Abstract
The article that follows reflects on the importance, the precision, and the guidance provided through theoretical foundations, science, and art of nursing as directed by these paradigmatic theoretical frameworks and their corresponding practice methodologies. The mainstay element common across all frameworks is the precise essentials contained within the nursing theoretical frameworks that, in turn, guide the contributions of the nursing discipline. The humanbecoming paradigm serves as the primary highlighted focus of the article.
Keywords
Living the Art
Nursing literature and commonplace vernacular often reference nursing practice as art. Within the discipline of nursing, art references occur within theory, research, teaching-learning, leadership, and practice projects; these references occur through the community of scholars who ascribe to a common commitment to values, knowledge, and research from a common and precise paradigmatic perspective. Thus, this practice column focuses on appreciating the precision and art of nursing from a totality, simultaneity, and humanbecoming paradigmatic perspectives as defined by Parse (2014, 2021a). The mainstay of this article’s focus is to highlight living the art and leading-following from a humanbecoming paradigmatic perspective.
Art is not a new concept that is utilized when referencing nursing. Nightingale (1860) defined nursing functions as the art of practicing the science. According to Nightingale, nursing utilized the patients’ environment to improve their conditions and assist in recovery or prevention of disease; the important themes that arise are nurses’ knowledge, presence, and artfully managing the environmental provision of fresh air, light, space, physical arrangement of wards. Dossey et al. (2005) further delineated Nightingale’s thoughts on nursing as science and art through referencing letters Nightingale wrote to nurses. “Nightingale instills the expectation that nursing will be practiced by educated individuals utilizing current research and methods (the science) as well as thorough compassion and common logic (the art)” (Dossey et al., 2005, p. 100). The importance of art continues. For example, in the current Scope and Standards of Nursing Practice, the American Nurses Association (2021) describes nursing as
integrating the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning, the prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity. (p. 1)
The revised statement within the Scope and Standards document brings to the forefront that a defining element within nursing consists of integrating art and science. The path and recognition of the importance of art continues within nursing; the missing element is connecting the art and science of the discipline to paradigmatic theoretical underpinnings. These connections serve to provide a clarity of purpose upon which the unique contributions herald and define the profession’s contributions.
A foundational step in connecting the science and art to the nursing discipline exists in paradigmatic perspectives of disciplinary knowledge. For example, as defined by Parse (2014, 2021a), the totality or medical model view of nursing traditionally views humans as composed of bio-psychosocial-spiritual entities upon which nursing practice methodologies focus. Nursing is viewed as an applied science with the nursing serving as experts, and the nursing process centers on managing both internal and external environments. Elements such as researching, implementing, and continuously evaluating the methodologies of the nursing process are important. For instance, goals and interventions aimed at enhancing quality of life for persons living a diagnosis of cancer may be guided by incorporating King’s theory of goal attainment to improve relationships, well-being, and quality of life (King, 1981). These approaches are precise, are significant, and have succeeded in advancing improvements within technology and medicine beyond a strict problem-solving approach. Although there are precise and artful conceptualizations of nursing’s contributions within this view, the overall approach is in line with a natural science medical model. The uniqueness of the discipline and art of nursing is not considered or designed as distinct in nature. Additional paradigmatic views as defined by Parse (2021a) reference the discipline as a basic human science and the contributions of nursing designated as distinct. The simultaneity and humanbecoming paradigmatic views, in the opinion of this author, highlight human science precision, art, and contributions of the nursing discipline.
In contrast to the totality paradigm, the simultaneity paradigm is a paradigmatic view that posits humans as a unitary, more than and different from the sum of parts with persons living and recognizing patterns. Health, from a simultaneity frame of reference, is defined as a value and process as opposed to a state of being on a continuum (Parse, 2014, 2021a). This paradigm artfully revolutionized the view of nursing as a distinct basic science (Parse, 1981, 2014, 2021a; Rogers, 1970). As an example, Barrett’s power as knowing participation in change tool (PKPCT) can be artfully placed into a health patterning practice model upon which a person’s power needs are explored with nurses exploring intentions and choices without having an attachment to or specifying an outcome (Barrett, 2010). Within the simultaneity paradigm, Barrett, utilizing Rogers’ unitary theory, ascribed to the notion, “Power just is! It is what it is and what it is-is the capacity to participate knowingly in change” (Barrett, 2010, p. 50). Barrett emphasized that this aspect of Rogerian science and inquiry highlights power as the freedom to participate knowingly in change within the universe. Barrett (2010) also emphasized a practice methodology described as two processes: “pattern manifestation knowing, and appreciation and voluntary mutual patterning” (p. 49). The practice methodology is described as consistent with postulates and principles of the science of unitary human beings and the modalities of imagery, therapeutic touch, and use of will with an artful consistency that weaves together a discipline-based knowledge and approach to nursing.
The humanbecoming paradigm defines humanbecoming as “cocreating reality as a seamless symphony of personal becoming” (Parse, 1996, p. 182). A key to this precise defining feature is the view that humanuniverse is engaged in cocreating a unique history. Humanuniverse is indivisible, unpredictable, and everchanging. And it is living quality that is the whatness of humanuniverse. Living quality is defined as “the becoming visible-invisible becoming of the emerging now and is the living moment that brings to the fore the idea that meaning changes with each unfolding living experience, incarnating remembering-prospecting all-at-once” (Parse, 2021b, p. 54). Each humanuniverse is living quality with its inherent core knowings of fortifying wisdom, discerning witness, and penetrating silence (Parse, 2021b). These core knowings precisely provide a “grounded quietude that weigh all humanuniverse presences in bringing to light understandings” (Parse, 2014, p. 29). This artful conceptualization incorporates the ethos of the nursing discipline that is embedded within the frameworks and theories of the discipline (Parse, 2021a). The ethos of humanbecoming paradigm is defined as dignity that in turn is defined as “a profound majesty and noble bearing” (Parse, 2018, p. 259). Dignity is defined as composed of four tenets: “Reverence is solemn regard for humanuniverse presence; Awe is beholding the unexplainable of humanuniverse existence; Betrayal is violation of humanuniverse trust; and Shame is humiliation with dishonoring humanuniverse worth” (Parse, 2018, p. 259-260). Of note, the paradoxes of the ethos of dignity revering-betraying and aweing-shaming artfully woven into dignity arose from the humanbecoming hermeneutic sciencing of reverence, awe, betrayal, and shame captured in the Lives of Others (Parse, 2016). Nursing from the humanbecoming perspective is living the art that arises from rigorous study and understanding of humanbecoming assumptions, principles, postulates, tenets, and concepts. The living the art of the paradigm is referred to as true presence, which honors the dignity of others not by diagnosing or labeling but rather living a deep, abiding commitment to the notion that individuals know their path and approach their living quality according to their unique value priorities. Humanbecoming professionals honor the unique dignity of individuals and thus have an availability to be with and bear witness as persons illuminate meaning, shift rhythms, and inspire anticipation as situations appear in new light arising from a true presence with others (Parse, 1981, 2021a). Whereas the term presence often has unclear boundaries and is often defined from a totality paradigm with antecedents, attributes, and consequences, true presence has a clarity of paradigmatic definition, inquiry, and methodology. Explicitly true presence is defined as:
a powerful humanuniverse whole-in-motion connection, a special way of being with others, attentive to moment-to-moment changes in meaning with the becoming visible-invisible becoming of the emerging now. It is bearing witness and being with others in their hanging pattern preferences attuned to the rhythms, hopes, and dreams as shown in the sounds and silences, the visions and blindness’s available with the illimitable mystery of humanuniverse. (Parse, 2021a, p. 119)
Living the art projects occur and are lived with person, family, or community. Of note, living the art of humanbecoming through true presence knowledgably and artfully provides a nonroutinized, nonjudgmental attentiveness, and appreciation of others’ intentions (Parse, 2022). One example of living the art is documented by Mitchell et al. (2006) in chronicling the education and the impact within nursing with the shifting perspective to being with persons and learning the framework, science, and art contained within humanbecoming. The teaching-learning education program for nurse participants in a chosen unit reviewed defined literature on the artistic expressions of living with cancer, as well as women’s experiences of living with metastatic breast cancer (Mitchell et al., 2006). These learnings and expressions were linked by the nurse participants in the context of their unique nursing work with persons having orthopedic surgery and patients living with chronic illnesses. The impact on patient satisfaction and nurse satisfaction was significant and chronicled (Mitchell et al., 2006).
Affiliated with the virtuosity contained within living the art of nursing, there is the model of leading-following from a humanbecoming paradigmatic perspective. The art of leading-following is rife with a commitment to visioning by way of forging a path that honors the dignity of individuals and groups. Leading-following moves with the vague and bears witness to the wonders that arise. There is an idiom that often is expressed in the everyday parlance and nursing literature. It is all nurses are leaders. This implies a power that is delivered through the constituents of a group, community, or team. What is not common is a theoretical framework and methodology upon which a nonlinear and multidimensional model explicitly defines the assumptions, essences, and processes of a model. Understanding the precision and art begins with underlying assumptions, essences, and processes. The culminated definition of leading-following from a humanbecoming perspective is “deliberately innovating with potent engaging in persistently pursuing excellence. It is indivisible, unpredictable, and everchanging cocreation” (Parse, 2008, p. 371; Parse, 2021a, p. 165). The model describes assumptions, essences, and processes. The essences are defined as: “deliberately innovating is committing to a vision with vigorous energizing, potent engaging is willingly risking in living with ambiguity, and persistently pursing excellence is revering others with vigilantly attending” (Parse, 2021a, p. 165). Both the definition and essences of leading-following are informed by the inherent belief that power is with persons, regardless of a specified leader or follower role, and all participants in situations possess an inherent dignity with important contributions to projects.
Living the art of leading-following’s first assumption is defined as “meanings unfold with deliberately innovating” (Parse, 2021a, p. 167). The essence of this assumption is “deliberately innovating is committing to a vision vigorous energizing” (Parse, 2021a, p. 167). There is a medley of infinite possibilities. One nurse leader-follower described the importance of having a clear understanding of one’s values, belief structures, and theoretical underpinnings upon which to draw and build with persons and groups working together. This leader-follower described defining those values upfront with an exercise of shared visioning prior to getting to creating a project of redesigning a unit. Participants put on the table, so to speak, the values and theoretical underpinnings that laid their foundational contributions for the work within their upcoming project. This exercise was important since leading-following is undergirded with the belief that participants choosing to share or not share values and ideas with clarity is laden with individual values and passions. Leading-following encompasses a disquiet in thoughts and intended actions that spark a commingling of diverse and energizing movements toward defining and achieving something of value. The leading-following project in this instance was framed as the guiding principles upon which to accomplish work, standards for working relationships, and standards for peer review. This committing to a vision cannot be understated. In other words, the commitment to a vision includes all. There is also a famous story about President Kennedy’s first visit to National Aeronautics and Space Administration (NASA) headquarters in 1961. As reported in an article authored by Both-Nwabuwe et al. (2017), President Kennedy, noticing a janitor carrying a broom, interrupted his tour, walked over to the man, and asked, “What are you doing? Well, Mr. President the janitor responded, I’m helping to put a man on the moon” (p. 1). Although this reference is often repeated in leadership literature, this story provides a simple demonstration of the passion, values, and power present within committing to a vision. Parse, (2021a) defined a second assumption as “changing patterns surface with potent engaging” (p. 168). The essence of which is “potent engaging is willingly risking in living with ambiguity” (p. 168). Leading-following from a humanbecoming perspective is synonymous with a daring willingness to risk. The leader-follower in this scenario described being in a board room; during project planning, the leader-follower mentioned a topic that was unspoken barrier to moving forward with a project. As the only leader-follower who ventured to express a barrier that lay beneath the surface, there was an understated courage to seek a novel approach. The outcome, in this scenario, was that others acknowledged the barrier and tapped into a courage to agree and subsequently vigorously explored alternatives. Yet, within this scenario, there also existed ambiguity and risk. Would the risk of expressing a perceived barrier result in being shamed for unearthing this expressed obstacle? One can never predict the results that arise from a willingness to risk, yet engaging with the unsettled opens possibilities of propelling forth with unique alternatives and unique ways of relating. A third assumption in leading-following is defined as “infinite possibilities emerge with persistently pursuing excellence” (Parse, 2021a, p. 169). The essence of which is “persistently pursing excellence is revering others with vigilantly attending” (Parse, 2021a, p. 169). This same leader-follower with the same project looked at configuration of patient care environment and with this visioning the team together looked at implementing a different role to improve organizational patient care workflows. This vigilantly attending to configuration as a leader-follower with important and connected staff brought about the novel idea of a different role, as a valued staff member’s movement-restrictions facilitated full participation in work redesign and a new job description was created. The vision and new role arose from revering others and vigilantly attending to creating anew. Leading-following constituents precisely and artfully cocreate relationships that change over time as each speaks and is silent, moves and is still; thus, new possibles emerge regarding mission, vision, and expectations.
The commonality of paradigms that focus on nursing as a basic human science is that there is a preciseness and congruence upon which the art and methodologies flow from the theories, inquires, and methodologies. The term avant-garde also comes to mind; avant-garde typically refers to innovation, and avant-garde works are often characterized by pushing boundaries and artfully challenging the norm through contributing to unique possibilities. Living the art of the science thus provides a beacon of light that drives creating projects with important others whether in practice with the totality or simultaneity paradigms or in living the art and the leading-following model from the humanbecoming paradigm. Thus, the purpose of the nursing profession to provide service to humankind is uniquely, precisely, knowledgeably, and artfully achieved.
