Overview – Patterns of Knowing in Nursing

Contributors: Deborah Lindell and Peggy Chinn
Updated October 27, 2022

Aesthetic Knowing
Ethical Knowing
Emancipatory and Sociopolitical Knowing
Empiric Knowing
Personal and Spiritual Knowing

In 1978, Barbara Carper published the article titled “Fundamental Patterns of Knowing in Nursing”.  In this article, now a classic publication with a profound effect on the discipline, Carper identified four patterns of knowing: empirical, personal, ethical, and aesthetic.  This section of Nursology.net provides an overview of these four patterns of knowing, along with additional knowing patterns that inform the development and practice of nursology .

Source: Fundamental Patterns of Knowing as depicted in Chinn, P. L., Kramer, M. & Sitzman, K. (2022). Knowledge Development in Nursing: Theory and Process (11th ed.). Elsevier. Used by permission.

Carper’s article was published at a time when nursologists were focused on developing quantitative research methods. Yet, at the same time, they recognized that many problems in nursing defied quantitative study. The notion that nursing requires patterns of knowing, different from empirics, that more adequately address the range of concerns nurses encounter in practice and how they understand them, was a welcome advance in understanding the nature of nursology.

Subsequently, Chinn and Kramer, over 11 editions of Knowledge Development in Nursing, extended Carper’s  initial work on the patterns of knowing in nursing. For each pattern, they added critical questions, creative inquiry processes, formal expressions, and means of authenticating knowledge. They also provided diagrams of the patterns that evolved as understanding of the patterns evolved and depicted dynamic interaction among them. Chinn and Kramer later introduced and described the concept of nursing praxis, expert practice that integrates all patterns of knowing; and, in 2010,  introduced a fifth pattern – emancipatory knowing. This pattern, depicted as central to the other four patterns, was based on the growing body of literature addressing knowledge required to make cultural, social and political change that is required to improve health and health care. 

The concept of emancipatory knowing is closely aligned with the concept introduced by Jill White – sociopolitical knowing, which focuses more specifically on the context of nursing and those who influence it. The concept of emancipatory knowing shares this focus but also focuses on critical dynamics of power that reveal inequities and disadvantages.

Source: Fundamental Patterns of Knowing as depicted in Chinn, P. L., Kramer, M., & Sitzman, K. (2022). Knowledge Development in Nursing: Theory and Process (11th ed.). Elsevier. Used by permission.

Seven Types of Middle-Range Theories and Situation-Specific Theories

Nursologist Jacqueline Fawcett conceptualizes seven fundamental patterns of knowing, highlighting distinctions in socio-political and spiritual knowing. She regards the seven fundamental patterns of knowing in nursology as middle-range or situation-specific theories of nursology. A brief overview of the seven types of nursological theories is given in this table.

Type of Theory  Description
Empirical theoriesNursological science, developed by means of empirical nursological research as descriptions of people and situations, explanations of relations between variables, or predictions about the effects of nursologists’ interventions on outcomes; the science of nursology.
Aesthetic theoriesNursological 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 nursology.
Spiritual theories“[H]uman beings’ perceiving and appreciating of nonmaterial spiritual qualities and experiences that provide meaning and purpose, awareness of a greater reality, and uplifting of the human spirit” (Willis & Leone-Sheehan, 2019, p. 62); the spiritual component of nursology.
Ethical theories  Nursological ethics, developed by means of values clarification and dialogue about beliefs and values; the moral component of nursology. 
Personal knowing theoriesNursologists’ interpersonal relations, developed by means of thinking and reflecting about how the individual nursologist expresses his or her authenticity in relationships with patients; the self and the other in nursology.
Sociopolitical  theoriesNursological 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 nursologist-patient interactions and of all healthcare settings; the politics and policies of nursology.
Emancipatory  theories   “The human capacity to be aware of an critically reflect on the social, cultural, and political status quo and to determine how and why it come to be that way” (Chinn & Kramer, 2018, p. 5); the praxis of nursology

Additional Sources

Archibald, Mandy M. (2012). The holism of aesthetic knowing in nursing. Nursing Philosophy: An International Journal for Healthcare Professionals, 13, 179–188. https://doi.org/10.1111/j.1466-769X.2012.00542.x

Bonis, S. A. (2009). Knowing in nursing: a concept analysis. Journal of Advanced Nursing, 65, 1328–1341.

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. https://doi.org/10.1177/089431849400700407

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

Carper, Barbara A. (1979). The ethics of caring. ANS. Advances in Nursing Science, 1, 11–19.

Chinn, P., Kramer, M., & Sitzman, K. (2022) Knowledge Development in Nursing: Theory and Process, 11th ed. 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.

Corwin, Elizabeth J., Jones, Dean P., & Dunlop, Anne L. (2019). Symptom Science Research in the Era of Big Data: Leveraging Interdisciplinary Resources and Partners to Make It Happen. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 51(1), 4–8. https://doi.org/10.1111/jnu.12446

Durepos, Pamela, Orr, Elizabeth, Ploeg, Jenny, & Kaasalainen, Sharon. (2018). The value of measurement for development of nursing knowledge: Underlying philosophy, contributions and critiques. Journal of Advanced Nursing, 74(10), 2290–2300. https://doi.org/10.1111/jan.13778

Eisenhauer, Elizabeth R. (2015). An Interview With Dr Barbara A. Carper. ANS. Advances in Nursing Science, 38(2), 73–82.

Fitzpatrick, J. et al (2019) The nursing disciplinary perspective- 50 years ago and the view  forward. Advances in Nursing Science, 42 (1) 2. DOI: 10.1097/ANS.0000000000000251 

Garrett, Bernard M., & Cutting, Roger 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. https://doi.org/10.1111/nin.12070

Haase, Kristen R., Thomas, Roanne T., Gifford, Wendy, & Holtslander, Lorraine F. (2018). Ways of knowing on the Internet: A qualitative review of cancer websites from a critical nursing perspective. Nursing Inquiry, 25(3), e12230. https://doi.org/10.1111/nin.12230

Jacobs, Barbara Bennett. (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. https://doi.org/10.1097/ANS.0000000000000002

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.

Silva, Mary Cipriano, Sorrell, Jeanne Merkle, & Sorrell, Christine Denise. (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.

Starkweather, Angela R., Colloca, Luana, Dorsey, Susan G., Griffioen, Mari, Lyon, Debra, & Renn, Cynthia. (2019). Strengthening Inter- and Intraprofessional Collaborations to Advance Biobehavioral Symptom Science. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 51(1), 9–16. https://doi.org/10.1111/jnu.12456

Terry, Louise, Carr, Graham, & Curzio, Joan. (2017). Expert Nurses’ Perceptions of the Relevance of Carper’s Patterns of Knowing to Junior Nurses. ANS. Advances in Nursing Science, 40(1), 85–102. https://doi.org/10.1097/ANS.0000000000000142

Thorne, Sally. (2020). Rethinking Carper’s personal knowing for 21st century nursing. Nursing Philosophy: An International Journal for Healthcare Professionals, e12307. https://doi.org/10.1111/nup.12307

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