use a different reference for each of the four descriptions. Use references other than those provided in assigned course readings. Be sure you know what a “scholarly reference” is; see 18200 Library Guide tab “Journal Types” for more information. APA formatting must be applied and errors in spelling and grammar must be absent; these are standard requirements for presenting scholarly, professional products.

Carper’s ways of knowing essay examples

Carper’s Ways of Knowing

Introduction

Barbara Carper introduced four critical ways of knowing that contribute to nursing knowledge’s conceptual and syntactical structure. These ways include; ethical, aesthetic, empirical, and personal knowledge. Personal understanding of practice requires precision, especially for clinicians.  Clinical personnel obtains their knowledge from philosophical assumptions. Nurses need to communicate symbolically with sensible information for them to do nursing activities effectively. Epistemology reveals how nurses know and acquire shared knowledge in nursing by examining how knowledge is produced. Knowing does a manner of perceiving and comprehending the world and oneself, whereas knowledge is a description of the world that is reasonably correct. Sounds, gestures, and actions are used to express the knowledge obtained through practice. Even in practice, much of what is already known may be represented formally. Carper examined early nursing literature in 1978 and identified four persistent and essential patterns of knowledge that have shown to be effective and valuable for nurses in practice.

These nursing patterns of knowing are linked because nurses learn part of the discipline’s information during their elementary education, and this knowledge develops during practice. Formalized nursing practice is established through the application of inquiry methods based on both formal and practical methodologies. In my pediatric emergency room nursing practice, I have used these means of knowing to guarantee that my practice methods are effective. This study addresses Carper’s four modes of knowledge: ethics, personal, empirics, and aesthetics. It will analyze my exemplar experiences critically, demonstrating these approaches and how they have informed my practice. The main aim of this paper is to describe how each of the patterns of thinking is applied in a clinical situation and the nursing interventions that clinicians can use while caring for the patients, it goes further explaining how the pattern of knowing informed the decision to implement the intervention.

Application of ways of knowing

Clinical situation

In the same hospital that I was serving, the  family members brought a patient suffering from Asthma. It was late at night; the nurses took the patients and started operating on the critical condition. The patient was a regular one, everyone knew his condition thus, and attending to the problem became easy. Since it was late, the family members did not go back home. They rested in one room of the health center worried but praying that their member could make it alive. As nurses, we carried out a diagnosis to know what exactly the patient was suffering. I realized that the patient was already breathing faster with a fast heartbeat. I was not supposed to show that I am worried but the condition of the man was not good at all. I also prayed while attending to the man because his condition had grown worse. Further information from the family indicated that the man fainted after feeling dizzy for some time.

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I offered him some quick relief inhalers known as bronchodilators to aid in opening swollen airways, which were limiting the breathing, additionally, I offered some medical allergy to the patient but he did not manage to work. When I examined closely, I realized the patient had died. Checking through the window, I saw how the members were heavily praying and crying and this made me worry. The situation had formed itself and the family members needed to know it. I just organized myself and using Carper’s Ways of Knowing, I managed to deliver the bad news effectively. As a nurse, I have learned to avoid euphemisms and medical jargon while being honest and empathetic. Allow for stillness and weeping, and move at the pace of the patient. Allow the patient to explain how he or she comprehended the news; repeat this information at following appointments. Allow time to respond to queries; jot down notes and provide written information.

This was just among the situations I face in the nursing practice. Breaking bad news is the most challenging part and as a professional nurse, I usually identify effective ways of intervention. It is unethical to break the bad news to individuals anyhow without considering the outcome. At some point, I had to break news about the demise of the patients to their families, bad news concerning infertility, or bad news concerning a test, for instance, HIV & AIDs test (Bumb et al., 2017).

Ethical knowing

According to Carper (1978), ethical knowing acknowledges the knowledge of ethical codes and norms by examining the codes, standards, and values that are seen as morally right, resulting in a better understanding of the moral choices that must be made.  As a nurse, the most appropriate action is having ethical knowing.  Ethical knowing helps the nurse to know how to break the bad news to either patients, family, friends, or community without breaking the moral standards. I always observed the moral standards, codes, and values, which both the organization and society considered right. For ethical knowing, I keep in mind the principles needed when breaking bad news. These principles include; the set-up/environment, the perception of the party present, the knowledge of the recipient, and empathy (Corwin et al., 2019) Carper’s ways of knowing essay examples.

Personal knowing

Personal knowing is concerned with knowing oneself as well as others. As a result, when one knows more about oneself, the other can also be known. Generally, this type of knowledge involves the knowledge that people have of themselves and the things they have seen and experienced. People acquire this knowledge through self-actualization, reflection, and observation. Carper realized that it is through the knowledge of oneself that one can establish therapeutic, authentic with high integrity. When I started studying nursing, I possessed a piece of knowledge on treating patients well. I also gained knowledge on how to break the bad news to patients without creating too much negative impact. As a nurse, I have gained personal knowledge on how various individuals interact, their reactions, and their perceptions. Before breaking any bad news, I first refer to my knowledge of the recipient (Thorne, 2020).

Aesthetic knowing

In nursing, aesthetic knowledge is a technique of recognizing realities that are not scientifically observable — the situation’s profound implications. As a nurse, I needed to gain a better understanding of problems so that I can easily develop an effective solution through critical and creative thinking. I gained aesthetic knowledge from subjective data. I therefore, employed aesthetic knowledge in this clinical situation. As a nurse, I had to employ much creativity in breaking the sad news to ensure that the recipient is not subjected to pain. In the face of universal human sensations like grief, joy, worry, fear, and love, aesthetic awareness is extracted. Even though these experiences are ubiquitous, they are expressed in unique ways for each individual. Anxiety, pain, fear, and love all have common expressions that people are familiar with. However, each individual’s journey is unique (Schwind & Manankil-Rankin, 2020).

Empirical knowing

Empirical knowing is acquired through research and objective facts. Mostly, the knowledge is organized into general laws and theories and is employed by using evidence-based practice. As a nurse, I have done a lot of research relating to my field and thus gaining empirical knowing. However, in a situation like breaking bad news, one has to apply more empirical knowing to achieve the goal. Study findings have changed my nursing practice and making me gain more knowledge on nursing practice. Despite breaking bad news being a heavy task, readings from various sources and research have aided in the development of this kind of knowledge (Swift & Twycross, 2020).

Conclusion

The practice of nursing is a holistic, human discipline. The ways of knowing to allow us to understand ourselves and nursing practice at a much deeper level; to appreciate nursing as both an art and a science. Consider how the ways of knowing can assist you in being a better person, a better student, and a better nurse. Nurses must comprehend what the various forms of knowing to imply to generate both collective and individual responses to the creation of knowledge. Nursing knowledge can help to facilitate coherence by allowing nurses to make conscious choices to avoid ethical issues during practice. As a nurse, it will be critical for me to expand on the knowledge I already have in my practice so that I may continue to grow and develop via new experiences. The ethical exemplar has had an impact on my practice by teaching me how to deal with difficulties regarding children and their guardians. The personal knowing model taught me to appreciate others, particularly children who are unable to protect themselves.

 

References

Bumb, M., Keefe, J., Miller, L., & Overcash, J. (2017). Breaking bad news: An evidence-based review of communication models for oncology nurses. Clinical journal of oncology nursing, 21(5), 573-580.

Corwin, E., Redeker, N. S., Richmond, T. S., Docherty, S. L., & Pickler, R. H. (2019). Ways of knowing in precision health. Nursing outlook, 67(4), 293-301.

Rafii, F., Nasrabadi, A. N., & Tehrani, F. J. (2021). How Nurses Apply Patterns of Knowing in Clinical Practice: A Grounded Theory Study. Ethiopian Journal of Health Sciences, 31(1).

Schwind, J. K., & Manankil-Rankin, L. (2020). Using Narrative Reflective Process to augment personal and aesthetic ways of knowing to support holistic person-centred relational practice. Reflective Practice, 21(4), 473-483 Carper’s ways of knowing essay examples

Swift, A., & Twycross, A. (2020). Using ways of knowing in nursing to develop educational strategies that support knowledge mobilization. Paediatric and Neonatal Pain, 2(4), 139-147.

Thorne, S. (2020). Rethinking Carper’s personal knowing for 21st century nursing. Nursing Philosophy, 21(4), e12307.

 

Carper’s ways of knowing essay examples

This is an individual writing assignment. For this assignment, consider Carper\’s Ways of Knowing: empirical, personal, ethical, and aesthetic. For each way of knowing, describe a clinical situation including a nursing intervention you implemented while caring for a patient, family, group, or community. In your description, explain how the particular way of knowing informed the decision to implement the intervention.

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Use one scholarly reference for each of your four explanations in order to provide support for your reasons that a particular intervention is an example of the selected way of knowing. Use a different reference for each of the four descriptions. Use references other than those provided in assigned course readings. APA formatting must be applied and errors in spelling and grammar must be absent; these are standard requirements for presenting scholarly, professional products. carper’s ways of knowing essay examples.

This assignment directly relates to course objective \” Explore the development of nursing knowledge in the context of nursing science.\”

 

Carper’s Ways of Knowing

For clinicians, personal knowledge about practice needs precision. Through philosophical assumptions, the clinical workers get their knowledge. During nursing practise, nurses need to have knowledge on symbolic communication with justifiable knowledge. The ways that knowing and knowledge are developed concern epistemology revealing how nurses know and acquire shared knowledge in nursing. Knowing is a way of perception and understanding of the world and the self, while knowledge is a reasonably accurate accounts of the world. The knowledge that is found in practice is expressed by use of sounds, movements and actions. Much of what is already known can be expressed formally even in practice.

In 1978, there was an examination of early nursing literature by Carper who mentioned four enduring and fundamental patterns of knowing that have been useful and valuable for nurses in practice. These patterns of knowing in nursing have an interrelation with nurses learning some of the discipline’s knowledge in the basic education they receive and the acquired knowledge is in turn built upon during practice (Benner, 2001). Nursing practice that is expressed formally is developed through the use of inquiry methods grounded in both formal and practice methods.  In my nursing practice in the paediatric emergency room, I have utilized these ways of knowing to ensure that my ways of practicing are successful. This paper considers an interpretation of the ways of knowing by Carper: ethics, personal, empirics and aesthetics. It will critically examine my exemplar experiences, illustrating these two ways and how they have influenced my practice. carper’s ways of knowing essay examples.

Carper’s Ways of Knowing

Proposed by Professor Barbara A. Carper, Carper’s Ways of Knowing is a classification of the diverse sources and patterns in nursing from which knowledge can be acquired. This categorization consists of four patterns; empirics, aesthetics, ethics, and personal knowledge. Carper proposed the four patterns in 1978 to characterize the complex phenomenon of knowledge utilized by nurses when providing care to the patients. The following is an analysis of two of the four patterns; ethical knowing and personal knowing.

Ethical knowing according to Carper (1978) acknowledges the knowledge of ethical codes and norms by examining the codes, standards and values that are seen as morally right resulting in better awareness of the moral choices that are to be made. Personal knowing is focused on knowing one self and also that of others. Thus, when one knows more about the self, then the other can also be known. carper’s ways of knowing essay examples.

Personal Knowing

In nursing, personal knowledge is a fundamental pattern but the most problematic in teaching and mastering. On the other hand, it is an essential pattern of understanding the meanings of health terms of the well-being of individuals. As an interpersonal process, nursing consists of transactions, relationships and interactions between the nurse and the patient (Carper, 1978).  Chinn and Kramer (1999) describe the pattern of personal knowing as a creation of experiences through self-encounters by focussing on the self and having a realization of the potentials and realities of life. There is also the involvement of encounters, experiences and focus.  The quality of interpersonal relationships and contact is evidently more influential on the illness of a person occurring, becoming well and coping with the illness (Chinn & Kramer, 1999). The main aspect of personal knowledge is the encountering, knowing and actualizing of the individual self. In this term, a person does not know about the self but keeps string to know.

In the therapeutic use of self, the nurse does not approach the patient as an object but keeps striving to have actual personal relationships (Chinn & Kramer, 1999). When other people accept to have an authentic personal relation, they then create a sense of freedom in themselves and recognize each person. Therefore, as a nurse, it becomes my responsibility to have social relationships with my patients and view them as individuals during my professional responsibilities (Carper, 1978). With the emergence of personal knowing throughout life there can be full expression of the genuine self with accessibility being possible only through deliberate interactions and actions. carper’s ways of knowing essay examples.

Ethical Knowing

There has been increased sensitivity by practitioners and nurses on the personal choices that are difficult to make in modern health care. Fundamental and significant questions are raised about the wrong actions and the moral rights related to care and treatment of illness and health promotion. The ethical way of knowing is a fundamental pattern of knowing that focuses on the moral obligations, guiding what needs to be done (Chinn & Kramer, 1999). This component offers guidance for the choices to be made in the event of complex situations. Through this pattern, nurses are directed into doing what’s right and what’s expected under any circumstance. This pattern covers fundamental values and aspects in the nursing code of ethics such as self-respect, value for human dignity, accountability, among others. However, it exceeds the knowledge of the ethical codes of conduct as according to Carper (1978), and is also inclusive of all deliberate voluntary actions that are subject to judgment of what is right or wrong. carper’s ways of knowing essay examples.

In situations of uncertainty and ambiguity, there are moral dilemmas that arise especially when one cannot predict the consequences of their actions and the traditional principles that they are supposed to follow without contradiction (Chinn & Kramer, 1999). The primary principle of obligation covered in the concept of serving people and respecting human life is what guides the moral code. Nursing holds the conservation of life, promotion of health and alleviation of suffering as valuable and essential in social services (Carper, 1978). Therefore, the use of this way of knowing becomes essential especially when dealing with children. In the assessment of this dimension, Jacobs-Kramer and Chinn focused on justice as it also accommodates the ethics of care.

It is evident that Chinn and Kramer agree with Carper on what ethical knowing and personal knowing entail as they serve nursing knowledge.  Ethical knowing is focussed on the moral obligations needed during practice, while personal knowing is based on knowing oneself in a better way so that service can be offered to others. The authors give related opinions as those of Carper on their definitions.

Exemplars in Practice

My encounter with a traumatized three year old boy, brought to the hospital by his grandmother, has left a mark in my pediatric career. I meet parents who are worried about their children every day; however, this grandmother had been shaken by her grandson’s situation. Upon admission, it was discovered that the child had suffered severe physical injuries, warranting for the immediate involvement of social work. The entrance of the social workers ended up complicating the emergency situation at hand. I was taken aback by the social workers’ handling of the situation. As a nurse, I was concerned with dealing with the emergency case in my hands. However, the social workers were concerned with questioning the patient’s grandmother on the cause of the physical injuries that the patient had suffered. The poor grandmother was at pains to explain the cause of the injuries. In so doing, the social workers were adding to the confusion and tension in the emergency room. carper’s ways of knowing essay examples.

The entrance of the social workers in the child’s case had created a serious issue that required the use of applied ethics to solve. On one hand, the life of the traumatized boy with physical abuse was at stake. Whereas on the other, there was the need to allow the social workers to discharge their obligation in a case involving physical abuse to a child. Knowledge in applied ethics came in handy. The grandmother of the child remained shocked while the social workers were interrogating her regarding the physical abuse. As such, she was not offering much help to the social workers. Tempers had risen, as the social workers were of the opinion that the grandmother was taking them for a ride. On noticing that the situation in the emergency room was working against the welfare of the patient, I moved with authority and sent the social workers out of the room. This allowed the medical team enough time and opportunity to concentrate on the patient. Within no time, the traumatized child was able to cool down. He was treated for the physical pain that he was suffering as well.

Working in a pediatric emergency room necessitates personal knowledge. My ability to bond with the child played a critical role in calming down the traumatized child. It was my knowledge and understanding that the child had gone through trauma in the hands of his tormentor that enabled me to explain to the child that he was in safe hands and that nothing bad would happen to him again. This assurance was what the poor child needed in order to smile again. By combining my personal knowledge with applied ethics, I embarked on a mission to finally bring an end to the bad blood between the child’s grandmother and the social workers. The now relaxed grandmother was able to explain how she had risked her own life by forcefully taking the child from his parents. From here, it was established that the child’s parents were deep into drug abuse and the child was seen as an obstacle. The child’s parents were responsible for the physical abuse that he had suffered. It was obvious that the social workers had wasted time on an equally traumatized grandmother, and in so doing, put the child’s life at risk. From this day, the use of personal knowledge and applied ethics form the core of my profession as a pediatric nurse.

Conclusion

As both collective and individual responses are developed by nurses on the development of knowledge, there has to be an understanding of what the ways of knowing actually entail. Coherence can be facilitated through nursing knowledge in making deliberate choices to avoid ethical dilemmas during practice. As a nurse, it will be essential for me to build upon the knowledge that I already have in my practice to enable growth and development through more experiences. The ethical exemplar has influenced my practice by giving me knowledge on how to face dilemmas involving children and their guardians. The personal knowing exemplar gave me an understanding of appreciating others especially children that cannot defend themselves. carper’s ways of knowing essay examples.

References

Benner, P. E. (2001). From novice to expert: Excellence and power in clinical nursing practice. Pearson.

Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in nursing science, 1(1), 13-24.

Chinn, P. L., & Kramer, M. K. (1999). Theory and nursing integrated knowledge development.

 

Applying Ways of Knowing to a Clinical Case

Nursing is seen as an art and a science.  Nurses must be able to portray different roles within the nursing profession.  Being able to meet a patient’s needs physically, emotionally, and spiritually leads to a holistic experience for the patient and the nurse.  Barbara Carper, a nurse, provided the basic framework for holistic nursing focusing on knowing and knowledge in the nursing profession.  “Carper’s way of knowing in nursing, empirics, esthetics, personal knowing, and ethics, provide a guide to holistic practice, education, and research” (Holtslander, 2008).  “Knowing is a cognitive process, and four patterns of knowing—empirical, ethical, personal, and aesthetic—characterize nursing” (Cipriano, 2007).  The four patterns that Carper’s method focus on are not isolated events and when used together the patient receives the best care.  In this paper, I will focus on Carper’s method, provide an example related to her method and identify/reflect on the situation as it relates to her model. carper’s ways of knowing essay examples.

Clinical Situation

While charging in the emergency room one night, I encountered a family that was not comfortable taking their mother home.  I had not been directly involved in the patient’s care, however, the patient’s primary nurse shared the same concerns as the patient’s family.  I reviewed the patient’s chart and noticed the patient presented to the emergency department with a sudden inset od shortness of breath and minor chest pain that was deemed noncardiac by the physician.  The emergency physician simply dismissed the patient’s symptoms and diagnosed her with an upper respiratory infection, gave her a dose of IV antibiotics, and a prescription for oral antibiotics to take home.  When I assess the patient, she was not in any acute distress, however, I auscultated expiratory and inspiratory wheezes in her right lung and diminished breath sounds in her left lung.  The patient did have a history of CHF and newly diagnosed COPD.  The family reported to me during my assessment that she had been seen earlier in the day as well for similar complaints but that this episode had been much worse than the first.  carper’s ways of knowing essay examples. The patient’s nurse reported to me that the physician had not physically evaluated the patient during this visit but had reviewed her visit from earlier in the day.  I reviewed the patient’s earlier visit and noted that the chest x-ray showed minor infiltrates in the left and right lung that was secondary to her COPD and that her lab work was overall unremarkable accept for a BNP level that was > 100 pg/mL.  I took this information to the physician and reported to him that the patient’s symptoms were worse and that she had diminished breath sounds in the left lung field.  He did not seem to be impressed or moved with my assessment and the family’s discomfort in taking her home.  He told me to discharge the patient because he was the doctor and I was just a nurse. I felt that the patient did not meet criteria for discharge, so I called our department manager and expressed my concerns.  The department manager spoke with the physician and expressed her concerns as well and he reluctantly ran some further testing on the patient.  Upon receiving her results, the patient had worsening infiltrates in the lung, an elevated WBC count, and a BNP level of 1500 pg/mL.  The patient was admitted to the hospital with CHF, exacerbation of COPD, and leukocytosis. carper’s ways of knowing essay examples.

Aesthetics (Esthetics)

“Aesthetics provides unique means through which clients and nurses can explore personal perceptions of aspects of their world and fosters a creative sense of self-awareness” (Koithan, 1996).  Nurses gain aesthetic knowledge from subjective data.  I believe the underlying situation was that the physician did not perform a complete head to toe assessment and based his assessment and diagnosis off previous information.  The physician did not take into consideration that the patient’s history and the fact that when she presented the second time her symptoms were worse and warranted further testing and physical evaluation.  Nursing staff demonstrated aesthetics by identifying the patient’s basic and social needs, interacting directly with the patient/patient’s family, and by recognizing the validity of the family’s concerns.

Personal

“Personal knowledge refers to the way in which nurses view themselves and the client” (McEwen & Mills, 2014, p. 13).  Nurses gain personal knowledge from subjective data.  This data promotes engagement instead of detachment (McEwen & Mills, 2014, p. 14).  In my nursing career, I have learned not to take things at face value.  By doing so, I learned to be more in sync with my patients and their families.  Engaging the patient and the patient’s family allowed me to use past experiences and encounters to provide further evaluation, testing, and inpatient hospital care for the patient. carper’s ways of knowing essay examples.

Ethics

“Ethics refers to the moral code of nursing and is based on obligation to service and respect for human life” (McEwen & Mills, 2014, p. 14).  A personal belief that impacted my actions was that this patient was in need and that she was not receiving the care that she had a right to receive and which she had access carper’s ways of knowing essay examples.  I acted as an advocate for this patient and her family following my own personal values.  The patient’s condition clearly did not meet discharge criteria and demanded a second look by myself and the physician.  Reporting the assessment information higher than the physician gave the patient access to the care that she needed.  According to White (1995), sociopolitical knowing causes the nurse to question the taken-for-granted assumptions about practice, the profession, and health policies (p. 84).

 

 

Empirical

“Empirical knowledge tends to be the most emphasized way of knowing in nursing because there is a need to know how knowledge can be organized into laws and theories for the purpose of describing” (McEwen & Mills, 2014, p. 13).  I applied this knowledge by using nursing interventions to assess the patient and review previous labs and x-rays from her earlier visit.  Evaluating the patient further gave me a reason to believe that the patient did not have a simple upper respiratory infection and since her symptoms were worse upon return that further testing and evaluation was needed.  The infiltrates in both lungs and the elevated BNP was indicative that the patient was in the early stages of heart failure.  “Measurement of brain natriuretic peptide (BNP), a cardiac hormone, this test may have a role in detecting, monitoring, and perhaps preventing chronic heart failure” (Doust, Lehman, & Glasziou, 2006).

Conclusion

The clinical case presented involved an intricacy of complications and issues related to patient care.  By using my assessment skills, reviewing the patient’s chart and implementing nursing interventions I was able to give the patient access to the care that she needed.  Easily observed issues were the patient’s worsening of symptoms, borderline lab values, and chest x-ray.  The reassessment and reflection of this clinical case has influenced my personal morals and experience as a nurse so that I will continue to provide care for patients, advocate for patients, and care for patients based on a holistic approach. carper’s ways of knowing essay examples I identified Carper’s four fundamental patterns of knowing to a clinical case by discussing each pattern that can lead to improvements in my personal nursing practice.  I also learned to appreciate Carper’s four fundamentals and how they apply to situations I am faced with daily.

 

References

Cipriano, P.F. (2007). Celebrating the art and science of nursing. American Nurse Today, 2(5). Retrieved from https://www.americannursetoday.com/celebrating-the-art-and-science-of-nurisng/.

Doust, J., Lehman, R., & Glasziou, P. (2006). The role of BNP testing in heart failure. American Family Physician, 74(11), 1893-1900. Retrieved from https://www.aafp.org/afp/2006/1201/p1893.html.

Holtslander, L.F. (2008). Ways of knowing hope: Carper’s fundamental patterns as a guide for hope research with bereaved palliative caregivers. Nursing Outlook, (56)1, 25-30. doi: 10.1016/j.outlook.2007.08.001. carper’s ways of knowing essay examples

Kothian, M.S. (1996). Aesthetics in nursing practice and education. Issues in Mental Health Nursing, 17(6), 529-539. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9052092.

McEwen, M., & Wills, E. (2014). Theoretical Basis for Nursing, 4th Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781469899992/.

White, J. (1995). Patterns of knowing: Review, critique, and update.  Advances in Nursing Practice, 17(4), 73-86. Retrieved form https://www.ncbi.nlm.nih.gov/pubmed/7625782 carper’s ways of knowing essay examples