I can’t think of a better way to explore than though A/R/Tography, a practice-based research situated in the in-between, where theory as practice-as process-as compilation serves to unsettle the perception and knowing through living inquiry (Irwin & Springgay, 2008). My interpretation: The who and the what of my being that leads my personal procession.

The concept and art of nursing, has been an evolutionary process (Donahue, 1985). Prior to the development of nursing schools in the mid 19th century, nursing was synonymous with the domestic arts and the routine practice of homemaking and mothering (Peplau, 1988). The role of nursing was mother like in nature whose biological function included nourishing and nurturing the young, caring for persons with diversabilities, the sick, aged, helpless, and wounded (Donahue).

The nurturing and caring role was socially highlighted during mid-1800’s and influential to Florence Nightingale as she developed the concept of modern nursing (Chinn & Kramer, 2008). Nightingale (as cited in Donahue, 1985) acknowledged the art of nursing as she stated,

Nursing is an art; and if it is made to be an art, it requires as exclusive a

definition, as hard a preparation, as any painter’s or sculptors work; for what is

the having to do with dead canvas or cold marble, compared with having to do

with the living body-the temple of God’s spirit; It is one of the fine arts; I had

almost said, the finest of the fine arts (p. 469).

During the time of Florence Nightingale, nursing consisted of basic nursing skills such as: bathing, bed making, comfort measures, housekeeping and positioning of the patient (Donahue, 1985; Peplau, 1988). Paplau (1988) adds during this time, the art of nursing was taught under the rubric of “nursing arts” and commonly called “nursing procedures” (p. 8).

Following the days of Florence Nightingale, the art of nursing was being conceptualized and the science of nursing was introduced in the 1940’s; although, there was no application of science to practice, there was at minimum a reference made to the relationship between science and nursing (Peplau, 1988). From the 1950’s to the 1970’s, nursing as a science took center stage and nursing as an art seemingly disappeared into an empirical shadow (Chinn & Kramer, 2008).

In 1976, Patterson & Zderad developed a humanistic nursing model which suggested that nurses develop knowledge through both personal and aesthetic patterns (Raymond, 2005).  Patterson and Zderad focused on aesthetic knowledge as a way to understand the nature of being with the patient (Appleton, 1991). Their approach assisted in establishing nursing as a human science and provided the nurse with a method to attend to the lived experiences of the patient (Raymond).

The art of nursing, returned to the forefront with Barbara Carper’s “Fundamental Patterns of Knowing” (1978) which emphasized esthetics as one of the four components of knowing. Her work was published at a time when there was a calling to identifying nursing as a unique discipline of knowledge (Boykin, Parker & Schoenhofer, 1993). Carper (1978) challenged those within the discipline to ponder the notion that nursing knowledge extended well beyond the empirical (Gramling, 2002).

Appleton (1991) derived descriptions on the artful craft of nursing from the viewpoint of both patients and clients (Gramling, 2002). Her research utilized a phenomenological-hermeneutic-aesthetic approach which identified five distinctive meta-themes: 1) a way of being there in caring; 2) a way of being-with in understanding caring; 4) a transcendent togetherness; and 5) the context of caring (Appleton, 1991; Gramling, 2002).

Peggy Chinn (1994) published her findings on the art/acts of nursing (Gramling, 2002). The results of her study suggested, aesthetic knowing could be shared as aesthetic criticism, where works of art like poetry, pictures, and stories could also be considered forms of aesthetic knowing (Chinn & Kramer, 2008). The overall purpose of her study was to show that nurses learn through the course of imitation, reflection, varied perspectives, and communal wisdom (Gramling). She believed this form of knowing provided the discipline of nursing with both appreciation and inspiration (Chinn & Kramer).

Today, the art of nursing continues to expand into the 21^st century, but too few have chosen to further investigate this aesthetic practice (Gramling, 2002). Nursing continues to be introspective and caring, as the nurse continues to find new ways to interact artfully not only with their patients, but with their students. Nurses use stories, poetry, music, costuming, and dance as some of many different ways to teach, describe, and provide closure (Wendler, 2002a).

Defining the Art in Nursing

Since the Nightingale era, there have been many contributory efforts to illustrate the art of nursing, but no one definition can adequately capture every aesthetic angle (Chinn & Kramer, 2008). The art of nursing is meant to express a sensitivity which is capable of perceiving both the inner and outer beauty of the being. This beauty represents the relationship between the object and its ideal. The interaction and relationship formed between the nurse and the patient is the foundation in which the art of nursing manifests (Burke, 1992).

Rogers (2005) identified five separate senses for which nursing art can be described. Those fives senses center around the nurse’s ability to: 1) grasp meaning in patient encounters; 2) establish a meaningful connection with the patient; 3) skillfully perform nursing activities; 4) rationally determine an appropriate course of nursing action; and 4) morally conduct his or her own nursing practice (Rogers, 2005).

Powers and Knapp (2006) state, “Nurses may call upon their creative, imaginative abilities to share perceptions of what is deeply meaningful about their practice experiences with others” (p. 2). Nursing is a creative discipline and an art which is directed towards caring for people (Burke, 1992). The art of nursing lies in the creative imagination and the sensitive spirit of the nurse, it is not per se in the technical, but in the background of her knowledge (Burke).

The Aesthetic Experience

The nurse is a frequent bystander to many of life’s finest moments, unforeseen twist, and most tragic times. Aesthetic knowing involves a deep appreciation in the meaning of a situation and calls forth an inner creative understanding which then transforms the experience (Chinn & Kramer, 2008). The following poem and picture captures just a piece of what we call the art of nursing:

As I sit next to his bed, I lean, and hold his cold limp hand.

I see, I hear, I touch, I smell, and I intuitively know.

His eyes are closed, his is mouth open, his body is still.

Not an auditory delusion, I hear the rattle and the marbles roll.

I feel a presence, warmth, a certain peacefulness within the room.

I smell the poignancy of sweet ketones.

He looks at me, I tell him it’s ok to let go, I am with you.

And within seconds, I sense his thoughts have gone.

His worries, his pain, are just a blank in his mind.

He sees no earthly light, he feels no strength.

I lean toward him, with my stethoscope upon his chest.

His heart beats ne’er more ̴

Artistic expressions such as this poem and picture represent the connectedness between the patient and the nurse. The poem is an artistic product which helps provide a subjective expression of emotions, thoughts, and feelings which can then in turn be felt and experienced by others (Wendler, 2002b). The words and descriptions chosen for the poem portray the knowledge inherently learned through practice and previous experiences (Burke, 1992). This author used Rogers (2005) five senses to convey meaning in the situation. The role of the nurse is exhibited using Appleton’s (1991) five meta-themes for caring. The poem also represents the art/act where there is an expression of relationship between the patient and the nurse (Chinn & Kramer, 2008; Wendler, 2002b).

The art of nursing is the ability to come to know the client aesthetically and through this interaction, you as the nurse appreciate the uniqueness of the situation and in turn can reflect upon the experience (Gramling, 2002). Donahue (1985) reminds us “Nursing is not merely a technique but a process that incorporates the elements of soul, mind, and imagination. It’s very essence lies in the creative imagination, the sensitive spirit, and the intelligent understanding that provide the very foundation for effective nursing care” (p. ix).

Conclusion

The nurse is unique as they have the heart and passion exhibited in artful creations and in self expression. The nurse has a soulful spirit which illuminates from beyond the self and searches to capture a greater understanding of the people in which they care for. The nurse is an explorer whose greatest quest is health and wellbeing of the individual and the communities. Nursing as a discipline is much like a tree, our roots continue to be explored and our branches continue to grow as we continue to expand our knowledge base (Parse, 1988).

Reflection:

In A/R/Tography, the rhizom is an assemblage that moves and flows in dynamic momentum (Irwin & Springgay, 2008). It’s the “in-between space” that is constantly changing who we are, what we are, and how we proceed.

1. How would you describe your present rhizome?

References

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