These comparisons bring many aesthetic qualities to mind, for instance, harmony, rhythm, tone, feeling. Nursing is like music and drama in other ways. The nursing procedure, like a musical score or a play script, allows for individual interpretations, adaptations, and embellishments.
Although nurses follow the same general principles, each can develop her own unique style. {92} If nursing really is viewed as a performing art, there are opportunities for creative exploration and development of the art of nursing. And furthermore, these individualized styles of nursing are worthy of description and sharing.
Another similarity is the ephemeral character of nursing, music, and drama. A particular nursing transaction, like a concert or play, is transitory, short-lived. Yet the effects may be long-lasting and remembered. There is this difference in nursing, I believe. Each nursing transaction may flow into a stream of nursing care extending continuously over 24 hours a day for weeks, months, years. And many individual nurses "get into the act." How does this affect the art of nursing? How is nursing like and unlike the other performing arts? The answers to these and similar questions must come from the nurse-artists.
HUMANISTIC NURSING AS CLINICAL ART
The relatedness of nursing and art, viewed existentially, is more basic, more fundamental than mere similarity of qualities and characteristics as discussed above. Both art and nursing are kinds of lived dialogue. In both, man responds to his world of men and things through distance and relation. They affect him and he affects them with the creative force of his relation.
In fact, one may say further that humanistic nursing is _itself_ an art--a clinical art--creative and existential. This is evident when one returns again to the thing itself, to the nursing dialogue as it is lived in the everyday world.
In genuine meeting the nurse recognizes the patient as distinct from herself and turns to him as a presence. She is fully present to him, authentically with her whole being and is open to him, not as an object, but as a presence, a human being with potentials. In such a genuine lived dialogue, the nurse sees within the patient a form (that is, a possibility) of well-being or more-being (or comfort or health or growth, and so forth). Like a beautiful landscape inspiring a painter or poet, the form in the patient addresses itself to the nurse, a call for help demanding recognition and response. The form is clearer than experienced objects; it is not an image of her fancy; it exists in the present although it is not "objective." The relation in which the nurse (artist) stands to the form is real for it affects her and she affects it. If she enters into genuine relation with the patient (I-Thou) her effective power (caring, nursing skills, hope) brings forth the form (well-being, more-being, comfort, growth), just as the painter"s or poet"s power and skill create a painting or a poem.
Of course, there is this difference. The art of nursing, being goal-directed and intersubjective, is more complex than the arts of painting and poetry, for example. As a clinical art, it involves _being with_ and _doing with_. For the patient must partic.i.p.ate as an active subject to actualize the possibility (form) within himself. Perhaps the art of nursing could be described as transactional. Not only does the nurse see the possibilities in the patient but the patient also sees a form in the nurse (for example, possibility of help, of comfort, of support), and he responds in relation to bring it forth. {93}
Then the question logically may be raised: Is the patient"s responses in relation (I-Thou) a necessary condition for the art of nursing? Or to state it differently: can there be any art of nursing the infant, the unresponsive, the comatose, the dying? I would answer that the art of nursing can exist even if the relation is not mutual. For as Buber writes,
"Even if the man to whom I say _Thou_ is not aware of it in the midst of his experience, yet relation may exist. For _Thou_ is more than _It_ realises. No deception penetrates here; here is the cradle of Real Life."[14]
DIALOGICAL NURSING: ART-SCIENCE
Art and science, like nursing, represent angular views. Each is a view with a particular purpose. They are human responses to the everyday world in which man lives. Existentially speaking, each is a form of living dialogue between man and his human situation.
It is possible that there is in nursing a kind of human response to reality that is a combination, a true synthesis of art and science? The more one focuses on nursing as it is lived, on the intersubjective transaction as it is experienced in the everyday world, the more questions arise about it as art and science. Elements of both art and science are evident in nursing. The practicing nurse must integrate them in her mode of being in the situation.
While Dr. Josephine Paterson was developing a methodology of inquiry from a clinical nursing process and describing her construct of the "all-at-once," she was so intent on communicating the interrelated reality of the art and science elements in nursing, that she welded them together with a hyphen into one word, "art-science." And even then there is some dissatisfaction when the weld is interpreted merely as a seam.
For the combination is more than additive; it is a new synthetic whole.
I experienced a similar difficulty in trying to describe the synthesis of art and science that takes place in the nursing process. The nursing dialogue reflects the orientations of art and science for it involves both the patient"s and the nurse"s subjective and objective worlds. I believe the synthesis of art and science is _lived_ by the nurse in the nursing act. This is a phenomenon more readily experienced than described.
Yet if we truly experience nursing as a kind of art-science, as a particular kind of flowing, synthesizing, subjective-objective intersubjective dialogue, then nursing offers a unique path to human knowledge and it is our responsibility to try to describe and share it.
FOOTNOTES:
[1] New England Council on Higher Education for Nursing, _Humanities and the Arts as Bases for Nursing:_ Implications for Newer Dimensions in Generic Nursing Education, Proceedings of the Fifth Inter-University Work Conference (Lennox, Ma.s.s: New England Council on Higher Education for Nursing, June, 1968). "Humanities, Humaneness, Humanitarianism,"
Editorial in _Nursing Outlook_, Vol. 18, No. 9 (September, 1970), p. 21.
Charles E. Berry and E. J. Drummond, "The Place of the Humanities in Nursing Education," _Nursing Outlook_, Vol. 18, No. 9 (September, 1970), pp. 30-31. Marion E. Kalkman, "The Role of the Humanities in Graduate Programs in Nursing," in _Doctoral Preparation for Nurses_, ed. Esther A. Garrison (San Francisco: University of California, 1973), pp.
138-155.
[2] Mary Jane Trautman, "Nurses as Poets," _American Journal of Nursing_, Vol. 71, No. 4 (April, 1971), p. 727.
[3] _Ibid._, p. 728.
[4] _Ibid._
[5] Chaim Potok, _My Name Is Asher Lev_ (Greenwich, Conn.: Fawcett Publications, 1972), p. 105.
[6] Grayce C. Scott Garner, "Qualitative and Quant.i.tative a.n.a.lyses of Schizophrenic Verbal and Non-Verbal Acts Related to Selected Kinds of Music," _Humanities and the Arts_, p. 49.
[7] Carol Ann Christoffers, "Movigenic Nursing: An Expanded Dimension,"
_Humanities and the Arts_, p. 95.
[8] Garner, p. 40.
[9] Pica.s.so as quoted in _My Name Is Asher Lev_.
[10] John Hersey, _The Conspiracy_ (New York: Alfred A. Knopf, 1972), p.
82.
[11] Faye G. Abdellah, "The Nature of Nursing Science," _Nursing Research_, Vol. XVIII (September-October, 1969), p. 393.
[12] "Art," _The Great Ideas_: A Syntopicon of Great Books of the Western World I, Vol. 2, 1952, pp. 64-65.
[13] Ellen T. Fahy, "Nursing Process as a Performing Art," _Humanities and the Arts_, p. 124.
[14] Martin Buber, _I and Thou_, 2nd ed., trans. Ronald Gregor Smith (New York: Charles Scribner"s Sons, 1958), p. 9.
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9
A HEURISTIC CULMINATION
This chapter presents an application of the humanistic nursing practice theory over time and an outcome. The outcome represents my present conscious conceptualization of my personal theory of nursing. It has grown out of my nursing practice experience, my reflecting, relating, describing, and synthesizing. This is heuristic culmination of much mulling over my lived world of nursing.
ANGULAR VIEW: PRESENT PERSPECTIVE
In 1971 after a presentation on concept development I heard myself in a chatty response to the audience declare my unique theory of nursing. It was based in constructs that I had developed and conceptualized.
Previously I had viewed these constructs only as distinct ent.i.ties. My synthesis of them surprised me. This was the first time I conveyed them as my why, how, and what of nursing. This synthesis may have emerged as a sequence to my reexamination and reflection on each of these constructs in preparation for this 1971 presentation.[1] Now it became evident that their sequential evolvement had a logic that had come from my being without my awareness.
Since 1971 I have planned to reflect on these synthetic constructs to better understand how they relate to one another complementarily. Why?
To further the development of these constructs and to state them as propositions. Statements of propositions are movement toward nursing theory. Theory is considered here as a conceptualized vision teased out of my knowing from my nursing experience.
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Like Elie Wiesel, the novelist and literary artist, I write to better understand and to attest to happenings. This chapter is the fruit of this endeavor.
The first term, "comfort," was developed as a construct in 1967. After recording and exploring my clinical experiential data, a conceptualized response emerged to my question: "Why, as a nurse, am I in the clinical health-nursing situation?" The second term, "clinical," was developed as a construct in 1968. It was a conceptualized response to a dialectical process within myself. I asked, "What is clinical?" I answered, "I am a clinician." I asked, "As a nurse clinician what do I do; what is the condition of my being in the nursing situation?" I answered, "This described would equate to clinical." Consequently I compared and contrasted two nursing experiences similarly labeled to properly grasp the principle of "clinical" for conceptualization. The third term or phrase, "all-at-once," arose intuitively within me as a construct in 1969 and was partially conceptualized. It arose after mulling over other nurses" published clinical data and asking, "What can you tell me of the clinical nursing situation?" "What do you perceive as the nature of nursing?" Therese G. Muller"s, Ruth Gilbert"s and my thought on the nursing situation merged into a view of these as multifariously loaded with all levels of incomparable data, the "all-at-once."
Incommensurables relate to the nature of nursing and its concerns. How can one study unrelated appearances? Muller often used an historical approach while Gilbert emphasized individualization. In humanistic nursing practice theory a descriptive, intersubjective, phenomenological approach is proposed for greater understanding and attestation of the events and process of the nursing situation. The construction of "comfort, clinical, and all-at-once" I would now label as conceptualized phenomenologically. I view them as relevant phenomena to any nurse and this nurse-in-her-nursing-world.
Theory: Unrest, Beginning Involvement
This desire to develop nursing theory goes back to my years (1959-64) as a faculty member in a graduate nursing program. I fussed with the idea, did not know exactly what I was fussing about, and expressed my desire, interest, and concern poorly. Much, I am sure now, to others" dismay.
Teaching in nursing was an offering of mult.i.tudinous theories developed in and for other disciplines using nursing examples. There were both similarities and differences in the many nursing examples in which attempts were made to describe the qualities of the partic.i.p.ants"
beings. Emphasis was placed on the observations by the nurse of the others" responses in the nursing situation. Nursing education was rife with lengthy repet.i.tive examples utilized to focus on particular variations. I desired a unifying base applicable to all nursing situations. This was not a seeking for conformity nor an attempt to negate individuality. Certainly I did not want such a base to exclude individual nurses" talents. Rather this base, foundation of nursing indicative of the nature of nursing, would heuristically promote endless variations to flow, blossom, cross-pollinate, and evolve. {97}