DNP/705 Week 1: Philosophy of Science and Nursing's Ways of Knowing, sample paper

A Bathroom Scale Still in Its Box: What Empirical, Ethical, Personal, Aesthetic and Sociopolitical Knowing Each Reveal About Heart Failure Patients Who Do Not Weigh Themselves

[Student Name]

University of Phoenix

DNP/705: Philosophy, Theory, and Science for Nursing Practice

Week 1 Assignment

[Instructor Name]

[Date]

The clinic and patient are composites written for a model paper.

I am a nurse practitioner in an outpatient heart failure clinic serving a mid-sized city and its rural surroundings. Daily weights are a cornerstone of self-care: a steady climb on the scale often shows fluid building up several days before a patient feels short of breath. Our clinic gives every new patient a scale. At a home visit last month, I found one still in its box, four months after it was given. When I checked our records, only about 40% of our patients reported weighing daily. This paper examines that problem through the philosophy of science and nursing's ways of knowing.

A Positivist Reading

In a positivist or postpositivist view of science, knowledge comes from observation and measurement, and causes can be identified by controlling variables. Weaver and Olson (2006) describe positivism as assuming a single reality that can be measured objectively and postpositivism as accepting that such measurement is imperfect and probabilistic. From this view, I would ask which variables predict daily weighing, such as age, education, depression or the number of reminders, and test an intervention in a controlled study.

What That View Misses

A positivist question assumes that the reasons patients do not weigh themselves can be captured as measurable variables. The woman with the boxed scale told me she did not weigh herself because "every time the number goes up, I feel like I've failed." No survey item in our clinic captured that meaning. Weaver and Olson (2006) describe interpretive paradigms as assuming that reality is constructed through human experience and meaning, which requires methods that explore how people understand their situations.

Carper's Patterns of Knowing

Carper (1978) proposed that nursing knowledge includes four fundamental patterns: empirics, the science of nursing, which is factual and generalizable; esthetics, the art of nursing, which involves perceiving and responding to the particular situation; personal knowledge, which concerns the nurse's knowledge of self and genuine relationships with patients; and ethics, the moral component, which involves judgments about what ought to be done. She argued that each pattern is necessary and none is sufficient alone.

The scale in the box was an empirical fact; the reason it stayed there was a question only the other patterns could answer.

Empirics

Empirical knowledge tells me that daily weighing, combined with a plan for weight gain, helps detect decompensation early. It also tells me the rate in our clinic, 40%, and could tell me whether reminders increase it. This knowledge is essential but incomplete.

Esthetics

Esthetic knowing is the art of perceiving what this particular patient needs. For the woman who felt failure at every rising number, the art lies in reframing the scale as an early warning that protects her rather than a test she fails. For another patient, a retired engineer, daily numbers were motivating. The same practice needs different framing for each person, and that framing is an art.

Personal Knowledge

Personal knowledge asked me to look at myself. I realized I had been telling patients to weigh daily in a tone that implied judgment. When I shared with one patient that I also struggle with habits I know are good for me, the conversation changed. Carper (1978) describes personal knowing as authentic engagement, which requires the nurse to know herself.

Ethics

The moral pattern concerns what I should do here. Should I push patients to weigh daily when it causes distress? Respecting autonomy means accepting that some patients choose not to, while beneficence means helping them understand the risk. For the woman with the boxed scale, we agreed she would weigh three times a week and call if she gained, a compromise she chose.

Sociopolitical Knowing

White (1995) reviewed Carper's patterns and proposed a fifth, sociopolitical knowing, recognizing the social, political and economic context of care. It asks about the conditions in which patients live. Two of our patients who did not weigh daily lived in apartments without a flat, hard floor where a scale could work reliably. Another shared a bathroom with five family members. A third could not read the small digits on our scale. These are not failures of motivation; they are conditions of living shaped by income, housing and the choices our clinic made when it bought inexpensive scales.

A Second Patient Through the Same Lens

Mr. T., 71, weighed himself daily for a month, then stopped. Empirically, his record showed a gap. Esthetically, I noticed he spoke about his late wife, who had kept the log for him. Personally, I recognized my own impulse to hand him a new form rather than ask about her. Ethically, I weighed whether to press. Sociopolitically, I learned he now lived alone on a fixed income and had stopped buying batteries for the scale. His lapse had five layers, and a reminder text would have reached none of them.

Integrating the Patterns

Each pattern changes my question. Empirics asks what predicts weighing. Esthetics asks how to frame it for this person. Personal knowing asks how I show up in the conversation. Ethics asks what I should require. Sociopolitical knowing asks what conditions make weighing possible or impossible. White (1995) argued that the patterns should be used together, and together they suggest an intervention far richer than a reminder text.

Implications for My DNP Work

A doctoral project on daily weighing could include a large-display scale for patients with low vision, a housing and space screen at enrollment, motivational framing tailored to each patient and measurement of weighing rates. It could also include interviews exploring what the numbers mean to patients, bringing interpretive knowledge alongside empirical data.

The Limits of Each Pattern Alone

Used alone, empirics can reduce patients to adherence rates, esthetics can drift into intuition without evidence, personal knowing can become self-absorption, ethics can stall action with deliberation and sociopolitical knowing can excuse clinicians from what they can change in the room. Carper (1978) warned that no single pattern is sufficient, and my experience with these patients bears that out.

Philosophy as a Practical Tool

Before this course, I would have called this problem "nonadherence" and looked for a better reminder system. Examining the philosophical assumptions behind that label shows that it assumes the problem lies in the patient. Nursing's broader ways of knowing locate the problem also in the relationship, the ethics of the request and the social conditions of patients' lives.

Conclusion

A positivist view of science can measure how many heart failure patients weigh themselves and test interventions, but it cannot capture the meaning a rising number holds for a patient or the housing that makes a scale unusable. Carper's four patterns of knowing and White's sociopolitical knowing each reveal something different about the scale still in its box, and together they point toward a more complete and humane approach to daily weighing.

References

Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13-24. https://doi.org/10.1097/00012272-197810000-00004

Weaver, K., & Olson, J. K. (2006). Understanding paradigms used for nursing research. Journal of Advanced Nursing, 53(4), 459-469. https://doi.org/10.1111/j.1365-2648.2006.03740.x

White, J. (1995). Patterns of knowing: Review, critique, and update. Advances in Nursing Science, 17(4), 73-86. https://doi.org/10.1097/00012272-199506000-00007