Carper’s Patterns of Knowing serve as the theoretical underpinning for this review, providing a comprehensive lens for analyzing how oncology nurses acquire and apply knowledge to address the complex needs of women diagnosed with breast cancer. Building on Carper’s foundational work and its subsequent advancements, nursing knowledge is delineated into 4 interrelated patterns: empirical knowing (the scientific foundations of nursing), personal knowing (reflective awareness within the nurse–patient relationship), ethical knowing (moral reasoning and advocacy in clinical practice), and aesthetic knowing (the art, intuition, and creativity integral to understanding individualized patient experiences). Collectively, these patterns advance nursing practice beyond a solely biomedical orientation, promoting a holistic approach that encompasses physical symptoms, psychological distress, social dynamics, and spiritual-existential concerns encountered throughout the breast cancer continuum. In this study, Carper’s framework is adopted as an organizing scaffold for interpreting the literature on concerns of patients with breast cancer, illustrating how each pattern of knowing informs and guides oncology nurses in recognizing, analyzing, and comprehensively managing these multifaceted concerns.10

In this analysis, the findings represent the outcome of a Carper-guided narrative conceptual analysis. Drawing on Carper’s 4 fundamental patterns of knowing represented in 4 primary themes—empirical, aesthetic, personal, and ethical—relevant literature and practice-based insights regarding the concerns of patients with breast cancer were repeatedly reviewed, reflected upon, and interpreted. Each source was examined in depth through the lens of these patterns to illuminate how women’s experiences, needs, and challenges are understood, articulated, and addressed within oncology nursing practice. The following sections provide a narrative synthesis of these interpretive insights, structured around Carper’s patterns of knowing. Figure 1, developed by the first author, summarizes the essential synthesized information from each pattern. It illustrates the 4 fundamental patterns of knowing, their sources, and their implications for nursing practice, nursing research, and women with breast cancer.

Carper’s theory of knowing emphasizes the importance of personal experiences in shaping one’s understanding and actions within a specific field.10 The first pattern of knowing, known as personal knowing, holds particular significance in oncology nursing, especially in understanding the self-compassion of patients with breast cancer. An oncology nurse’s personal experiences can profoundly influence their emotional state and drive to address the mental and physical concerns of these patients. These experiences have enabled nurses to recognize the necessity for improvements in practice, particularly as they have encountered numerous women after breast cancer surgery who were psychologically distressed and struggled with changes to their body image in their daily lives.11

The personal and professional experiences embedded within a nurse’s practice fundamentally inform their motivation, shape their actions, and deepen their expertise. These lived encounters serve as a critical foundation, empowering nurses to more effectively explore, refine, and theorize the art and science of their clinical work. By reflecting on these experiences, oncology nurses can better understand their patients’ needs and challenges, which can contribute to their clinical training and improve patient outcomes.12 The role of personal experience in shaping the emotional understanding and motivation of nurses is significant within clinical practice.13 By engaging in self-reflection on their own experiences, nurses can enhance their emotional intelligence and develop a deeper understanding of their patients’ needs.14 This reflective process is essential for developing the skills and knowledge necessary to deliver compassionate and effective patient care. Through learning from both positive and challenging experiences, nurses can develop resilience and empathy, ultimately enhancing their professional competence and the quality of care they provide.14

Aesthetic knowing, as proposed by Carper, highlights the significance of the art and beauty of nursing in enhancing the understanding of oncology nursing regarding the mental and physical concerns of women diagnosed with breast cancer.10 This approach involves using qualitative research methods and creative expression through media, such as poetry, to provide a more comprehensive and holistic approach to patient care. It emphasizes the importance of subjective experience and personal interpretation, highlighting the role of intuition, emotion, and imagination in understanding patients’ perspectives and needs.

Qualitative research investigates the perception of patients with breast cancer of their bodies, a perception profoundly influenced by the aesthetic pattern of knowing; phenomenological qualitative research allows the researcher to explore the participants’ lived experiences.15 Phenomenological research plays a crucial role in advancing our understanding of individuals’ experiences, particularly in the context of breast cancer and the profound implications of mastectomy.16 By delving into the narratives of those affected, this research facilitates a more in-depth examination of how women perceive their bodies after breast cancer surgery. Insights gained from these personal stories are instrumental for nurses and healthcare professionals, as they can better comprehend the mental and physical needs, as well as the concerns of their patients. This understanding ultimately fosters more compassionate and tailored care approaches, thereby enhancing the overall support provided to individuals navigating their breast cancer journeys.17

Poetry is a valuable artistic medium that nurses use to convey their sense of individuality in caring for patients. It is a significant representation of nursing aesthetics and aids oncology nurses in gaining insights to cultivate a novel understanding about patients and the nursing profession.18 Nurses can draw inspiration from poetry to reflect on their interactions with patients, ultimately enriching their practice and fostering a more profound understanding of the compassionate aspects of nursing.19 Poetry illuminates the significance of the distinctive attributes of a healthy nurse–patient relationship, enhances the emotional intelligence of healthcare professionals, and underscores the importance of a supportive relationship in the healing process.

Aesthetic knowing involves the ability to perceive, interpret, and empathically connect with the unique emotional and psychological landscape of a patient facing a cancer diagnosis.20 By integrating aesthetic knowing into their clinical practice, oncology nurses can gain a deeper understanding of the complexities of cancer care and develop more meaningful relationships with their patients.19 Moreover, by incorporating the principles of aesthetic knowing, nurses can be better equipped to address the multifaceted challenges that patients and their families face, ultimately enhancing patient satisfaction, providing a more compassionate and empathetic approach to patient care, and acknowledging their unique experiences and perspectives.21

Empirical knowing is an essential and valuable pattern of knowing that plays a critical role in enhancing nurses’ understanding of their patients with breast cancer.22 This pattern of knowing involves conducting extensive research to assess the fundamental concepts related to patients with breast cancer, developing precise measurement scales to measure the effectiveness of treatments, and constructing compassion-focused therapies that cater to the unique needs of women with breast cancer. By leveraging empirical knowledge, nurses can gain deeper insights into the complex and nuanced nature of breast cancer, enabling them to provide more personalized and effective care to their patients.

Research indicates that self-compassion is crucial in mediating the relationship between changes in body image and postsurgery distress among women who have undergone breast cancer surgery.9 Furthermore, the mediation model suggests that self-compassion has an indirect effect on body image disturbance, with body surveillance and body shame acting as mediators in the relationship.23

The measurement scale of self-compassion was developed by the theorist Kristen Neff based on empirical research and theory development.24 The self-compassion scale is intended to measure 3 positive components, including self-kindness, common humanity, and mindfulness, with 26 items, where a lower score indicates a lower level of self-compassion.5

Empirical research and scientific knowledge have played a crucial role in the development of compassion-focused therapy. This therapeutic approach aims to alleviate the emotional distress experienced by women who have survived breast cancer. Studies have shown that this innovative therapy has a significant and positive effect on breast cancer survivors, helping them cope with the psychological challenges associated with their disease and improve their overall well-being.25

Empirical knowledge is fundamental for deepening nurses’ comprehension of patients with breast cancer. This encompasses conducting research, creating measurement scales, and formulating compassion-focused therapy. Findings indicate that self-compassion serves as a mediating factor between body image changes and distress experienced by women following breast cancer surgery. The Self-Compassion Measurement Scale, developed by Kristen Neff, assesses self-kindness, common humanity, and mindfulness.5 This empirical knowledge has been instrumental in developing compassion-focused therapy, which has shown a positive effect on breast cancer survivors.26

Healthcare professionals who engage in their practice with a robust ethical foundation typically subscribe to a comprehensive set of ethical standards. They consistently evaluate their decisions to ensure alignment with principles that are deemed morally appropriate and justifiable. This commitment facilitates the preservation of ethical values within their professional conduct.27

Although Carper recognized the importance of adhering to a code of ethics in nursing practice, she argued that these codes may sometimes be at odds with the prevailing healthcare system.10 This discrepancy may result in ethical dilemmas for nurses, as it can conflict with their personal values and hinder their decision-making processes.28 Consequently, nurses frequently find themselves compelled to rely on their moral compass, adjusting it to accommodate the specific circumstances they encounter.29 In oncology departments, nurses play a pivotal role in patient care, often making critical judgment calls that are deeply influenced by their ethical beliefs and commitment to providing care.30 The complexities of cancer treatment require a nuanced understanding of each patient’s unique situation, integrating clinical knowledge with ethical considerations. This intersection of ethics and clinical practice ensures that nurses not only advocate for patient needs but also uphold the principles of fairness and justice in the healthcare system.31

The findings of this study will have significant implications for nursing research and practice, particularly for women who have undergone breast cancer surgery. By illuminating the factors that contribute to body image distress and diminished psychological well-being, the results will help nursing researchers develop effective self-compassion strategies tailored to this population. Furthermore, nursing practitioners will acquire a deeper understanding of these factors, enabling them to implement targeted interventions that foster self-compassion and alleviate psychological distress. This approach can inform nursing education and practice, ultimately enhancing patient-centered care and outcomes. Ultimately, women with breast cancer will benefit from evidence-based strategies aimed at enhancing their body image and overall well-being.

Future research is essential to explore the intricate relationship between ethical knowing and patient outcomes. Additionally, it is essential to evaluate how the application of various patterns of knowing can improve patient outcomes. This investigation will provide deeper insights into the ethical dimensions of healthcare and their tangible effects on patient care.

This Carper-guided analysis advocates integrating Carper’s fundamental patterns of knowing: personal, aesthetic, empirical, and ethical to assist oncology nurses in understanding the comprehensive concerns of women with breast cancer and especially, identifying the role of self-compassion in their concerns. We recommend further research to determine the role of oncology nurses’ personal experience in understanding women’s concerns. Furthermore, investigating the cultural and contextual factors that influence these patterns among diverse oncology nurses is crucial for a comprehensive understanding of this topic.