Carper’s Ways Of Knowing And Dementia Care: A Nursing Perspective

Introduction and Event Description

Discuss about the Carper’s Ways of Knowing and Dementia Care.

Barbara Carper’s “ways of knowing” approach is a very important approach for learning four significant ways of nursing practice. The approach provides the inspiration and influence for the nursing practice. This approach can be considered as the typology that provides assistance in using different sources, beliefs and knowledge in the professional nursing practice. I will apply the ways of knowing in providing dementia care in the residential care setting. I will explore that how does the ‘ways of knowing’ can help in providing quality care for the patients suffering with dementia in residential aged care setting. My aim in this paper is examine this question in relation to providing care in the long term care facility and my own current and future nursing practice. Dementia is a mental disorder, which is not considered as the normal part of aging, rather it is understood as the group of degenerative neurological diseases. Such neurological disorder results in number of impairments in the patients. Such impairments include memory loss, orientation problem, problem in thinking, loss of problem solving and learning capacity, language impairment, lack of judgment and problem with activities of daily life (ADL’s). Since dementia is not a normal part of aging, the risk of this degenerative disease increases with age. The progress of this disease is from mild, moderate to severe. The patient suffering with severe dementia may require 24 hours of surveillance, supervision and care.  Residential care becomes the reality for most of the dementia patients, where some time patients have to face a physical restraint that challenges their right to autonomy and ethical principle of nonmaleficence (Mohr, 2010). I also found that emotional needs of the patients are not completely meet and use of physical restraints remains questionable. During my nursing practice in Dementia residential care, I felt that I must use the ‘ways of knowing’ approach to my nursing practice. This is because I felt that this approach can help in using evidence based practice in providing care to the patients and for improving their health outcomes.

The “Fundamental Patterns of Knowing in Nursing” by Barbara Carper is a framework that provides the way towards quality nursing. The four patterns of knowing are identified by Carper that includes empirical, personal, ethical and aesthetic. According to carpe these four patters are important for the nursing knowledge. Carper’s article one of the most significant study of the 20^th century, which helps the nurses to reflect on their knowledge and practice. I have always been interested in the residential care of the dementia patients, because I have found that pervasive belief affects knowledge and care practices of the nurses. Elderly people living with dementia often have a very difficult life and also their illness affects their families and loved ones (McIntosh, 2013). The event when I came in contact with the severe dementia patient encouraged me to reflect my nursing practice through Carper’s “ways of knowing.”A holistic care model is required for such patients to shift the focus to patient-centered care in the residential setting.

Ways of Knowing

Empirical knowing refers to the knowledge which is obtained from gathering evidences from science and other evidence based studies that can be empirically verified. According to the study of Barker (2016) “the discipline of nursing was experiencing a sense of urgency to develop empirical knowledge that explains and predicts phenomena specific to nursing” (p. 7). The driving force behind this concept was to view the profession of nursing as the unique body of knowledge and experience. Empirical knowing refers to the evidences or the knowledge that is achieved from the sources which are quantifiable, testable, and objective as well as those source that work as the theoretical frameworks. These are the sources on which nurses can base their nursing practice (Zander, 2007). I required extensive knowledge to provide quality care to the dementia patients especially when the disease is advances and patients are unable to communicate their problem and feeling due to cognitive loss and much other impairment. The strong empirical evidences were required in relation to Pathophysiology, cognitive assessment, medication, rehabilitation of the residents, pain management and behavior management strategies (Chang et al, 2009).

Strong knowledge base helped me to provide patient centered care, as some times the care is shifted to “taken for granted”. Empirical knowledge related to restraints being used in the residential care for dementia patients helped to understand the issues. Nurses working with the dementia patients require theoretical frameworks and underpinnings. Physical restraints are an important area required to be empirical evaluated for the dementia patients. However, the studies states that such restraints should be reduced in residential care (Pellfook, Gustafson, Bucht & Karlsson, 2010). Physical restraints have raised many ethical issues and also challenges patient’s autonomy. I learned the empirical knowing that Physical restraints harms the patients and may cause injures that can result in reduced mobility, psychological damage and skin breakdown. Baker’s ways of knowing helped to gather the empirical evidences in relation to use of physical restraints in residential care for dementia patients.

This way of knowing refers to that nurse should understand and interpret the behavior in order to form the empathetic understanding towards patient (Zander, 2007). The main aspect of the patient centered care is that nurses must understand what patients are experiencing empathetic manner. According to the theory of Carper, the more experienced nurses become empathetic and tend to perceive the life of others. The nurses develop more ways of perceiving reality by gaining more knowledge. Under this way of knowing, I imagined that what the patient undergoing dementia is experiencing or feeling (Ramshaw, 2012). Though imagination is not a major concept in health care, yet it helped me to understand that what later stage dementia patients are experiencing (Kontos, & Naglie, 2007). The author further states that “by the imagination we place ourselves in [a sufferer’s] situation, we conceive ourselves enduring the same torments, we enter as it were into his body, and become in some measure the same person with him” (p. 562). Therefore it is important to understand the behavior of the patients to provide the care, which responsive to the patient’s needs according to Carper’s esthetical way of knowing.

Dementia Care and Empirical Knowing

Personal knowing is the personal knowledge that is gained about an individual, which helps to develop the sense of understanding and awareness. Personal knowledge required me to engage with my patients and to make therapeutic connection with them (Zander, 2007). When the dementia advance, patients are often not able to articulate their feelings and thoughts, this is the stage when strategies for developing ‘personal knowledge’ are required. I developed my way of personal knowing through various strategies. The fist strategy was the continuation of the care and consistently looking after the residents. The second strategy was the involvement of the family in care and third strategy was to understand the life stories of the residents (Rasin & Kautz, 2007). Through these strategies I developed the method of learning about the residents and also developed a sense of knowing about the patient suffering with dementia. The involvement of family in the process of personal knowing has also been helpful, as they know the past to present of the patient and helped to provide key information. Personal knowing helped me to understand patient’s behavior and to reject physical constraint to maintain patient’s dignity and respect.

Ethical decision making is very important for providing care to the patients with progressive dementia. It is the duty of the nurse and the caregivers to constantly provide respectful care and considering the ethical principles of autonomy and beneficence. Hope (2009) states that caregivers and nurses should provide “appropriate and responsive care; preserve a person’s autonomy; provide a safe environment and at the same time, honor an individual’s personhood” (p. 549). Ethical knowing can also be considered as the moral aspect and requires the nurses to act in morally correct manner. During my nursing practice, where I provided care to old dementia patients, I always offered safe and ethical care. In the case of physical constraints the ethical dilemma of upholding patient’s rights arises (Woods & Pratt, 2005). Therefore, in order to maintain the ethical principles of autonomy, beneficence, nonmaleficence and justice, I focused on making therapeutic relationship with patient to control their behavior instead of using physical constraints. Personal knowing helped me providing care which is closely related to ethics.

Conclusion

This paper is based on providing the insight of Carper’s ‘ways of knowing’ approach and using this approach in nursing practice. Paper focused on applying physical restraint on dementia patients in aged care residential setting. His reflection helped me to learn empirical, esthetic, personal and ethical way of knowing and understanding patient’s needs and reducing any harm. Physical restraint is the way of controlling the behavior of the patient, which can harm the physically and psychologically. Through this reflection I learned that physical restraints can be reduced by applying Carper’s way of knowing approach to nursing practice in residential care setting.

References

Barker, S. (2016). Psychology for Nursing and Healthcare Professionals: Developing

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