To provide optimal care in today’s complex healthcare environment, nurses must be knowledgeable, technologically savvy, compassionate, and caring. They must practice high levels of communication. The American Nurses Association (ANA) describes nursing as the “glue that holds the patient’s healthcare journey together, a science and an art” (ANA, n.d., para. 1). Meeting the many challenges inherent to providing safe, quality, patient-centered care takes both scientific knowledge and creative art.

The Art and Science of Nursing

Throughout history, leaders in the profession of nursing have grappled with the separation, integration, and synergy of the art and science of the discipline. Throughout history, leaders in the profession of nursing have grappled with the separation, integration, and synergy of the art and science of the discipline. Writings of nurse scholars such as Peplau (1988) explain the beauty of both the art and the science to provide a holistic lens to describe the complexity of nursing care. Carper’s (1978) description of the values and beliefs for professional practice expanded our understanding of empirical and aesthetic ways of knowing. Empirical knowing allows scientific evidence to guide practice, while the aesthetic way of knowing embraces the art of nursing.

Science, as a way of knowing, serves as a basis to advance nursing practice necessary to continue the service of human health needs (Grace & Zumstein-Shaha, 2019). This perspective is encompassed in the four nursing metaparadigm concepts of health, person, environment, and nurse. Empirical knowledge informs professional practice not only from the common understanding of scientific systematic assessments and observations, but also the subjective experiences of persons and the meaning they attach to these events (Carper, 1978).

Collectively, nursing science informs the evidence base necessary for the practice arm of the profession and is vital to improve healthcare and patient outcomes (Titler, 2011). Evidence-based practice includes evidence from scientific studies, as well as patient preferences and nurse expertise. It is nurse expertise that may often be unobserved and only known through a deeper understanding of the art of nursing.

Evolving over time, the art of nursing has been defined as the nurse’s ability to be compassionate, caring, and communicative The art of nursing, in its earliest history, was rooted in vocational norms related to motherhood and homemaking (Peplau, 1988; White, 2002). Evolving over time, the art of nursing has been defined as the nurse’s ability to be compassionate, caring, and communicative (Palos, 2014). These behaviors enable nurses to interpersonally connect with patients, a skill which is critical to quality patient-centered care and deeply valued by patients and families. Holistic care by nurses explores a patient’s illness or cause for seeking healthcare. It offers to nurses a framework to learn about patients’ physical, mental, and psychosocial needs to optimize care for them and their families.

Nurses are the most present of healthcare professionals and thus best able to read the emotional cues of patients and establish human connections and relationships. Intrinsic to the art of nursing, compassion aligns with nurses’ highest professional ideals. Compassion is an emotional response to reduce another’s pain or suffering (Goetz, Dacher, & Simon-Thomas, 2010). It involves taking action, and is distinguished from empathy, a necessary precursor of compassion defined as feeling and understanding one’s suffering (Trzeciak & Mazzarelli, 2019). Compassion elevates care through actions, voice, and touch, motivating other forms of relational connectedness demonstrated through caring practices and communication (Goetz et al., 2010). When relational connectedness is established, individualized opportunities for tailored, patient-centered care exist, giving nurses needed insight to know and do things differently. The value of this work is in the resulting physical actions and intellectual and emotionally invested decisions at the core of nurses’ work. Sadly, these often remain invisible.

Caring is a multi-dimensional concept interpreted within one’s experiences. Caring is a multi-dimensional concept interpreted within one’s experiences. Watson (1979) summarized the work of caring as holding humanistic values of trust, developing relationships, maintaining hope, and recognizing the importance of spiritual, physical, and mental support. She also associated the work of caring with systematic creative problem solving and teaching patients to improve their quality of life. The unique role of nurses to be present around the clock, both physically and mentally, provides the opportunity to engage in meaningful patient relationships that demonstrate caring.

Communication, as an art form, encompasses both verbal and non-verbal interaction and active listening. Nurses use both instrumental and affective communication skills to provide optimal care to patients. Instrumental communication fulfills the patient need to gain knowledge about diagnosis, treatments, and the healthcare journey. Affective communication, sometimes considered a soft skill, is the ability of nurses to provide an empathetic, compassionate, and caring approach toward patients and families (Van Vliet & Epstein, 2014). Clear, concise, and relational communication is essential to quality, safe nursing practice and patient-centered care. When the art and science aspects of nursing practice become synergistic, they shape a holistic and powerful approach to improve patient and family care.

Nurses use the science of knowing and art of nursing in their daily practice across a breadth of situations. Nurses use the science of knowing and art of nursing in their daily practice across a breadth of situations. For example, nurses learn the best approach to provide comfort for patients and families, especially for those who struggle to cope with a diagnosis and experience frustration and anger. Nurses advocate for patients and families using compassionate and empathetic communication to help them understand and navigate the healthcare environment and health outcomes. Nurses bring calm to an often chaotic experience by being present with patients.

The Art of Nursing and the COVID-19 Pandemic

During the COVID-19 outbreak...nurses orchestrated the art of nursing to provide quality care. During the COVID-19 outbreak when patients were critically ill and the disease and treatments defied the boundaries of available science, nurses orchestrated the art of nursing to provide quality care. When family support was prohibited, nurses understood patients’ needs for the comfort of human connections. They were proactive in providing and facilitating communication with families. They wrote inspirational messages on hospital room windows and ensured that families could communicate with loved ones using technology. In final moments, nurses, as surrogate family members, held patients’ hands; they cried with and consoled families (Levitz & Berger, 2020). Capturing the meaning of these indescribable experiences, common in nursing practice, may be best expressed by a medium that captures the essence of their practice.

Celebrating Nurses with Poetry

In contrast to science, which defines what something is, poetry gives a deeper and richer understanding about the experience... Nurse leaders at Kent State University (KSU), located in Kent, OH, aspired to celebrate nurses during the 50^th anniversary of the College of Nursing by using poetry to unveil the meaning of the art of nursing. As an art form, poetry provides a unique opportunity for nurses to understand the lived experiences they share with patients (Hunter, 2002). In contrast to science, which defines what something is, poetry gives a deeper and richer understanding about the experience by describing the “ofness” of something and the emotional connection to these experiences and feelings that help give meaning to the event (Hunter, 2002). Creation of the poem “Some Days” gave voice to students, faculty, and alumni who participated in developing a community poem to describe the complex emotions that provide meaning to everyday nursing practice.

Reflecting on Practice
In partnership with the university Wick Poetry Center, KSU College of Nursing faculty created a unique experience for the nursing community to engage in creative dialogue that considered the art and science of nursing to develop a community poem that reflects this “ofness” of nursing practice. The experience of crafting the “Some Days” poem began with eight workshops for College of Nursing faculty, students, and alumni led by the Director of the Wick Poetry Center (DH). During each workshop, a poem was shared about healing and the work of nursing to inspire conversation and reflection. Each poem served as an invitation and guide for participants to engage in the writing process and explore their own feelings, memories, ideas, and emotional responses about their experiences as a professional nurse.

During each workshop, a poem was shared about healing and the work of nursing to inspire conversation and reflection. Examples of poems used during the experience included “Gaudeamus Igitur” by poet and physician John Stone (1983), as well as other poems curated by the Wick Poetry Center from community workshops, such as “Ode to My Body” by a group of senior high school students; “Things That Have No Name” by an outpatient therapy group; and “Nurse’s Prayer” by an oncology nurse (Wick Poetry Center, 2020). Following their consideration of the model poem, the group was led through a discussion that challenged participants to connect with their inner emotions as they relate to day-to-day nursing practice. A prompt from one of the poems was then used to inspire each participant to reflect and create their own stanza to give meaning to the experience of being a nurse.

Creating a Poem
This process required a deep reading and “listening” to the language... After the eight workshops were completed, individual lines and images from nearly 300 participating college of nursing faculty, students, and alumni were woven into a collective poem by Director of the Wick Poetry Center, (DH) using an organic and intuitive approach. This process required a deep reading and “listening” to the language and then searching for connections to discover how one line or image could speak to another. This method offered an exciting way to connect each individual story and experience with a larger collective story and voice. The “Some Days” community poem is the culmination of this process and celebrates the work of nurses.

Inviting the Public
During the COVID-19 pandemic, the power of the poem was reinforced through the narration of the images that were publicly voiced by frontline nurses. Once the poem was designed and installed as a mural on the first floor of the College of Nursing academic building, it took on greater meaning and significance as a public work of art and point of pride for the college to memorialize the complex emotional truth of nursing and inspire future nurses. During the COVID-19 pandemic, the power of the poem was reinforced through the narration of the images that were publicly voiced by frontline nurses. Coupled with striking, colorful illustrations, this public installation invites all, particularly those who might not normally read a poem or pick up a poetry book, to pause and reflect on the emotions of what makes being a nurse unique and different, to feel renewed or inspired, and to connect with others through a shared, creative expression. (Figure 1)

Figure 1.

There is no one correct way to interpret a poem. There is no one correct way to interpret a poem. Individual readers interpret the poem based on their unique experiences. The art of developing a community poem is what allows the poem to impact those who experience it. Stanzas such as “Your arms will open like doors welcoming those in need” express the art of compassion and making human connections exemplified by nurses. Questions imbedded in the stanza, “Who will wipe the face of the unknown?” and “Who will care for the lonely one in the room,” emphasize the art of caring, and the phrase “You’ll speak directly with death yet still hear life’s wavering mumble” expresses the verbal and non-verbal communication skills nurses use in times of need. (Figure 2)

Figure 2.

Conclusion

Nursing is indeed an art and science. Science helps to explain the work of a nurse, while art addresses the human connections, empathetic communication, and dedicated care and compassion that make nursing a critical element of healthcare. Although the science and the art of nursing practice are synergistic, in recent years, the worldview of the art of nursing continues to evolve. Emerging scientific evidence indicates that the art of nursing promotes positive physical and psychological effects on healing (Trzeciak & Mazzarelli, 2019).

To experience the complete “Some Days” poem, please see (LINK to “Some Days” PDF version). If you would like to participate in developing the “Some Days” Community poem further, please visit https://communitypoems.travelingstanzas.com/somedays.

The poem celebrates the distinctive contributions of nurses to the healthcare journeys of patients and families. Developing a community poem focused on the many complexities of nursing offered a meaningful platform about the holistic work of nurses, especially during, but not limited to, this time of challenge arising from the pandemic. The poem celebrates the distinctive contributions of nurses to the healthcare journeys of patients and families. While the art of nursing practice can sometimes be invisible, it is what makes the role of the nurse unique, trusted, and valued by patients and families.

Authors

Tracey Motter, DNP, MSN, RN
Email: tmotter2@kent.edu

Tracey Motter is the Associate Dean of Undergraduate Programs at Kent State University College of Nursing in Kent, OH. During her tenure at Kent State, she has received numerous teaching awards at the college, university, and national level and has received national workforce development funding to increase diversity in nursing. She is an expert in NCLEX preparation and teaches the NCLEX success course. Dr. Motter is also a co-investigator in funded research on interdisciplinary end of life care. Her area of interest for research is in nurses’ self-care and resiliency, transition to practice, and preparing nurses to be leaders in providing quality cost-effective healthcare. She is a member of Sigma Theta Tau and the American Nurses Association.

David Hassler, MFA
Email: dhassle1@kent.edu

David Hassler directs the Wick Poetry Center at Kent State University in Kent, OH. In 2009, he co-founded Traveling Stanzas, a community arts project which creates illustrations in response to poems generated from community workshops in schools, healthcare facilities, libraries, senior centers, and veterans’ organizations. Hassler is the author or editor of nine books of poetry and nonfiction, including Red Kimono, Yellow Barn; Growing Season: The Life of a Migrant Community; and Speak a Powerful Magic: Ten Years of the Traveling Stanzas Poetry Project. His play, May 4th Voices: Kent State, 1970, based on the Kent State Shootings Oral History Project, was published by The Kent State University Press along with a Teacher’s Resource Book and was produced in 2020 as a national radio play by the WKSU NPR station. Hassler’s awards include Ohio Poet of the Year, the Ohioana Book Award, and the Carter G. Woodson Honor Book Award. His TEDx talk, “The Conversation of Poetry,” conveys the power of poetry to strengthen communities. In addition to his creative writing publications, he has co-authored articles on poetry, technology, and healing in the Journal of Palliative Medicine and the Journal of Technology and Teacher Education.

Mary K. Anthony, PhD, RN
Email: manthony@kent.edu

Mary K. Anthony serves as Professor and Associate Dean for Research at Kent State University College of Nursing in Kent, OH and Director of Nursing Research at University Hospitals Cleveland Medical Center in Cleveland, OH. Dr. Anthony received a PhD in nursing from Case Western Reserve University in Cleveland, OH. Her area of research focuses on the structure and processes of healthcare delivery systems, including decision making, delegation, leadership, and interruptions. She has investigated patient-centered models of care, particularly those associated with building caring patient and family relationships and how those relationships relate to hospital discharge. Dr. Anthony has held leadership positions in several professional and community healthcare organizations.