The small municipality of Nuoro in Sardinia, Italy, is known for the world's rarest pasta, made for 300 years by women of the Abrainis family. It is estimated that fewer than 10 women in the world can make su filindeu, the threads of God. It has three ingredients: semolina wheat flour, salt, and water. Paola Abraini is the renowned master of su filindeu. She is teaching others to make it so that its tradition will not die out.
UNDERSTANDING WITH THE HANDS
Su filindeu is extremely difficult to make and faces extinction; it has been added to the Slow Food Foundation for Biodiversity's Ark of Taste, a record of cultural foods facing possible extinction. This "ritual pasta," a sacred Christian dish, is served only during the Feast of San Francisco. The dough must be kneaded extensively to an elastic state. The balance of water and salt is critical and is determined by feel. A portion is cut off and stretched, folded back on itself, stretched again, and folded again until it has been stretched eight times. Each time, the threads become thinner until the final stretch reaches 256 threads half the diameter of angel hair pasta. Threads are then laid on a circular platform, a fundu, in three layers, each laid at an angle to the previous, then placed in the sun to dry. To cook, pieces are boiled in mutton broth with fresh pecorino cheese. The dish is served to the hundreds of pilgrims who come to Nuoro on the feast of San Francisco (Atlas Obscura, 2021; Stein, 2016).
After intensively kneading the dough to its perfect elasticity and readiness to be stretched, Paola says,
Then comes the hardest part, a process she calls, "understanding the dough with your hands." When she feels that it needs to be more elastic, she dips her fingers into a bowl of salt water. When it needs more moisture, she dips them into a separate bowl of regular water. "It can take years to understand," she beamed. "It's like a game with your hands. But once you achieve it, then the magic happens." (Stein, 2016, para 8)
Paola reaches into the bowl of flour, scooping in a bit of salt water. She gathers it into a ragged ball and turns it out onto the table. She kneads it for a very long time, her hands judging its denseness, softness, warmth, resilience, elasticity. Her hands know the proper moment at which the dough is to be rolled, cut, then stretched. Her hands know when the dough has reached the limit of stretching, beyond which it will break apart. She then lays the fine strands on the fundu and prepares the next two layers as well, in a weave-like pattern. It is then dried and broken in a specific manner, that her hands know.
This embodied, experiential, socially embedded, cultural, gendered, familial artistry cannot be taught or learned through a typed list of steps; it cannot be mastered without practice and experience. A chef with 20 years of pasta-making experience could not master it in the time he allotted. Nor could Barilla pasta engineers replicate Paola's art by machine. Paola has had 40 years of experience in making filindeu. She is an artist who creates her art by understanding the dough with her hands. In a sense, she and the filindeu exist together in a family and culture that honor and recognize it as both a rare pasta and as more than pasta (Stein, 2016).
EMBODIED NURSING PRACTICE
We cannot stretch the analogy so far that it breaks like a failed attempt at filindeu. There are, however, several important points of connection with nursing: an embodied practice lodged within a community and a tradition that requires skilled know-how developed over years that "makes magic."
Paola's comment that the hardest part of the process of making filindeu is understanding "the dough with your hand" bears direct relationship to nursing. Like nursing, it is an embodied process. Her hands know the dough. In a touch, a nurse's hands come to know the patient: hot, cold, clammy, goosebumps, tense, tremulous, relaxed. By touch, the nurse knows something about the patient, but also knows something of the patient. Nursing is an embodied practice of skilled know-how where touch is a central feature. That touch can lead to both response (another blanket) and responsiveness (a smile that says "You're all right"). A nurse touches a patient, but there is an embodied patient who is touched; that is, touch involves two embodied beings. Both persons are reciprocally touched. This requires both caring on the part of the nurse and trust on the part of the patient.
There is a donative, or gift, element in nursing. The patient rarely chooses the nurse; instead, the nurse is a stranger to whom patients gift their life and well-being-into the hands of the nurse. There is an underlying trust that the nurse is skilled and caring. There is also an underlying sacred and moral responsibility for the nurse. It is then all the more shocking if the nurse is rough or abrasive or unfeeling or unwilling. This nurse does not enter into a nurse-patient relationship as nursing understands relationship. This is the nurse, and I hesitate to even use the term nurse, who does not seek the goods intrinsic to nursing practice (such as caring, dignity, respect), one who is not a good nurse, good in the moral sense, and perhaps not even a nurse.
THE ESSENCE OF THE NURSE-PATIENT RELATIONSHIP
Good nursing considers the nurse-patient relationship to be an actual relationship of two persons-one with a health need and one who seeks to meet that need in its fullness. Meeting a patient's needs usually requires a variety of tasks, or interventions. These require the technical skills of nursing, what Aristotle (1962) called techne. The nurse who stops here, with techne, does not fully meet the patient's needs. The nurse who meets the patient in a caring relationship is one who is willing to undertake the obligations inherent in nursing practice and who seeks the goods intrinsic to nursing practice in what Aristotle terms phronesis or practical wisdom. Patricia Benner (2001) writes,
Learning to be a good practitioner requires developing the moral imagination and skills of being a good practitioner...Aristotle made a distinction between embodied being and knowing and called this kind of knowing that required moral agency, discernment, and relationship, phronesis, in contrast to techne...nursing as a practice requires both techne and phronesis...Phronesis is a kind of practical reasoning engaged in by an excellent practitioner lodged in a community of practitioners who through experiential learning for the sake of good practice continually lives out and improves practice...phronesis is lodged in a practice..[where] one's acts are governed by concern for doing good in particular circumstances, where being in relationship and discerning particular human concerns are at stake and guide action. (p. 9)
Although nursing requires both technical intervention and practical wisdom, that is, both techne and phronesis, techne without phronesis is not nursing and fails to meet nursing's moral demand. Phronesis is where the "magic happens." It is where the good nurse is one who embodies moral agency, goodness, discernment, and relationship. These come together in the community of moral discourse-that is the extraordinary community and tradition of nursing. Perhaps it is nurses themselves who are the threads of God.
FOR REFLECTION:
* Can you recall a care experience where you sensed the patient and their needs like su filindeu? Why or how were you able to be "threads of God"?
* What could prevent you from engaging in techne without phronesis? How will you engage in both?