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Feature: SHARING

True presence: Practicing the art of nursing

Robinson, Sheria Grice MSN, MHA, RN, CHPN

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doi: 10.1097/01.NURSE.0000444533.58704.e5
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A LOCAL DAY SPA in Birmingham, Michigan, is one of my favorite places to visit. What makes this place special isn't the two receptionists who greet you with a look that says, “We've been expecting you and are happy to see you.” Nor is it the painstaking attention to detail that's transformed this small space into a luxurious retreat: ambient lighting, bergamot- and lavender-scented candles, and beautiful gold-framed artwork. What makes this place special is the owner, Margot.

Margot has a way of making you feel as if you're the most beautiful and most important person on the planet, deserving only the best. But Margot hasn't been in business for 30 years because she's mastered the skill of whispering sweet nothings into her clients' ears. Margot understands that the external environment, which she controls and creates, influences the internal environment of every person who walks through her doors. Her skillful interweaving of art and science is what sets her above her competitors and keeps me, and others, coming back. What I've learned from Margot is the art of service and how it applies to nursing practice.

Nursing as an art

Every day, nurses are faced with the challenge of making a difference. In the midst of technologic advances that limit physical contact, increasing patient acuity, higher patient loads, and diminished staffing, it's easy to become caught up in the practical tasks of our work. Just as Margot and her staff understand that everyone who comes into the spa likes to feel beautiful and pampered, nurses understand that regardless of a person's health, everyone desires a high quality of life. While individual views may vary regarding what's a “good” quality of life, a few constants are universal: peace of mind, a comfortable environment, and a sense of accomplishment. As nurses, we help patients adapt to changes in health by artistically applying our science.

The art of nursing is our perception of patient needs based on their expressed behaviors.1 Unlike scientific knowledge, art doesn't rely on systematic explanations to reach conclusions; instead, the focus is on how experiences feel and what they mean. This abstract body of knowledge helps nurses connect with patients during care and is completely reliant upon being genuine, attentive, and immersed in the moment with patients—what some call being in true presence.2 This requires nurses to practice the skill of active listening and encourage communication that draws attention to patient, family, and community values.

Practicing true presence

Values are evidenced through both language and patterns of behavior. At Margot's, the services I select, my rationale for choosing those services, and the products I browse while waiting, provide important clues about my skin care concerns and relaxation desires. Through seemingly casual conversation, Margot can clarify this information and then provide exceptional service that meets all of my needs.

Similarly, when nurses practice true presence, they can determine what's most important to patients by listening to what they say, what they don't say, and how they describe things that were done, and by noting nonverbal feedback such as facial expressions, gestures, and silences. With this information, nurses can facilitate health by introducing new possibilities that may help patients enhance their quality of life.2 This therapeutic use of self allows nurses to intuitively understand how to deliver effective and satisfying care with both creativity and style.3,4

Like the photographer prepared to experiment with various types of lighting to produce a beautiful picture, nurses come prepared to meet patients with wide-ranging skill sets that cover all aspects of the person: physical, mental, spiritual, cultural, and emotional. By adding some imagination to these skills, nurses can develop a sense of what quality of life means to the individual, group, or community and develop innovative approaches to care. When at their best, nurses create environments that make patients feel that they have value.

Art plus science

Nurses don't have to give up on art in order to practice the science of nursing. Good science produces answers while good art asks questions. The intermingling of the two doesn't present a paradox but simply raises new questions. As we perform the tasks of our jobs, let's not forget to express the artistic side of nursing.

REFERENCES

1. Carper B. Fundamental patterns of knowing in nursing. ANS Adv Nurs Sci. 1978;1(1):13–23.
2. Parse RR. The Human Becoming School of Thought. Thousand Oaks: Sage Publications; 1998.
3. Orem DE. Nursing: Concepts of Practice. New York: McGraw-Hill Book Co.; 1971.
4. Finfgeld-Connett D. Concept synthesis of the art of nursing. J Adv Nurs. 2008;62(3):381–388.
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