Nurses play one of the most important roles in medicine because they assist physicians, patients and monitor numerous processes maintaining treatment and care. For this reason, they require obtaining numerous critical competences in this sphere. These competences incorporate skills and knowledge required for performing daily tasks and providing support in everyday and critical situations. This paper discusses the aspects of nursing, which refer to the fundamental patterns of knowing of a nurse. In the case registered nurses are aware of this essential information, they obtain integrity of their knowledge and practice skills raising their efficacy.

Nursings Fundamental Patterns of Knowing

A typical nursing care plan may depend on different variables, but it may undergo peculiar changes if a nurse addresses all patterns of knowing. They include empiric, personal, ethical and aesthetic knowing, which are believed to foster the quality of care in the case of their comprehensive consideration (Chinn & Kramer, 2010). However, a certain percent of nurses tends to think that their tasks are reduced to functional aspects of care such as assistance to physicians during operation or medical care for injured patients. As a result of these thoughts, a care plan may lack certain ethical aspects or fail to consider personal knowing and experiences of a patient. In consequence, the quality of care reduces or has the possibility of improvement whereas the nurse is not aware of this issue. Therefore, nurses should consider every mentioned aspect in order to broaden the scope of knowledge and provide comprehensive care.

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In addition, one may support the above mentioned pinion with personal reflections and analysis. For instance, I can recall the case of caring for an elderly patient named John who had diabetes and dementia. He was prescribed a plan for nutrition and followed it, but his short losses of memory prevented him from visiting insulin injection sessions in time. I considered such domains of knowing as empiric and ethical. It allowed caring for John and calling him in case he forgot about the need for the visit to the hospital. However, if I happened to consider personal and aesthetic aspects of the problem, I would have discovered several critical factors. The first one is that his relatives might have assisted him if they were instructed by a qualified nurse. Furthermore, John was cautious about his dementia, which led to the fact that he had occasionally panicked, and it aggravated his weakness in memory. I should have managed this issue either or notified the physician, but I lacked experience and awareness of the gravity of this knowledge. Therefore, I had a possibility of bettering the level of care for the patient.

Furthermore, one may consider medical articles from the past and address some aspects of nursing care considering the mentioned knowing. For example, the article by Dripps and Waters (1941) considers the issues of a nursing care provided for surgical patients. The authors discuss the idea of the management of interventions, which allows providing adequate postoperative recovery of a patient. It is evident that the authors considered such aspects of knowledge as personal, aesthetic and ethical. Thus, they discuss practical tasks, which allow fostering patients recovery. For instance, they propose paying attention to the respiratory activity of the patient in order to avoid the decrease of intake of oxygen. They connect this issue with the cases of depression in order to manage its occurrence, which means that they consider the aesthetical knowing. In this sense, reduction of depression is connected with overall experiences of the patient and the hospital. In addition, the scholars discuss the ways of reducing harm to patients, which means that they are aware of ethical knowing. Similarly, it is evident that the authors of the article are concerned about personal issues of patients and presume that they have individual post-surgery experiences, which may differ. For this reason, they propose considering each individual case accordingly. At the same time, the article is a result of the analysis of the evidence-based practices and empiric knowing. Consequently, the scholars propose stirring the patient up by means of turning him or her in order to increase ones respiratory abilities. However, one presumes that stirring up may be painful for specific patients and requires implementation of alternative measures. Therefore, the authors of the article failed to apply aesthetic and ethical aspects of knowledge properly. In contrast, substitution of turning by additional lung training devices might have bettered the caring experience in patients who suffered from increased pain.

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Additionally, nurses should be aware of the principles of emancipatory knowing. This specific domain of knowledge allows focusing on the barriers for provision of the best level of care or even any type of care. Scholars describe it as a critical examination of the reasons for injustices as well as identification of social and structural changes required for improving the issue (Chinn & Kramer, 2010). This knowing may be helpful regarding different ethical, religious and racial challenges, which serve as a barrier for assuring the appropriate level of care. For example, the cases of occasional racial discrimination among nurses may lead to the refusal of medical practitioners from the treatment, which is a grave malpractice. Another example is the cases when the followers of specific religious movements refuse from taking medicine, undergoing operations or transfusing blood. The last case occurred during my nursing practice when a member of Jehovahs Witness refused from the blood transfusion after being injured in a car accident and losing a significant amount of blood. This case was critical and might have finished with a death of the patient. In such cases, the activation of the principles of emancipatory knowing is beneficial. The application of the principles of emancipatory knowing allows a nurse analyzing such cases with the aim of prioritizing the obstacles for the provision of qualified assistance. Along with that, it fosters the processes of searching for strategies to mitigate the conflict and remove the existing barriers for care. In this particular case, the physician investigated the problem and took a decision of administering a blood fraction, which had no human blood products. Thus, there is a need for the provision of adequate instructions for nurses regarding the management of typical problems connected with patients refusal of care. In addition, prepared blood fractions, which have no human blood cells, might be introduced specifically for the mentioned cases of patients refusal from the blood transfusion.

It should be noted that nursings primary purpose aims at providing qualified care for patients and support physicians activities aimed at patients diagnosing and treatment. As a result, the outcomes of this activity lead to patients recovery avoiding repeated admission with similar diagnoses. This purpose requires all patterns of knowing because nursing is a comprehensive activity, which cannot be guided by limited patterns of knowing. For instance, a nurse should be aware of any factors, which restrict adequate care, make ethically correct choices, and involve personal analysis and reflections. At the same time, one should consider the aspects, which may increase positive outcomes for the patient, as well as skills for obtaining and analyzing empiric knowledge in the sphere. Therefore, these aspects are crucial because they provide conducting a comprehensive overview of a nurses activity and increase its efficiency.

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As a nursing situation that was particularly problematic for me as a nurse, I recollect the case with a male patient aged 56 who refused from the blood transfusion after a car accident because he was Jehovahs Witness. Reflecting on this situation, I should consider the critical questions for each pattern of knowing: From an emancipatory perspective: 1. a) The wrong aspect of the case is that the patient refused from a procedure, which could save his life. 2. b) There were no individuals who might have benefited from the situation. 3. c) There was a limit in knowledge and information regarding the activities, which involve religious obstacles that restrain the performance of critical procedures. 4. d) The predominant part of medical practitioners were not aware that there are clinical substitutes that can serve as human blood. From an ethical perspective: 1. a) The injustice of the situation was that patients religious beliefs restricted him from lifesaving interventions. 2. b) The actions of the involved personnel were responsible. From a personal perspective: 1. a) I know what I did as I tried to search for the information, which could have assisted in the management of the issue. I definitely did what I knew, but my knowledge was limited. 2. b) I did not do anything bad, but I did not take measures, which could have improved the patients condition either. 3. c) I acted in a manner consistent with my inner knowing, and I did not betray myself. 4. d) I would have acted differently understanding what I now know about myself. The reason for it is the awareness of the domains of knowledge. From an aesthetic perspective: 1. a) The involved personnel considered the issue as critical because it required rapid decisions and adequate components used for blood transfusion. 2. b) How was this situation significant for those involved in it? From an empiric perspective: 1. a) My colleagues and I tried to apply traditional practices caring for the patient. 2. b) The empirical knowledge was used appropriately, but it was not enough until the moment when physicians consulted the personnel from another hospital. 3. c) The nurse was scientifically incompetent because ones experience did not include the evidence of cases when patients refuse from blood transfusion on the religious basis.


Summarizing the presented information, one comes to a conclusion that nurses should be aware of the fundamental principles of knowing as well as the need for their integration. This praxis makes it possible to raise the quality of the provided care for patients and the level of assistance to other medical practitioners. Consequently, the quality of the provided care is expected to rise if nurses take courses dedicated to fundamental patterns of knowing. Therefore, nursing educational institutions and hospitals should arrange such courses in order to raise the qualification of the nursing staff.

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