Patient-Centred Care Flashcards
Silence, received knowing, subjective knowing, procedural knowing, and constructed knowing.
5 ways of knowing
Through ___, people “feel passive, reactive, and dependent, they see authorities as being all-powerful, if not overpowering”. For instance, if Mrs. Black used ___, she would listen to whatever you as her nurse told her and would do as you wished, but she would not question why because she would see you as an authority that she must obey. Therefore, it would be difficult for her to enter into a relationship with you that is patient-centred, unless you could encourage her to ___ in her care with you. In order for her care to be patient-centred, a partnership would need to be established between you as her nurse in a way that you both learn from each other.
silence x2 / participate
Nurses whose knowing relates to ___ knowing believe what they know on the basis of what they hear, and thus they learn through listening. For example, when you take notes in a class and only memorize these notes and then repeat the notes back in your reflections, you are practising ___ knowing.
received x2
If you asked Mrs. Black to repeat the instruction you provided to her and she was able to do this but did not question why this was important to her care she might be using ___ knowing. Again, this would not be a true p___ that is needed for patient-centred care to occur. In order to establish a p___, you would need to encourage her to share how her life situation will affect her being able to do what you are guiding her in.
received
If you, as a nurse, listen to what others say and then internalize it to assess its meaning to you, you are practising ___ knowing. For example, if Mrs. Black shared that she wondered how she might be able to care for herself at home, she might be demonstrating ___ knowing. Mrs. Black would therefore be more ___ to be able to participate with you in making decisions about her care, allowing for a partnership to be created.
subjective x2 / likely
When i___ becomes a debate within yourself as to what its meaning is to you, you are beginning to use your ___ knowing. For example, if Mrs. Black then debated the importance of being at home to care for her daughter with CF, while also realizing that this new diagnosis of diabetes means she could not fulfill this role, leading her to explore who might be able to provide her daughter’s care at home, she might be demonstrating ___ knowing. In this form of knowing, you are beginning to identify what your assumptions are and how these relate to your own ___. If Mrs. Black was using ___ knowing, then a partnership between the two of you would be a likely way of working ___.
i-nternalization / procedural x2 / values / procedural / together
When you are able to compare what you hear against your assumptions and challenge your own assumptions and those of others, you have moved into ___ knowing. If Mrs. Black uses ___ knowing, she might identify which aspects of her daughter’s care different family members at home could provide, and then in her mind could develop a plan for discussing their individual roles to achieve the total care that needs to be provided while she is incapacitated. Again, a partnership between you ___ can be achieved without modifying your interaction with the patient.
constructed x2 / both
When the more ___ forms of knowing (received, procedural, and constructive) provide the means for a nurse-patient partnership to be established, this allows for patient-centred care to occur.
active
While nursing professional practice requires nurses to use their ___ and ___ knowing, it is important to remember that patients are not always operating at the same level. The success of nursing care with them requires nurses to explore with them the s___ that brought them into the hospital, to gain insight into how they arrived at the decision to seek help. This will allow you as a nurse to determine how you might develop a relationship with your patient and create a patient-centred partnership.
procedural / constructed /s-tory
In summary, for all, knowing by ___ knowledge means deferring to an “authority figure” and accepting without debate what that person teaches you; knowing by ___ knowing means receiving knowledge from others but also considering how this knowledge relates to what you understand. Knowing by ___ knowledge means experiencing something and then considering its meaning not only to you but also to others; you also listen to others and consider their perspective and assess this in relation to yourself.
receiving / procedural / constructing
As you move forward and develop into the nurse you wish to be, you will expand your ways of knowing beyond those just identified. Carper (1978) identified four ___ of knowing that are essential to nursing knowledge development: empirical knowing, or “the science of nursing”; aesthetic knowing, or “the art of nursing”; personal knowing; and ethical knowing, or “moral knowledge in nursing”.
patterns
“The science of nursing”.
Empirical knowing
“The art of nursing”.
Aesthetic knowing
“Moral knowledge in nursing”.
Ethical knowing
When knowledge you apply to your practice arises from exploratory, descriptive, or inferential studies about key findings that influence aspects of practice, you will generate knowledge to guide your clinical decision-making process around one of your patterns of knowing referred to as ___ knowing.
empirical
Aligns with much of the research evidence applied in evidence-informed practice, but it also can be limited when it does not include the complex health and social aspects of families that influence how a patient can respond to such approaches.
Empirical knowing
From working with children that they like to participate in adult conversations and share what they are doing, rather than be told what to do. This scenario illustrates the integration of empirical knowledge about the impact of CF on her lung capacity coupled with an ___ pattern of knowing how to approach children.
aesthetic
The way we begin to shape our approaches to care using empirical knowing allows us to reflect on our comfort levels. This is where our personalities and approaches to creating relationships with others come into play. Returning to Mrs. Black and her family, you might approach her daughter with CF who is visiting with her mother, squat down to her height, and ask her how she is doing and how her breathing is today. Then you might ask her what she has been able to do on her own to help with her breathing. You do this because you know from working with children that they like to participate in adult conversations and share what they are doing, rather than be told what to do. This scenario illustrates the integration of empirical knowledge about the impact of CF on her lung capacity coupled with an ___ pattern of knowing how to approach children.
aesthetic
Another nurse might like to draw pictures and encourage the daughter to draw a picture of how she is feeling today. This action might result in different information being gained. Hence, there is no single way to use an ___pattern of knowing.
aesthetic
When you are able to use your own comfort level to develop relationships with your patients and their families, you are more likely to be seen by them as being g___.
g-enuine
Forms a basis for trust.
Genuineness
Relates to how you, as a unique individual, choose to respond in a patient situation. It is a reflection of your personality and your creativity.
Aesthetic pattern of knowing
National framework for organizing practice competencies.
Foundation of nursing practice. CIHC, Canadian Interprofessional Health Collaborative; CNA, Canadian Nursing Association.
