Reflective Practice in Nursing: Applying Carper's Ways of Knowing

This report delves into reflective practice within nursing, employing Carper's fundamental ways of knowing—empirics, esthetics, personal, and ethical—to analyze a clinical scenario involving an aboriginal patient. The student nurse describes a challenging situation where the patient, suffering from osteoarthritis and impacted by previous negative healthcare experiences, exhibited unresponsiveness and a lack of cooperation. Through the application of Carper's framework, the report explores how empirical knowledge, derived from evidence-based practice, informed the development of a therapeutic, patient-centered approach. The analysis further examines the role of esthetics, highlighting the importance of developing compassionate relationships and adapting communication styles. Personal knowing is discussed as a developing aspect, while ethical considerations, particularly cultural competency and adherence to ethical codes, are emphasized as crucial for providing equitable and respectful care. The report concludes with recommendations for future practice, including the importance of continued learning, ethical reflection, and the application of Carper's framework to improve patient outcomes and navigate complex clinical situations. The student emphasizes the significance of person-centered care, cultural sensitivity, and the ethical responsibility to provide holistic patient care.

Running head: REFLECTIVE PRACTICE IN NURSING
REFLECTIVE PRACTICE IN NURSING
Name of the student:
Name of the university:
Author note:

1REFLECTIVE PRACTICE IN NURSING
Carpers’s fundamental ways of knowing is a systematic process which is helpful in classifying
the different sources form which proefessionals can derive knowledge and belifes in professional
practice (Carnago and Mast 2015 pp 389). The utility of it can be shown with the help of an
event and then sequentially describing the knowledge accordingly.
Event description:
An aboriginal patient was admitted to the ward by his son and daughter in law where they
told that their father is facing severe issues with the pain of osteoarthritis and increased body
weight. He had been sleepless the entire night due to the pain and he was found to be very weak.
He had been mostly unresponsive to the various questions asked to him and was not willing to
cooperate with the nurses who were trying to ease him of the pain. The family members told that
he was humiliated as the nurses on duty in the previous hospitals did not maintain his dignity and
pressurized their intervention on them. When he wanted to inquire about the intervention, they
insulted him saying he was illiterate and a backward class and that he would have no idea even if
they discuss their decisions with them. His fear for such humiliation had prevented him to visit
other hospitals as well as and hence the situations with his osteoarthritis had become so worse.
He was not responding to any questions asked and he was also not cooperating with the
treatment interventions given. His self-respect was overpowering his will to live and this created
a challenge for the nurses on duty including me.
Carper’s way of knowing:

2REFLECTIVE PRACTICE IN NURSING
Empirics:
One can gain empirical knowledge form research as well as objective facts. The knowledge
usually remains systematically organized in a number of different general laws and also in
theories (de Olivera and Toledo 2017 pp 33). The best ways by which empirical knowledge is
gained is by the evidence based practices. While I faced the issue with the patient, I tried to
search for articles that would help to match up with the case I was handling. The articles that I
came across helped me to develop an idea that in such cases, becoming aggressive with the
patients or forcing him to take interventions would have negative effects. Instead, developing a
therapeutic relationship with him full of compassion and empathy may help him to develop trust
on the nursing professionals (Nielson et al. 2014 pp 95). Making him feel important by sharing
with him the interventions applied on him and also involving him in decision making was
suggested by the researchers who conducted qualitative studies on patients with similar
symptoms (Hole et al. 2017 pp 1668). Therefore this ways, evidence based practice helped me to
develop an idea about how to approach with the task assigned to me and helped me to act as a
responsible professional. From this kind of knowing, I learnt that I would use person centered
care, value the patient’s decision making skills, discuss the treatment plan with him and
concentrate on developing a therapeutic relationships with him. However, I faced various issues
while conducting this procedure as I was not rightly using the correct search terms and therefore
it took me a large amount o time to find correct evidences. Hence, is should develop my skill in
searching engines for evidence based practices.

3REFLECTIVE PRACTICE IN NURSING
Esthetics:
It mainly refers to the form of nursing where the profession is considered to be an art. Proper
knowing of different aspects of the profession with the correct understanding of phenomena is
the main central part of this type of knowing (Garrett and Cutting 2015 pp 99). It mainly focuses
on the new perspectives that individuals develop when they uncover something new through
their interventions and practices while treating for patients. I was previously a follower of routine
method of caring where I used to communicate very less with the patients but however never ill
treated patients. As a result my introvert behavior offended many patients and they could not
open themselves with me. However, with the seriousness of the mentioned patient, I tried to
change my working style and with the help of the advices of my mentor nurses, I learnt to strike
a right kind of conversation with the patient. I gradually came to understand how developing a
therapeutic relationship helped not only me to apply my interventions easily but also helped the
patient t get over his insecurities and find a friend and companion in me (Ray 2016 pp 455-460).
I gradually noticed that developing a therapeutic relationship with the patient helped the patient
to recover faster (Jacob et al. 2016 pp 319). Whereas the empirics helped me to learn about some
strategies from evidence based knowledge, esthetics helped me to develop idea form my own
experiences.
Personal:
Personal knowing refers to the knowledge one his about himself or her and also about anything
that he or she has experienced or seen. This type of knowledge usually comes through the
process of observation, self reflection and self actualization (Robert, Tilley and Peterson 2014 pp

4REFLECTIVE PRACTICE IN NURSING
351). It is through this knowledge which when gained by the professional help them to establish
the authentic, therapeutic relationships as these attributes help the professional to attain integrity
and wholeness. On a personal, level, I had very few experiences as I was a new comer and I
needed more time to observe, learn and establish new interventions strategies to handle these
situations I could not gain any help from my personal knowledge learning procedure as is was
not experienced enough to dvelop personal learning form situations.
Ethical:
Ethical knowledge helps one develop an idea about his or her moral code along with the sense of
knowing what is right and wrong. For a nursing professional, personal ethics are based on the
duty to protect and respect human lives (Carnago and Mast 2015 pp: 387). A nurse should
always follow the Codes of ethics given forward by the NMBA in order to provide quality care
to patients and prevent from getting involved in any legal obligations. Codes of ethics advise us
to follow that we should never discriminate any patients based on race, ethnicity, religion,
culture and classes. Following the ethics, it becomes duty to maintain cultural competency and to
provide the best treatment to the patient according to the norms of the culture practiced by them.
Here I learnt that we should never force our decisions on them and should never perform
anything that affects their cultural sentiments (Josif et al. 2017 pp 93). I noticed that the person
was mostly affected because the previous nurses did not important to their cultural norms. The
patient declared that the nurse had talked with him by directly looking into his eyes which is a
symptom of disrespect for them. Moreover, he previous nurse showed cultural biasness when he
said that aboriginals are illiterate and they have no proper ways of maintaining health. This is
absolutely a violation of the principle of justice where the responsively of a nurse is provide the
best quality acre to the patient irrespective of caste, creed and religion (Freeman et al. 2014, pp:

5REFLECTIVE PRACTICE IN NURSING
358). The previous nurse had also not maintained his dignity and autonomy of the patient giving
him no scope to take decisions for himself. Hence, I as a nurse, would try to be culturally
competent and never discriminate between my patients. This results in mental and emotional
turmoil in patients which might affect his health. Hence, I came to know that following the codes
of ethics and maintaining the principle of autonomy, justice, beneficence and non-, maleficence
are extremely important for providing an ethically safe treatment procedures.
Conclusion:
The Carper’s system of knowing helps to provide us a systematic process of reflecting on the
procedure of the development of knowledge. Empirically, I used a large number of evidence
based journals which showed that person centered care can help in the present situation where an
aboriginal patient should be treated in a culturally competent environment, allowing him to
participate in decision making. Esthetically, I learned how to be more compassionate and
empathetic towards my patent and develop a successful relationship with him unlike the routine
care of patients that I used to carry on for all patients. I believe with the passage of time, I would
develop personal knowledge to cope such strenuous situations. However, ethically, I learnt that
how not being compliant with the ethics and not following the principles of justice, autonomy,
beneficence and non maleficence may have negative effects on the patients. If a similar situation
arise again in front of me, I would recommend proper reading of journal based articles, develop
aesthetic sense and aligning more with the code of ethics and following the principles of nursing
would help anyone who overcomes the situation. I would also recommend that I should also
perform proper reflective skills and self actualization and closely observe every experience to
become expert in the profession.

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