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Definition of Curriculum Terms

Patient:  A person, group, family, or community who engages with the nurse for the purpose of interpreting the human health experience for the potential of achieving transpersonal healing.  Individuals—experiencing, developing, and perceiving beings reflecting fundamental patterns of knowing through mind/body/spirit manifesting as a unified whole.  The concept of patient may be used interchangeably with the terms individual or group or community.

In addition to person, group, family or community, the patient can be an organization.  An organization is conceptualized as a community of individuals who come together to accomplish health care goals through the medium of an organization.

Human Health Experience:  A subjective sense of harmony, unity, and congruence in mind/body/spirit, which may occur in the presence or absence of disease.  It is an emerging, dynamic process.  Illness is the subjective experience of disharmony, turmoil, and incongruence in mind/body/spirit that necessarily affects the integrity of the whole.  Illness is not the opposite of health but may be seen as a potential health experience, as it offers the individual an opportunity to gain greater self-knowledge and a greater awareness of the purpose and meaning of life.  In the diagram, the human health experience is culturally based and interactive with the patterns of knowing as indicated by the dotted line around the core.

The health care organization functions as a structured context in which aspects of the human health experience are enacted.  The nurse is part of the organizational context and exhibits a transpersonal leadership role in facilitating patient care.

Caring:  the core of nursing in the human health experience by:

1. Intentional acts based on the welfare of another: which may promote health, prevent illness and/or encourage wellness: the process of caring.

2. An affective dimension of nursing in which the nurse experiences a concern for another (e.g. empathy), an attitude rather than an action (e.g., warmth): the context of caring.

3. A “mind-set” of carefulness, precision, accuracy, caution, and commitment in one’s actions: the content of caring.

4. Moral imperative, attitudes, beliefs, values and moral basis: the ethics of caring.

In the diagram, caring is depicted as the core of nursing in dynamic interchange with nursing patterns of knowing as indicated by the dotted lines.  Caring is a rhythmic interchange between self, groups and organizations.

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Fundamental Patterns of Knowing in Nursing:  Five fundamental patterns of knowing have been identified as necessary for the practice of professional nursing; empirics, esthetics, ethics, socio-political and personal knowledge (Carper, 1978).  Embedded in each pattern of knowing is an area of unknowing which allows for the decentering of self.

Empirics: The Science of Nursing:  Factual, descriptive, empirical.  Aimed at developing general laws, principles and theories for the purpose of explaining, describing and predicting phenomena of relevance to nursing.  Typified by such traditional nursing content as anatomy, physiology, and pharmacology, as well as, the developing body of scientific knowledge in general, specialty and advanced nursing practice.

Esthetics: The Art of Nursing:  The expressive aspect of nursing.  Knowledge gained through the “subjective acquaintance” of direct experience and made visible in the unique ways in which the nurse uses self on behalf of the individual (Carper, 1984, p. 16). It involves the synthesis and expression of all of the patterns of nursing knowledge into caring which is unique to each nurse.  It necessitates the recognition of the particular rather than the universal and requires integration, synthesis, perception, intuition, creativity, and empathy.  In esthetic knowing there is engaging, interpreting and envisioning.  It is the dance of nursing, it can be seen, and when it is over the effect is still there.

Ethics:  The Moral Imperative of Nursing:  The moral component.  Focuses on issues of duty and responsibility.  This is not just the knowing of ethical codes of conduct, but the ability to discriminate and make moral judgments.  This knowing requires the understanding and the ability to apply a variety of moral and ethical frameworks to complex situations requiring moral insight and judgment.  It is valuing, clarifying and the existential advocacy of the other.  Existential means that the person (other) has the human freedom, will, and knowledge to make decisions on their own behalf.

Personal Knowledge: Self-Understanding:  “concerned with the knowing, encountering, and actualizing the concrete, individual self” (Carper, 19084, p. 18). That knowing of one’s self that makes possible therapeutic use of self and thus, the experience of transpersonal healing.  Personal knowledge is dependent upon the “core capacity” to “access one’s own feeling life-one’s range of emotions: the capacity to instantly effect discriminations among the feelings and, eventually, to label them, to enmesh them in symbolic codes, e.g., language, touch, writing to draw upon them as a means of understanding and guiding one’s behavior” (Gardner, 1983, p. 239). Personal knowledge, then, is encountering the self, focusing on the self, and realizing the self.

Socio-Political:  The context of nursing.  This pattern of knowing addresses the context of persons (nurses and others) and the practice of profession (both society’s understanding of nursing and nursing’s understanding of society and its politics). In other words, whose views are being heard and whose are being silenced.  The essential characteristics are exposing, exploring, transforming, transposing and critiquing (White, 1955).

Socio-Political knowing is operationalized through knowledge of Health Care Systems and Policy.  Knowledge of health care systems includes an understanding of the organization and environment in which nursing and health care is provided.  Health care policy shapes health care systems and helps determine accessibility, accountability and affordability.

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The fundamental patterns of knowing are revealed through the following processes:

Critical Thinking:  A cognitive process based on reflective thought and a tolerance for ambiguity which has the following attributes:

1. Disciplined and self directed.

2. Oriented toward inquiry, analysis and critique.

3. Multidimensional and multilogical problem-solving rather than unidimensional, monological, or linear requisite knowledge and ability to generate options and make discriminating judgments.

A model within nursing used to depict an aspect of critical thinking is the nursing process.  The nursing process may be defined as a systematic problem solving method, used in any patient care situation, for assessing the patient’s health status and related needs, formulating nursing diagnosis, planning with the patient to resolve identified needs, implementing nursing interventions, and evaluating the outcomes to determine the effectiveness of the plan or the need for further revision.

Communication:  Reciprocal sharing with individuals of written, oral and non-verbal information according to a common set of rules (e.g. language).  This definition includes:

1. Communication in groups

2. Communication through information technology, audiovisual media production

3. Communication includes using information in clinical decision-making and maintaining confidentiality.

4. Communication through esthetic endeavor such as sculpture, painting, and performance (e.g. drama).

5. One to one communication

Therapeutic Nursing Interventions:  To do no harm.  Actions, behaviors and healing strategies of the nurse which facilitate transpersonal healing through a shared human health experience.  Skills used to support and empower the other to maximize their healing potential.  This definition includes:

1. Implementation of clinical decision-making and skills.

2. Interventions critical to the practice of nursing.

3. Theory based nursing activities.

4. Interdisciplinary collaboration.

Healing:  transformative and spiritual; a basic key to healing is acceptance.