1 The Art of Nursing

The Art of Nursing

The concept of the “art of nursing” has been shaped by an array of historical, social, and philosophical influences that highlight the multifaceted nature of the nursing profession.

• “Historically, the term “art” was used to describe expertise or mastery in various fields, including mathematics, medicine, and even fishing” (Riegel et al., 2022). This historical context underscores the initial understanding of the art of nursing as a skillful practice. As nursing evolved, its artistic dimension became increasingly intertwined with its scientific foundation, particularly with the emergence of evidence-based practice in the 19th century (Lima et al., 2022) shift towards scientific rigor, while essential for professionalizing nursing, also created a perceived dichotomy between art and science (Lima et al., 2022).
• Socially, the art of nursing has been deeply influenced by gender roles. In the 19th century, nursing was often viewed as an extension of women’s traditional domestic duties, linked to motherhood and homemaking (Motter et al., 2021). Florence Nightingale, a pioneer of modern nursing, strategically positioned nursing as a respectable profession for upper-class women by comparing it to revered arts like painting and sculpture (Lima et al., 2022). This social positioning aimed to elevate nursing’s status and attract well-educated women to the profession.
• Philosophically, the art of nursing has been influenced by the concept of holistic care. Nursing theorists like Madeline Leininger and Patricia Benner emphasized the importance of considering the patient’s physical, mental, cultural and spiritual well-being. This holistic perspective acknowledges the subjective experience of illness and the significance of empathy, compassion, and communication in nursing practice. It recognizes that the art of nursing extends beyond technical skills to encompass the human connection between nurse and patient (Benner, 2020; Leininger, 2012).

Figure 1-1

Florence Nightengale 

Note. Free for use under the Pixabay Content License

Florence Nightingale, often regarded as the founder of modern nursing, played a pivotal role in shaping the concept of the ‘art of nursing’. She compared nursing to art, emphasizing the need for dedication, preparation, and skill (Motter et al., 2021). Nightingale viewed nursing as a noble calling that requires technical competence and a deep sense of caring and compassion (Nightingale, 1897). Her influence is evident in the continued emphasis on caring as a central tenet of the “art of nursing” (Lima, 2022).

The historical, social, and philosophical factors have converged to shape the ‘art of nursing’ as it is understood today. It represents a complex interplay of scientific knowledge, technical skills, and humanistic values. While the scientific basis of nursing provides the framework for evidence-based practice, the art of nursing infuses care with intuition, empathy, sensitivity, cultural humility, and an appreciation for the individual patient’s unique experience in the world. “High-quality nursing practice continues to be a national goal and a prominent theme in the nursing literature. Research findings indicate that practicing nurses recognize the importance of an authentic nurse-patient relationship based on values that align with the art of nursing” (Alligood & Fawcett, 2017). The art of nursing today is the application of the cognitive skill of involvement coupled with ways of knowing that consider the nurse/patient social determinants of health and provide patient-centered care that is both relevant and meaningful in diverse healthcare settings.

Figure 1-2

Holistic Nursing Care 

Note. Free for use under the Pixabay Content License

Integrating the Art and Science of Nursing

The “art of nursing” and evidence-based practice (EBP) are not mutually exclusive, but rather complementary aspects of nursing that contribute to holistic patient care. While EBP focuses on using scientific evidence to inform decision-making, the art of nursing involves compassion, empathy, intuition, and skillful communication (Lima et al., 2022). Integrating both effectively enhances patient outcomes and elevates nursing practice.

Defining the “Art of Nursing”

The “art of nursing” is often described as the humanistic and subjective side of the profession (Lima et al., 2022; Motter et al., 2021) . It emphasizes:

• Empathy and Compassion: Feeling and understanding a patient’s emotions and suffering, and demonstrating a desire to help alleviate their pain (West, 2022; Motter et al., 2021).
• Intuition and Insight: Sensing subtle cues about a patient’s needs and well-being, going beyond just physical assessments (Lima et al., 2022; Weaver, 2021].
• Skillful Communication: Using both verbal and non-verbal communication to connect with patients, build trust, and create a therapeutic relationship (Weaver, 2021).
• Individualized Care: Recognizing that each patient is unique and adapting care practices to meet their specific needs and preferences (Weaver, 2021).

Figure 1- 3

Humanizing Healthcare by Connecting The Art of Nursing and EBP

Note. Free for use under the Pixabay Content License

Connecting the Art of Nursing to Evidence-Based Practice (EBP)

While EBP relies on scientific research and clinical expertise, the “art of nursing” enriches this practice by:

• Informing Patient Preferences: Through empathetic communication and insightful observation, nurses can better understand a patient’s values, beliefs, and individual circumstances. This knowledge helps tailor EBP recommendations to the patient’s unique context (Weaver, 2021).
• Enhancing Clinical Expertise: The art of nursing cultivates a deeper understanding of the human experience of illness. This understanding informs clinical judgment and allows nurses to go beyond textbook knowledge to provide truly holistic care (Benner, 2000).
• Improving Patient Outcomes: Compassionate care and strong therapeutic relationships have been linked to positive patient outcomes, including increased satisfaction, improved adherence to treatment plans, and better emotional well-being (Lima et al., 2022).

Integrating Art and Science More Effectively

• Mentorship and Role Modeling: Experienced nurses can mentor novice nurses in integrating the art of nursing. Sharing personal experiences through storytelling and demonstrating compassionate care can inspire and guide newer nurses (Benner, 2000).
• Reflective Practice: Nurses can engage in regular reflective practice to examine their experiences, identify areas for growth, and consciously integrate both the art and science into their approach (Benner, 2000).

By recognizing the value and significance of the art of nursing alongside the rigor of EBP, nursing practice can evolve to provide truly patient-centered and holistic care.

REFLECTION JOURNAL

How can you, as a future nurse, balance the scientific foundation of nursing, such as evidence-based practice, with the art of nursing, which includes empathy, intuition, compassion, and cultural humility to provide patient-centered care?

• Think about the complementary nature of the art and science of nursing.

Think about a time you received care from a nurse or observed a nurse providing care. What specific actions or behaviors did the nurse demonstrate that exemplified the art of nursing? How did those actions impact the patient’s experience?

• Connect the concepts from the chapter to real-world examples, and form a deeper understanding of the practical application of the art of nursing.

GLOSSARY

• Art of Nursing: The humanistic and subjective aspects of nursing practice. It encompasses empathy, sensitivity, compassion, intuition, insight, skillful communication, and cultural humility in the provision of individualized care.
• Compassion: A feeling of deep sympathy and sorrow for another stricken by misfortune, accompanied by a strong desire to alleviate the suffering.
• Cultural Humility: The ongoing process of examining one’s own biases and assumptions, recognizing the limitations of one’s cultural knowledge, and being open to learning from others.
• Empathy: The ability to understand and share the feelings of another person.
• Evidence-Based Practice (EBP): The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
• Holistic Care: A philosophy of healthcare that considers the whole person, including their physical, mental, emotional, social, and spiritual well-being.
• Individualized Care: Tailoring care practices to meet each patient’s specific needs and preferences.
• Intuition: The ability to understand something immediately, without the need for conscious reasoning. In nursing, it is a way of knowing that goes beyond physical assessments and involves sensing subtle cues about a patient’s needs and well-being.
• Insight: The capacity to understand a situation accurately and deeply.
• Skillful Communication: The ability to use both verbal and non-verbal communication effectively to connect with patients, build trust, and create a therapeutic relationship.
• Therapeutic Relationship: A professional and caring relationship between a nurse and a patient that is focused on promoting the patient’s health and well-being.

NCLEX PRACTICE QUESTIONS 

Question 1

A nurse is caring for a patient who is anxious about an upcoming surgery. Which action by the nurse best demonstrates the “art of nursing”?

a) Explaining the surgical procedure in detail.

b) Administering prescribed anti-anxiety medication.

c) Sitting with the patient and actively listening to their concerns.

d) Checking the patient’s vital signs frequently.

Question 2

Which of the following statements best reflects the integration of the “art of nursing” with evidence-based practice (EBP)?

a) The art of nursing is outdated and has no place in modern healthcare.

b) EBP should solely guide nursing care, minimizing the need for subjective judgment.

c) The art of nursing enhances EBP by considering patients’ individual needs and preferences.

d) The art of nursing and EBP are separate entities with no connection.

Question 3

Florence Nightingale’s contributions to nursing primarily emphasized:

a) The importance of research and data collection in nursing.

b) The significance of caring and compassion in nursing practice.

c) The need for nurses to have advanced medical knowledge.

d) The role of technology in improving patient care.

Question 4

A novice nurse asks her preceptor how to develop the “art of nursing”. Which response by the preceptor is most appropriate?

a) “Focus on perfecting your technical skills; the rest will come with time.”

b) “Read nursing journals to stay updated on the latest research and procedures.”

c) “Observe experienced nurses and try to imitate their bedside manner.”

d) “Engage in reflective practice to gain insights from your patient interactions.”

Question 5

Which of the following is NOT a key element of the “art of nursing”?

a) Intuition and insight.

b) Empathy and compassion.

c) Strict adherence to standardized protocols.

d) Skillful communication.

Question 6

Historically, what social factor significantly shaped the perception of nursing?

a) Traditional gender roles linking women to caregiving.

b) The high academic requirements for nursing education.

c) The emphasis on technology and innovation in healthcare.

d) The financial incentives associated with the nursing profession.

References:

Alligood, M. R., & Fawcett, J. (2017). The Theory of the Art of Nursing and the Practice of Human Care Quality. Visions: The Journal of Rogerian Nursing Science, 23(1), 4+. https://link.gale.com/apps/doc/A536746496/HRCA?u=anon~54d4fb80&sid=googleScholar&xid=0a22bb81

Benner, P. (2000). The wisdom of our practice. American Journal of Nursing, 100(10), 99–105. https://doi.org/10.1097/00000446-200010000-00075

Leininger, M. (2012). The phenomenon of caring, part V: Caring: The essence and central focus of nursing. International Journal for Human Caring, 16(2), 57–58. https://doi.org/10.20467/1091-5710.16.2.57

Lima, J. J., Miranda, K. C. L., Cestari, V. R. F., Pessoa, V. L.M. P. (2022). Art in evidence-based nursing practice from the perspective of Florence Nightingale. Rev Bras Enferm. 75(4):e20210664. https://doi.org/10.1590/0034-7167-2021-0664

Motter, T., Hassler, D., & Anthony, M. K. (2021). The art of nursing becomes a celebration of nurses. OJIN: The Online Journal of Issues in Nursing, 26(2). https://doi.org/10.3912/OJIN.Vol26No02PPT72

Nightingale, F. (1897). To the nurses and probationers trained under the Nightingale Fund. Spottiswoode & Co. Bottom of Form

Weaver, A. E. (2021). The art of nursing: A concept analysis. International Journal for Human Caring, 25(1), 16–21. https://doi.org/10.20467/HumanCaring-D-20-00021

West, S. (2022). Is Nursing an Art or a Science. diversitynursing.com. https://blog.diversitynursing.com/blog/is-nursing-an-art-or-a-science