Abstract
In this column, the author argues that art, literary, visual, and performing should be requisite concepts in nurse curricula, and describes her personal journey teaching-learning the humanbecoming paradigm.
“Be present in a way that has a golden shimmer to it.” (Threshold Choir International, 2023)
In Notes on Nursing: What it is and What it is Not, Florence Nightingale (1859/2021) wrote:
Little as we know about the way in which we are affected by form, by color, and light, we do know this, that they have an actual physical effect. Variety of form and brilliancy of color in the objects presented to patients are actual means of recovery. (p. 29)
Art conjures thoughts of visual pieces including drawing, painting, sculpture, and photography; literary art from fairy tale, mystery, to provocative essays; and performing art like ballet, theater, and music. Within the large categories of art are innumerable genre and classifications. Artists express ideas and values through their works. Even those who cannot put pen to paper, brush to canvas, hands to clay, or bow to strings can visualize, read, and hear art. Both artistic expression and appreciation facilitate understanding of others, integral to the human experience (Malinsky, 2005). Within the nurse-humanuniverse experience relationship, there is creativity, as with visual, literary, and performing art (Peplau, 1987). In this column, the author will first describe music and its usefulness in human experience, make a case for the inclusion of art in professional nurse curricula, and describe the art of teaching-learning the humanbecoming paradigm.
Music
The form of art that most resonates with me is music. It can be sung, hummed, percussed, and played. A choir, for example, is an ensemble of vocalists, often accompanied by musical instruments like a piano or guitar, who serenade an appreciative assembly. A band or orchestra is a group of individuals with cohesive intentions sharing unique talents playing stringed, wind, brass, and percussion instruments.
My journey with music began in early childhood. My mom used to play classical music on the radio while she was going about her tasks for the day, like sewing, cleaning, baking, cooking. Spirited tunes became energetic family dance parties and the slower, contemplative melodies served as a backdrop for intimate conversations. She taught our family to appreciate music, and more than once each week, my brother and I rode in the hot, backwards-facing "way back" of our station wagon while our mom drove our sister to and from piano and voice lessons. When I was older, my mom transported me to countless lessons and rehearsals. Through elementary, high school, and university, I sang my part in musicals, solo competitions and exhibitions, and school and regional honor choirs.
On to adulthood, I continued in church choir and led songs for the congregation. I considered music making service, an honor, and it was fun. A few years ago, while participating in church choir, I had the opportunity to sing at Carnegie Hall. It was overwhelming as I stood on that stage in our dress rehearsal and looked out at the velvet covered seats and gilded columns. I remember wanting to imprint those sights on my mind so I would never forget how I felt.
Less impressive but perhaps most importantly, I am involved in Threshold Choir International. In trios and quartets, we go to bedsides of individuals during a tender stage of life and offer soft, comforting melodies and harmonies to soothe and calm in that threshold between this life and the next. We sing as an instrument of peace—with compassion—to affirm the beauty and human dignity of all people (Threshold Choir International, 2023). The preparation for such a bedside sing, in addition to learning the music and practicing sufficient blend in our voices, is to find a sacred space and, between songs, hold sacred silence for a few moments (Threshold Choir International, 2023).
Music can be used to decorate the silence of the mind (Yancey, 2020). Music has been appreciated, used as therapy to affect health, and used to improve learning among nurse students. Whether created or consumed, music and other art has the ability to spark memory and imagination which can be inspirational and exhilarating (Bunkers, 2008). Music may be beneficial while studying to promote inspiration and concentration (Yancey, 2020). Music is a validated intervention to decrease anxiety. Horn et al. (2022) studied music therapy with individuals in antepartum settings, for example, and found a combination of listening to instrumental pieces with guided imagery, listening to a song chosen by the individual with lyrics that helped express their feelings, singing songs, rewriting lyrics of songs, and playing percussion instruments improved their “emotional well-being” (p. 59).
Professional Nurse Curricula and Art
Music can be transformational, yet it is often not the focus of professional nurse curricula and is sometimes slashed from nurse education entirely. Nurse students should be afforded the opportunity to participate in or at least appreciate art. Art is not bound by limits except for the nurse’s conscience and the profession’s ethics (Peplau, 1987, p. 10). There is evidence to support the requirement of art in professional nurse curricula.
Nurse curricula have been prescribed by boards of nursing, accreditors, and professional bodies. In 2021 the American Association of Colleges of Nursing (AACN) presented the new Essentials which indicate a framework of competencies for professional nurse practice to help nurse educators develop quality curricula. The first Essential is a foundation in liberal arts (AACN, 2021). Although existing professional nurse curricula are content laden, infusion with art is not a new concept.
In 1927, Titus argued that nurse education should be treated as a distinct form of professional education and include the same "general objectives as for other fields of education," rather than "mere training in handicraft" (p. 958). Titus (1927) stated that teaching art "will sharpen and deepen the appreciation of beauty" and "help provide the precious and rare ability to lift [one] from the depths to the stars" (p. 962). Nurse educators have an immense responsibility to guide nurse students in their development of ethics, spirituality, and aesthetics (Titus, 1927).
In 1953, Strohmann encouraged nurses to improve "thinking habits" (p. 1232) by participating in music and art appreciation. Strohmann (1953) stated that nurses with knowledge of music and art appreciation will better understand people and live in a more constructive and meaningful way. Peplau (1987) affirmed that understanding not only science but art is crucial for nurse practice. Art in nurse education will bring "an appreciation of the mystery, tragedy, and possibilities of human life" (Titus, 1927, p. 962). Art is always an expressive response, a statement of what the artist sees, said in the artist’s way, with great pride in the necessary craftsmanship and, in the case of nursing, often for an audience of one (Peplau, 1987, p. 10).
Frei et al. (2010) shared that art in nurse education fulfilled the learning objectives of assessment, communication, and empathy. The integration of humanities within nurse curricula will advance the profession by providing a foundation that provides new ways of thinking (Frei et al., 2010). Elhammoumi and Kellam (2017) reported that teaching art in nurse education created a deep understanding of the complexity of human experience. Studying art helped nurse students to be more connected with their patients (Elhammoumi & Kellam, 2017). Knowledge of art and music fused with nursing practice creates innovation and opportunity in teaching-learning (Bunkers, 2008; Yancey, 2020).
From a humanbecoming perspective, teaching-learning is sciencing, never-ending coming-to-know, and art, the aesthetic creative endeavor of respecting knowing as changing (Parse, 2021, p. 180). Using art in teaching-learning with nurse students allows a great shift in perspective. Nurse faculty and nurse students alike have perspective changes in teaching-learning as experiences move and shift the unfamiliar with the familiar. This shift, with art infused in nurse curricula, enables nurse students to think and perceive differently. As Clark (2022) asserted, the stage is set for application of the humanbecoming paradigm in educational settings, promoting teaching-learning innovation. However, much content taught in traditional nursing curricula is borrowed, or worse, indistinguishable from other disciplines.
Teaching-Learning the Humanbecoming Paradigm
In 2015, Dr. Yancey interviewed the previous Dean, Dr. Geneva Oaks, and previous Associate Dean, Dr. Susan Drummond, at California Baptist University (CBU) in Riverside, California. Dr. Yancey (2015) presented their example of the dynamic nursing education founded on the humanbecoming paradigm. Today, the Division of Undergraduate and Prelicensure Nursing in the College of Nursing (CON) at CBU continues to embrace and use the humanbecoming paradigm (Parse, 2021) which undergirds the philosophy and mission.
I wholly credit our Dean, Dr. Karen Bradley, for her steadfast unremitting support of the humanbecoming paradigm and my passionate faculty colleagues for recognizing the worth of teaching-learning this essential nurse philosophy with students. Earlier this year we had a continuing approval visit by the California Board of Registered Nursing (BRN), and on-site accreditation survey visitors from the Commission on Collegiate Nursing Education (CCNE), with both fully affirming our philosophy and mission using the humanbecoming paradigm. Each CON document and Division of Undergraduate and Prelicensure Nursing syllabus includes the language of the humanbecoming paradigm.
Each undergraduate and prelicensure nurse student completes the compulsory Theoretical Foundations course in their first semester in each of the three programs in the Division. In this course I share the humanbecoming paradigm like a gift, and it lives in our nurse faculty, students, and graduates. The course begins with the notion of a paradigm shift. I have the students identify who the nurse is and what the nurse does that is unique. Throughout the course, I introduce and help nurse students illuminate the humanbecoming nature of existence and living the art of humanbecoming (Parse, 2021). Nurse students participate in teaching-learning the humanbecoming paradigm and begin to embrace this paradigm shift.
The significant assignment in this course uses art to help describe the nature of existence. Nurse students explain the humanbecoming paradigm and how it resounds with them. They each choose an artform to share with their contemporaries that represents who they are.
Throughout the first and each subsequent semester of their program, in each clinical course, nurse students complete a humanbecoming assignment. Each student lives true presence, revering humanuniverse as august presence and their unique value priorities (Parse, 2021), and asks three questions: What is important to you now? What are your thoughts and feelings day to day? What are you experiencing and what are your hopes and dreams? The student embraces this different way of being with people arising from humanbecoming beliefs to understand the humanuniverse living quality (Parse, 2021). "What surfaces is illuminating meaning, shifting rhythms, and inspiring anticipation" (Parse, 2021, p. 121).
Nurse students then link the statements humanuniverse articulated with the humanbecoming paradigm (Parse, 2021). The revision in this assignment this year is that, rather than linking expressions humanuniverse revealed-concealed with the assumptions, postulates, principles, concepts, and paradoxes, they are assigned a specific component such as solely the assumptions, or simply one principle, for example. I believe this change will help nurse students dig deep to find meaning and help them to better understand the language of the humanbecoming paradigm.
Nurse students who understand the meaning of living experiences (Bunkers, 2008) are forever changed by creating or appreciating art. The art of teaching-learning nursing is affirming the highest values of the human community (Peplau, 1987). Learning about art helps the nurse student to transcend current circumstances to sustain hope and convey compassion and caring (Peplau, 1987). Teaching-learning the humanbecoming paradigm is incredibly creative and artistic and communicates the freedom to explore (Clark, 2022).
The most special thing about the humanbecoming paradigm is also exactly the thing that makes the teaching-learning model special. Parse (2021) explicates,
Humanuniverse is indivisible, unpredictable, and everchanging; cocreating a seamless symphony of becoming; the ethos of humanbecoming is dignity, a noble bearing of immanent distinctness; and living quality is the becoming visible-invisible becoming of the emerging now, the personal expression of uniqueness. (p. 40)
The art of teaching-learning nursing is affirming the highest values of the human community (Peplau, 1987).
The nurse teacher who lives humanbecoming reveres the nurse learner and cocreates a sacred space similar to nurse with person. Together, the nurse teacher and nurse learner embrace the "aesthetic creative endeavor of respecting knowing as changing" (Parse, 2021, p. 180). The use of art in teaching-learning nursing helps nurse students to understand their changing perspective so when the humanbecoming paradigm is communicated they are familiar with the essences.
Teaching-learning is never-ending coming-to-know and a creative endeavor of respecting knowing as changing (Parse, 2021, p. 180). The energy of ongoing change in perspective is critical in teaching-learning nursing (Bunkers, 2008). Nurse faculty and nurse students alike have perspective changes in teaching-learning as experiences move and shift the unfamiliar with the familiar. Participating in the creation and appreciation of art shifts one’s perspective and benefits nurse education. This changed perspective and ability to relate with others is just the reason why teaching-learning art is crucial in teaching-learning the humanbecoming paradigm.
