In honor of National Nurses Week, this nurse—now library director—is wondering how NLM, the world’s largest repository of biomedical knowledge, serves nurses and nursing.
Certainly, the Library—with its rich collections and extensive services—addresses the scientific, scholarly practice of nursing well, but what about the other dimensions of nurses’ ways of knowing?
In 1975, for her doctoral dissertation, Barbara Carper explored the published writings of nurses and works about nursing and found through her analysis a structure or typology to the practice of nursing. She labeled this typology “patterns of knowing” and proposed that the following four patterns work together to inform how nurses know patients and how to care for them:
- Empirics, the science of nursing
- Esthetics, the art of nursing
- Personal, the therapeutic use of self
- Ethics, the moral reasoning base of nursing
The empirical foundations of nursing arise from systematic inquiry, whether experimental, naturalistic, or observational. Nurses “know” about human response through controlled studies, though science, and as the emphasis on empirical foundations grew through the 20th century, nursing embraced the ideals of evidence-based practice.
But Carper’s influential work affirmed that the real practice of nursing went beyond science and, in fact, is significantly shaped by the other three patterns of knowing.
Esthetics as a means of knowing in nursing is part perception, part empathy, and part action. As the “art” in the practice of nursing, it involves paying attention to a patient’s health concerns and behaviors, along with scattered, relevant details and intangibles, and integrating them into a holistic understanding of the person and what she needs. It provides the creative spark that leads a nurse to know both what to do and how to get it done—that is, how to approach a patient and address her therapeutic needs.
Personal knowing reflects the engagement between nurse and patient. It demands that a nurse know himself so that he can approach the patient as a person and form an authentic relationship. Then, through that relationship, the nurse can apply scientific knowledge to help.
Ethical knowing focuses on “matters of obligation or what ought to be done.” Lying at the foundation of action, ethics requires judgment about what to do and what not to do. It arises as a complex consequence of learning, deliberation, and engagement with the standards, codes, and values of the profession and society.
As Carper noted, these four kinds of knowing “provide the discipline with its particular perspectives and significance.” As such, all four are important to the practice of nursing—and by extension, to the work of the National Library of Medicine.
NLM counts among its collections many of nursing’s important foundational, theoretical, and empirical articles and books. We preserve monographs that explore the nurse-patient relationship and that provide guidance for integrating the various ways of knowing others into clinical interventions. Our History of Medicine Division holds photographs and drawings that depict the healing dialogue between patients and nurses. And we have materials that reflect on the ethical premises for care.
Where I think we fall short is in the realm of personal knowing.
Perhaps NLM privileges what is shared and publicly validated, such as scientific articles, over nurses’ personal stories of knowing self and knowing others. It’s also possible that the language for documenting the personal knowing patterns of nursing doesn’t quite convey its essence. Maybe the personal knowing of nursing is indeed ephemeral and dissipates even if it is captured.
That said, I want NLM to support all of nursing’s patterns of knowing—to include descriptions of how one observes, studies, and verifies these patterns; to present the results of these patterns so the human experience is fully depicted; and to document the clinical impact of fully knowing a person.
I don’t quite know what that support might look like. We might find that words are not enough, and the best way NLM can support nursing’s patterns of knowing awaits future discoveries.
That’s why I invite you to come along with me to make sure this important perspective on the knowledge of health remains present and vibrant among our holdings. We owe it to nursing, and we owe it to ourselves.