DB 2 Barbara Carper Patterns of Knowing PDF

Preview

Summary

Download DB 2 Barbara Carper Patterns of Knowing PDF

Description

   

Read Barbara Carper's Patterns of Knowing that can be retrieved from http://samples.jbpub.com/9780763765705/65705_CH03_V1xx.pdf Select one of the four patterns that best reflects how you derive knowledge in your professional practice. Provide a specific, unique, detailed example of how you utilize your selected pattern of knowing in your professional practice as a registered nurse Discuss how your selected pattern of knowing has improved your critical thinking/ability to learn, thereby enabling your to improve your health care delivery

Esthetic knowledge is based on an individual’s skills and experiences, and how they are applied in any given situation (Chinn & Krammer, 2011). A 99.5 years old Vietnamese man recently had a fall. He lives at home with his wife, daughter, son-in-law, and grandson. His other daughter comes and visits him daily. She would bring him meals that she had prepared. She would also bring him to his doctor’s appointments. Today he is not feeling well and decides to stay in bed. The family notices his breathing is labored and he complains of pain. They telephoned the doctor and asked if he should be in the hospital to which the doctor said, “No.” After much pleading, the doctor order for a hospice consult. A hospice nurse arrived and assessed the elderly man. The man is now on oxygen and has an order for morphine. Later that night before I went to sleep, I had a strange urge to check my E-mail. I scanned my E-mails that came through and found one from my mother. It was a group E-mail addressed to my siblings and me where she informed us about our 99.5-year-old maternal grandfather’s health condition. She said that hospice came and gave him oxygen and that he is on morphine and that she cannot visit my older sister in Alabama. Within seconds my mind was bombarded with endless questions (e.g., Why can she not go to Birmingham? Why was she going to Birmingham? When was Grandfather started on hospice? And why were we not informed? What is Grandfather’s oxygen saturation? How is his breathing? Is he in pain? What is the morphine dosage and frequency?) Do I play the family member or the nurse role? With all of these unanswered questions, sleep was nonexistent. I contacted my aunt who was still awake. She would have all the answers I need, especially since Grandfather lives with her. She stated that Grandfather was started on hospice earlier in the day when they noticed his breathing was very shallow. She checked his oxygen saturation at room air which was 84% and his heart rate was 104 BPM. She contacted the doctor about his change in condition, and the doctor was hesitant about sending him to the hospital. Hospice nurse came and assessed Grandfather. She stated that Grandfather has about a week to live based on his heart rate and oxygen saturation. From my experience, medication errors can occur with morphine solution, especially in administering the medication where nurses either overmedicate or under medicate a

patient. In one study conducted by Cheragi, Manoocheri, Mohammadnejad, and Ehsani (2013) where 237 nurses were given a questionnaire, 64.55% of the nurses reported medication errors and 31.37% of the participants almost had an occurrence (p. 1). Last month I was doing an audit on narcotic inventory and found a discrepancy involving morphine 20 mG/ mL solution. The order is give 5 milligrams sublingually every 2 hours as needed for shortness of breath or pain, but there were four entries indicating that 5 milliliters were given which is 20 times more than the prescribed dosage. I verified the physician’s order with what was ordered and transcribed by the nurse and the pharmacy. There is a notation on the pharmacy label indicating “5 mG = 0.25 mL”. (Each calibrated bottle of morphine has 30 milliliters in it and from looking at the bottle, there was more than 20 milliliters left. [Manufacturers often fill the bottles with a little excess or over 30 mL at the start.]) I asked each of the nurses who had documented 5 mL what the dosage was to be given to the patient. Each of them promptly replied “5 mL”. While they answered 5 mL, they did not administer 5 mL, because if they did, after four administrations, the bottle would only have 10 milliliters left. Although in this incident there was no harm done to the patient, but in 1998 a premature 35-week-old infant was not so fortunate when he suffered respiratory arrest after an overdose of morphine was administered. The nurse’s calculation was correct, but when she administered the medication, she drew 0.4 mL instead of 0.04 mL (Keyes, 1998, p. 357). With this in mind, I asked my aunt to tell me exactly how the doctor ordered morphine: its dosage and frequency. I also asked if he is on an antianxiety medication. I checked the medication and verified it with the medication order. I consulted two of my colleagues: one in hospice and one in critical care about Grandfather’s condition, his treatment plan, and his prognosis. What do I tell my family? How do I tell my mother that her father is rapidly declining? As a nurse and as a family member (daughter, sister, and niece), I explained to them from my (esthetics pattern of knowing) experience, when a person starts receiving morphine, he or she does not last longer than a week and that they usually expire within a week. I urged them to prepare themselves and to start making arrangements. Two days later I received a message from my oldest sister to telephone her and when I did, she informed me of Grandfather’s passing. This was the first death in my fourgeneration family. We celebrated birthdays, graduations, weddings, baby showers, and memorials of those who are deceased or of those who died and we never knew. How do I comfort my grandmother, my mother, and my aunts? What can I do to alleviate some of the pressures and pain that they are enduring? I exercised empathy by anticipating their needs. I offer my presence and completed tasks for them to prepare for the wake and funeral. I suggested to make a collage of Grandfather to remind everyone of his life and legacy. To accomplish this task, I reviewed over 7000 photos from various sources and created three collages using 90 photos. I had the collages printed and then I rushed to FedEx and had them shipped Priority Overnight to New

Orleans. The collages arrived the next morning and the family was very happy when they saw them.

1. Select one of the four patterns that best reflects how you derive knowledge in your professional practice. Carper (1978) described the four patterns of knowing in nursing: empirics, the science of nursing, esthetics, the arts of nursing, personal knowledge, and ethics (p.13). Of the four patterns, this writer chooses esthetics as to how she derives her knowledge in her professional practice. Esthetics knowledge is based on an individual’s skills and experiences, and how they are applied in any given situation (Chinn & Krammer, 2011). The art of nursing differs from the other patterns as follows:  



Empirics knowledge originates from factual and evidence-based practice that has been proven through science and research. Personal knowledge is based on experiences and self-awareness. This type of knowing increases a nurse’s knowledge by incorporating those experiences into nursing practice. Ethical knowledge emphasizes morality, accountability and principles that govern standards of care in the nursing profession (Chinn & Kramer, 2011).

2. Provide a specific, unique, detailed example of how you utilize your selected pattern of knowing in your professional practice as a registered nurse. In utilizing esthetics, when one is not familiar with a specific task or topic or when there are no readily available resources, then one’s course of action is to be creative. One would seek and find advice from those who are knowledgeable and learn from them which is similar to the apprentice system. Carper explained this system as “‘an imitative learning style’ and procurement of knowledge through gathering various experiences” (1978, p. 15-16). Nursing is not only a science, but it is also an art. In other words, when there are no available supplies, one would think of creative solutions. For example, there was a patient who had a tracheostomy and a stage 4 sacral pressure ulcer. He could not talk, so the nurse encouraged him to write on a notepad. After a while, he would be fatigued and lose his train of thought which delayed and impeded his communication with the (already frustrated) nursing staff. To help him communicate his needs, the nurse created note cards with words or phrases (e.g., clean/change, pain, suction, nurse, etc.) The nurse explained to him and to the rest of the staff on how to use the note cards. This was an effective method of communication for everyone and his needs were met. As Carper pointed out, “The art of nursing is creative in that it requires development of the ability to “envision valid modes of helping in relation to ‘results’ which are appropriate” (1978, p.17).

3. Discuss how your selected pattern of knowing has improved your critical thinking/ability to learn, thereby enabling you to improve your health care delivery. As a nurse, this writer uses esthetics pattern of knowing daily. It has improved her critical thinking and ability to learn which led her to develop her two other patterns of knowing: personal knowledge and ethics. Through this pattern of knowledge, she is more effective and conscientious in her health care delivery. She is more empathetic not only to patients and family members, but also to staff as she continues to develop interpersonal skills and relationships. She is more ethical than she realized and she leads by example in an effort to encourage other nurses to take ownership and pride in their work with a heavy emphasis on being ethical and compassionate. By being understanding and exemplifying esthetics through creativity, one of those creations can be put into use as an evidence-based practice.

References: Carper, B. (1978). Fundamental patterns of knowing in nursing. ANS. Advances in nursing science, 1(1), 13-23. Retrieved from http://samples.jbpub.com/ 9780766376505 /65705_CH03_V1xx.pdf

Chinn, P. & Kramer, M. (2011). Integrated theory and knowledge development in nursing (8th ed.). St. Louis: Mosby....