Another critique on Carper’s work is that it seemed to lack the element of ‘context’—or the sociopolitical environment of the individuals and their relationships (Heath, 1998). In this regard, a fifth pattern of knowing is suggested (White, 1995), which seemed to adequately describe the nurse-patient relationship as well as the ‘persons’ of the nurse and the patient. In other words, this fifth pattern of knowing is crucial to understand all individuals within the sphere caring from the nurse’s perspective.
The pattern of sociopolitical knowing transfers the nurse’s focus from the reflective nurse-patient relationship and positions it within the bigger environment in which health care and nursing occurs. This pattern allows the nurse to make an inquiry about things which have usually been taken for granted in the nursing practice and other pertinent matters like health policies. There are two levels upon which sociopolitical knowing may be conceptualized.
These are the sociopolitical framework of nursing as a profession—which is the mutual understanding between the nurse and society, and the sociopolitical framework of the individuals—patient and nurse. The sociopolitical perspective of the individuals involved in the nurse-patient relationship basically involved cultural identity, since that ‘self’ is inherently situated in culture. This pattern of knowing is further than the concepts of personal knowing of Mayeroff (1971) and Carper (1978).
Nursing concepts, as commented by Chopoorian (1986), require an archeology of society, politics and economy which affect nursing roles and states of patients. Disparate social classification, economic and political control, among others, result in classism, ageism, racism and sexism which impact health and eventually lead to illness (Chopoorian, 1986). Stevens (1989) recommends that nurses must provide a “critique of domination within fundamental social, political and economic structures and the analysis of how domination affects the health of persons and communities.
” This impact covers the visibility and position of nursing in decision making and policy planning regarding issues on health. White (1995) suggests that, in order to partake in these important functions (policy making and decision making), nurses should be distinguished by other individuals as major participants in intellectual pursuits and must be expressive of what they know.
There is a reciprocal relationship between conceptual models of nursing—both grand and midrange—and the nursing practice (Fawcett, 1992). Conceptual models from both theories influence clinical nursing practice and in turn, nursing practice provides information that can then be employed determine the validity of these conceptual models (Fawcett, 1992). Aside from abovementioned uses, King’s general systems theory offers a practical means in organizing and implementing nursing curricula (Gulitz & King, 1988).
The theory elucidates the correlation between individuals and families to communities by employing concepts that describe personal, interpersonal, and social systems. Covering major concepts regarding nursing, society, health and the individual, King’s model has been very useful for nurses whose key element in their practice is their interactions with patients (Ruby, 1995).
The various types of nursing theories offer diverse perspectives to critique and interpret the various types of evidence critical for theory-guided, evidence-based practice of nursing (Fawcett et al. , 2001). Carper’s pattern of knowing has been a well-utilized framework for the past decades. However, as the time-space continuum does change, particularly in the advancements in nursing knowledge, various critical assessments on Carper’s framework has been made and have produced promising results, some of which have been discussed in this paper.