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Blending the art and science of nursing

Vega, Heather RN; Hayes, Kristy RN

doi: 10.1097/01.NURSE.0000577752.54139.4e
Department: STUDENT VOICES
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Heather Vega is a SICU RN at Methodist University Hospital in Memphis, Tenn., and Kristy Hayes is an RN at West Tennessee Healthcare in Jackson, Tenn. The authors are also BSN students at the University of Tennessee at Martin in Martin, Tenn.

The authors have disclosed no financial relationships related to this article.

AS NURSING becomes more complex, nurses are expected to have the most up-to-date knowledge and clinical skills for providing the best patient-centered care possible. Patients also expect nurses to be compassionate and to communicate effectively. In today's healthcare environment, due to heavy workloads and the continual integration of technology into the nursing profession, the art of nursing seems to be slowly diminishing because nurses have less time to practice it.1 This article is intended to help nursing students understand why nursing is both an art and a science and discusses how to best balance the two.

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Care, compassion, and communication

The art of nursing refers to the highly valued qualities of care, compassion, and communication—three core principles guiding nursing practice.2 These principles encompass all aspects of patient care, including biopsychosocial needs, cultural preferences, and spiritual needs.

One case study examined how patients in an inpatient hospital setting perceived compassion in nursing care.3 The authors confirmed nursing care should focus on treating the patient with dignity, humanity, and respect. This includes demonstrating a caring attitude and treating patients as individuals. Nurses should practice effective communication (verbal and nonverbal) by actively listening to their patients' needs, wants, and concerns and responding to them directly. Nurses should be empathic and ask themselves, “How would I feel in my patient's shoes?” Practicing the three C's (care, compassion, and communication) promotes trust and increases overall patient satisfaction.3

Although all healthcare employees should be incorporating these qualities in the care of patients, it is especially important for nurses because they are involved in direct patient care 24 hours a day. A patient's hospital experience depends primarily on the nurses he or she encounters. Patients are out of their element, in an unfamiliar environment, and do not know what to expect. As nurses, our responsibility is to provide emotional support as well as physical care.

The qualities of care, compassion, and communication can be challenging to teach, and their effectiveness is sometimes difficult to measure. However, these qualities are often learned early in life through observation, life experience, demonstration, and role modeling, and they drive many people to pursue a nursing career. In addition, many nursing programs offer communication courses that incorporate the basic concepts of the art of nursing into the curriculum, and therapeutic communication is a test subject on the NCLEX-RN.4 In practice, utilizing the core nursing principles of care, compassion, and communication and applying them to everyday nursing care can increase patient satisfaction and enrich the patient-care experience.5

As healthcare continues to grow into a more customer service-based industry, the question remains as to whether exhibiting care, compassion, and effective communication should be equally weighted with the traditional clinical competencies that are required of nurses and nursing students. Hospitals have attempted to screen for these competencies by requiring potential employees to take preemployment screenings with therapeutic communication-based questions. Preemployment interviews are also a good time to screen for these important qualities.

Continued annual education is another effective way to reinforce the significance of care, compassion, and communication. This can be achieved during initial hospital/facility orientations and yearly with online continued education modules. Including simulation videos or examples of patients' perceptions of nursing care may be beneficial for nurses to understand how the art of nursing can affect care and increase patient satisfaction. In addition, annual competencies will help nurses who are experiencing compassion fatigue remember why they chose the nursing profession.

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The science of nursing

Although all nurses should exhibit the qualities that are essential to the art of nursing, nursing interventions should be practical decisions based on evidence-based research and rigorous scientific inquiry. According to the Academy of Medical-Surgical Nurses, evidence-based practice (EBP) is “a method that allows the practitioner to assess research, clinical guidelines, and other information resources based on high quality findings and apply the results to practice.”6 EBP helps guide nursing care and is associated with better patient outcomes. Examples of EBP include clinical practice guidelines to prevent central line-associated bloodstream infections and ventilator-associated pneumonia. Utilizing EBP in everyday nursing care improves patient outcomes and decreases healthcare-related costs.7

Nursing schools focus on the science of nursing and EBP when teaching students about clinical topics such as health disorders and management strategies. To maintain clinical competency, nurses must commit to continuous learning.2 Nurses need to develop and use critical thinking and clinical decision-making skills to incorporate new academic and scientific knowledge into everyday practice.

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Striking a balance

For the 17th consecutive year, nurses were recently ranked as the most trusted professionals in a national survey.8 Although many factors contribute to this, the most satisfying comes back to the art of nursing.

Healthcare organizations should explore strategies that support nursing and enhance the patient experience. For example, as nurses are continually expected to do more with less time to do it, they can make the strong business case that hospitals hire extra concierge or liaison staff to perform nonnursing duties, such as providing blankets and keeping patients informed about time frames for procedures. Some hospitals are already utilizing concierge or liaison support staff in certain areas of the hospital, and studies have shown that having this type of role can decrease anxiety and increase patient and family satisfaction.9,10 In lieu of hiring extra staff for these duties, engaged volunteers or preprofessional students seeking general experience in the healthcare setting may also be considered.

As the nursing profession continues to grow more complex, it is important for nurses to do all they can to unburden themselves from extra or unnecessary duties on the unit. This initiative may include working with IT to make the electronic health record less burdensome by removing fields that have low utility or by streamlining care processes on nursing units. Though small, these improvements can provide extra time for the nurse to practice the 3 C's of the art of nursing.

Our responsibility as nurses is to provide the best patient care possible. Patients and families expect nurses who care for them to be both knowledgeable and compassionate. When nurses can combine their technical skills and clinical knowledge with compassion and sensitivity, patients receive optimum care.

Mastering the powerful combination of the art and the science of nursing comes with time and experience. As nurses, we should strive every day to intentionally incorporate both art and science into patient care to produce the best possible outcomes.

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REFERENCES

1. Nash BA. Maintaining the art of nursing in an age of technology. Ohio Nurses Rev. 2014;89(6):12–13.
2. Palos GR. Care, compassion, and communication in professional nursing: art, science, or both. Clin J Oncol Nurs. 2014;18(2):247–248.
3. Bramley L, Matiti M. How does it really feel to be in my shoes? Patients' experiences of compassion within nursing care and their perceptions of developing compassionate nurses. J Clin Nurs. 2014;23(19–20):2790–2799.
4. National Council of State Boards of Nursing. 2013 NCLEX-RN® Test Plan. 2013. http://www.ncsbn.org/2013_NCLEX_RN_Test_Plan.pdf.
5. Bloomfield J, Pegram A. Care, compassion and communication. Nurs Stand. 2015;29(25):45–50.
6. Academy of Medical-Surgical Nurses. Evidence-based practice. 2018. http://www.amsn.org/practice-resources/evidence-based-practice.
8. Brenan M. Nurses again outpace other professions for honesty, ethics. Gallup. 2018. https://news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty-ethics.aspx.
9. Herd HA, Rieben MA. Establishing the surgical nurse liaison role to improve patient and family member communication. AORN J. 2014;99(5):594–599.
10. Tabanejad Z, Pazokian M, Ebadi A. A systematic review of the liaison nurse role on patient's outcomes after intensive care unit discharge. Int J Community Based Nurs Midwifery. 2014;2(4):202–210.
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