Michael Wyllys
Ways of Knowing

I firmly grasped my patient’s hand with my own, her breathing rattled through the oxygen mask with each labored gasp. The tourniquet tightly wrapped around her forearm, I ran the alcohol wipe over the precious vein that popped up on the top of her hand. Taking an artist’s grip of the IV catheter, I inserted the needle at a 45-degree angle into the vein. Once seeing the flash of blood in the catheter, the angle was lowered and the needle was advanced ever so slightly more to ensure the catheter had penetrated the lumen. I slipped the cannula off into the vein, pulled back the needle and disconnected. I calmly, but quickly, connected my primed line and opened up the valve, feeling that flood of excitement and relief as I watched the drops begin to fall in the drip chamber. I had just successfully inserted my first intravenous cannula, on the first try, on my own as a brand new nurse.
This experience was an amazing feeling, and when reflecting back on it I can see why I was successful as I relied on the empirics of nursing. This was of knowing was impressed on me in nursing school and is what I believe to be the core of every brand new nurse. To put this way of knowing sin understandable terms, it is the factual descriptions, explanations, and predictions that make up empirical knowing (Pipe, Wellik, Buchda, Hansen, & Martyn, 2005). The proper techniques for inserting an IV cannula had been described and explained to me in the classroom and clinical settings and I was able to accurately predict my success by following these explanations as I attempted this technique on my own. Using the empirical way of knowing, I was able to provide effective nursing care for my patient, but being successful on the first attempt and not having to subject them to the pain and stress of multiple failed attempts. Being a brand new nurse of a little over two months, it is the esthetic way of knowing that that is not quite instilled in me. As Carper (1978) explains, ‘the more skilled a nurse becomes…the more knowledge or understanding will be gained’ and then the ‘nurse will have a larger repertoire of choices in designing and providing nursing care that is effective and satisfying.’ I am in my very first nursing job and working in the dementia unit of a nursing home is not the goal of my career, but even here I have begun to develop my esthetic way of knowing. In the administration of medications to my residents, which seems to be the bulk of my duties for the day, I have begun to develop a rapport with them. I know which ones are able to swallow pills whole and which ones require them crushed. I am keen to the substances I mix the crushed medications in as I have learned what makes it a more pleasant experience for the resident and a easier task for me. Knowing what times are best for my residents to take their medications and where they would like to be when they take them are all a part of the skill I am developing as I begin my nursing career. Becoming perceptive of my patient’s behavior and the significance in that behavior is the first step in developing my own esthetic way of knowing (Pipe et al., 2005).
The personal way of knowing is one that can be difficult to understand, but it relates well for me when I think of my first experience with an actively dying patient. Barker (2009) explains that this way of knowing is considered as an interpersonal process involving interactions, relationships, and transactions between the nurse and the patient. Being a new nurse and terribly oriented to my position, I found myself regularly stressed on a daily basis the first few weeks on the job. I entered the patient’s room to obtain a “quick” set of vital signs for monitoring purposes as we waited for the inevitable, I felt the strong urge to realize myself in this position. This was the last few moments of this persons life and I imagined it how I would want my own to be. There was no family present and I suddenly felt terribly alone for this person, their condition was not good at all, but I couldn’t help but feel that they still had some sensation to what was going on around them. I felt the incredible urge to sit with them for awhile and hold their hand. In the middle of my hectic, stressful day I felt such a calmness come over me, hoping that this person could feel some comfort in their dying moments. It was in these moments I felt like a true nurse. Beyond all the science and processes, it was in this simple act that I realized why I had always wanted to be a nurse and why this profession could be so rewarding.
The last way of knowing, is something very crucial for the safety of nurses and patients alike. The ethics way of knowing, or quite simply, the moral obligations, values, and desired ends (Pipe et al., 2005) is something crucial to all aspects of nursing. I abide by this every day, knowing that the information I am privy to in my patient’s healthcare, is theirs and theirs alone. I provide the best possible care to them each day and hold important the principle of nonmaleficence, or do no harm, which is directly tied to our duty as nurses to protect the patient’s safety (Silva & Ludwick, 1999). Working in the dementia unit of a nursing home, it is imperative that I follow the ethics way of knowing, in ensuring my patients receive the proper care, even when they cannot speak for themselves.

References
Barker, A. M. (2009). Advanced Practice Nursing: Essential Knowledge for the Profession (p.
413). Sudbury, MA: Jones & Bartlett Publishers. Retrieved August 21, 2014
Carper, B. A. (1978, October). Fundamental patterns of knowing in nursing. Advances in
Nursing Science, 1(1), 13-24. Retrieved August 21, 2014
Pipe, T. B., Wellik, K. E., Buchda, V. L., Hansen, C. M., & Martyn, D. R. (2005, May).
Implementing evidence-based nursing practice. Urologic Nursing, 25(5), 365-370. Retrieved August 21, 2014
Silva, M. C., & Ludwick, R. (1999, July 2). Ethics: Interstate nursing practice and regulation:
Ethical issues for the 21st century. The Online Journal of Issues in Nursing, 4(2). Retrieved August 21, 2014