Five Ways of Knowing, One Mentor Model and a Teacher's Sequence: A Personal Framework for Doctoral Practice in a Community Health Center, Tested Against a Case of Uncontrolled Hypertension
[Student Name]
University of Phoenix
DNP/705: Philosophy, Theory, and Science for Nursing Practice
Week 8 Assignment
[Instructor Name]
[Date]
The author and case are composites written for a model paper.
I am a family nurse practitioner in a community health center serving 9,000 patients, most with public insurance or none. Over this course, I have examined philosophy of science, nursing theory, implementation, ethics and teaching. This paper assembles what I will carry forward into a personal framework for doctoral practice and tests it on a patient and on a clinic problem.
Philosophical Grounding
I hold that reality in health care is both material and experienced: blood pressure is measurable, and what it means to a patient is constructed through her life. This leads me to value empirical evidence while insisting on interpretive understanding and attention to social conditions. My framework therefore begins with nursing's patterns of knowing.
Component One: Five Patterns of Knowing
White (1995) extended Carper's four fundamental patterns, empirical, esthetic, personal and ethical, by adding sociopolitical knowing, which attends to the forces of money, policy and social position that surround every encounter. For me, sociopolitical knowing is essential in a community health center, where transportation, insurance and housing shape every plan. In my framework, every problem is examined through all five patterns before a plan is made.
Component Two: EBP Mentorship
Melnyk et al. (2017) tested the ARCC model in a health system and found significant increases in clinicians' evidence-based practice beliefs and implementation, movement toward an evidence-based organizational culture and improvements in several patient outcomes. The model's central idea, that mentors build clinicians' beliefs and skills, which then drive practice, fits my role as a doctoral nurse who will both use and spread evidence. In my framework, I act as an EBP mentor for our clinic's nurses and medical assistants.
Component Three: A Teaching Sequence
Taylor and Hamdy (2013) present a model of adult learning moving from prior knowledge and a trigger, to gathering information, to sense-making, application with feedback and consolidation. In my framework, this sequence guides how I teach patients, staff and students, since so much of doctoral practice is teaching.
A framework is only useful if I would reach for it on a busy Tuesday; this one has to earn its place in a 20-minute visit.
Why These Three
I considered building my framework around a single grand theory, but in a community health center I need tools that fit many kinds of problems. The patterns of knowing are broad enough for any encounter, the ARCC model addresses the gap between evidence and practice that I see every day and the teaching sequence addresses the fact that most of my influence comes through teaching patients and colleagues.
Ethics as the Thread
Ethics is not a separate component but a thread. Respect for autonomy shapes how I use the patterns of knowing, justice shapes which clinic problems I prioritize and honesty shapes how I mentor. In a setting where many patients have been poorly served, I hold that fairness is part of good practice, not an addition to it.
How the Components Fit
The patterns of knowing tell me what to look at. The ARCC model tells me how to build evidence into the practice of others. The teaching sequence tells me how to help people learn and change. Ethics runs through all three: every plan respects autonomy and pursues justice, especially for patients whom the system underserves.
Test One: A Patient
Mr. D., 56, a line cook, has blood pressure of 168/102 despite two medications. Empirically, the evidence supports adding a third agent and home monitoring. Esthetically, I notice he is embarrassed and answers briefly. Personally, I recognize my frustration and set it aside. Ethically, I ask what he wants: he wants to avoid a stroke like his father's. Sociopolitically, I learn he cannot afford a home monitor and works split shifts, so he misses doses. Using the teaching sequence, I start with his knowledge, "My dad took pills and still had a stroke", provide information through a teach-back conversation, let him practice using a loaner monitor in the clinic, give feedback on his technique and schedule a call to consolidate. We simplify to a once-daily combination pill.
Test Two: A Clinic Problem
Only 52% of our patients with hypertension have controlled blood pressure. The five patterns frame the problem broadly: evidence on team-based care, the experience of patients, our own clinic habits, fairness across groups and social barriers. The ARCC component suggests training two medical assistants as blood pressure champions, with me as mentor. The teaching sequence structures their training. The framework turns a statistic into a plan.
Results of the Tests
Three months after the visit, Mr. D.'s blood pressure was 138/86, and he reported taking his pill daily. In the clinic, the medical assistant champions began rechecking elevated readings and teaching home monitoring. Our control rate rose to 58% over six months. Without a comparison group, these gains prove little on their own, yet they show the framework producing action.
Using the Framework in My DNP Project
My project will address hypertension control. The patterns of knowing will shape the assessment, the ARCC model will shape how I build staff capacity, the teaching sequence will shape patient and staff education and ethics will guide attention to patients least likely to reach control. The framework gives the project coherence.
A Third Test: A Student
When a student recently wanted to lecture a patient about diet, I used the teaching sequence with the student instead: what did she already know about the patient, what information was missing, what could she try and what feedback would help. The framework applied to teaching the teacher.
What the Framework Leaves Out
My framework is weaker on organizational systems and finance. As a DNP-prepared leader, I will need to add systems thinking, which later courses will address.
Teaching Students With the Framework
I precept nurse practitioner students each term. The framework gives me a way to teach them to look beyond the diagnosis: after each visit, I ask a student what each pattern of knowing revealed. Students often begin with empirics only, and by the end of the term they notice the sociopolitical details that change plans. The teaching sequence structures how I give them feedback.
Revising the Framework
A framework should change as I learn. My current version emphasizes individual encounters and small-team mentoring; as I take on larger leadership roles, it may need components for organizational change and policy. I will review it each year against my practice and the evidence, keeping what helps and revising what does not.
Conclusion
My personal framework joins White's five patterns of knowing, the ARCC model of EBP mentorship and an adult learning sequence, with ethics running through each. Tested on one patient and one clinic problem, it helped me see more of the situation, act on evidence through others and teach for change. It will guide my DNP project and my practice as a doctoral nurse.
References
Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Choy, K. (2017). A test of the ARCC model improves implementation of evidence-based practice, healthcare culture, and patient outcomes. Worldviews on Evidence-Based Nursing, 14(1), 5-9. https://doi.org/10.1111/wvn.12188
Taylor, D. C. M., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11), e1561-e1572. https://doi.org/10.3109/0142159X.2013.828153
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
How this DNP 705 Week 8 example is structured
The DNP/705 Week 8 work usually closes with a personal framework for doctoral practice. This paper states the framework's components and their philosophical grounding, shows how they fit together and demonstrates the framework in use, so that it serves practice rather than decoration. Students search this week as DNP 705 Week 8, DNP705 Wk 8 or DNP/705 Wk 8; all three are the same assignment.
DNP/705 Week 8 questions, answered
What does DNP/705 Week 8 usually ask for?
Many sections close with a personal framework for doctoral practice that integrates philosophy, nursing theory, ethics and teaching-learning theory into a coherent approach.
What is the ARCC model?
The Advancing Research and Clinical practice through close Collaboration model, which uses evidence-based practice mentors to build clinicians' beliefs and skills and move organizations toward an evidence-based culture.
Why build a personal framework?
A framework makes a practitioner's assumptions explicit and gives a consistent structure for assessing problems, choosing evidence, acting ethically and teaching others, which guides doctoral practice and the DNP project.
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