Fowler et al1 analyzed stories written by new graduate nurses or registered nurse (RN) residents on graduation day after completing a 12-month transition to practice program (TPP). Five themes and subcategories were identified through qualitative analysis. One them was the art of nursing, with subcategories of senses, patients as people, and families too.
Study results were used in the TPP by changing the questions to focus on the 5 themes. At graduation from the yearlong nurse residency program, nurses had the option to answer any 1 of 5 questions, including "What is the art of nursing?" Investigators took a "deep dive," through qualitative description, into answers to this question.
THE ART OF NURSING
Three subcategories depicting the art of nursing included use of the senses, patients as people, and inclusion of families.1 A few nurse resident graduates wrote about the tears, hugs, laughter, and smiles, all reflective of our senses, that are part of the art of nursing. These actions speak to compassion, empathy, and communication, "sometimes without words" and provide "hope, comfort, and simple kindness."
Treating patients as people was commonly noted in the art of nursing as described by the nurse resident graduates. Treating the patient in a holist manner was noted in the following words:
* "Nurses are the hands, legs, voice, ears, stomach, backbone, and heart of the patient."
* "Nurses attend to physical and medical needs AND the patient's heart needs too."
There were other mentions of heart in the stories besides the one noted above. The art of nursing is "a work of heart," and nurses must attend to physical and medical needs of patients and 'the patient's heart needs too."
When caring for patients as persons, nurses need to respect their individual needs, recognizing that "every patient requires a different kind of care" with interventions tailored to each individual patient. Developing a relationship with the patient meant including the family as well by "building trust."
Graduation stories about the art of nursing by the RN residents depicted a number of "pictures" of what the art of nursing might look like. One nurse resident described the art of nursing being similar to a painting with "a seamless blend of colors, shapes, and lines." Consistent mention was made about the art of nursing being a blend of compassion, along with empathy, patience, integrity, and knowledge. The art of nursing reflects nurses as "the face of the hospital" since they are "the first and last step in observing, advising, implementing, and evaluating a patient's course of treatment." "Nursing is a full-service island, caring for the total patient," wrote one nurse resident. Another "picture" had to do with balance, with residents describing the art of nursing as "a balancing act."
A common word used to highlight the art of nursing was advocating, both for patients and nursing. The act of advocating meant that nurses "take care of patients at their best and worst times of their lives while maintaining professionalism and calmness under pressure and stress." In other words, nurses advocate or "promote healing." They advocate for patients when they are unable to speak for themselves.
DISCUSSION
The art of nursing did address the subcategories of senses and patients as people. Senses attest to the use of nurses' whole self, especially their eyes, seeing and crying. The art of nursing does not require words for communication, but it seems to require seeing the patient leading to the heart of nurses, as described by nurse residents. Patients were seen as persons or individuals in the writings of the nurse residents, and nurses use their whole being that they extend to the whole patient, recognizing that each patient is an individual with unique needs. Within this nursing care there is advocacy, RN residents created a visual representation of the art of nursing in their stories. The picture is a blend of colors with a start and finish in which the pattern is balanced by nurses.
Nursing extends beyond the parameters of checking boxes and completing tasks. The art of nursing, as described by nurse residents, aligns with literature that highlights attributes of the art of nursing. Benner2 suggests that gentle touch, one of the senses noted by the nurse residents, is an attribute of the art of nursing. Palos3 suggests that care, compassion, and communication are 3 core principles guiding nursing practice. Use of senses is embedded in these principles. Our nurses expressed that they often balance knowledge and skills required to take care of patients with compassion, empathy, and sensitivity. The holistic nature of the art of nursing described by nurse residents is supported in the literature as well.2,4,5
IMPLICATIONS FOR PRACTICE AND EDUCATION
Clinical nurse specialists can assist new nurses with exploration of the art of nursing by encouraging collaboration among nurses with volunteer services, pastoral care, guest services, and other departments committed to patient-centered care. Collaboration with the information technology department to streamline the electronic health record to remove duplication and increase ease of use can assist the new nurse by allowing extra time to practice such skills as showing compassion and expressing sensitivity.
Research has shown benefits to introducing the humanities into TPPs (also known as "Arts-Based Pedagogy"), such as improving observation and description skills and facilitating the development of empathy, compassion, and cultural awareness; collaboration; awareness of multiple perspectives; understanding one's unique personal context; and holism in nursing care.6,7 By exploring various works of art in several classroom exercises, the nurses reported a sense of self-awareness and were better able to make emotional connections with patients and families. Anglin et al6 report showing new nurses, across several different nursing specialties, the picture of Van Gogh's Seated Woman and Bruegel's The Harvesters. In this active listening exercise, each nurse was asked to give a description of the painting to others in their small groups, focusing on 1 aspect of the painting. The groups rotated roles among being the speaker, listener, and observer. Reported takeaways from this activity were that although the art was the same for each participant, each nurse "noticed" different details and interacted differently with the images. Arts-Based Pedagogy can include creating works of art through several outlets such painting, sculpting, poetry, and song.
SUMMARY
Reflective opportunities throughout a TPP offer new RNs the time to think about their practice, the art and science of nursing. Reflective stories at graduation from a TPP provided investigators with written transcripts to determine themes and a deep dive into the richness of these stories.
References