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JENNER Nursing as an ART

JENNER Nursing as an ART

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The
Art
of
Nursing:
A
Concept Analusis
J
Cathleen
A.
Jenner,
RN,
MSN
That nursing is
a
science and
an
art is commonlyaccepted. While much emphasis has been
placed
on
the science in nursing, the art
of
nursing is
less
well-understood.
A
concept analysis usingRodgers' evolutionary perspective was conductedto examine the meaning
of
the art
of
nursing.Through the analysis,
a
definition emergedsuggesting that the art
of
nursing is theintentional creative use
of
oneself, based uponskill and expertise, to transmit emotion andmeaning to another. It is
a
process
that
is
subjective and requires interpretation, sensitivity,imagination, and active participation.
Key
words:
Concept analysis,
nursing
as
an
art
Cathleen
A.
enner,
RN,
MSN, s Assistant Professor
of
Nursing, Holy Family College, Philadelphia,
and
a
doctoralstudent, Widener University, Chester, PA.
Thatnursing is an art and a science is commonlyaccepted and
is
a notion that students encounter in theirvery first nursing course.
This
is consistent with highereducation in general, which
has
divided knowledge intothe
arts
and the sciences. Traditionally, the sciences havebeen given higher status, and this also has been true innursing (Rose
&
Parker, 1994).Despite the emphasis on science, the art in nursinghas been valued since Florence Nightingale firstdescribed nursing as "the finest of the fine arts"(Donahue,
1996).
Nursing leaders such
as
Nutting,
Dock,
Henderson, Stewart, and Peplau all have written aboutnursing as an art. Recently there has been greater atten-tion to this aspect of nursing as evidenced by editorialsin
Image
(Henry, 1995) and Nursing Science Quarterly,(Parse,
1992),
which addressed art and aesthetics n nurs-
ing,
as well as the devotion of a whole issue of Advancesin Nursing Science (1994) to the topic.While a common understanding of "nursing as a sci-ence and an art" is assumed, what is actually meant byart is not well-understood within the discipline. Definingart
is
one of the most longstanding,
f
not the core,
ques-
tion
of
the field of aesthetics (Leddy, 1993). A conceptanalysis using Rodgers and Knafl (1993) evolutionaryperspective was undertaken to
clanfy
the concept of art,examine its usage
in
nursing over time, and determineareas
of
agreement and disagreement in the use of theconcept as it is discussed in nursing literature and in aes-thetics. The Rodgers model was chosen because of itsview of concept development as a dynamic cycle, anapproach that
seems
harmonious
with a concept such asart.Sample SelectionThe samples used for the concept analysis wereselected from literature published in the fields of nursing
Nursing
Forum Volume
32,
No.
4,
October-December,
1997
5
 
The
Art
of
Nursing:
A
Concept
Analysis
and aesthetics, a branch of Western philosophy. Relevant
articles
published between 1990 and 1996 in both fieldswere reviewed. Online databases searched were
CINAHL
and Academic Abstracts for literature in nurs-ing and aesthetics, respectively. The
CINAHL
search
in-
tially yielded 1,999 items for the keyword "Art;"
1,172
items for
"Art
and Nursing;" and
112
items for "Nursingas an
art."
The items were cross-referenced, and
25
nurs-ing articles were reviewed. After perusing AcademicAbstracts, it was determined that
The
Journal
of
Aesthetics
and
Art Criticism
seemed to have the most relevant arti-cles for this analysis, and it was used predominantly torepresent the aesthetics literature. A manual review of allissues published between 1990 and 1996 yielded eightarticles for review. In addition, several books thataddressed the subject of
art
were reviewed.Literature Review
A
linpistic definition of
art
as identified in Webster'sThirdInternational Dictionary (1986)
s:
1)
power of performing certain actions
. . .
acquiredby experience, study or observation;
2)
skill
in theadaptation of things in the natural world to
. . .
human life;
3)
human contrivance or ingenuity;
4)
one of the humanities
.
.
the fine arts;
5)
occupa-tion.
. .
requiring
knowledge or
skill;
6)
application
of
skill and taste to production according to aes-thetic principles;
7)
conscious use of
skill,
taste, andcreative imagination in the
.
.
.
definition
or
pro-duction of beauty;
8)
in its most distinct sense artcontrasts with skill, artifice, and craft in puttingstress upon something more,
in
employing a per-sonal, unanalyzable creative force that transmitsand raises the art or product beyond a
skill,
artifice,or craft though it may involve the essential ele-ments of all three (p.
122).
Among the eight definitions s
a
recurrent theme of acreative use of skill or expertise, which is the usagefound most often in the nursing literature and the focus
of
this concept analysis. Other meanings not addressedin the analysis include art as an occupation or a branchof learning.
Art
as
process
and
product. The term
"art"
was
used
primarily intwoways, as both a process and a product.
This
was consistent in dictionary definitions, as well asthroughout the aesthetics and nursing literature.
In
many cases, the two were
utilized
interchangeably;how-ever, an attempt to distinguish between them was foundin each field. Within aesthetics, Lind (1992) maintainsthat artwork
is
the product or result of art, whichisa
cre-
ative process.
"Art
is
the creative arrangement of one ormore media with the immediate principal purpose
of
communicating a sigruficant aesthetic object.
. . .
An
art-work
is
any creative arrangement of one or more mediawhose principal function
is
to communicate a sigruficantaesthetic object" (p.
118).
Rose and Parker (19941, whoconducted a philosophic inquiry of the art of nursing,noted that to some, the process of nursing is viewed asthe art
of
nursing, yet others believe nursing is an artform underpinned by the philosophy of art and carryingaesthetic qualities. They
claim
it is important to differen-tiate between the two. The "art of nursing" may be theprocess by which nursing as an art form emerges but
also
could be the process by which nursing as a science
is
expressed.
On
the other hand, "nursing as an
art"
shouldcarry the characteristics of art, such as representation,expression,
form
and beauty, as well as being the processby which these
are
achieved (Rose
&
Parker).From these two distinctions within aesthetics andnursing it would seem that the "art
of
nursing"
is
equiv-alent to the
"a&
of aesthetics, and "nursing as an
art"
is
equivalent to "artwork" as described in aesthetics.The function of
art.
The review indicated that artserves a function in people's daily experience and is evenconsidered as essential to human well-being (Gardner,1948). t is expected to enrich our lives by affordinginsights, values, and emotional understanding; it isthrough
art
that meaning is derived (Cody,
1994;
Novitz,1996; Read, 1972).
Art
versus
science.
Art
has been frequently contrastedwith science or with nature. Values such as subjectivity,involvement, participation, and expression have been
6
Nursing
Forum
Volume
32,
No.
4,
October-December,
1997
 
associated with art, while the values of objectivity anddetachment have been ascribed to science (Cody, 1994;Peplau, 1988; Smith, 1993).Science has been portrayed asdescribing facts, while art expresses values. In nursingliterature, the integration of the
two
was deemed essen-
tia
to practice (Peplau; Rose
&
Parker, 1994; Smith).
Attributes
of
Art
In
the aesthetics literature, Rader (1962) listed the fol-lowing concepts that are involved in art: play, illusion,imitation, beauty, emotional expression, imagination,intuition, wish-fulfillment, pleasure, technique, sensuoussurface, meaning, form, function, empathy, abstraction,esthetic distance, and isolation. Few authors in the nurs-ing literature provided a definition of art. However, avariety
of
terms have been consistently found to be asso-ciated with the word "art" in both fields, which indicatesconsensus. There
are
six
most frequently cited attributesthat seem to reflect art across both nursing and aesthet-ics: creative, expressive, communal, interpretive, subjec-tive, and evocative.
Creative.
This characteristic helps distinguishbetween mere skillful technique and art. The use ofimagination and innovation contributes to the unique-ness of the artistry.
A
house painter uses dexterity and
skill
to
paint a wall; an artist uses creativity to producethe painting that
is
placed on that wall.Noone wouldconfuse the painted wall with the artwork hanging on it.
While
both painters use the same tools, paint and brush,only one creates art. Isabel Stewart distinguishedbetween the two when she described the essence of nurs-ing
"
.
. .
as of any fine art, lies not in the mechanicaldetails of execution, nor dexterity, but in creative imagi-nation, sensitive spirit.
. ."
(Chinn
&
Watson, 1994, p.
64).
Expressive.
That art is expressive is about as well-established as any fact in the field of aesthetics (Rader,1962).
In
nursing, the expressive nature
of
art
also
is con-sidered essential and is manifest in the descriptions ofnursing as a performing art, placing it in
such
companyas drama, music, and dance (Cody 1994; Johnson, 1994;Parse, 1992). Subjectivity
s
closely associated with artis-tic expression. Mood, feeling, spirit, and emotion aregiven voice through the
artist's
rendition.
At
has author-ship. It
is
the product of its creator.
In
order to engage in
art,
one must make a statement.
"I
see this art every time
I
walk into anenvironment where
a
nurse is busy'creating' the day for another person'' (Rose
&
Parker,
1994,
p.
1009).
Communal.
Art communicates some meaning. Itshares that meaning. It requires active participation notonly by the artist, but also by the individual who isbeholding the artwork. One must see, hear, or feel art.Without an audience, it is questionable whether an art-work could be considered the creation of art.
Is
a paint-ing a work
of
art to a blind person?
Is
a symphony awork of art to a deaf person? Lumby (cited in Rose
&
Parker, 1994) depicts this in relation to nursingI see this
art
every time I walk into an environmentwhere a nurse
is
busy 'creating' the day for anotherperson. They (sic) are busy using light, space,sound, wods, movement, and touch to deliver themessage of care. And like true
artists
they
are
will-
ing, indeed they see it as essential, to share theirperformance with others (p. 1009).Rose
&
Parker (1994) suggest the analogy of viewingthe nursing unit as a concert hall and the patients as theaudience, as a way of considering nursing as
an
art.
Interpretive.
Art has an explanatory nature. It com-municates a message that expresses the artist's feelingsabout the subject and requires an interpretation on thepart of the beholder. Participation in the creation and
Nursing Forum Volume
32,
No.
4,
October-December,
1997
7

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