NR 501 Week 2 Discussion: Ways of Knowing
Ways of Knowing Reflective Essay
NR 501: Theoretical Basis for Advanced Nursing Practice
Clinical
... [Show More] Situation
While working in the emergency room one day, I encountered a family that was not comfortable taking their mother home. I reviewed the patient’s chart and noticed that the patient presented to the emergency department with a sudden onset of shortness of breath and minor chest pain that was deemed noncardiac by the physician. The emergency department physician simply dismissed the patient’s symptoms and diagnosed her with an upper respiratory infection, gave her a dose of IV antibiotic and a prescription for oral antibiotic to take home. When I assessed 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 the patient had visited ED at an early date as well for similar complaints but that this episode had been much worse than the first. 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 as ordered based on his assessment. 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.
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.
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). Nurses gain personal knowledge from subjective data. This data promotes engagement instead of detachment (McEwen & Mills, 2014). 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.
Ethics
“Ethics refers to the moral code of nursing and is based on obligation to service and respect for human life” (McEwen & Mills, 2014). 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 to. 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. Following the chain of command gave the patient access to the care that she needed. Sociopolitical knowing causes the nurse to question the taken-for-granted assumptions about practice, the profession, and health policies (White, 1995).
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). 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 of the patient worsening CHF. “Measurement of brain natriuretic peptide (BNP), a cardiac hormone, 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. 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.
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. [Show Less]