The Death of a Newborn- A Case Study of Carpers Ways of Knowing in Nursing Practice
Integral to quality and effective nursing is the ability of nurses to utilize a new knowledge base to inform their practice. Carper’s way of knowing is a typology that theorizes a working framework valuable in the acquisition of knowledge 1. In nursing, this framework stratifies diverse sources of beliefs and knowledge in nursing professional practice and encompasses personal, empirical, aesthetic, and ethical knowledge. This paper analyzes an article – “Death of a Newborn,” through the lens of Carper’s way of knowing.
The article depicts a caregiver attending to his Lamaze couple, who had just lost their newborn shortly after the birthing process. Evident in the case were the grieving parents and the caregiver’s willingness to create a healing experience for the couple. Nurses play a role in providing care during bereavement periods. The resolve to create a healing environment for the involved parties is informed in part by their obligation to maintain high standards of care for their patients.
The article details the knowledge acquisition patterns and processes as articulated by Carper’s ways of knowing postulates. The first stratum of knowing per these provisions is empirical knowing. Empirical knowing is factual, verifiable information informed by scientific principles 2. In nursing, empirical knowledge forms the basis of nursing education. In the article, empirical knowledge is illustrated by the caregiver’s deliberate attempt to utilize his nursing knowledge to improve the outcomes of the pregnancy in the couple presented. As evident in the article, the Lamaze classes utilized scientific principles to inform the couple on how to ensure safety during pregnancy. Provisions such as rest, avoidance of alcohol, and vigilance in keeping prenatal appointments, proven to improve maternal and child health, were passed to the mother.
The second stratum of knowing is personal knowing. This knowledge is derived from an individual’s self-understanding. It enables nurses to identify their strengths, weakness, and responses to the presenting situation, as well as their awareness of the potential biases that may affect their relationships with the patients 2. In the article presented, personal knowing is demonstrated by the caregiver’s actions toward the patient. He showed genuine concern for the couple’s wellness during the bereavement period. He was also able to identify his strengths in the prevailing circumstances and leverage them to help the couple. As evident in the case, when he realized that nurses in the unit were uncomfortable and inexperienced in caring for bereaved patients, he took it upon himself to care for the couple.
The third strata of knowing is aesthetic knowing. Aesthetic knowing involves maintaining awareness of the immediate situation and informs instant practical action taken by the nurse 2. In the case presented, the caregiver demonstrated awareness of the prevailing situation and took action to better it. As evident in the case, the caregiver was empathetic when he understood the prevailing situation. He held their hands and cried with them. Upon realizing that the couple hadn’t seen their child, he immediately initiated the process of advocating for them to see the child.
The fourth stratum of knowing is ethical knowing. Ethical knowing is centered on the ethical provisions guiding nursing practice. It encompasses understanding the apparent ethical and moral questions that come into play and using ethical judgment to answer them 2. Per the article, ethical knowledge stretches beyond the confines of the ethical codes and includes discerning what is responsible to do in specific situations. Clarifying a situation based on intrinsic beliefs and value systems is thus paramount in this regard. In the article, ethical knowing is demonstrated by the caregiver’s advocacy for the couple to see their dead child. Despite initial resentment from the hospital, the caregiver utilized his advocacy skills to help the couple mourn their child.
Subsequently, empirical knowledge has contributed to my knowledge development. Nursing education has imparted to me scientific nursing knowledge that involves describing and predicting issues of nursing concerns 3. In the critical care unit, empirical knowledge can inform my decisions when caring for diverse patients. I can leverage the knowledge learned during educational nursing, such as medication administration, to provide the best care to my patients.
Carper’s way of knowing strata of personal knowing has enabled me to present a genuine and authentic self during my interactions with the patients. Personal knowing is often based on the nurses’ life experiences and allows them to deeply understand their clients 3. Personal knowledge has widened my perspective on the role of nurses when handling patients in the critical care unit. I can now leverage my strengths and awareness of the patient’s situation to better care for them. By remaining empathetic and aware of their situation and suffering, I can make better clinical decisions that may alleviate their suffering.
Provisions of aesthetic knowing have also contributed to my clinical practice. Aesthetic knowing is another stratum articulated in Carper’s typology. Aesthetic knowing can be attained through understanding the situation wholly, dynamic adaptation, demonstration of empathy, and recognition of the prevailing circumstances as unique situations. This knowledge has given me insight into the need for understanding the individual patient’s presentation and treating them respectfully. Central to this is making decisions based on the client’s presentation rather than using absolute empirical knowledge.
On the other hand, ethical knowing is centered on nursing ethics. It calls upon nurses to discern whether their actions are right and responsible. These provisions have widened my perspective on clinical decision-making for patients under critical care. Nurses, in this respect, must work with other caregivers to analyze competing choices and select options that protect the welfare of their patients.
References
Forough Rafii, Alireza Nikbakht Nasrabadi, Fereshteh Javaheri Tehrani. How nurses apply patterns of knowing in clinical practice: A grounded theory study. Ethiopian Journal of Health Sciences. 2021;31(1). doi:10.4314/ejhs.v31i1.16 https://doi.org/10.4314/ejhs.v31i1.16
Sherman, D.W. (1997). Death of a newborn: healing the pain through Carper’s patterns of knowing in nursing. The Journal of the New York State Nurses’ Association, 28 1, 4-6.
Swift A, Twycross A. Using ways of knowing in nursing to develop educational strategies that support knowledge mobilization. Pediatric and Neonatal Pain. 2020;2(4):139-147. doi:10.1002/
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Question 
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Read the article: Sherman, D. W. (1997). Death of a newborn: Healing the pain through Carper’s patterns of knowing. Journal of the New York State Nurses Association, 28(1), 4-6.
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Discuss how the “death of a newborn” article illustrates Carper’s four ways of knowing (Empirical, Aesthetic, Personal, and Ethical Knowledge). in informing knowledge development in nursing and clinical practice.
The Death of a Newborn- A Case Study of Carpers Ways of Knowing in Nursing Practice
Based on a clinical nursing experience in the critical care unit, identify in your case study Carper’s four ways of knowing and how it has informed your knowledge development and clinical practice. (Explain each of Carper’s ways of knowing and relate it to your example).
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