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Embracing the art and the science of nursing: nursing must pay equal attention to the art and the science of practice to achieve its full professional potential and assume a leadership role in health.

DISCOVERING WHAT is unique about nursing is a necessary

evolutionary process. The history of our profession, compared to some

others, is relatively short, and this may contribute to the view that

nursing has yet to arrive at a consensus of role and function. (1)

Nursing has been described as both an art and a science. An

elaboration of these terms could be considered foundational to thinking

about nursing and increasing nursing specific knowledge. In what ways is

nursing an art? What is the science of nursing? And how do art and

science help nurses to articulate the essence of their profession in the

context of political and health change?

The art of nursing

Many nurse writers agree there are elements of nursing that are

artful. More rigorous debate tends to occur when the finer meaning of

the word "art" is applied to the nursing context. One writer

describes art to be applicable to nursing in the everyday sense. Art is

about the whole of the nursing experience and not a distinctly separate

part of it. (2)

Because nursing involves people in a variety of settings and

situations, effectiveness is dependent on the quality of those

interactions. The art of nursing will often be practised in environments

that are unpredictable and spontaneous, requiring the nurse to be

creative in her/his response to individual client needs, hence the term

art is used.

Additional aspects of nursing considered artful are the knowledge,

judgement and skill exercised by nurses in their everyday practice. (3)

Nurses develop the ability to sense, feel, perceive and know how to

deliver care in ways that increasingly demonstrate mastery in their


Nursing has also been described as a helping art and one that is

able to empower and transform situations with clients toward favourable

health changes. The great psychiatric nursing theorist Hildegard Peplau

described three major components of nursing art--medium, process and

product. (4) The medium is the art of bringing about change towards

health through activating the potential of clients. The process is the

interaction that is initiated by the nurse and moves towards an end

point, which may include the application of technical skill. The product

aspects of art are described as the improved functioning of the client

that may or may not include observable outcomes.

As a complement to the demonstrable aspects of art, outcomes in

practice can also be legitimately intangible. The arts of caring and

practising intuitively, for example, could be described as elusive

elements of nursing that can lead to health change. Such change can also

remain private to a client, who may not share this with the nurse.

Practising in a reflective manner through the enhanced knowledge of

self is also artful. This integration of being and self-expression is

not dissimilar to that of an artist. (5)

These elements of nursing, however, cannot be easily accounted for

by objective science and are therefore more likely to be shunned by

others in the health environment for being overly subjective. (6) It may

be however, that these elusive aspects of our practice are the very

issues that define the art of nursing. (7) In contrast, another writer

suggests nurses are also able to celebrate their art through a variety

of expressions including song, inspirational verse, comedy and stories

from professional practice. (8)

Although the outward expression of art in nursing is not uniform,

an iterative process of scholarly debate will help us to understand the

artistic parameters of our profession. This will add to existing

knowledge, and the implementation of art in everyday practice.

What is the science of nursing?

To many nurses, the word "science" is more likely to be

associated with medicine than nursing. To understand science in a

nursing context we must first examine what science is and what it is

not. The primary aim for the development of science is to expand a body

of knowledge. This increasing knowledge then underpins and informs the

thinking and practice of a particular discipline. Scientific methods

have been developed and refined, permitting issues previously beyond the

bounds of scientific investigation to be addressed. The scope of

scientific endeavour has expanded enormously in recent decades with the

acceptance of qualitative methods and computer based data analysis.

Developing the science of nursing cannot be viewed within the

realms of a traditional medical paradigm, or be confused with the goals

of medical scientific method. Medical science has undoubtedly made a

significant contribution to health, though as one commentator suggests,

the quest for objective truth limits the scope of this science to

methodologies that have increasingly become reliant on technological

tools. (9) As a consequence, the need to "re-tool" has become

the primary focus of further scientific development.

Technological advances in nursing often provide practical aids workforce management metrics with

which nurses can enhance their relationship with, and caring for people.

As nurses, we have no need to emphasise technology over art, or become

so enamoured with science we become narrow minded in our methods of

Inquiry necessary to mature the body of nursing science.

Contributions to the advance of nursing knowledge do not always

seek to verify truth, although this may be appropriate in some

circumstances. Nursing science aims to generate and test extant theory,

discover meaning and to develop a growing knowledge with which to

articulate the work we do. Nursing science has been described as,

"a scholarly adventure, one guided by purpose undertaken with

boldness, sense of freedom and creativity, merged intellectual rigor and

integrity". (10)

Many examples of creative scholarship in nursing science can

already be found in the nursing literature: one writer brings to our

attention the relevance of critical language inquiry in nursing,;

another discusses a "womanist" perspective as a framework for

encouraging health-promoting behaviours in the lives of African American women. (12) Each is an example of nurses discovering and sharing their

personal scholarship to extend the knowledge of the profession.

Many more nurses are creating their art and practising their

science on a daily basis without any formal recognition. These creative

and scholarly workforce management quiz abilities must continue to be exercised and celebrated, so

nurses can demonstrate not only their tangible skill, but also

articulate the nursing knowledge that has led to these skills being


Benner (6) reminds us that a great strength of the nursing

practitioner lies in her/his ability to overcome the 'objectifying

gaze' that would otherwise describe only a disease and not include

the human experience. Policy makers are continuing to seek ways to meet

more than just the physical health needs of clients. This concept is not

new to nurses, but as yet has not been well articulated. The integration

of art and science can produce a professional balance of discovery and

verification, and provide the means to link nursing theory with practice

in ways meaningful to nurses devoted to scholarship or clinical


Health change and the future

These ideals for the development and implementation of the art and

science of nursing have been difficult to attain in a less than optimal

environment. A decade of health reform incorporating the goals of profit

and competition has been the antithesis of the essence of nursing care.

Although nurses have historically proven their ability to

'survive' in ways not dissimilar to the pioneers of our

profession, (13) we need to extend ourselves beyond a re active level to

address the challenges of the future.

There is a growing national and international recognition of the

need for a strategic approach to workforce development. (14) This

presents nurses, as the largest professional group within the health

sector, with an ideal opportunity to accept the challenge of developing

nursing academically and professionally.

Whatever the agenda set by the government of the day, nurses must

continue to delineate and articulate the exceptional elements of

nursing. Our art and science will enable us to achieve this task. The

art of nursing, which is already an integral part of our practice and

valued by our members, must be creatively presented in ways workforce management features recognisable

by those outside nursing as a unique and valuable phenomenon.

The science of discovery and verification will increase the body of

nursing knowledge, underpinned by research through a nursing lens.

Developing art and science that promotes the ability of nurses to think

and act, will add credibility to nursing practice in years to come.

The complementary relationship between art and science is

fundamental to the practice of nursing. All nurses are able to make a

contribution to the future workforce management events shape of their profession, or create what has

been described as, "a passion for our own destiny". (15) The

potential exists for our science to add even greater significance to our

art, and for our practice to reflect a profession with the skills to

more than adequately meet the challenges of an increasingly complex

health system.

As we continue the journey to a consensus of role and function, we

must nurture our art and develop our science. The maturation of a body

of unique nursing knowledge will provide nurses with the foundation from

which to take a lead role in the future of health care in New Zealand.


(1) Hilton, P. (1997) Theoretical perspectives of nursing: A review

of the literature. Journal of Advanced Nursing; 26: 6, 1211-1220.

(2) Wainwright, P. (1999) The art of nursing. International Journal

of Nursing Studies; 36,379-385.

(3) Johnson, I. (1994) A dialectical examination of nursing art.

Advances in Nursing Science; 17: 1, 1 14.

(4) Peplau, H. (1988) The art and science of nursing: similarities,

differences, and relations. Nursing Science Quarterly; 1: 1,8-15.

(5) Cody, W. (2000) Nursing science frameworks for practice and

research as means of knowing self. Nursing Science Quarterly; 3: 3,


(6) Benner, P. (2000) The wisdom of our practice. American Journal

of Nursing, 100: 10, 99-105.

(7) Le Vasseur, I. (1999) Toward an understanding of art in

nursing. Nursing theory for the 21st century. Advances in Nursing

Science; 21: 4, 48-63.

(8) Masson, V. (1996) A decent paying job not art and beauty.

Nursing and Health Perspectives on Community; 17: 3, 150.

(9) Kuhn, T. (1970) The structure of scientific revolutions. 2nd

Edition. London: The University of Chicago Press Ltd.

(10) Hinshaw, A. (1989) Nursing science: The challenge to develop

knowledge. Nursing Science Quarterly; 2: 4, 162-171.

(11) Boutain, D. (1999) Critical language and discourse study:

Their tranformative relevance for critical nursing inquiry. Advances in

Nursing Science; 21: 3, 1-8.

(12) Banks-Wallace, J. (2000) Womanist ways of knowing: Theoretical

considerations for research with African American women. Advances in

Nursing Science; 22: 3, 33-45.

(13) Brown, E. (2000) Nightingale's values live on. Kai Tiaki

Nursing New Zealand; 6: 3, 31.

(14) Health Workforce Advisory Committee, (2002) The New Zealand

health workforce: A stocktake of issues and capacity 2001. Ministry of

Health, Wellington, New Zealand.

(15) Fawcett, J. (1999) The state of nursing science: Hallmarks of

the 20th and 21st centuries. Nursing Science Quarterly; 12: 4, 311-318.

--Jeffrey Gage, RCpN, MPH, is in his third year of PhD studies at

the Sinclair School of Nursing, University of Missouri, Columbia. Before

embarking on his overseas studies he worked as a public health nurse in

Timaru and Christchurch.

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