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Running Head: Patterns of Knowing
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Patterns of Knowing in Nursing
NURS 351 Role Transition for the RN- Lab
California State University- San Marcos
Machel Gilmore, MSN-Ed, RN, PHN
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September 20, 2020
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Running Head: Patterns of Knowing
Reflection
As a nursing profession we develop knowing through self-knowledge and the long-term
perceived knowledge of the world. Patterns of Nursing Knowing are gained through one’s
complete experience. The four key patterns are Empirical Knowing which account for the
science portion of nursing. Aesthetic Knowing, the individualization of care for all patients.
Personal knowledge is based off experience and intuition. Ethical Knowing is the ethical and
moral of nursing to problem solve and advocating for patient’s rights. During my healthcare
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experience I’ve been able to apply the knowledge to my new Role as a Registered Nurse in a
highly complex unit. Mr. Smith a 90-year-old male admitted for a Cerebral vascular Accident to
the right-side hemisphere with weakness to the left side, expressive and receptive aphasia. His
inability to swollen and frequently aspiration related to his chronic dysphagia due to severe
scarring to the pharynx due to radiation due to history of throat cancer. Furthermore, has multiple
comorbidities, hypertension, previous CVA’s, Cancer, Hyperlipidemia and Heart failure with an
ejection fraction of 15%. Mr. Smith at the time was a full code and has 3 daughters that are his
representatives and are communicating with multidisciplinary team frequently. Upon assessing
Mr. Smith, he is agitated and trying to get out of bed. Objectively looks frustrated when awoken
for patient care and will refuse care from time to time. In addition to previous reports he has
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worsen since his admission.
Four Ways of Knowing
Empirical Knowing, is based on abiding by nursing, science led protocol and clinical
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procedures. This knowledge is gained through prerequisite courses and nursing school. By
applying evidence practice strategies of prevention of complications. Mr. Smith was rounded
hourly, set the bed alarm, applyied nonskid sock, lowered the bed, and provided the call light and
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Running Head: Patterns of Knowing
personal items within reach due to his high risk of falling. In addition to assessing, cardiac
monitoring, medication administration through I.V, doing the 3 medication checks, neuro
assessment and electrolyte protocols throughout the day.
Aesthetic Knowing is to individualize care for all patients. Mr. Smith seemed very
frustrated with the healthcare team coming in to do care very couple hours. To adapt to Mr.
Smith’s frustration, I decided to cluster care every time going into the room. He is also placed
Infront of the nurse’s station for close observation. In addition, when leaving the room, I would
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provide him with the most soothing environment by turning on channel 70 which continuously
played relaxing music while he rested, also brought him warm blankets to comfort him as he
complained of being cold. The pattern that’s that Mr. Smith showed were those of the patients
that I cared for during my previous work experience as a Hospice Aide.
Personal Knowing is that to connecting deeply with your patients and families, to rely on
your intuition for better patient outcomes. Mr. Smith throughout my care, seemed to get really
frustrated when I tried to do any time of procedure, such trying to place a nasogastric tube
because family request some sort nutrition. Placing a New I.V since he pulled his last one, and he
needed one to continue providing the necessary medication to control his hypertension,
hydration, electrolytes and so forth. Throughout my shift, Mr. Smith condition declined, when
sleeping his oxygen status would decrease, decrease sections, dry mouth, decrease muscle tone d,
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and there was a decrease in urine output although he had fluid running throughout the shift.
Progressively throughout the shift his energy decreased and would not try getting up out of the
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bed anymore and decrease muscle tone and on contrary he was deeply asleep when not providing
care. When woken up to provide care he’s grimace he seemed to be in pain or irritable, he was
showed signs of nesting into his bed. As Kim states in the article Nurses way of knowing about
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Running Head: Patterns of Knowing
peaceful death and end of life care it is important to recognize the changes such as “The
cognitive status of residents changes gradually. Physical changes include shortness of breath,
reduced sputum levels, loss of elasticity, changes in skin color, decreased food intake, exertion of
black stools, urine incontinence, decreased urine output, decreased vital signs, cognitive decline
and premonition of dying.” Using my intuitive knowing of Mr. Smith’s care was something that I
had have seen through my previous experience with patients in their end of life.
Ethical Knowing, is the ability to do what is best for the patient, during this part of my
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knowledge after applying my personal intuition of Mr. Smith symptoms, my obligation to
advocate of what is right and most comforting for my patient was ought to be done. I did this by
expressing my moral knowledge to the interdisciplinary team, such as having PT/OT not work
him, requesting to discontinue the electrode leads since he kept taking them off and disrupting
his comfort. Furthermore, since I had been talking with the daughters throughout the whole day
about Mr. Smith deterioration and inability to continue some of the care such unable to place the
NG tube and his refusal of care, placed me in an ethical situation. I decided to go forth and talk
to my charge nurse about letting the daughter come to do a short visit and see his dad physically.
I knew it’s hard to an end of life care decision of a loved one by the phone and trying to do
everything in your power to keep them keep your loved one alive as much as possible. My
ethical knowing kicked in, I considered the nurse-client and family relationship and based my
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ethics of caring. My efforts were to allow a daughter to see his dad at this end of life to decide at
bedside since most of these decisions have to be made by phone due to the pandemic. In
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addition, I communicated with the MD about the need for palliative or hospice consult and the
need to further speak with the family member of his status and future care. This “caring
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Running Head: Patterns of Knowing
orientation is based on the moral ideal of doing what is good, rather that which is just.”
(Hood,2018)
In the chapter patterns of knowing Hood explains “Many years of practice may be needed
to develop competence and confidence in using all the patterns of knowing.”(Hood,2018)
Although as a new graduate RN , patterns of knowing is something that will continue to increase
with time. But I have the basic foundation to apply my knowledge gained throughout school,
previous and recent work into my future clinical practice. I choose this topic and situation
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because I believe it is important to recognize and know how to handle situation that can be
uncomfortable such an ethical situation and death. As Kim states “nurses especially play a core
role in hospice care, so it is very important to research what actions they take that enable
residents to have a peaceful death.”(Su Jin,2014) I will continue to apply new knowledge and
patterns of knowing from the article to my future nursing profession such as recognizing the
symptoms, and using effective interpersonal communication with the family, patient and
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collaborative team to provide a holistic care within an ethical and death situation.
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Running Head: Patterns of Knowing
Reference
Hood, L. J. (2018). Leddy & Pepper's professional nursing. Philadelphia: Wolters Kluwer.
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Su Jin Kim, Kim, Su Jin, Kim, Mi So, Kim, Hyun Ju, Choi, Jung Eun, and Chang, Sung Ok.
"Nursing Home Nurses’ Ways of Knowing About Peaceful Deaths in End-of-Life Care
of Residents." Journal of Hospice and Palliative Nursing: JHPN. 16.7 (2014):
438-45. Web.
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