A
lthough Carper’s (1978) seminal work on ways of knowing in nursing is over 30 years old, it still provides an excellent foundation for under- standing knowledge development within the discipline. In this important work, Carper identified four fundamental patterns that emerge as the way nurses come to know—come to understand their world of work: empirical knowing, aesthetic knowing, personal knowing, and moral knowing.Empirical knowing represents the traditional, objective, logical, and posi- tivist tradition of science. Empirical knowing and thus empirical science is
committed to providing explanations for phenomena and then controlling them. An example of empirical knowing is the knowledge derived from the biologic sciences that describes and explains human function. Biologic sci- entists have been able to predict and control certain aspects of human struc- ture and function. Treatment of diabetes mellitus is an example of empirical research being applied in the health care field. From their empirical studies, biologic scientists know that providing insulin to individuals with diabetes mellitus controls the symptoms created by the nonfunctioning pancreas.
The nursing profession’s alignment with empirical knowing and its subse- quent pursuit of this mode of inquiry follows the positivist paradigm, which believes that objective data, measurement, and generalizability are essential to the generation and dissemination of knowledge. This type of nursing knowledge is critical in situations in which control and generalizability are important. Chinn and Kramer (2004) expanded our understanding of the traditional meaning of empirics to include theory development and the use of research methods that are not based strictly on hypothesis testing, such as phenomenology and ethnography.
Aesthetic knowingis the art of nursing. The understanding and interpreta- tion of subjective experience and the creative development of nursing care are based on an appreciation of subjective expression. Aesthetic knowing is abstract and defies a formal description and measurement. According to Carper (1978),
The aesthetic pattern of knowing in nursing involves the perception of abstract particulars as distinguished from the recognition of abstracted universals. It is the knowing of the unique particular rather than an exemplary class. (p. 16)
Aesthetic knowing in nursing provides the framework for the explo- ration of qualitative research methodologies. Qualitative research calls for recognition of patterns in phenomena rather than the explication of facts that will be controllable and generalizable. An example of aesthetic know- ing is the way a nurse would provide care differently for two elderly women who are preparing for cataract surgery, based on the nurse’s knowledge of each woman’s particular life patterns.
Wainwright (2000) states, “a nursing aesthetic can provide us with an es- sential set of tools to help answer the question of what amounts to good nursing. It may also provide us with additional insights into the nature of nursing ethics” (p. 755). “Nursing knowledge as defined in nursing theories and when lived by nurses creates the art of nursing” (Mitchell, 2001, p. 207).
Personal knowingrequires that the individual—in this case, the nurse—
knows the self. The degree to which an individual knows oneself is deter- mined by his or her abilities to self-actualize. Movement toward knowledge of the self and self-actualization requires comfort with ambiguity and a commitment to patience in understanding. Personal knowing is a commit- ment to authentication of relationships and a presencingwith others, that is,
the enlightenment and sensitization people bring to genuine human inter- actions. Personal knowing deals with the fundamental existentialismof hu- mans, that is, the capacity for change and the value placed on becoming.
Personal knowing also supports the qualitative research paradigm. In the conduct of qualitative inquiry, researchers are obligated by the philo- sophic underpinnings of the methodologies they use to accept the self as part of the research enterprise and to approach research participants in a genuine and authentic manner. An awareness of one’s beliefs and under- standings is essential to fully discover the phenomena studied in a qualita- tive research inquiry. Furthermore, qualitative researchers believe there is always subjectivity in their pursuit of the truth. The very nature of human in- teractions is based on subjective knowledge. In the most objective research endeavor, subjective realities will affect what is studied. “Scientific research, as a human endeavor to advance knowledge, is influenced by the sociocul- tural and historical context in which it takes place and is considered neither value free, objective, nor neutral” (Henderson, 1995, p. 59).
Moral knowingreflects our ethical obligations in a situation or our ideas about what should be done in a given situation. Through the moral way of knowing, individuals come to a realization of what is right and just. As with personal knowing and aesthetic knowing, moral knowing is another abstract dimension of how it is that individuals come to understand a situation.
Moral knowing is based on traditional principles and codes of ethics or con- duct. This type of knowing becomes most important when humans face sit- uations in which decisions of right and wrong are blurred by differences in values or beliefs. Moral knowing requires an openness to differences in philosophic positions. Ethics and logic are required to examine the intrica- cies of human situations that do not fit standard formulas for conduct.
Munhall (2001) states, “all of the foregoing patterns are rich and essen- tial sources of nursing knowledge that can be studied from various perspec- tives of science” (p. 41). The importance of sharing these ways of knowing is to offer the reader a context in which to judge the appropriateness of nurs- ing knowledge and the way that nurses develop that knowledge. It is only through examinations of current belief structures that people are able to achieve their own standards of what will be best in a given situation.
Moreover, when we select our research methods, we should choose them based on the questions we are asking (Burnard & Hannigan, 2000) within the context of what is known and what we believe.
May (1994) and Sandelowski (1994) expanded on the idea of knowing as it relates to nursing knowledge. May (1994) used the term abstract know- ingto describe the analytic experience of knowing:
The rigorous implementation and explication of method alone never explains the process of abstract knowing, regardless of which paradigm the scientist espouses and which method is chosen.
Method does not produce insight or understanding or the creative
leap that the agile mind makes in the struggle to comprehend obser- vation and to link them together. Regardless of the paradigmatic perspective held by the scientist, the process of knowing itself cannot be observed and measured directly, but only by its product. (p. 13) May (1994) further suggested that knowledge is “shaped but not com- pletely definedby the process through which it is created” (p. 14). Based on her ideas about knowing, she gave credibility to what she called “magic,”
which is similar to the intuitive connections discussed in Benner’s (1984) work on expert clinical judgment. Based on her conversations with and ob- servations of qualitative researchers, May determined that, at a certain point, pattern recognition creates the insight into the phenomenon under study.
She believes that the ability to see knowledge is a result of intellectual rigor and readiness (magic). Her ideas support the concept of intuition or, as she labeled it, “abstract knowing” in nursing research.
Sandelowski (1994) took a position on knowing similar to the aesthetic knowing described by Carper (1978): We must accept the art as well as the science of research. Sandelowski believed that the two are not mutually exclusive.
What differentiates the arts from the sciences is not the search for truth per se, but rather the kinds of truths that are sought. Science typically is concerned with propositional truths, or truth about something. Art is concerned with universal truths, with being true to: even with being more true to life than life itself. (Hospers, as cited in Sandelowski, 1994, p. 52)
Both May (1994) and Sandelowski (1994) provide us with an expansion of the original positions on knowing offered by Carper (1978). These au- thors provide a validation for knowing other than in the empirical sense.
Most important, they offer nurse researchers a way to discover knowledge that complements the positivist paradigm and gives voice to other ways of knowing. In the case of qualitative research and nursing practice, it is only through examination of the prevailing ideologies that nurses will be able to decide which ideology most reflects their personal patterns of discovery and creation of meaning.