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Embracing the art and the science of nursing: nursing must pay equal attention to the art and the science of practice to achieve its full professional potential and assume a leadership role in health.

DISCOVERING WHAT is unique about nursing is a necessary evolutionary process. The history of our profession, compared to some others, is relatively short, and this may contribute to the view that nursing has yet to arrive at a consensus of role and function. (1)

Nursing has been described as both an art and a science. An elaboration of these terms could be considered foundational to thinking about nursing and increasing nursing specific knowledge. In what ways is nursing an art? What is the science of nursing? And how do art and science help nurses to articulate the essence of their profession in the context of political and health change?

The art of nursing

Many nurse writers agree there are elements of nursing that are artful. More rigorous debate tends to occur when the finer meaning of the word "art" is applied to the nursing context. One writer describes art to be applicable to nursing in the everyday sense. Art is about the whole of the nursing experience and not a distinctly separate part of it. (2)

Because nursing involves people in a variety of settings and situations, effectiveness is dependent on the quality of those interactions. The art of nursing will often be practised in environments that are unpredictable and spontaneous, requiring the nurse to be creative in her/his response to individual client needs, hence the term art is used.

Additional aspects of nursing considered artful are the knowledge, judgement and skill exercised by nurses in their everyday practice. (3) Nurses develop the ability to sense, feel, perceive and know how to deliver care in ways that increasingly demonstrate mastery in their field.

Nursing has also been described as a helping art and one that is able to empower and transform situations with clients toward favourable health changes. The great psychiatric nursing theorist Hildegard Peplau described three major components of nursing art--medium, process and product. (4) The medium is the art of bringing about change towards health through activating the potential of clients. The process is the interaction that is initiated by the nurse and moves towards an end point, which may include the application of technical skill. The product aspects of art are described as the improved functioning of the client that may or may not include observable outcomes.

As a complement to the demonstrable aspects of art, outcomes in practice can also be legitimately intangible. The arts of caring and practising intuitively, for example, could be described as elusive elements of nursing that can lead to health change. Such change can also remain private to a client, who may not share this with the nurse.

Practising in a reflective manner through the enhanced knowledge of self is also artful. This integration of being and self-expression is not dissimilar to that of an artist. (5)

These elements of nursing, however, cannot be easily accounted for by objective science and are therefore more likely to be shunned by others in the health environment for being overly subjective. (6) It may be however, that these elusive aspects of our practice are the very issues that define the art of nursing. (7) In contrast, another writer suggests nurses are also able to celebrate their art through a variety of expressions including song, inspirational verse, comedy and stories from professional practice. (8)

Although the outward expression of art in nursing is not uniform, an iterative process of scholarly debate will help us to understand the artistic parameters of our profession. This will add to existing knowledge, and the implementation of art in everyday practice.

What is the science of nursing?

To many nurses, the word "science" is more likely to be associated with medicine than nursing. To understand science in a nursing context we must first examine what science is and what it is not. The primary aim for the development of science is to expand a body of knowledge. This increasing knowledge then underpins and informs the thinking and practice of a particular discipline. Scientific methods have been developed and refined, permitting issues previously beyond the bounds of scientific investigation to be addressed. The scope of scientific endeavour has expanded enormously in recent decades with the acceptance of qualitative methods and computer based data analysis.

Developing the science of nursing cannot be viewed within the realms of a traditional medical paradigm, or be confused with the goals of medical scientific method. Medical science has undoubtedly made a significant contribution to health, though as one commentator suggests, the quest for objective truth limits the scope of this science to methodologies that have increasingly become reliant on technological tools. (9) As a consequence, the need to "re-tool" has become the primary focus of further scientific development.

Technological advances in nursing often provide practical aids with which nurses can enhance their relationship with, and caring for people. As nurses, we have no need to emphasise technology over art, or become so enamoured with science we become narrow minded in our methods of Inquiry necessary to mature the body of nursing science.

Contributions to the advance of nursing knowledge do not always seek to verify truth, although this may be appropriate in some circumstances. Nursing science aims to generate and test extant theory, discover meaning and to develop a growing knowledge with which to articulate the work we do. Nursing science has been described as, "a scholarly adventure, one guided by purpose undertaken with boldness, sense of freedom and creativity, merged intellectual rigor and integrity". (10)

Many examples of creative scholarship in nursing science can already be found in the nursing literature: one writer brings to our attention the relevance of critical language inquiry in nursing,; another discusses a "womanist" perspective as a framework for encouraging health-promoting behaviours in the lives of African American women. (12) Each is an example of nurses discovering and sharing their personal scholarship to extend the knowledge of the profession.

Many more nurses are creating their art and practising their science on a daily basis without any formal recognition. These creative and scholarly abilities must continue to be exercised and celebrated, so nurses can demonstrate not only their tangible skill, but also articulate the nursing knowledge that has led to these skills being developed.

Benner (6) reminds us that a great strength of the nursing practitioner lies in her/his ability to overcome the 'objectifying gaze' that would otherwise describe only a disease and not include the human experience. Policy makers are continuing to seek ways to meet more than just the physical health needs of clients. This concept is not new to nurses, but as yet has not been well articulated. The integration of art and science can produce a professional balance of discovery and verification, and provide the means to link nursing theory with practice in ways meaningful to nurses devoted to scholarship or clinical specialty.

Health change and the future

These ideals for the development and implementation of the art and science of nursing have been difficult to attain in a less than optimal environment. A decade of health reform incorporating the goals of profit and competition has been the antithesis of the essence of nursing care. Although nurses have historically proven their ability to 'survive' in ways not dissimilar to the pioneers of our profession, (13) we need to extend ourselves beyond a re active level to address the challenges of the future.

There is a growing national and international recognition of the need for a strategic approach to workforce development. (14) This presents nurses, as the largest professional group within the health sector, with an ideal opportunity to accept the challenge of developing nursing academically and professionally.

Whatever the agenda set by the government of the day, nurses must continue to delineate and articulate the exceptional elements of nursing. Our art and science will enable us to achieve this task. The art of nursing, which is already an integral part of our practice and valued by our members, must be creatively presented in ways recognisable by those outside nursing as a unique and valuable phenomenon.

The science of discovery and verification will increase the body of nursing knowledge, underpinned by research through a nursing lens. Developing art and science that promotes the ability of nurses to think and act, will add credibility to nursing practice in years to come.

The complementary relationship between art and science is fundamental to the practice of nursing. All nurses are able to make a contribution to the future shape of their profession, or create what has been described as, "a passion for our own destiny". (15) The potential exists for our science to add even greater significance to our art, and for our practice to reflect a profession with the skills to more than adequately meet the challenges of an increasingly complex health system.

As we continue the journey to a consensus of role and function, we must nurture our art and develop our science. The maturation of a body of unique nursing knowledge will provide nurses with the foundation from which to take a lead role in the future of health care in New Zealand.

REFERENCES

(1) Hilton, P. (1997) Theoretical perspectives of nursing: A review of the literature. Journal of Advanced Nursing; 26: 6, 1211-1220.

(2) Wainwright, P. (1999) The art of nursing. International Journal of Nursing Studies; 36,379-385.

(3) Johnson, I. (1994) A dialectical examination of nursing art. Advances in Nursing Science; 17: 1, 1 14.

(4) Peplau, H. (1988) The art and science of nursing: similarities, differences, and relations. Nursing Science Quarterly; 1: 1,8-15.

(5) Cody, W. (2000) Nursing science frameworks for practice and research as means of knowing self. Nursing Science Quarterly; 3: 3, 188-195.

(6) Benner, P. (2000) The wisdom of our practice. American Journal of Nursing, 100: 10, 99-105.

(7) Le Vasseur, I. (1999) Toward an understanding of art in nursing. Nursing theory for the 21st century. Advances in Nursing Science; 21: 4, 48-63.

(8) Masson, V. (1996) A decent paying job not art and beauty. Nursing and Health Perspectives on Community; 17: 3, 150.

(9) Kuhn, T. (1970) The structure of scientific revolutions. 2nd Edition. London: The University of Chicago Press Ltd.

(10) Hinshaw, A. (1989) Nursing science: The challenge to develop knowledge. Nursing Science Quarterly; 2: 4, 162-171.

(11) Boutain, D. (1999) Critical language and discourse study: Their tranformative relevance for critical nursing inquiry. Advances in Nursing Science; 21: 3, 1-8.

(12) Banks-Wallace, J. (2000) Womanist ways of knowing: Theoretical considerations for research with African American women. Advances in Nursing Science; 22: 3, 33-45.

(13) Brown, E. (2000) Nightingale's values live on. Kai Tiaki Nursing New Zealand; 6: 3, 31.

(14) Health Workforce Advisory Committee, (2002) The New Zealand health workforce: A stocktake of issues and capacity 2001. Ministry of Health, Wellington, New Zealand.

(15) Fawcett, J. (1999) The state of nursing science: Hallmarks of the 20th and 21st centuries. Nursing Science Quarterly; 12: 4, 311-318.

--Jeffrey Gage, RCpN, MPH, is in his third year of PhD studies at the Sinclair School of Nursing, University of Missouri, Columbia. Before embarking on his overseas studies he worked as a public health nurse in Timaru and Christchurch.
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Title Annotation:viewpoint
Author:Gage, Jeffrey
Publication:Kai Tiaki: Nursing New Zealand
Date:Nov 1, 2003
Words:1857
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