The four patterns of knowing as identify by Carper, are empirics, esthetics, personal knowledge and ethics. More recently, Chin & Kramer (2008) added the fifth, emancipatory knowing (Jackson, 2009). As stated by Carper (1978), these patterns represented the complex phenomenon of knowing that nurses use when caring for their patients. Chin & Kramer added emancipatory knowing to address the issue of equality, justice, and transformation in all areas of practice to include nursing leadership. The five patterns of knowing when used together are beneficial to nursing leadership theory, specifically because they were developed by nurses and for nurses.
Empirics: According to Carper (1978); Fawcett et al (2001), empirics leadership knowing is based on the science of nursing and includes a body of empirical knowledge that is based on research and systematically organized. They noted that empirical knowing is factual, objective and can be verified by “outcome measures” (Jackson, 2009). The postpositivist and interpretive paradigms have attained a welcoming approach in nursing as paradigms for guiding knowledge development (Alligood & Tomey, 2010). For Carper (1978), empirical knowing is how we came to understand the science of nursing and other disciplines that are used in the practice of nursing (Jackson, 2009).
Esthetics: Carper (1978), defines the esthetic knowing as the art of nursing. It is the creative and imaginative use of nursing knowledge in practice as stated in Jackson (2009). This pattern of knowing encompasses non-verbal expressions, therapeutic actions, unconditional presence, and empathy. As stated by Parker & Smith (2010), each nurse is an artist, expressing and interpreting the guiding theory uniquely in his or her practice. One needs to reflect on the experience of nursing to enhance the understanding of esthetic knowing. Only through such reflection, the nurse understands that each instance of nursing is unique, and that outcomes of nursing cannot be precisely predicted (Parker & Smith, 2010). Esthetic knowing gives meaning to the wholeness of experience.
Ethical Knowing: As stated by Parker (2010), ethical knowing is increasingly important to the discipline and practice of nursing today. According to Carper (1978), ethics in nursing is the moral component providing guidance for choices within the complex structure of health care. Ethical knowing guides and direct nurses in doing what’s right, doing what’s ask of them, and what a prudent nurse should or most under any circumstances. Ethical nursing plays a pivotal role in every action taken by the nurse in his/her daily undertaking. Nurses are expected to maintain a high level of professionalism and to maintain their ethical standards at all times. Respect for human dignity, right to self-determination, relationships with peers, accountability and responsibility for own actions, self-respect, influence of environment on nurses, advancement of the profession and assertion of values are all included in the code of nursing ethics (Jackson, 2009).
Personal Knowing: Carper (1978), describes personal knowing as striving to know the self and to actualize authentic relationship between the nurse and the one nursed. By applying this pattern of knowing in nursing, the nurse sees the patient as a person heading toward attainment of potential, rather than viewing the individual as an object (Jackson, 2009). As stated by Jackson (2009), personal knowing encompasses consistency between what one knows and what he/she does. Reflecting on a person as a client and a person as a nurse in the nursing situation can foster understanding of nursing practice and can centrality of relationships in nursing.