In the last decade, there has been a revitalized recalibration of the focus of health care. We are once again convinced that the person, the human being, is indeed the center of the sum of all our efforts. In addition to the person-client, there are also the providers and the significant relationships with which we are all connected - all have an impact on the health care experience.
This is not new. All nursing theories profess both an elegiac and hopeful view of the centrality of the "human" and "being," the main focus of the study of humanities and health sciences. Therefore, it came as a surprise when a report by Benner and colleagues announced that "US nursing programs are not generally effective in teaching nursing science, natural science, social sciences [horizontal ellipsis] and humanities" (Benner, Sutphen, Leonard, & Day, 2010, p. 12). This article aims to add a small voice to the call for teaching for a sense of salience in nursing through the meaningful synthesis of humanities in baccalaureate education.
WHAT IS MEANT BY HUMANITIES?
In simple terms, the humanities encompass the study of how people process and document the human experience. They are the stories, the ideas, and the words that help us make sense of our lives and our world (Stanford Humanities Center, n.d.). The narratives of the human experience have been expressed in literature, art, history, languages, philosophy, and many other branches of the humanities to help us make sense of our world. They are, in some way, our umbilical connection to our collective humanity and human becoming. In nursing, the humanities are implicit in the formal and experiential elements of the curriculum, given that nursing is both a humanist and professional field of study (Carper, 1978).
WHY THE HUMANITIES ARE IMPORTANT IN NURSING
The seminal recognition of the importance of integrating the humanities in nursing education came from Carper's (1978) pioneering work, Fundamental Patterns of Knowing in Nursing. Carper proposed that esthetic knowing is a valid and an indispensable component in the cultivation of empathy and development of ethical comportment of nurses (Benner, 1982; Carper, 1978). Because aesthetics are intricately linked with humanities, both are potent means to know what we know. The caring professions, which include nurses and doctors and other disciplines, have the unique privilege to enter willingly into the human experience when caring for a patient or client. There is a revered expectation that, as health providers, we can make better sense of the human condition because we interface with people in their most vulnerable situation through emphatic acquaintance. This might be true to some extent, but the human experience is vast and multilayered and not so easily understood.
The value of the lifelong study of humanities for nurses is the invitation for contemplation on the human experience so we can make informed moral, spiritual, and intellectual sense of the world. In essence, when we understand, we become more empathetic. The purposeful study of humanities brings nurses to a higher level of sensitivity and critical analysis about life. Carper asserts that "the more skilled the nurses become in perceiving and empathizing with the lives of others, the more knowledge or understanding will be gained of alternate modes of perceiving reality. The nurse will thereby have available a larger repertoire of choices in designing and providing nursing care that is effective and satisfying" (Carper, 1978, p. 18). Through cultivated use of aesthetics, nurses can become a certain kind of person, not merely doing certain kinds of things (Carper, 1978).
PROSPECT FOR CURRICULAR INTEGRATION
A nursing curriculum that values the study of humanities is enriched with student-centered activities that make use of esthetic patterns of knowing and promote intellectual curiosity. Institute of Medicine and Quality and Safety Education for Nurses competencies indirectly allude to the merits of integrating humanities in health professional education. The aim of the empirics is the discovery of truth, whereas in aesthetics, it is the recovery of once-known truth (Harvard University, 2013) with the use of human intuition. Both empirics and aesthetics are essential elements in the formation of clinical and moral imagination (Benner et al., 2010), before they are taken over by the hegemony of evidence-based practice.
A short curricular crosswalk is an easy first step to appraise areas for meaningful synthesis of nursing and humanities. One such strategy is to contact a local museum and set up a health care-focused tour. From our experience, museums are willing to curate specialized tours after we explain the aim of the activity (e.g., highlighting the intersection of health and the arts). One such tour, organized by a world-renowned museum, was titled "Health and Illness in the Arts." It highlighted artifacts from prehistoric times to modern art that depict health and illness themes - both in the artwork and of the artist - situated in their historical context.
Another activity is to organize a trip to see live opera. Watching the opera Madam Butterfly is a creative way to highlight cultural sensitivity and themes in health difference. Faculty are encouraged to explore intrauniversity collaboration (e.g., with the humanities or the arts department) or local institutions (e.g., historical societies) to implement novel programming in nursing humanities.
HUMANITIES IN FACULTY DEVELOPMENT
In many institutions of higher education today, faculty development is a serious and thriving enterprise. Nurse faculty development needs are unique in that they are charged with shaping the future nursing workforce's social and moral contract with society. It is hoped that the study of humanities will boost faculty habits of critical thought. We propose that humanities-infused faculty development (e.g., critiquing art as a means to develop skills in giving feedback or using a trip to the museum to inspire integration of history in lectures) offers fresh ground for enhancing faculty capacity for creative teaching, team building, leadership development, adoption of instructional technology, and enhancing faculty work satisfaction and collaboration.
Our school recently collaborated with the Arts Fusion Initiative to conduct a humanities-inspired faculty development workshop. The Arts Fusion Initiative is a group of students and alumni from the Julliard School who fuse their different artistic backgrounds - dance, drama, and music - to create original live performances that reflect a synthesis of shared and conflicting interpretations of a given theme from poetry. During the workshop, the group incorporated our faculty into their multidisciplinary, collaborative process, ultimately creating an original work of music, dance, and theater that reflected faculty interpretations and was performed by the faculty and artists.
Although marketed to faculty as a workshop on collaboration, creativity, and time to escape the bounds of their disciplines, the workshop demonstrated the bountiful confluence of nursing and the humanities and how it can be tapped in a physically, intellectually, and emotionally engaging experience. Although it is unknown what the measureable outcomes of this exercise are, anecdotal feedback from attendees was very positive and optimistic. One faculty member remarked: "I've fully come to believe that in places where the deepest necessary conversations are lacking or where it becomes too easy to fall into the regimented mindsets that govern our everyday lives, engaging with each other through our common language of the arts brings the possibility of transformative connection." Another wrote: "I thought I hated poetry, until today, when I realized how many ways and approaches there could be into it. I felt my spirit elevated by the inclusion of classical music and dance[horizontal ellipsis]without a PowerPoint presentation."
The school's next faculty workshop explored creative writing and reflective practice through narrative medicine. It was facilitated by a nurse-midwife on the faculty of the narrative medicine department from another school of nursing.
WHAT OUTCOMES ARE EXPECTED FROM NURSING HUMANITIES?
The renewed focus on the patient's perspective and a departure from paternalistic care appear to coincide with an evidence-based shift toward viewing learning as an incremental, social, and participatory process and teaching as developing these environments and facilitating these engagements. The study of humanities can help clarify sense of purpose for health providers and nursing faculty (Harvard University, 2013) through the assiduous contemplation of the patient or the teaching-learning experience. To complement the technical competencies expected from nurse graduates, humanities experts envision the translation of formal skills from university to the professional world that includes competencies such as the ability to absorb, analyze, and interpret complex artifacts or texts; the capacity to speak and write intelligently, lucidly, and persuasively; and the ability to participate effectively in deliberative conversations.
These combined competencies underscore the notion that nursing arts is an intellectual as well as a manual activity (Carper, 1978). In addition, there is a tacit understanding that (nursing) students aspire to be more. By virtue of their curiosity and idealism, they seek not only training but also a well-rounded education that will prepare them for both a career and for life (Harvard University, 2013). Developing such competencies is not self-indulgence or an educational luxury; it is a reasonable expectation of those who would lead the future of nursing.
Combined together, nursing humanities is the purposeful synthesis of the art and science of nursing, humanities, narrative medicine, and interprofessional education for creating a sense of salience. Central to this amalgam is the development of creative and competent person-centered care for all health care consumers - patients, clients, families, and communities. Nursing humanities offer an opportunity to map powerful interprofessional synergies and affinities with social and natural sciences (Harvard University, 2013).
High-quality and inquiry-based educational programming in nursing humanities, beyond the confines of the classroom, will provide a qualitatively robust approach to enhance person-centered care competencies of future nurses. Ultimately, a nursing education steeped in nursing humanities will create a cadre of future nurses who will value reflection, creativity, and self-discovery.
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