NURSING IS AN ART self.
Because nursing is an interpersonal process, the
A. Why is nursing an art
Is the art of caring sick and well individual. It refers to
the dynamic skills and methods in assisting sick and well
individual in their recovery and in the promotion and
maintenance of health. It involves the creative
application of knowledge in the service of people.
B. Concept map reflecting the theory of bureaucratic
caring.
• Caring is contextual, influenced by
organizational structure.
 Meaning of caring varies in emergency
department, intensive care unit,
oncology unit, etc.
 Role and position of staff members
• Spiritual-ethical caring influences each branch
of bureaucratic system
C. Self- awareness/concept (Who am I?
D. Self-enhancement (How do I become a better
person?)
Personal Knowing: The Therapeutic Use of Self Personal
knowledge is concerned with the knowing,
encountering, and actualizing of the concrete, individual
nurse’s view of self, as well as the client, is a critical
factor in the therapeutic relationship. The nurse is
aware of his or her own attitudes and behavior and
views the client as a unique individual who is free to
choose and create her or his own life.
Personal knowing promotes wholeness and integrity in
the personal encounter, achieves engagement rather
than detachment, and denies the manipulative or
impersonal approach. Ethical Knowing: The Moral
Component Goals of nursing include the conservation of
life, alleviation of suffering, and promotion of health.
Ethical knowing focuses on “matters of obligation or
what ought to be done” (Carper, 2009, p. 382), and goes
beyond simply observing the nursing code of ethics.
Nursing care involves a series of deliberate actions or
choices that are subject to the judgment of right or
wrong. Occasionally, the principles and norms that
guide choices may be in conflict. The more sensitive and
knowledgeable the nurse is to these issues, the more
“ethical” the nurse will be. Aesthetic Knowing: The Art
of Nursing Aesthetic knowing is the art of nursing and is
expressed by the individual nurse through his or her
creativity and style in meeting the needs of clients. The
nurse uses aesthetic knowing to provide care that is
both effective and satisfying. Empathy, compassion,
holism, and sensitivity are important modes in the
aesthetic pattern of knowing.
Developing Ways of Knowing The methods for
developing each type of knowledge are unique (Chinn &
Kramer, 2011). The methods that are required for
developing one pattern cannot be used to develop
knowledge within another pattern. For example,
personal knowing is developed through critical
reflection on one’s own actions and feelings in practice.
Empirical knowing is gained from studying scientific
models and theories and from making objective
observations. Ethical knowing involves confronting and
resolving conflicting values and beliefs. Aesthetic
knowing arises from a deep appreciation of the
uniqueness of each individual and the meanings that
individual ascribes to a given situation. The nurse who
practices effectively is able to integrate all types of
knowledge to understand situations more holistically.
Caring for Self Mayeroff (1990) describes caring for self
as helping oneself grow and actualize one’s possibilities.
Self-care, when defined as responding to one’s own
needs to grow, is the opposite of the self-complacency
that often accompanies egocentricity. Caring for self
means taking the time to nurture oneself. This involves
initiating and maintaining behaviors that promote
healthy living and well-being. Although different
activities may be helpful to different people, some
examples of these activities include: • A healthy lifestyle
(e.g., nutrition, activity and exercise, recreation) •
Mind–body therapies (e.g., guided imagery, meditation,
yoga). Self-care focuses on care of the self in the
deepest sense. Selfawareness and self-esteem are
intimately connected to self-care. Each person is unique
and possesses individual strengths and weaknesses.
Self-care practices are intentionally created by the self
and vigilantly maintained. This is a lifelong unfolding
process, leading to wholeness that comes from and
contributes to self-esteem. In its code of ethics, the
American Holistic Nurses Association (2012) states that
“the nurse has a responsibility to model health care
behaviors. Holistic nurses strive to achieve harmony in
their own lives and assist others striving to do the
same.” Individuals with high self-esteem can critically
problem solve and tackle obstacles more effectively.
Selfcare practices build self-esteem, leading to feelings
of comfort and accomplishment.
A HEALTHY LIFESTYLE Everyone needs to pay attention
to nutrition and exercise, and to avoid unhealthy
lifestyle practices. Key words for a healthy lifestyle are
balance and moderation. These lifestyle practices are
supplemented by regular physical examinations and
health screenings. NUTRITION Healthy eating is
important for everyone. A nutritionally balanced eating
plan provides energy, builds endurance to carry out
daily activities, and reduces the risk for certain health
problems. Healthy eating means learning to make good
choices in the foods eaten, preparing foods
appropriately, and eating in moderation. It is important
to select a variety of foods, to eat regular meals, and to
eat the correct amount to maintain a healthy weight.
Determining a healthy weight depends on several
factors, including age, activity level, and the presence of
weight-related medical problems such as high blood
pressure.
ACTIVITY AND EXERCISE Exercise is recognized as a
lifetime endeavor that is essential for energetic, active,
and healthy living. The benefits of exercise have been
linked to many physiological and psychological
responses, from a reduced feeling of stress to an
increased sense of well-being. Exercise strengthens the
heart, lungs, and blood vessels to prevent heart disease,
keeps the joints flexible, and helps many people deal
with sad or unhappy feelings. For individuals who are
overweight, exercise has the added benefit of burning
calories, resulting in weight loss or maintenance.
American Heart Association (2013) guidelines
recommend that healthy adults, ages 18 to 65 years,
engage in the following activities to promote and
maintain health: • At least 30 minutes of moderate-
intensity aerobic activity at least 5 days per week for a
total of 150 minutes OR • At least 25 minutes of
vigorous aerobic activity at least 3 days per week for a
total of 75 minutes; or a combination of the two AND •
Moderate to high intensity muscle-strengthening
activity at least 2 or more days per week for additional
health benefits. Nurses participate in activities that call
for knowledge to prevent self-injuries. Self-care
practices are based on competence and compliance
with use of assistive devices, such as the different types
of hydraulic lifts, and assistive transfer equipment.
RECREATION Self-care also includes taking time to do
the things that bring joy and stimulate creativity. Nurses
need to reward themselves, to experience spontaneity,
and even to take downtime or time to do nothing.
Defending the right to this time may take courage and
conviction in the face of others’ demands. “Twelve
Things You” Would Love to Do” in Box 25–3 is intended
to help a person recapture a sense of joy, fun, and self-
reward.
AVOIDING UNHEALTHY PATTERNS Part of staying
healthy is avoiding unhealthy life patterns. This means
avoiding activities or thought patterns that contribute to
negative health outcomes.
Negative thinking can create a stress response with all
its physiological, mental, and emotional outcomes. It is
not what happens, but how events are perceived, that
determines an individual’s reaction. Practices such as
identifying negative feelings, refocusing on the positive,
and using humor are helpful to avert the stress
response by changing thought patterns.
MIND–BODY THERAPIES The interconnectedness of the
mind and body is the basis for the complementary
therapies. Imagery, meditation, storytelling, music
therapy, and yoga are examples of complementary
therapies that bring balance to thoughts and emotions.
Practice of one or more mind–body therapies is an
effective self-care strategy to help restore peace and
balance. More in-depth information on different types
of complementary therapies.
GUIDED IMAGERY Imagery is a mind–body intervention
that uses the power of the imagination as a therapeutic
tool. Imagery is used to promote relaxation, decrease
anxiety, and enhance psychological or spiritual insight.
Through forming mental images of an object, event, or
situation, the individual can reframe negative responses
into positive images, enhancing healing and emotional
well-being.
MEDITATION Through quieting the mind and focusing it
on the present, meditation assists the individual in
releasing fears, worries, and doubts. The technique
involves both relaxation and focused attention.
Guidelines for mindful meditation include choosing a
quiet space, sitting comfortably, achieving progressive
relaxation through deep breathing, and focusing
attention on breathing or a mental image.
STORYTELLING As expressions of human consciousness,
stories help individuals gain a greater understanding of
life. Stories communicate life experience and are often
shared with clients and others to inspire and comfort.
The language of stories allows nurses to begin to
understand the deeper meaning of clinical situations.
Stories are also a mechanism to deal with stress and
move toward wholeness.
MUSIC THERAPY Using music as therapy includes
listening, singing, rhythm, and body movement. Quiet,
soothing music is often used to induce relaxation. Active
rhythms can awaken feelings of power and control.
Familiar music allows the listener to recall past events
or feelings. Music can also serve as an effective
distraction technique. Each person’s likes and dislikes
are taken into account in order to achieve the desired
emotional response.
YOGA The practice of yoga unites the body, mind, and
spirit. Through daily practice of the various postures and
breathing practices of yoga, an individual can achieve
increased balance and flexibility, mental alertness, and
calmness. The bending, stretching, and holding
properties of the postures help to relax and tone the
muscles and improve function of the internal organs.
Breath control is designed to still the mind and enhance
awareness. Eliopoulos (2010) sums up the goal of yoga:
to “create balance between movement and stillness,
which is said to be the state of a healthy body”
E. Cultural Diversity
What Is Diversity Awareness?
The American Nurses Association (ANA) defines
diversity awareness in nursing as the following:
Acknowledgement and appreciation of the existence of
differences in attitudes, beliefs, thoughts, and priorities
in the health-seeking behaviors of different patient
populations; it reflects the nursing profession’s contract
with society and our responsibility to act according to a
strong code of ethics, i.e., to be aware of our own
attitudes, beliefs, thoughts, and priorities in providing
care to individual patients, families, communities, and
populations.
Each day, nurses must make ethical decisions when
assessing patients’ conditions and documenting their
observations for physicians and other medical staff to
review. Integrating an appreciation for cultural diversity
into a nurse’s decision-making process can foster a
positive nurse-patient relationship and encourage safer
and healthier environments in care facilities.
Aspects of Cultural Diversity in Nursing
Culture has a significant influence in health-related
beliefs and practices, according to an article by the
American Association of Critical-Care Nurses (AACN).
Factors such as language, geography, socioeconomics,
gender, and education can play a large role in
determining the decisions patients make about medical
care, both for themselves and their families. The ANA
has identified primary areas of cultural diversity:
 Health insurance and health care access
 Racial and ethnic minority communities
 Mental health
 Elderly
 Bariatric/obesity
Patients in each of these areas can experience barriers
to receiving an appropriate level of care if providers do
not account for cultural differences. Nurses who are
trained to deliver culturally competent care are
prepared to alleviate these types of stress. Nurses must
also understand how to accommodate patients’ cultural
beliefs in conjunction with conventional medical
practices. Acknowledging these types of patient
differences can decrease the stress of the patient, which
can positively impact the outcomes of their treatments,
according to AACN.
Culturally Competent Nurses
While the nation’s current population is predominantly
Caucasian, the United States Census Bureau anticipates
that more than 50 percent of Americans will belong to a
minority group by 2044. As the likelihood of working
with patients from different cultural backgrounds
increases, nurses must be motivated to learn about
cultural diversity in their nursing practices to reduce
risks to patients during treatment.
Increasing the cultural diversity of the nursing
workforce begins in programs that educate the health
care professionals of the future. Earning an advanced
degree, such as a Doctor of Nursing Practice, can
prepare nurses to provide equitable, inclusive care that
promotes a healthier, less stressful experience for
patients and their families.
F. Caring: Six C’s of caring, Gilligan’s theory

An NIH study found that nurses who lack a firm grasp of

cultural differences can experience stress and
frustration when working with culturally diverse
patients and their families. To better prepare for these
situations, nurses follow a cultural competence model
to identify their own cultural health care beliefs, gain
knowledge and skills about caring for different cultural
groups, and engage with diverse patients to practice
their skills on an ongoing basis. These actions can
reduce risks to patients by opening lines of
communication, which can reduce medical errors and
make it easier for providers to identify early indications
of disease, according to a study in the journal Critical
Care Clinics.

Importance of a Culturally Diverse Nursing Workforce

As the population of patients accessing health care

services in the U.S. becomes increasingly diverse,
providers will need to make significant changes in their G. Types of knowledge in nursing
approaches to care. A 2014 paper by the National
Conference of State Legislatures noted disparities in the • Identified by Carper, 2009
cultural makeup of the health care workforce and of the
• Method for developing each type is unique.
country as a whole. At the time of the study, people of
color represented over 25 percent of the nation’s • Integrating all types leads to holistic care.
population but only 10 percent of health professionals.
• Empirical knowing: the science of nursing
The study suggested that increasing the diversity of the
• From factual, observable phenomena to
medical workforce could improve health outcomes in
theoretical analysis
culturally diverse patients in two different ways. First,
when teams of health care professionals reflect the • Personal knowing: the therapeutic use of self
diversity of their patients, it is easier for providers to
develop cultural competency, thus allowing patients • Promotes wholeness, integrity in
and providers to communicate more openly. Also, personal encounter
patients tend to feel safer in facilities where they see • Achieves engagement
diverse teams working together effectively.
• Ethical knowing: the moral component
 • "Matters of obligation on what ought to Knowing the Client
be done"
• Uniqueness
• Beyond observing code of ethics
• Physiological variables
• Aesthetic knowing: the art of nursing
 Perception of pain
• Expressed by individual nurse's
 Meaning of diagnosis, surgery
creativity and style in meeting needs of
clients • Support persons and family
• Care that is effective and satisfying • Increases possibilities for therapeutic
interventions to be perceived as relevant
• Developing ways of knowing
Nursing Presence
• Methods required for one pattern
cannot be used to develop knowledge • Mutuality
within another pattern.
• Transpersonal caring relationship
• Effective nurses integrate all types to
understand situations holistically. • Openness and consciousness of self and client

 Authenticity

• Emotional, physical presence

 Responding promptly

Empowering the Client

• Mutual respect, trust, confidence in other's

abilities and motives

• Substitutive care, but no more than is needed at

the time

• Environment in which client can function safely,

effectively

• Advocating

• Mindfulness of professional boundaries

Compassion

H. Nurse-client relationship • Warm, empathetic

Caring Encounters • Concerned

• Contextual • Requires courage and openness

• Caring responses as varied as clients' needs • Attenuation to spiritual needs

• Clients experience: • Comfort

 Increased sense of dignity and self-  Based on individual's perceptions

worth
 Creative, innovative interventions based
 Expression of feelings of connectedness on client's preferences
Competence • Moderate to high
intensity muscle-
• Necessary knowledge, judgment, skills,
strengthening 2 or
motivation to respond adequately to client's
more days
needs
 Recreation
• Understanding of client's condition, treatment,
and associated care • Reward

• Ability to assess, plan, implement, and evaluate • Spontaneity

a plan of care
 Recreation
• Cognitive, affective, technical, and
• Downtime
administrative skills
 Avoiding unhealthy patterns
Maintaining Caring Practice
• Thought patterns
• Emphasis on meeting others' needs
• Identify negative
• Obstacles to self-care
feelings
 Professional
• Refocus on positive
 Demands of particular work setting
• Positive affirmations
 Personal
• Mind–body therapies
• Poor health habits
 Guided imagery
• Unrealistic expectations of self
• Imagination as therapeutic tool
Caring for Self
• Promote relaxation
• Care of self is central to care of others.
• Decrease anxiety
• Helping oneself grow and self-actualize
• Enhance psychological, spiritual
• Taking time to nurture oneself insight

• A healthy lifestyle  Meditation

 Nutrition • Focusing mind on present

• Making good choices in foods • Relaxation through deep

eaten breathing

• Eat regular meals  Storytelling

• Determine healthy weight • Communicate life experience

for greater understanding
• A healthy lifestyle
• Deeper meaning of clinical
 Activity and exercise
experiences
• Per week:
 Music therapy
• 150 minutes of
• Listening, singing, rhythm, body
moderate-intensity or
movement
75 minutes of vigorous
aerobic activity
 • Can be effective distraction
technique

 Yoga

• Unites body, mind, spirit

• Improves balance, flexibility,

mental alertness, calmness

Reflection on Practice

• Reflection

 Thinking from a critical point of view

 Analyzing why one acted in a certain

way

 Assessing the results of one's action

• Reflection on Practice

• Reflection

 Thinking about what happened in a

nursing situation

 Becoming aware of how one feels about

oneself

 Requires discipline, action, openness,

trust

• Reflective journaling

 Partnership with a mentor or teacher

 Framework for reflective journaling