More Than Evidence: How Experience and Reflection Shape My Epistemological Stance in Nursing
Submitted by MacKenzie O'Keefe, BScN RN
Tags: empirical knowledge ethical principles in nursing Nurse Education nursing epistemology Patient-centered care
Introduction
In nursing school, we’re often taught to trust the world of research and clinical evidence, the foundation on which modern nursing was built. However, with just over a year of bedside experience, I’ve come to realize that not all knowledge comes from textbooks or peer-reviewed articles. Each and every patient brings lived experiences, personal truths, and emotional insights that can’t always be measured or studied. While my practice is rooted in empirical knowledge, it continues to evolve through direct patient care and ongoing reflection. Epistemology, defined as the study of knowledge and how it is acquired, challenges nurses to consider not only what they know but how they come to know it (Kim, 2015). This paper will explore how my epistemological stance, shaped by both evidence and experience, influences my understanding of nursing and approach to critical thinking in everyday practice. I will also examine how my perspective aligns with Barbara Carper’s patterns of knowing and how her framework is reflected in my daily decisions and patient interactions.
More than Evidence:
My Epistemological Stance in Nursing My epistemological stance in nursing is grounded in both empirical evidence and experiential insight that I gain through direct patient care. While I value research, clinical guidelines, and policies as essential tools, I’ve come to recognize that my knowledge base extends far beyond textbooks. Much of what I know comes from listening to patients’ stories, observing their lived realities, and responding to their unique needs in the moment. This recognition emerged through caring for individuals whose values, emotions, and responses often challenged textbook assumptions. As Antonsen et al. (2023) found, establishing "an equal and trusting relationship" with socially marginalized patients led to more person-centred care. Carper (1978) emphasized in her foundational work, nursing knowledge is not singular; it arises through multiple patterns, including personal and aesthetic knowledge, that recognize the uniqueness of each patient and the depth of care. Working in a hospital that serves marginalized and vulnerable populations has further deepened my understanding of how traditional knowledge sources can fall short. Textbooks and standard protocols often overlook the complexity of patients' social contexts and may carry implicit biases about behaviours or outcomes. As Thorne (2025) emphasizes, nursing practice must extend beyond a strict biomedical lens to engage with the realities of patients’ lived experiences, recognizing the social, cultural, and structural factors that shape health. It is common for patients to return to our hospital repeatedly because their basic human needs or underlying health disparities were not fully addressed. These recurring patterns reveal the importance of seeing each patient as a whole person rather than a diagnosis. Over time, I have come to appreciate the importance of compassion, empathy, and relational understanding in shaping how I care for others. These values align closely with Carper’s (1978) emphasis on personal and ethical knowledge, which highlight the moral and relational dimensions of nursing knowledge essential to providing holistic and just care.
Understanding Nursing Knowledge through Carper’s Lens
Barbara Carper’s Fundamental Patterns of Knowing in Nursing (1978) has had a profound impact on nursing epistemology by expanding the concept of knowledge beyond the empirical and scientific. To critically evaluate Carper’s relevance to my practice, I will briefly outline the strengths and limitations of her framework. Strengths One of the primary strengths of Carper’s theory is its recognition of the complexity and multidimensionality of nursing knowledge. By identifying four distinct patterns, empirical, personal, ethical, and aesthetic, Carper provides a comprehensive framework that acknowledges both objective data and subjective experience as essential components of nursing practice (Carper, 1978). This holistic view encourages nurses to integrate scientific evidence with empathy, ethical judgment, and the art of caring, which supports individualized and compassionate care (Chinn & Kramer, 2015). Additionally, Carper’s theory fosters reflective practice and critical thinking by prompting nurses to examine how different ways of knowing influence their clinical decisions and relationships with patients (Fawcett, 2014). The inclusion of personal knowledge, in particular, highlights the therapeutic potential of nurse-patient relationships, fostering trust and understanding that are crucial for effective care (Thorne, 2025).
Limitations
Although Barbara Carper’s framework has made a lasting contribution to nursing epistemology, it has been critiqued for its limitations in addressing broader socio-political realities. While her patterns of knowledge emphasize individual and relational aspects of care, they do not explicitly engage with systemic issues such as structural inequality, cultural marginalization, or racism in healthcare (White, 2021). Moreover, Carper’s concept of personal knowledge, though essential for fostering authentic nurse–patient relationships, has been challenged for its potential misuse. Thorne (2020) cautions that without critical reflection, personal knowing can reinforce personal biases and subjective interpretations, ultimately compromising the integrity of care.
Bridging Theory and Practice
A Clinical Illustration To illustrate how my epistemological stance and Barbara Carper’s patterns of knowing influence my approach to nursing, I will present a fictional case study based on a compilation of clinical experience. This case involves a patient whose medical and social complexities challenged conventional clinical pathways and required a more holistic, reflective approach. By examining the case through both my own understanding of knowledge in practice and Carper’s four ways of knowing, empirical, personal, ethical, and aesthetic, I aim to demonstrate how diverse forms of knowledge inform real-time decision-making, foster compassionate care, and support individualized patient outcomes. Mrs. Evelyn Shaw is a 41-year-old female who presented to the Emergency Department at St. Clare’s Mercy Hospital with generalized chest pain and a sharp, “knife-like” pain radiating between her shoulder blades. Upon triage, Mrs. Shaw’s vital signs were stable, but she reported her pain as 8 out of 10 and persistently requested Demerol for pain management. Over the past month, Mrs. Shaw has visited the Emergency Department on three separate occasions, each related to substance misuse. During one of these visits, the administration of Narcan was required. Mrs. Shaw is a former pharmacist who was found diverting medications for personal use. As a consequence, she lost her license, is currently unemployed, and is experiencing homelessness. This initial presentation highlights several of Carper’s fundamental patterns of knowing. Empirical knowing is evident in the clinical assessment of her vital signs and pain level, providing objective data to guide care. The complexity of Mrs. Shaw’s history, including substance misuse and homelessness, calls upon ethical knowledge, as nurses must navigate issues of stigma, patient autonomy, and justice while advocating for her well-being. Personal knowledge is central here, requiring the nurse to acknowledge Mrs. Shaw’s unique lived experience, values, and struggles to build a trusting therapeutic relationship. Lastly, aesthetic knowledge is reflected in the nurse’s sensitivity and intuition to perceive the unspoken emotional distress underlying Mrs. Shaw’s pain and social circumstances, shaping a compassionate and individualized response. After Mrs. Shaw’s initial triage assessment, an electrocardiogram (ECG), bloodwork, and a urinalysis were conducted. The charge nurse also requested an opioid panel due to concerns related to Mrs. Shaw’s substance use history. Despite interventions, Mrs. Shaw continued to writhe in pain, expressing significant discomfort. Based on her medical history and frequent prior visits, some members of the nursing staff demonstrated visible bias, opting to initially manage her pain with acetaminophen rather than stronger analgesics. After hours of unmanaged pain, Mrs. Shaw requested to speak directly with a physician. Once given the opportunity, she voiced multiple concerns. Primarily, she reported that her pain had not been effectively managed, noting that she had only been given acetaminophen despite initially requesting Demerol, a medication she stated is typically used to treat gallbladder attacks (Yasaei et al, 2025). Mrs. Shaw also expressed concern that no ultrasound had been performed to confirm a gallbladder-related issue, yet an opioid urinalysis had been prioritized in her care. This phase of care clearly illustrates the interplay of Carper’s patterns of knowing. Empirical knowing is demonstrated through the use of diagnostic tests such as ECG, bloodwork, and urinalysis to gather objective data. However, the staff’s bias and pain management decisions expose a gap in ethical knowledge, as they challenge the principles of justice and respect for patient dignity. Mrs. Shaw’s advocacy for her pain relief and diagnostic concerns underscores the importance of personal knowledge, emphasizing the nurse’s need to understand and validate the patient’s unique experiences and perspectives. Finally, aesthetic knowledge is reflected in recognizing the emotional and psychological toll of inadequate pain management, prompting a compassionate response that moves beyond clinical facts to truly listen and respond to Mrs. Shaw’s distress.
Based on Mrs. Shaw’s background in the pharmaceutical field and her active involvement in her plan of care, the attending physician agreed to order an ultrasound and appropriate analgesia. The ultrasound confirmed a gallbladder attack, and Mrs. Shaw was given 100 mg of subcutaneous Demerol for rapid pain relief (Yasaei et al. 2025). Following diagnosis, surgical removal of the gallbladder was recommended. This case illustrates the value of listening to patients as partners in their care. By acknowledging Mrs. Shaw’s knowledge and encouraging her involvement, the healthcare team was able to provide timely and compassionate care. This approach not only aligns with best clinical practices but also reflects the core principles of relational nursing and patient-centered decision-making. This phase exemplifies Carper’s patterns of knowing in practice. Empirical knowing is demonstrated through the accurate use of diagnostic imaging and evidence-based treatment to guide clinical decisions. Mrs. Shaw’s professional background and active participation highlight personal knowledge, emphasizing the nurse’s recognition of the patient as a knowledgeable individual whose experiences shape care. The healthcare team’s responsiveness to her concerns reflects ethical knowledge, showing respect for patient autonomy and justice by advocating for fair and individualized treatment. Finally, the holistic and compassionate approach to Mrs. Shaw’s care embodies aesthetic knowledge, capturing the art of nursing that integrates empathy, intuition, and relational understanding to foster healing and trust.
Analyzing Practice Through my Epistemological Lens
The case study of Mrs. Shaw highlights the importance of recognizing and valuing the patient’s voice in clinical decision-making. Her professional background and active participation in her care plan exemplify how collaborative, patient-centered care can lead to timely diagnosis and effective treatment. By integrating her insights and advocating for appropriate interventions, the healthcare team was able to address her concerns, alleviate her pain, and implement a clear treatment plan. This approach illustrates the integration of both empirical knowledge and relational practice, demonstrating how acknowledging the patient’s lived experience can lead to more holistic and effective outcomes. My epistemological stance is rooted in the belief that patient experiences are among the most valuable sources of knowledge in nursing practice. While empirical evidence, clinical guidelines, and institutional policies are essential, they do not capture the emotional and relational dimensions that influence healing. I believe that meaningful care is built on understanding the patient's unique story, values, and experiences. Barbara Carper’s patterns of knowing, particularly personal knowledge, highlight the importance of honoring the patient’s lived experience as a vital source of nursing knowledge. In caring for Mrs. Shaw, I would draw upon Carper’s framework by valuing her individual perspective and professional background, using this knowledge to build trust, foster mutual respect, and guide clinical decisions. This fusion of empirical and personal knowledge reflects my commitment to a holistic, person-centered model of care.
Conclusion
In conclusion, my epistemological stance in nursing is grounded in both evidence-based practice and the humanistic principles outlined in Barbara Carper’s patterns of knowing. I believe the most effective nursing care arises from integrating empirical knowledge with the lived experiences of each patient. Recognizing patients as unique individuals, each with their own stories, values, and insights, enables more compassionate and personalized care. By valuing both scientific data and relational understanding, I develop care plans that are not only clinically sound but also deeply respectful of the human experience. This dual approach supports healing in a way that is both effective and authentically caring.
References
- Antonsen, L. K., Lassen, A. T., Nielsen, D., & Østervang, C. (2023). Receiving person‑centred care in a hospital: A qualitative study of socially marginalised patients’ experiences of social nursing. Scandinavian Journal of Caring Sciences, 38(1), 220–230. https://doi.org/10.1111/scs.13212
- Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13–23. https://doi.org/10.1097/00012272-197810000-00004
- Chinn, P. L., & Kramer, M. K. (2015). Knowledge development in nursing: Theory and process (9th ed.). Elsevier. Fawcett, J. (2014). Analysis and evaluation of nursing theories (5th ed.).
- F.A. Davis Company. Kim, H.S. (2015). Nursing knowledge for practice [e-book] (Chapter 4). In The essence of nursing practice: Philosophy and perspective. (pp. 55-66).
- Thorne, S. (2020). Rethinking Carper’s personal knowing for 21st-century nursing. Nursing Philosophy, 21(4), e12307. https://doi.org/10.1111/nup.12307
- Thorne, S. (2025). Interpretive description: Qualitative research for applied practice (3rd ed.).
- Routledge. Yasaei, R., Rosani, A., & Saadabadi, A. (2025). Meperidine. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470362/podcasts.apple.com+6