own health beliefs as well as how they may respond to illness, future life events and experiences.
Defined as the ‘ability to recognise the meaning of emotions and their relationships and to use them as a basis of reasoning and problem‐solving’ (Mayer et al. 2001, p. 234), emotional intelligence is not always easy to translate. To be emotionally intelligent is generally described as a core aptitude related to one’s ability and capacity to reason with one’s emotions, especially in relation to others (Freshwater & Stickley 2004, cited in Williams 2015), which might suggest that nursing associates may possess the knowledge and skills but lack the ability to transmit them, and for a successful nurse–patient relationship, a balance of both would seem essential. This will be discussed further within this chapter.
The final of Carper’s (1978) four patterns of knowing is concerned with ethics. This focuses on the moral knowledge of the nurse, more specifically, a sense of knowing what is right and wrong for the patient. Every nursing associate will possess their own set of personal ethics and morals which they live by. Within healthcare practices, nursing associates should recognise healthcare dilemmas and make good judgements and decisions based on their values whilst keeping within the laws that govern them (Östman et al. 2019). Carper (1978) acknowledges that these patterns of knowing are not mutually exclusive, and nurses are seen to use attributes of all four patterns to successfully deliver patient‐centred care.
Incorporating Carper’s (1978) patterns of knowing, Johns (2000) suggests guided reflection as an addition pattern of knowing. The use of reflecting on experience as a means of enhancing clinical practice stems from the work of Schön (1983). Reflective and critical thought can help reason prejudices ensuring a growing awareness through reflective critical thought with regards to the nature of knowledge so not to assume things are true when they simply are not (Rolston et al. 2016). Benner (1984) points out that not all knowledge embedded in expertise can be captured in theory and furthermore believes that nurses need emotional space to think and feel about their practice. Reflective practice allows the nursing associate to explore the emotions that engaged or involved them in the situation, in the first place. Reflection can be described as the ability to explore one’s own actions, thoughts and feelings and think purposefully to gain new insights, ideas and understanding (Rolston et al. 2016).
Following Carper (1978), further theories have focused on how nurses go about gathering information to get to know the patient. In brief, Watson’s (1985) Transpersonal Caring theory indicated that nurses gain insight into a patient’s response to illness through a relationship exemplified by respect, compassion and support, pointing out the critical link between a deep connection with the patient and the nurse’s knowing, mirroring features of the therapeutic nurse–patient relationship. This is reinforced in Swanson’s (1991) theory of caring, where the dimensions of knowing are defined further to include avoiding assumptions, cue seeking and engagement of self, alluding to features of emotional intelligence.
Touch Point
Carper’s (1978) four patterns of nursing knowledge:
Personal knowing
Refers to the knowledge of ourselves, what we have seen and experienced. This type of knowledge comes through the process of observation, reflection and self‐actualisation. As we know ourselves, we are able to establish authentic, therapeutic relationships.
Empirical knowing
Empirical knowledge is gained from research and objective facts. This knowledge is systematically organised into general laws and theories. This way of knowing is often referred to as the science of nursing.
Ethical knowing
This way of knowing helps develop our own moral code and our sense of knowing what is right and wrong. Nursing associates’ personal ethics are based on their obligation to protect and respect human life.
Aesthetic knowing
Aesthetic knowing makes nursing an art. All the other ways of knowing are considered and through it aesthetic knowing.
Source: Based on Carper (1978)
Interestingly, Munhall (1993, cited in Stevens 2018) identified ‘unknowing’ as a further component of knowing, suggesting this is an awareness that the nurse does not and cannot know or understand of the patient when they initially meet. The skill of recognising this unknowing ensures that the nursing associate remains alert to the patients’ perception of need. This echoes Mayer & Salovey’s (1997) theoretical framework of emotional intelligence, where on initial meeting with the patient, the nurse perceives the situation by tuning in to his/her own self and emotional awareness and that of the patient in order to gauge the need of the situation. Part of this awareness is sometimes referred to as intuitive or tacit knowledge, just knowing and understanding common thoughts. Such knowledge adds to the gathering of information in the development of the therapeutic nurse–patient relationship.
Take Note
To summarise these theories (Carper 1978; Watson 1985; Swanson 1991; Johns 2000), it is evident that the concept of knowing emerges from a deep and meaningful relationship between the nurse and the patient. Through the delivery of care, the nursing associate continuously strives to understand and interpret the needs of the patient. The ability to gather relevant information and use a variety of sources demonstrates a strong conceptual foundation of the meaning of knowing; however, it should be acknowledged that the level of information gathered will depend on the nursing associates’ previous clinical experiences and interactions.
Violet Flag
Health screening in the prison service occurs upon reception into custody and provides an ideal opportunity to detect and treat previously unmet healthcare needs. When assessment during reception is effective, this has real potential to identify health problems, especially serious mental illness.
Emotional Intelligence
Emotional intelligence is defined as the ‘ability to recognise the meaning of emotions and their relationships and to use them as a basis of reasoning and problem‐solving’ (Mayer et al. 2001, p. 234).
Mayer & Salovey (1997) believed that emotional intelligence is related to thinking, through the ability to use reasoning, by way of information, to find meaning. This model is composed of four branches (see Table 6.1). Each branch has specific characteristics to meet the criteria of emotional intelligence. Each level or branch builds upon the previous one, and awareness of what each branch offers is individual. Enhancing relationships with others is a key component of healthy emotional interactions. The following is a brief description of the four branches. The first branch is the perception of
