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In healthcare, Carper’s fundamentals ways of knowing is a typology that attempts to classify the
different sources from which knowledge and beliefs in professional practice ( originally specifically
nursing) can be or have been derived. It was proposed by Barbra A. Carpers, a professor at the college of
nursing Texas woman’s university.

The typology identifies four fundamental patterns of knowing.

First talks about empirical which is the factual knowledge from science or other external source that can
be empirically verified. Empirical means originating in or based on observation or experienced is also the
information received by means of senses particularly by observation and documentation of patterns and
behavior through experimentation. Empirical has been a synonymous with science for many years as its
purpose as to describe, explain an predict natural and social phenomenon. In these traditional view of
science reality can be validated by different observers and knowledge can only be obtained through the
senses. Nosing broadened the legitimate ways of inquiry which a part from hypothesis testing, now
includes inductive and deductive reasoning and phenomenology description.

Knowledge expression no empirics includes facts, organized descriptions concerted models and
theories which explains and predict relationships. The expressing of knowledge is important when the
credibility index is validity of knowledge which must appear as it was first predicted to be

Personal is the second typology by Carpers. This is knowledge and attitudes derived from personal
self-understanding and empathy imagine once self in the patient’s position. The nature of personal has
been explored by many authors that it promotes wholeness and integrity in the personal encounter. She
continues to say that there is a continues process toward knowing the self since ‘’one strives simply to
know the self’’.

Chinn and Kramer suggested that through knowing the self-one can truly know another person. As
carper’s states, none of the empirical categories of personal characteristics and the behavior provide a
deep understanding of human being as person; as self. In addition, carper highlight the importance of
the therapeutic use of self’ ’which only become possible through the personal knowing. In the
therapeutic use of the self, the nurse brings as much of themselves as possible to the relationship the
nurse s and clients interrelated openly towards’ ’fulfillment of human potential’’. The nurse need to be
authentic which means that they reflect their true selves not hiding behind the roles but enacting the
role so as to express their uniquness as persons. The authentic personal relationship rests upon the
acceptance of the freedom of each individual for self so as to absorb in an interaction.

Self-awareness can be increased by engaging in self-reflecting by perceiving and accepting input

from others and openly disclosing oneself. According to chin and Kramer the self-awareness of the
person in interaction, facilitates sharing a meaningful experience. They describe the creative dimension
of personal knowing as experiencing the self. In similar way,Moch describe the elements of personal
knowing wholeness as encountering passion commitment .Passion is identified as the vial and valuable
nature of personal knowing. The assessment of personal knowing involves examining the congruity of
the expressed self with authentic self.

Ethical which is attitudes and knowledge derived from an ethical framework, including an awareness
of moral questions and choices, is the third typology and it is pertaining to right or wrong in conduct.
Ethics identified by carper as the moral component of nursing constitute a fundamental pattern of
knowing. Both carper and chin and Kramer, suggest that this pattern goes beyond he knowledge of the
ethical codes the discipline to includes moment to moment moral judgement according to motives,
intentions, and personal characteristics.

According to chin and Kramer the creative dimension of ethical knowledge involves valuing and
advocating. Clarifying and valuing constitute base for a personal ethics after developing different
philosophical positions. Nurses act as advocate of their patients and themselves through their process.

Ethical knowledge is expressed through codes, standards, normative ethical theories as well through
description of ethical decision making. Ethics is judge on justness, rightness and responsibleness.
Dialogue rather than codes and standards is required to analyzed an ethical decision.

For nurses the processes of ethical knowing such as advocating for their patients and clarifying the
meaning of life and living can change all the existing values in health care.

The last but not the least typology of Barbra Carper is aesthetic. That is the awareness of the
immediate situation, seated in immediate practical action including awareness of the patient in their
circumstances as uniquely individual, and of the combined wholeness of the situation.

Carper described aesthetics as the art of nursing which is based on the direct feeling of experience.
Both carper and chin and Kramer regard aesthetics knowledge as unique and subjective. However,
Benner that experience is not entirely subjective and the knowledge derived from experience can be
described in a language and practice.IT is the understanding of knowledge and experience that can be
change our view of how nurses might know their patients.

The art of nursing described by parse includes valuing the human presence showing respect to
different options that a client may hold and connecting with him. Aesthetic require from the nurse to be
fully engaged in the moment of experience and interpret a client situation all at once by elucidating the
meaning of the process and working beyond the situation to focus on which might be envisioning, so as
to act according to what has been envisioned.

In other to elaborate on the meaning of aesthetics knowledge, the conception of nursing must be
made more explicit Boykin et al suggested that carper fails to provide and explicit conception of nursing
which will facilitate the finding of the meaning aesthetics knowing, Boykin and Screenhofet reflected on
nursing main goal as’’ nurturing person living caring and growing in caring’ ’a conception that regards all
person as caring a result of their humanness. Caring is a human experience based on aesthetics
qualities, which actualizes beauty in a nurse-client relationship. The beauty makes the person s to realize
their common humanity. The caring process in nursing widens our understanding of the world and
evokes a fuller sense of aesthetics knowing about the core qualities of human links and interrelations.

Carper’s ways of knowing in nursing, empiric’s aesthetics personal knowing an ethics provide a
guide to holistic practice, education and research. Using Carpers ways of knowing as a guide for ‘’hope’’
research with bereaved palliative care givers with the ultimate goal of promoting healthy, positive
outcome for this unique population as an example: bereaved palliative caregivers have unmet needs
that may be addressed by research by exploring grave from an empirical perspective, hope is identified
as a variable in grief resolution. Esthetic knowing guides qualitative research on hope, personal knowing
provides a constructivist philosophy to a qualitative inquiry and ethical knowing includes the moral
obligation for evaluation research.


I do agree with Carper’s pattern of knowing due to its value and significance of knowing the patient
for professional practice. Nursing effort to know man is a weaving of threads of conceptions, perception,
remembrances and reflection into fabrics of meaning. This threads may be comic from the nursing
science or other science, acts life or experience. However, the weavers nursing create undue process
and product.

According to rationalism the only source of knowledge, is reason rather than experience. This
philosophy has influenced nursing for many years so as to get involved in formalizing knowledge in order
to become explicit and legitimate. Carper’s paper on ‘’pattern of knowing ‘’was a landmark into
literature which extended in a perspective our understanding of a practice oriented discipline such as

According to history Carper’s work was published in a time that nursing was struggling to obtain a
consensus of identity with a unique baly of knowledge. Nursing was very much influenced by scientism
which holds the positivistic view that only reality is the one that can be empirically verified. She started
that he only valid and reliable knowledge of that time in nursing was ‘’empirical, factual objectively
descriptive and generable ‘’ so in addition to empirical knowledge, carper identified ethics, aesthetics
and personal knowing. She suggested that the patterns are all necessary, interrelated, independent and
overlapping and create the whole of knowing.

`` Carper’s work counted upon assumption that the patterns and structure of nursing knowledge
provide the unique perspective of the discipline. However, Boykin et al reject this thesis, proposing that
is the conception of nursing which provides the structure of knowing. In addition, they comment on her
failure to distinguish between knowing and knowledge which disintegrate it unity. Nevertheless, her
evolutionary work stimulated and motivated action in order to define and develop nursing knowledge
which would truly be unique and congruent with its nature.


Benner,P.(1984).From novice to export: excellence and power in clinical nursing practice

Addison Wesley ,Calif Menlo: Park