Abstract Knowing is defined by Meriam Webster as “having or reflecting knowledge

Abstract
Knowing is defined by Meriam Webster as “having or reflecting knowledge, information, or intelligence”(n.d.). The evolution of health care, and specifically the nursing practice, has evolved tremendously over centuries resulting from the increase of new knowledge. If we took a glance back in time we would see nurses who simply followed the instructions of physicians closely without making clinical judgements, this could not be farther then how nurses practice today. As health care professionals, nurses must perform quickly and efficiently applying all aspects of acquired knowledge into their practice to allow for best possible patient outcomes. The purpose of this paper is to explain and rationalize the differing methods of acquiring and utilizing knowledge and knowing as processes implemented in nursing relationships.

Knowing in Practice
There are five central patterns of knowing in nursing, according to Carper, that are crucial for both learning as well as teaching and include ethics, personal knowledge, empirics, esthetics, and socioeconomical. Applying all five of these pieces of the pattern are necessary to achieve excellence in care.
Empirics, defined by Carper, “represents the knowing that is obtained by rigorous observation or measurement”( McKenna, H. P., Murphy, F. A., & Pajnkihar, M. 2014) to develop theoretical and intellectual clarifications. This type of knowing is applied through textbooks in classrooms as it operates via theory and applying scientific based evidence. Empirics also continues to measure and yield evidence to encourage curriculum upcoming in nursing all while enhancing the viewpoint of science in the nursing field.
The second pattern of knowing is termed ethics and is a category of knowing that is more personal via our moral code and ethical patterns. When exhausting this form of knowing we are provided with intuition that guides our decision making whether right or wrong. Each time we step into our scrubs we are presented with multiple patient interventions that we must ultimately perform to the best of our ability though they might challenge our beliefs. A great example of this type of knowing is a nurse who does not participate in physician-assisted suicide due to her ethics or beliefs.
Personal knowing is a type of perceptive that also requires a personal reflection to administer care and is a reflection of how nurses relate to patients during care. This form of information emphases “self-consciousness, personal awareness and empathy” ( McKenna, H. P., Murphy, F. A., & Pajnkihar, M. 2014). This type of knowing can often be most difficult as it requires health care professionals to step out of their comfort zone and begin to examine scenarios for each patients using compassion and understanding. Nurses are responsible for a grave amount of time with patients and interact regularly throughout a single shift, instilling empathy and understanding allows for better patient relationships. As nurses connect with patients on this personal level they are able to offer assistance in their results and understanding creating a bond that patients can relate too when making difficult care decisions.
The art of nursing knowledge is identified as aesthetics due to its connections of “knowledge, skill, and intuition” ( McKenna, H. P., Murphy, F. A., & Pajnkihar, M. 2014). This type of knowing involves more than carefully following evidence-based practice as not all patient scenarios can be predicted, measured, or studied. Therefore, nurses must use their best judgements to apply experience, instincts, understanding and empathy for patient circumstances that are not predictable. For instance, an aesthetic example would be a patient who continues to refuse medications and is classified as non-compliant. However upon further investigation by the practicing nurse the patients is simply in need of more education upon why the medication is essential and to teach them how to take the medications correctly resulting in compliance. This is an example of using knowledge, skill, and intuition to recognize why this patient is being non-compliant and then educating the patient so that compliance is achieved.
The fifth and final knowing pattern in Carpers Ways of Knowing in Nursing revised is socioeconomical, which examines the social political environment of each patient to define their interactions. (White, 1995). This can be defined as the nurse understanding and articulating social problems that patients may encounter such as no income, segregation, being poor, estrangement, and malnutrition. Despite what one might believe these problems are fundamentally political in involvement rather than personal problems. As nurses, we must understand the importance of economic power that influences and effects healthcare as a whole including the health of the community as well as the individual. An example of this would be nursing involvement in developing new nursing policies regarding health care for patients across the economic board.
As we view the five patterns of knowing in regards to nursing practice, we are able to enhance our patient’s holistic care. These five patterns interlace with each other to contribute differing pieces of the puzzle throughout the patient’s experience as not one element could provide adequate results for nursing practice.
As knowing patterns are implied within nursing practice, Watsons’s theory of human caring must also be incorporated to enable the art of caring to allow for dignity as well as compassion in health care. The major elements of Jean Watson’s theory include transpersonal caring relationships, caring occasion/caring moment, and the ten carative factors (Sitzman, & Watson, 2013).
Caring occasions is the initial point of Watson’s theory of human caring as it outlines the point in which the nurse and patient connect in such a way that a deeper connection is formed secondary to simple care. At the core of nursing the ten caritas then act as an escort to honor patient experiences through ten elements. With these ten carative factors in place, professionals can develop a spiritual connection with their patients. This theory is more than caring for basic patient needs it incorporates the emotions that attach to practicing love and kindness for holistic care without bias of fresh feelings or experiences while providing patient care. Transpersonal Caring relationships like the ten carative factors incorporates more than textbook care as it attempts to explain the relationships that form between nurse and patient through caring consciousness and observing dignity. Ultimately, transpersonal caring is putting aside personal egos and placing patient outcomes foremost.
Watson’s theory of human caring proves the importance of establishing a healthy relationship between your patients and nursing staff to create better conclusions. While comparing The Theory of Human Caring we can note the similarities in care to the patterns of knowing. In the Theory of Human Caring Watson’s opinion proceeding esthetics is that of integrating more than just knowledge and skill to care for a patient as she states incorporating feelings and connections is vital which closely relates to the art of nursing knowledge. Empirical knowledge is also labeled in her ten caritas as she states in carita number six the “use creative scientific problem-solving methods for caring decision making” (Sitzman, K., ; Watson, J. 2013). Ethical knowing can also be found in the ten caritas as number one confirms “embracing altruistic values and practice love and kindness with self and others” (Sitzman, K., ; Watson, J. 2013). Carita number four promotes personal knowing as it states, “develop helping-trusting-caring relationships” (Sitzman, K., ; Watson, J. 2013).
There are many patterns that are utilized in my own practice routinely and appear to be easier to implement then others following Watson’s theory of human caring. “Embracing altruistic values and practice love and kindness with self and others” (Sitzman, K., & Watson, J. 2013) is something that I strive for each time I clock into work as compassion is something I can implement without skill that has a detrimental effect on patient relationships. Practicing love and kindness is a simple act but can open up patients to better relationships and ultimately can foster better patient outcomes as there appears to be more communication that is open. Another factor that is important to me as I practice is to “be sensitive to self and others by nurturing individual beliefs and practices” (Sitzman, K., & Watson, J. 2013). This factor is so significant to me as I consider this is the true definition of advocating correctly and efficiently for our patients as they don’t always have the same beliefs as ourselves. Lastly I believe that as health care professionals we should always be “open to mysteries and allow miracles to happen” (Sitzman, ; Watson, 2013) as things are not always textbook perfect allowing for very special memories and connections with patients.
Recently in my own practice, I had the pleasure of working with a young lady who was positive for amphetamines, opiates, THC, and benzodiazepines. Working in a detox center a sort of stigma gets placed on patients as they come in, one that is not positive, and tends to hinder patient nursing relationships. As I try to connect with each patient somedays this is difficult, but this particular day something about this young girl really drew me to her, she was sad, disappointed, frightened, and obviously embarrassed. Not only was she experiencing horrific withdrawals but she also refused to ask for anything to aid in these withdrawals. Upon taking her vitals and doing an initial assessment, I noticed right away that she was uncomfortable not only physically but also emotionally. Without knowing about or having every read Watson’s theory of human caring I began to apply some of her factors to foster what would become an effective patient relationship. Initiating a “helping-trusting-caring relationship” (Sitzman, K., & Watson, J. 2013) was soon followed by promoting and accepting “positive and negative feelings as you authentically listen to another’s story” (Sitzman, K., & Watson, J. 2013). As I was able to connect with this patient more in depth I learned her story and was able to effectively advocate for her needs and ultimately get her into our outpatient substance use counseling and change her whole outlook on her situation.

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Conclusion
As nursing becomes a more autonomous field instead of strictly science knowing and knowledge patterns both integrated by Watson as well as Carper can support and foster better patient relationships and ultimately patient outcomes. Nurses are instilled with tons of knowledge and evidence based practice in which they may rely on, however humanities as well as empathy with the help of these knowing factors aid the nurse in applying and understanding compassion in care.