Contributor: Bibiane Dimanche Sykes
Knowing is an elusive concept. It is fluid, and it is internal to the knower (Chinn & Kramer, 2018). Carper (1978) identified four fundamental patterns of knowing for an understanding of the conceptual structure of nursing knowledge. The four patterns are classified logically to elucidate aspects of empirics, personal knowledge, ethics and aesthetic knowing in nursing. Here, the pattern of aesthetic knowing is demonstrated through the actions, comportment, thoughts, behaviors and exchanges of the nurse’s relationship with the patient. It is aesthetic knowing that allows us to navigate when faced with nuanced situations.
It was late on a Tuesday morning. I was pleased to finally have a few days of rest from work and was already planning how I was going to spend my second day off, when I heard the ring tone from my phone. I glimpsed at the phone screen and noticed that it was a number I was unfamiliar with, so I decided to skip the call and told myself that they can always leave me a voice message if it is important. Ten minutes later, I heard the same familiar ringtone of my phone. This time it was coming from work. “Oh my,” I thought, what could it be…. did I forget to enter a note on the computer, or have I failed to sign the medication sheet? When I picked up the phone, the Director of Nursing at the subacute nursing facility I worked for was on the line. She mentioned that Ms. Smith’s situation took a turn for the worse; her condition had weakened overnight. According to Nancy, the Director of Nursing, Ms. Smith had been asking to see me since yesterday, and it was her nephew whose desperate call I had moments earlier ignored.
Ms. Smith was a 75-year-old widow who moved about 7 months ago to the hospice unit where I worked as a charge nurse. Her overall health and well-being had since deteriorated. Her cancer had metastasized to other adjacent organs of her body, and treatment was no longer a viable option. She had very little family support. Her only living relative was a nephew who visited occasionally. Although she had many other disciplines assigned to her care, she seemed to gravitate more towards me. I also enjoyed her company and spent many hours of my free time listening to her joys and regrets about life. I would play her favorite songs, encourage her to eat, to bathe, and to take her medications, before her pain became unbearable. She looked forward to the days I was at work, and I would always stop by her room for a chat whenever I had the chance. She confided in me and shared many of her life and death expectations, which included the minute details of her imminent death and funeral wishes. She and I developed a bond and maintained a caring nurse-patient relationship that encompassed understanding, trust and compassion.
It was already afternoon when I rushed into Ms. Smith’s room that Tuesday. She seemed agitated; however, she immediately became calm at the sound of my voice, telling her that it was going to be okay. As I was helping her take her prescribed medications, she appeared to be hallucinating. She kept on saying something about not being able to get on the bus. She was becoming restless and continued to repeat this for about an hour. I finally approached her and asked why she was not able to get on the bus. She opened her eyes for the first time since I entered her room and mumbled, “they wouldn’t let me, I don’t have money to pay for it.” I was devastated at the thought of that. I knew this day would come but still I was becoming emotional. I reminded myself that I needed to stay on course to help fulfill her wish of an undisturbed, smoothed transition. I thought for a second, what could I do to alleviate her suffering at this moment? I searched in my pocket and found a quarter. I slipped it into her hand and whispered in her ear, “use this for your bus fare, it’s going to be fine.” I felt her tight squeeze as she received the quarter, and less than five minutes later, Ms. Smith peacefully took her last breath with poise and dignity.
Aesthetic knowing is what makes possible knowing what to do and how to be in the moment, instantly, without conscious deliberation (Chinn & Kramer, 2018). I am currently an adjunct professor, teaching nursing fundamental to first year students. Every semester, I share this experience with my students. It serves as the perfect introduction to the conceptual framework of the nursing discipline through the patterns of knowing (Carper, 1978). The patterns of knowing in nursing ultimately presents a tool for developing abstract and theoretical thinking in the classroom. It allows for broader, clearer perspectives and self-integration of the concepts of empirics, personal knowledge, ethics and finally aesthetic in nursing education (Carper, 1978). This transformative encounter that I had experienced with my patient embodies the true essence and elements of aesthetic knowing.
Carper, B. (1978). Fundamental patterns of knowing in nursing. ANS. Advances in Nursing Science, 1(1), 13–23. https://doi.org/10.1097/00012272-197810000-00004
Chinn, P. L. & Kramer, M. K. (2018). Knowledge Development in Nursing: Theory and Process. 10th Ed. Elsevier. St. Louis, MO.
Aesthetic Knowing. (2021, February 2). https://nursology.net/aesthetic-knowing/
About Bibiane Dimanche Sykes
Bibiane Dimanche Sykes is a student in the Doctorate of Nursing Education (EdD) Program at Teachers College, Columbia University. She earned a Master of Science degree in Nursing Education at Mercy College in Dobbs Ferry, New York. She’s an Adjunct Professor at Mercy College in Dobbs Ferry, New York and also works as a Clinical Nurse Quality Assurance in New York City. Bibiane is a wife and mother of 4 sons. She enjoys reading, traveling and prides herself in giving back to the community. She serves her community through various philanthropic and nursing organizations.
3 thoughts on “Guest post: Aesthetic Knowing: A Transformative Encounter”
Thank you so much, Bibiane, for giving me a ‘knowledge’ definition for how I practiced for almost 50 years! For me it fits with Modeling and Role Modeling (MRM) Theory so well in that aesthetic knowledge is a way of unconsciously sliding into the model of the person’s world and intervening in a way that uses their model. Finding out about MRM two years before I retired helped legitimize my practice for all those years. And now this. I have more peace about what I was able to offer my patients/clients/persons, those entrusted to my care. Besides that, learning through stories is one of the most impactful ways for me to learn.
Warm gratitude to you as well as Helen Erickson
Thank you for this beautiful example! While Carper put forward the thesis of the “four fundamental patterns of knowing for an understanding of the conceptual structure of nursing knowledge”, many including me have found them to be pathways to knowing in the unfolding nursing situation. Taken together these two functions of the patterns of knowing come together in knowing the fullness of nursing, as an experience and as a conceptual structure. You have illustrated each of these functions in your reflection.
Wonderful that you were able to reply. This example demonstrates the exquisite personal relationship you had with the patient and her family. A hallmark of nursing presence.