Literature and nursing: why reading makes for a more complete long-term care nurse.

Nursing is a profession which, at its best, combines the use of scientific principles and methodology with the art of caring for human beings. For its art component it derives much of its substance and direction from the study of and immersion in the humanities. The human expression of life is no better represented than in literature; it is literature that readily provides the foundation for man's understanding and exploration of the human spirit. Novels and various types of nonfiction, replete with the tragedies, ecstasies and all emotions in between, provide a fertile source for nurses to reflect upon and integrate into their professional lives.

Nursing students spend most of their day studying anatomy, physiology, pharmacology and clinical skills. Much time is devoted to diagnoses and various disease states as if they existed apart from the patient's life history and persona. It is a certainty that nurses must know and understand medications and their side effects. They must know about changing inner cannulas and trachs. In this quest to read ECGs or insert PIC lines, the patient's disease or condition might, at times, become a distraction from other important considerations. Although nursing education certainly attempts to teach nurses the importance of treating the whole patient, this lofty ideal is sometimes lost in the day-to-day practicalities of simply completing the task.

Nurses may utilize literature in understanding and reinforcing the importance of disease in the patient's total life story. Literature reaffirms that disease is a part and parcel of that person, a fact of the entirety of his or her life. Disease is not an abstraction. Reading offers the nurse the opportunity to realize and understand the relationship and/or perceptions of disease by various cultures and disparate age groups. The exposure to stories in literature augments the nurse's insights into cultural meanings of disease. Reading tweaks the mind. It engages the imagination in a journey that allows one to step out of one's personal reality. For such a nurse, literature might offer perspectives that could differ from her (or his) own. In this way, the reader may reinterpret her own perceptions, resulting in a much broader or compassionate sensibility.

Literature frequently presents characters who are involved in their own internal struggles or in struggles with other characters. Observing their manners of communication and mediation as well as their dialogues offers nurses insight into the development of effective and empathetic skills. A vital aspect of the practice of nursing is the need for compassion and tolerance. Understanding human emotions through literary characters may assist the nurse in her ability to empathize with the patients in a myriad of situations and circumstances. Let me offer a few examples:

In the novel, Joshua, by Joseph F. Girzone, a simple unpretentious man has the opportunity to interact with various characters, each with different values and belief systems. Despite criticism, disdain and other forms of anger directed toward Joshua, he responds with kindness, tolerance and compassion. Although the book is a parable with significant religious symbolism woven through its pages, one can easily empathize with his responses and gain a greater understanding of the human spirit.

At one point, Joshua is confronted by a man who is enraged by what he perceives as years of"his people" being victimized. The angry man projects his hostility and years of pent-up emotion upon Joshua, who waits patiently until the man has finished. Joshua then quietly embraces the man, whose anger rapidly dissipates into tears of relief, followed by a calm, rational dialogue between the two men.

Frequently nurses interact with patients who feel anger because of their health status or because of the inequities of life. This anger is often projected onto the nurse. By being tolerant, empathetic and compassionate, the nurse can help enable a patient to experience a feeling of serenity.

The Seven Habits of Highly Effective People: Powerful Lessons in Personal Change, by Stephen Covey, is a wonderful book that guides the reader along a journey of introspection. Through amusing anecdotes and poignant stories, the author offers philosophical perspectives and insights into our behavior. This book assists the reader in assessing and understanding him/herself and provides the tools needed to become a more effective leader and communicator. Nurses are called upon to assist patients in the process of rationalization, understanding and acceptance of their fate. A strong sense of self - i.e., knowing who you are and why certain circumstances elicit certain reactions from you, is essential in the process of helping another person sort out his feelings.

Tracy Kidder in his book, Old Friends, paints a vivid picture of the lives of the residents of a nursing facility. He portrays a broad spectrum of situations, histories, events and interactions in a sensitive and perceptive account of residents' day-to-day existence. The book offers tremendous meaning for all nurses attempting to understand and empathize with their patients' struggles at living.

Literature consistently lays before us themes of ethical concern. Characters grapple with right and wrong, good and evil. Dealing with difficult questions with no absolute answers is a fundamental part of any healthcare provider's professional life. If nurses are to serve as a sounding board, resource and guide for unsettled patients, they must develop the ability to wrestle internally with life and death, moral and ethical problems. Literature helps provide invaluable strength, tolerance and direction, as well as a support system for those who are wise enough to embrace it.

Nursing serves its charges best, is most meaningful and is most effective when the riches of compassionate humanity are woven into the fabric of nursing care. Taking a step into literature is the beginning of an endless source of enrichment for a nurse.

Jill Smoller, RNC, MS, FNP, is Director of Nursing at the Woodbury Center for Health Care, Woodbury, NY (this year's Optima Award winner).