Answer below discussion. Two paragraphs and two references no later than 5 years.
This week’s discussion questions caused a lot of reflection on how I practice nursing. The questions led me to reflect on what type of nurse I am. Am I doing the best I can, or have I done the best I could? While considering the six ways of knowing I kept coming back to unknowing. The act of being unaware or not being able to fully understand what the patient is experiencing or going through (Heath, 1998). That is how I approach every patient. I have no preconceived notion that I have even the faintest idea of what they must be feeling. It is the ability to be fully present of yourself and open to the patient and their life. The other is empirical knowing. Empirical knowing is the first introduction we have in nursing school. Understanding the science, the epidemiology, the physical nature of the illness or medical situation. I believe there is a lot of value in empirical knowing, as the patients want us to know why and how to do what we do. They place a lot of trust in us to do the right thing. It is part of our daily responsibility to assess and monitor therapeutic response to treatment (Zander, 2007).
Though the entire 6 ways of knowing were brand new to me and it took me some time to reflect on my understanding of these concepts, I fear the two I have put the least focus on in the past but am keenly aware of their implications are emancipatory and aesthetic knowing. This is not to say that I did not practice the art of nursing, using my years of experience to draw on and I am astutely aware of the social, cultural, and political implications of those in my care. I never was able to put a name or definition to them. Emancipatory knowing, the ability to be astutely aware of the social injustices and be able to act in a way to reduce the negative impact of these inequalities (Peart & MacKinnon 2018). Aesthetic knowing, the ability to interpret the patient’s behavior or expression of self and then asking what this means (Zander, 2007). Aesthetic knowing in a simpler phrase might be considered that gut feeling a nurse often refers to.
I am reminded of a recent experience I had when I was given the privilege to assist another nurse on a home visit. This nurse is an incredible pediatric nurse. I admire her aesthetic way of knowing and how she is so patient and kind with the children she cares for. This young boy, age 11, was recently diagnosed with Pediatric Autoimmune Neurological Disorders Associated with Streptococcal Infections (PANDAS). It is a horrid and unexpected disease that takes an otherwise perfectly healthy child and they become severely paranoid, have expressions of sudden onset OCD type behaviors, and a myriad of other symptoms (International OCD Foundation, n.d.). This young boy was to receive Intravenous Immunoglobulin (IVIG) at his home, requiring placement of a peripheral IV. I was called in for reinforcements in case she could not get the IV started or just needed help holding him or reassuring him. Empirically I know how to administer IVIG, start an IV, and care for an 11-year-old boy. I understand his disease process and am well prepared for the various situations I could find myself in. Personally, I was aware of myself, my role in this situation, and how my presence in his home required empathy and compassion. Ethically I was concerned that we were going to be causing a lot of mental trauma simply by giving him this medication which is the only drug known to help PANDAS patients. The IV start and the presence of two nurses in his home are also traumatic. We arrived to meet the boy and his parents, who have had to find ways to stay home with him 24 hours a day because he cannot be left alone. The mother lost her job, and the father was now the sole provider while the mother managed him never letting him out of her sight 24 hours a day. The Emancipatory situation here was the financial burden and social isolation of both the parents and the young boy. It took 2 hours to start the IV, while we worked to gain his trust, listen empathetically to his fears and rationalizations. We could not even touch him for 30 minutes. Overall, those 2 hours to gain his trust and start the IV in one swift poke when he finally conceded was traumatic for all. I am not sure it could have gone any differently, as this is uncharted territory for these PANDAS kids. I am thankful that I start each situation out with the unknowing way of knowing that had I tried to set limits or expectations on this boy, I may not have been as open to going along with his needs or his fear. I have the pleasure of seeing him again this week and will reapproach him and his situation with an unknowing but more empirically aware of his situation.
Heath. H. (1998). Reflections and Patterns of Knowing in Nursing, Journal of Advanced Nursing, 27(1054-1059).
International OCD Foundation. (n.d.). Sudden Onset OCD PANS/PANDAS. Retrieved March 7, 2021, from International OCD Foundation | Sudden and Severe Onset OCD (PANS/PANDAS) – Practical Advice for Practitioners and Parents (iocdf.org) (Links to an external site.)
Peart, J. & MacKinnon, K. (2018). Cultivating Praxis Through Chinn and Kramer’s Emancipatory Knowing, Advances in Nursing Science, 41(351-358).
Zander, P. (2007). Ways of Knowing in Nursing: The Historical Evolution of a Concept, Journal of Theory Construction & Testing, 11(7-11).