In this first level, logic and analysis are used to assess knowledge about knowledge to determine what is already known by the practitioner and methods for obtaining existing knowledge from other sources. Carper had originally defined this level as empirics, since the term relates to specifically to nursing science, with its knowledge base formed on proven solid facts. The nursing scholars, Patricia A. Higgins and Shirley M. Moore, in their 2000 research paper Levels of Theoretical Thinking in Nursing, note that at this stage philosophical questions may be asked that science cannot answer.
Originally defined as ethics by Carper, this level was based on moral codes and ethical decision making. Today, this level is defined as grand theories, which is made up of a wide number of paradigms built on theoretical and disciplinary knowledge from the nursing science. These are theories that hold true regardless of the patient, geographical area or cause of illness or injury. The grand theories are often defined by particular individuals throughout the history of nursing considered the grand theorists, according to Higgins and Moore. One such individual is Margaret A. Newman, an R.N. and a Ph.D., and her Health As Expanding Consciousness Theory.
The art of nursing, what Carper called esthetics, was based on intuition, interpretation, understanding and valuing. It is highly subjective for both the nurse and the patient. Nursing practice theories within this level do not address all patients in all circumstances or environments. Patient age, pain tolerances, type of trauma or illness and cultural norms are but a few things that affect the way a nurse applies treatments.
The term "practice theory" is often used as a description of this level basing knowledge on technical skills. Originally, Carper had defined this level as personal knowing, referring to an awareness of self and how one relates to others, since nursing is an interpersonal process. Higgins and Moore proposed that this level not be limited only to the knowledge of technical skills, but should include a second part that acknowledges the necessity of a nurse to theoretically think through various scenarios while administering treatments.