Patricia E. Zander, PhD, RN ^ " ^ Abstract: Using^ Rodger's (2000) model of concept analysis the historical evolution of ways of knowing in nursing will be discussed. The ways of knowing in nursing will be explored through their antecedents of learning styles and knowledge, their attributes, and their consequences. The primary focus of the article is the four ways or patterns of knowing in nursing identified by Carper (1978) which have become known as nursing's epistemology. facobs-Kramer and Chinn (1997) later described these ele- ments of the epistemology in depth with Silva, Sorrell, and Sorrell (1995) using them to explicate the ontology of nursing. Key words: Nursing, Historical Evolution of Concept, Ways of Knowing Ways of Knowing in Nursing: The Historical Evolution of a Concept n 1978, Carper wrote that nursing sought to develop a way in which each person begins to gather, concentrate on, holistic, individualistic, and therapeutic model of practice process, internalize, and remember new and difficult academic that took the profession away from the autocratic, reduction- content. Several types of learning styles have been proposed. The I most widely recognized is the Learning Styles Moctel of Dunn and ist, and behaviorist characteristics of the medical model. This futuristic evolution of nursing called for a shift away from the Dunn (1993), whose model addressed 21 unique learning ontological and epistemological assumptions associated with "old elements that were classified into five broad categories. The model school' nursing and nursing education toward a more flexible was based on the cognitive style and brain laterafization theories paradigm. In order to be able to make this dramatic shift. Carper of learning (Morse, Oberer, Dobbins, & Mitchell, 1998) and proposed that four ways or patterns of knowing be utilized to took into account the visual, auditory, tactual, and kinesthetic structure nursing education and evaluate nursing practice. These strengths needed for learning (Dunn & Dunn, 1993). patterns or ways of knowing were empirics, ethics, esthetics, and Learning style theory conceives of the brain as a unit that personal. Since the publication of Carper's seminal work, many processes information in one of two ways, globally or analytically. authors have focused on the four patterns collectively and Global or right brain learners are holistic learners who need to individually in order to further define and describe them; there understand the overall concept before they can focus on the have been others (e. g. Benner, 1982, 1983; Munhall, 1993; Rew, details (Morse et al., 1998; Van Wynen, 1997, 1998; Zenhausen,' 1986; White, 1995; Young, 1987) who have proposed additional 1980). They want to know what learning is required and why ways of knowing. These multiple viewpoints will be presented in (Morse et al.). Analytic or left brain learners (Morse et al.; Van an analysis of what has come to be known as the epistemological Wynen; Zenhausen) use a sequential, step-by-step, building block and ontological foundation of nursing. style of learning; they require the details before they can under- stand the information being presented. , Using the evolutionary model of concept analysis (Rodgers, 2000), ways of knowing in nursing will be explored through their Learning styles are concerned with the processes of learning antecedents, attributes, and consequences; exemplars will be (Silver et al., 1997; Snyder, 2000). Gardner (1993, 2001) provided to illustrate the various ways of knowing in nursing conceived a theory of multiple intelligences that centers on the practice. The evolutionary model was chosen because it perceives product and the contents of learning. Gardner described human concepts to be dynamic entities whose attributes are not stable intellectual competence (intelligence) as "the ability to solve but are in continuous flux and in need of "purposeful redefinition problems, or to create products, that are valued within one or to maintain a useful, applicable, and effective concept" (Rodgers, more cultural settings" (Gardner, 1993, p. x). Three intelligences p. 81). Nursing is a dynamic profession and therefore needs are related to the senses in name. The intelligences are not continual exploration of the various concepts linked to its comparable to sensory systems, but they can be realized through educational and evaluative processes. several sensory systems (Gardner, 1993). The learning styles and multiple intelligences theories lead Ways of Knowing in Nursing: An Evolutionary Analysis the way to what is currently termed the "brain-based" or "whole Antecedents: Learning Styles and Knowledge brain" approach to learning that is focused on how the brain Knowing connotes that one has a solid base on which to processes the information it receives. Gaine, Caine, and Growell structure an action or way of being. That base is knowledge, but in (1994) and Gaine and Caine (1995) state that the brain is a order to gain knowledge one has to employ a process known as parallel non-linear processor that performs many functions such learning. Each individual has special means by which he or she as the simultaneous processing of parts and wholes. Therefore the learns; these are known as learning styles. Because both concepts left and right sides of the brain are interactive in the learning are the foundation of all knowing, they need to be discussed prior process. to looking at the attributes of the ways of knowing in nursing. Be it by learning style, multiple intelligences, whole brain, or Learning styles. Learning styles have been defined by Dunn, a combination of all, nurses acquire their knowledge base from Denig, and Lovelace (2001), Dunn and Dunn (1993), Dunn and many sources. Nurses use this knowledge in their ways of Griggs (1998), Gregorc, (1979), Silver, Strong, and Perini (1997), knowing as they practice their profession in many contexts. and Van Zwanenberg, Wilkinson, and Anderson (2000) as the The fournal of Theory Construction & Testing -7- Volume 11, Number 1 Knowledge. Knowledge as an antecedent to the concept Empirics. Empirics, the science of nutsing, is concerned with "ways of knowing in nursing"; it is the general knowledge an the objective, abstract, and general knowledge that is quantifiable individual possesses prior to entering a discipline such as nursing. and verified through repeated testing over time (Carper, 1978, Knowledge has been defined as "understanding of or information 1992). Empirics was conceptualized by Carper, with substantia- about a subject which has been obtained by experience or study, tion by Sarvimaki (1994), as the objective, absttact, general and which is in either a person's mind or possessed by people knowledge that is methodically arranged into the theoties, generally" (Cambridge Dictionaries, 2003); as "the fact or models, and principles that govern the profession. Empirical condition of knowing something with familiarity gained through knowledge fits Earle's (1992) criteria for knowledge in that it is experience or association, acquaintance with or understanding of believed, true, and justifiable. Liaschenko and Fisher (1999) a science, art, or technique" (Merriam-Webster, 2003); or termed empirical knowledge "case knowledge" and framed it "awareness, familiarity", or a "person's range of information, within the biomedicai model stating that case knowledge understanding (of a subject)", "information", or a sum of what is "legitimizes that aspect of nursing work that is concerned with known" (AskOxford, 2003). Chinn and Kramer (1999) defmed monitoring disease processes and therapeutic responses" (p. 34). knowledge as "knowing that is in a form that can be shared and By its use of experience when gathering data in research. Booth, communicated with otriers" (p.l), and describe knowledge as the Kenrick, and Woods (1997) believe nursing is devoted to accurate representation of the perceived world of a discipline's empirics. members. The development or knowledge through knowing is Ethics. Ethical knowing, the moral component, was de- considered the epistemologic concern of a discipline (Chinn & scribed by Carper (1978) as being concerned with choosing, Kramer). justifying, and judging actions involving moral duty, rights, and Epistemology, theory of knowledge, derives from two Creek obligations. Practicing within an ethical discipline requires a words: episteme, meaning "knowledge' and logos, meaning, "study philosophical foundation concerning the concepts of good, rights, of" or "theory of"; in English epistemology and theory of duties, and oughts. A comprehension of various ethical frame- knowledge are used interchangeably (Earle, 1992, p. 21). Yorks works can be used to help clarify ethical problems. Carper (1992) and Sharoff (2001) described epistemology as "the relationship further describes ethical knowing as "normative and abstract as between the person as a seeker of knowledge and the knowledge well as singular and particular" (p. 75). Ethical decision-making itself" (p. 22). occurs in the context of a concrete situation; therefore, it is Two types of knowledge are inherent in nurses' ways of patticulat, but the decisions made are based on moral principles knowing, explicit and tacit. Polanyi (1962) described explicit that are abstract and general. These principles are considered knowledge as the formal information gained from written words, universally valid and applicable to all similar situations. Benner maps, or symbols and tacit knowledge as the knowledge gained