Evidence-Based Practice and Ways of Knowing

Carper’s Ways of Knowing have been used to help nurses understand all of the ways they know and bring evidence to their nursing practice.  Empirical knowing is easy to associate with Evidence-based Practice (EBP), but there is not as clear of a connection between others ways of knowing and EBP. For example, where do esthetic, personal, or ethical knowing belong when considering evidence in practice? Is there credible “evidence” that nurses use these types of knowing in their practice?  Registered nurses with an Associate degree working on their Baccalaureate degree bring to the academic setting some level of personal experience and knowing about practice. Being able to help them use reflective practice to clarify their personal knowing and add it to what they are learning about empirical evidence helps them experience empowerment. Registered nurses also have experienced and observed “artful” practice and can often apply this form of evidence to their nursing interventions. Furthermore, ethical knowing in this group of nursing students means having seen the Codes of Conduct and Patient’s Bill of Rights enacted in a clinical context. So, for this group of students, the evidence is in different forms with different criteria for credibility – but all potentially helpful in evidence-based practice.

In their first course in the RN-BSN program, these students are asked to identify a practice concept of concern to them. In the past they have selected practice focused topics such as PICC line infections, PTSD post ICU admission, and “Chemo Brain.”  After selecting a practice concept, over the weeks of the course students begin to identify sources of evidence, including the research literature, Codes of Ethics, reflections on their own clinical practice, and interviews with patients and other clinical experts. They rate the research literature using a traditional pyramid scale, but also critique the evidence from other sources including their own expertise, the insights from patients they have cared for, and other clinical experts. In doing this they use the appropriate credibility index such as congruity, justness, consensual judgment, and validity. The students also identify esthetic experiences that capture their concepts.

Feedback from the students indicates that doing the multiple separate sections of this assignment across the course, and then always relating them to their concept of interest, helps them to better understand all of the ways nurses bring evidence to their practice and the how the credibility of that evidence relates to the pattern of knowing.