How Nurse Practitioner can Apply Carper's Patterns of Knowing

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Class Question:

"Can you share an example of how the Nurse Practitioner can apply Carper's Patterns of Knowing to achieving a high quality supportive role transition for new graduate NPs?

Post:

When I was a new graduate nurse working my first job on a labor and delivery unit, I was presented with a challenging patient situation to manage. I was assigned a difficult patient who was severely ill. She had a high BMI that made it difficult to monitor the fetus. She had just moved to my city from states away and the specifics of her prenatal care was unclear. When I received her, her pressures were dangerously high and we did not have IV access. I coordinated with the MD to give her an oral dose of labetalol and with the CRNA to initiate IV access due to her being a difficult “stick.” Her situation got progressively worse throughout the rest of the shift. Her hemoglobin and hematocrit levels were dangerously low and she was ordered to receive 4 units of PRBCs prior to her urgent Cesarean section. Her pressures were not well responsive to the labetalol protocol and she needed an arterial line to be placed to better titrate her medications and control her pressures. I felt underprepared in this situation because as stated earlier, I was a new grad. I hadn’t had much experience with giving the amount of labetalol to control pressures as was needed for that patient. I had also never had experience with giving blood. While the charge nurse said she would be available to assist me with interventions and decision making, she was frequently unavailable and I was left to find other busy nurses for help.

Many important nursing issues and topics were relevant to that clinical situation including nursing competency of new graduate nurses, short nurse-patient ratios, and providing holistic care. The Pattern of Knowing of Carper’s that I chose to analyze this situation was Personal Knowing. I felt overwhelmed related to being a new nurse in a scary clinical situation. I was afraid that I was going to cause the patient harm because of my incompetence and my lack of support due to a busy unit and being short staffed. I was also frustrated because I did not feel prepared well enough to handle that situation. Frustration carried through to the lack of staff available as well. However, I did feel proud of myself because I was able to use my critical thinking skills and keep my patient safe from a serious injury. While I didn’t have the nurses necessary to be of assistance, I was able to coordinate well with physicians and APRNs to give the patient the care that she needed. Finally, I provided holistic care by tending to my patient’s emotional well-being as well as her physical health. I communicated well and provided a therapeutic environment where she felt safe to confide in me and trusted that I would take care of her in those scary times. This reflective practice was valuable because reviewing Personal Knowing on this situation allowed me to assess my strengths and weaknesses in greater detail, which allows me to identify areas where I can grow in my career. It also helped me to assess how my lack of competence and confidence impacted the level of care I was able to give, and to identify where I can respond differently in other situations where I do not feel prepared (Rafii et al., 2021). Using Carper’s Personal Knowing will help me in my practice as an NP because this practice helps to identify the need for collaboration and coordination with other providers. The pattern of Personal Knowing is important because the knowledge of self leads to patient advocacy. Using this tool will help me be an empathetic NP who can provide personalized patient care and be my patients’ advocate at all times (Jacobs, 2013).

References

Jacobs, B. B. (2013). A innovative professional practice model: Adaptation of Carper’s patterns of knowing, patterns of research, and Aristotle’s intellectual virtues. Advances in Nursing Science, 36(4), 271-288. https://doi(dot)org/10.1097/ANS.0000000000000002

Rafii, F., Nasrabadi, A. N., & Tehrani, F. J. (2021). How nurses apply patterns of knowing in clinical practice: A grounded theory study. Ethiopian Journal of Health Science, 31(1), 139-146. https://doi(dot)org/10.4314/ejhs.v31i1.16