Sometimes I wonder what nursing theory will look like in the future. What if nurses truly viewed our mission in society as deeply connected with the healing arts? My perspective on nursing as a healing art has begun to change over the past several months as I have been teaching beginning nursing skills to entering nursing students and at the same time completing a study on the art of nursing. Ironically, what I find I am called on to teach as "nursing skills" and what practicing nurses reveal as their "skills" are drastically different.
In my nursing skills classes, we address things that nurses in the acute care setting are called on to do. Despite many theoretical and philosophical perspectives that defy defining nursing by what we do, the entering students still encounter the "doing" of nursing. Their questions, wisely, usually enter into the realm of being and knowing. They imagine various circumstances and wonder how to adapt their approach to the circumstances. They recall their own experiences as patients and imagine how their experience might have been different.
They typically begin with a desire to make a deep connection with the people they encounter in the "doing" and keep probing for ways to imagine how this connection might be fulfilled while they are "doing" the acts of bathing, giving medications, or assisting with walking. Indeed, I encounter the beginner's concern with becoming practiced and skilled with the various nursing acts, but their concern is much more complex than simply wanting to have the psychomotor skills in place.
In my study of the art of nursing, the concern for connection is even more evident. We found a deep, heartfelt reaching out that was expressed in words and movements as the nurses responded to the experience in the moment. We observed nurses looking deeply into the situation using their eyes, their touch, their words, their moves in and out of a situation to create a connection. The "doing" of tasks seemed like the ability to play a scale on a musical instrument, making it sound like a symphony. What came through was the experience of deep connection, of a nurse giving meaning to a situation through her way of being and acting in the situation. It was never the prescribed ways that might be implied in physician's prescriptions; rather, it was a way of creating experience that spoke through the situation.
In my recent experience, both beginning students and experienced nurses are challenging the predominance of epistemologic primacy and calling for a way of being that conveys both personal and professional meaning to their experiences in interaction with other people. What I have experienced in these two aspects of my work-my teaching and my research-is reflective of the challenges raised by Silva, Sorrell, and Sorrell.  In the future, they state, "both nurses and nursing students must understand how to learn rather than how to hoard knowledge, how to critique rather than how to accept, how to expand rather than how to contract."  (p12) The theories of the discipline will begin to change drastically if these shifts are to occur. Theories will become avenues for learning, for critical thinking, for expanding possibilities beyond that which can be predicted and into realms that can be created.
There are many aspects of the articles collected for this issue of ANS (19:3) that point in the direction of emerging possibilities. The very definitions of middle-range theory implied in this collection defy a single, limited perspective. Together, the articles in this issue point to a number of possibilities for the future of nursing as a healing science-art.
Peggy L. Chinn, RN, PhD, FAAN
1. Silva MC, Sorrell JM, Sorrell CD. From Carper's patterns of knowing to ways of being: an ontological philosophical shift in nursing. ANS. 1995;18(1):1-13.