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Introduction
Evidence-based practice is often presented as if research evidence were the only knowledge that matters in nursing. Carper's (1978) analysis of the patterns of knowing in nursing offers a broader account, which is useful for doctoral students who will both generate research and lead practice.
Carper's four patterns
Carper (1978) identified four fundamental patterns of knowing from an analysis of the conceptual and syntactical structure of nursing knowledge:
- Empirics, the science of nursing: knowledge that is systematically organized into general laws and theories for describing, explaining and predicting phenomena.
- Esthetics, the art of nursing: the expressive, perceptive knowledge that lets a nurse grasp the meaning of a particular situation and act skillfully within it.
- Personal knowledge: the nurse's knowing of self, which makes authentic, therapeutic relationships possible.
- Ethics, the moral component: knowledge of what ought to be done, including obligations and the reasoning behind moral choices.
Carper argued that each pattern is necessary and that none alone is sufficient for nursing practice.
White's update: sociopolitical knowing
Reviewing the patterns in the mid-1990s, White (1995) proposed a fifth pattern, sociopolitical knowing. It concerns the social, political and economic context of the nurse–patient relationship and of nursing as a profession, such as how policy, culture and power shape health and care. White argued that without it, the other patterns focus too narrowly on the individual encounter.
Implications for evidence-based practice
Evidence-based practice models typically combine research evidence, clinical expertise and patient preferences. The patterns of knowing map onto, and extend, this combination:
| Pattern | Role in an evidence-based decision |
|---|---|
| Empirics | Appraising and applying research findings |
| Esthetics | Recognizing what matters in this patient's situation and adapting care to it |
| Personal knowledge | Being aware of the nurse's own assumptions and reactions |
| Ethics | Weighing obligations, rights and consequences, especially when evidence and patient wishes conflict |
| Sociopolitical | Recognizing how insurance, policy and structural inequities limit or shape options |
An example illustrates the point. Research supports early mobility in critical care, but for a frightened older adult, the esthetic and personal patterns guide how and when mobility happens; ethics guides respecting a refusal; and sociopolitical knowing raises questions about whether the unit has enough staff to mobilize patients at all.
Critique
Carper's patterns have been widely cited, but they have been criticized as hard to measure and as describing types of knowledge rather than how each is developed or tested. White's (1995) addition also suggested modifying an existing model of nursing knowledge development to make the patterns more useful as a framework for inquiry. For doctoral nurses, the value of the patterns lies less in measuring them than in keeping a wider view of knowledge during research design and practice change.
Conclusion
Carper's patterns, with White's sociopolitical addition, remind doctoral nurses that research evidence is essential but not sufficient. Good decisions also draw on artful perception, self-awareness, ethical reasoning and an understanding of the social context of care.
References
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13–24. https://doi.org/10.1097/00012272-197810000-00004
White, J. (1995). Patterns of knowing: Review, critique, and update. Advances in Nursing Science, 17(4), 73–86. https://doi.org/10.1097/00012272-199506000-00007
