Fundamental Patterns of Knowing in Nursing

Contributor: Peggy Chinn
September 15, 2018

Author: Barbara A. Carper, RN, EdD

Year First Published – 1978
Primary Focus of the Work

Patterns of Knowing – this is the initial work that has prompted widespread exploration of the nature of knowing in nursing.

Fundamental Patterns of Knowing as depicted in Chinn, P. L., & Kramer, M. (2018). Knowledge Development in Nursing: Theory and Process (10th ed.). St Louis: Elsevier. Used by permission.

Brief Summary of the work

In this foundational article, Dr. Carper describes the results of her philosophic analysis of the conceptual and syntactical structure of nursing knowledge. Her analysis was based on early nursing texts, and resulted in the identification of four patterns: empirics, ethics, esthetics and personal knowing. In her aritlcle Carper stated: “A philosophical discussion of patterns of knowing may appear to some as a somewhat idle, if not arbitrary and artificial, undertaking having little or no connection with the practical concerns and difficulties encountered in the day-to-day doing and teaching of nursing. But it represents a personal conviction that there is a need to examine the kinds of knowing that provide the discipline with its particular perspectives and significance. Understanding four fundamental patterns of knowing makes possible an increased awareness of the complexity and diversity of nursing.knowledge.” (page 21). Her work provided a vision of nursing to break free from the constraints of empirics alone, and has advanced debate and discussion of the unique nature of nursing as a discipline and as a practice.

Primary Source

Carper, B. A. (1978). Fundamental patterns of knowing in nursing. ANS. Advances in nursing science, 1, 13–23.

Implications of the work for development of nursing

Carper’s work has prompted a rich literature extending, debating and challenging her ideas. See these sources as examples:

Archibald, M. M. (2012). The holism of aesthetic knowing in nursing. Nursing philosophy: an international journal for healthcare professionals, 13, 179–188.

Averill, J. B., & Clements, P. T. (2007). Patterns of knowing as a foundation for action-sensitive pedagogy. Qualitative health research, 17, 386–399.

Bickford, D. (2014). Postcolonial theory, nursing knowledge, and the development of emancipatory knowing. ANS. Advances in nursing science, 37(3), 213–223. Retrieved from

Blegen, M. A. (2011). The winding road from research to practice through theory. Nursing Research, 60, 367.

Boykin, A., Parker, M. E., & Schoenhofer, S. O. (1994). Aesthetic knowing grounded in an explicit conception of nursing. Nursing science quarterly, 7(4), 158–161.

Carper, B. A. (1979). The ethics of caring. ANS. Advances in nursing science, 1, 11–19.

Chinn, P. L., & Kramer, M. (2018). Knowledge Development in Nursing: Theory and Process (10th ed.). St Louis: Elsevier.

Cloutier, J. D., Duncan, C., & Bailey, P. H. (2007). Locating Carper’s aesthetic pattern of knowing within contemporary nursing evidence, praxis and theory. International journal of nursing education scholarship, 4, 1–11.

Eisenhauer, E. R. (2015). An Interview With Dr Barbara A. Carper. ANS. Advances in nursing science, 38(2), 73–82.

Fawcett, J. (2006). Commentary: Finding patterns of knowing in the work of Florence Nightingale. Nursing outlook, 54, 275–277.

Fawcett, J., & Garity, J. (2009). Evaluating research for evidence-based nursing practice. Philadelphia, PA: F. A. Davis.

Garrett, B. M., & Cutting, R. L. (2015). Ways of knowing: realism, non-realism, nominalism and a typology revisited with a counter perspective for nursing science. Nursing inquiry, 22(2), 95–105.

Green, C. (2018). A philosophical model of the nature of nursing. Nursing Research, 67, 93-98.

Henry, D. (2018). Rediscovering the art of nursing to enhance nursing practice. Nursing Science Quarterly, 31, 47-54.

Jacobs, B. B. (2013). An innovative professional practice model: adaptation of Carper’s patterns of knowing, patterns of research, and Aristotle’s intellectual virtues. ANS. Advances in nursing science, 36(4), 271–288.

Mantzorou, M., & Mastrogiannis, D. (2011). The Value and Significance of Knowing the Patient for Professional Practice, according to the Carper’s Patterns of Knowing. Health Science Journal, 5, 251–261.

Paley, J., Cheyne, H., Dalgleish, L., Duncan, E. A. S., & Niven, C. A. (2007). Nursing’s ways of knowing and dual process theories of cognition. Journal of advanced nursing, 60, 692–701.

PIckler, R. H. (2018). Editorial: Theory use and usefulness in scientific advancement. Nursing Research, 67, 61-62.

Silva, M. C., Sorrell, J. M., & Sorrell, C. D. (1995). From Carper’s patterns of knowing to ways of being: An ontological philosophical shift in nursing. ANS. Advances in nursing science, 18, 1–13.

Terry, L., Carr, G., & Curzio, J. (2017). Expert Nursesʼ Perceptions of the Relevance of Carperʼs Patterns of Knowing to Junior Nurses. ANS. Advances in nursing science, 40(1), 85–102.

Thorne, S., & Sawatzky, R. (2014). Particularizing the General: Sustaining Theoretical Integrity in the Context of an Evidence-Based Practice Agenda. ANS. Advances in nursing science, 37(1), 5–18.

Wainwright, P. (2000). Towards an aesthetics of nursing. Journal of advanced nursing, 32, 750–756.

White, J. (1995). Patterns of knowing: Review, critique, and update. ANS. Advances in nursing science, 17, 73–86.


Barbara A. Carper

Dr. Carper earned her bachelor’s degree in nursing at Texas Woman’s University in 1959, one of the earliest 4-year nursing programs in Texas. She earned a nurse Anesthetist certificate at the University of Michigan Medical School in Ann Arbor. After several years of practice as a Nurse Anesthetist, she went to Teacher’s College Columbia for a Masters, and then an EdD degree, where she completed the research that resulted in the conceptualization of nursing’s fundamental Patterns of knowing. She held faculty positions in Texas, Maine and North Carolina until her retirement in 1999.

Types of theory related to each pattern of knowing*

Type of Theory   Description
Empirical theories Nursing science, developed by means of empirical research as descriptions of people and situations, explanations of relations between variables, or predictions about the effects of nursing interventions on outcomes; the science of nursing.
Aesthetic theories Nursing art, developed by means of envisioning the individual’s situation to understand the importance of that individual’s behavior at a particular time; the art of nursing.
Ethical theories


Nursing ethics, developed by means of values clarification and dialogue about beliefs and values; the moral component of nursing. 
Personal knowing theories Nursing interpersonal relations, developed by means of thinking and reflecting about how the individual nurse expresses his or her authenticity in relationships with patients; the self and other in nursing.
Sociopolitical or emancipatory theories Nursing politics and policies, developed by means of paying attention to all relevant voices in healthcare situations so to describe the social, cultural, and political contexts of nurse-patient interactions and of all healthcare settings; the praxis of nursing.
  • © Jacqueline Fawcett 2018