Abstract
Conceptions of the art and aesthetics of nursing traditionally focus on the nurse and nursing practice. My purpose here is to propose a shift in thinking from this traditional focus that dominates the “art of nursing” literature, to consider a new nursing aesthetic that focuses on human beings proper: health as wellbecoming. I present a framework based on everyday aesthetics, feminist aesthetics, and Deweyan perspectives, along with attention to the nursing disciplinary perspective of health and well-being. I conclude with a look ahead to philosophical questions and scientific issues regarding theorizing and scientific inquiry about the health as wellbecoming aesthetic to advance nursing knowledge.
Stop, look, and listen. The aesthetic of nursing is evident, most foundationally, in human beings, formed through the health-related needs, values, and practices in their daily person-environment interactions.
Conceptions of the art and aesthetics of nursing traditionally focus on the nurse and nursing practice. The emphasis is on the nurse’s helping experiences and caring repertoire including technical, interpersonal, cognitive, and affective skills and knowledge. This “art of nursing” focus on the nurse is as old as professional nursing. In the 19th century, Nightingale (1859/1969) used art metaphorically to convey that nursing required specialized skill, unique learning, and excellence in practice (Austgard, 2006). In the next century, Wiedenbach (1964) wrote on the “art of nursing” as evident through the nurse’s help in providing whatever the patient needs, with the aesthetic quality residing in the nurse’s perception of what is significantly expressed in the patient’s behavior. More recently, nursing aesthetics is still being described in terms of the nurse and the “beauty in caring” (Siles-González & Solano-Ruiz, 2016). My purpose here is to propose a shift in thinking from this traditional focus that dominates the “art of nursing” literature, to consider a new nursing aesthetic that focuses on human beings proper: health as wellbecoming.
While nursing practice and practicing nurses are important if not pivotal in advancing nursing knowledge—and a key reason why I developed a philosophy of nursing science called intermodernism (Reed, 2019)—neither practice nor nurses per se are the substantive focus of our science. The focus is human-environment-health processes and phenomena, which incidentally may include the study of professional nurses’ and others’ caring practices. The new aesthetic I propose shifts the traditional emphasis in nursing aesthetics on the methodology of nursing practice to the ontology of nursing.
A Framework of Everyday Aesthetics
My conception of this new aesthetic for nursing was largely influenced by the philosophical field of study called aesthetics of the everyday and by feminist aesthetics. In addition, a Deweyan pragmatist approach (Dewey, 1934/1980) was useful in clarifying the features that qualify life experiences, particularly health as wellbecoming, to be an aesthetic experience.
Dewey (1934/1980) was an important forerunner of everyday aesthetics and influencer in contemporary philosophical thinking about aesthetic experience. Dewey’s ideas “enlarge the terrain of aesthetic experience from the realm of art to the everyday” and provide a framework, though not a formula, for understanding an expanded and pragmatic view of aesthetic experience (Puolakka, 2015). Deweyan influences (Dewey, 1934/1980; Leddy & Puolakka, 2021) are evident in the following key characteristics of aesthetic experience: temporality (the past is carried into the present in a way that enriches understanding of the present situation); rhythm (a pattern of building intensity toward some resolution or fulfillment); and integrity (an organization of parts that are connected in a way to produce a sense of coherence and sense of completion about the experience).
An aesthetic experience begins with an identifiable event or problem that arises out of and is formed through ongoing person-environment interactions. The features of temporality, rhythm, and integrity make it stand out as an experience among many other everyday encounters (Dewey, 1934/1980). The temporal nature of the experience varies depending upon the person and situation. Some experiences are momentary. Others are formed and understood over a much longer period of time depending upon the nature of the problem or event, as well as the person’s perceptual or conceptual work. Aesthetic experience derives from the human capacity some Deweyan scholars call imagination or imaginative vision “to see and feel things as complex integral wholes . . . to structure the experience into an articulate, complex unity” (Dewey, 1934/1980, p. 274, as cited in Puolakka, 2014). And the end point of an aesthetic experience does not mean its cessation but instead marks the point of gaining some sense of completion or consummation (Puolakka, 2015). Everyday experiences remain connected within the individual’s larger web of human-environment experiences.
The Health as Wellbecoming Aesthetic
Health as wellbecoming, first described by Phillips (2017, 2019), captures a substantive focus of nursing from his disciplinary perspective of nursing, based upon the seminal work of Rogers (for example, Rogers, 1990) and other Rogerian scholars. A key philosophical tenet of this perspective is that the purpose of nursing is to promote human betterment, health and well-being, and human-environment patterning as based upon health patterns defined and experienced by each individual.
The one-word phrase, wellbecoming, is unique to nursing. The hyphenated phrase, well-becoming, is used in several other disciplines to convey similar ideas but in reference to “future well-being” of children and youth. Interdisciplinary and global researchers have been studying a wide spectrum of health and non-health factors that relate to child and adolescent well-being outcomes in adulthood (Moore & Lippman, 2005; Rocco et al., 2021). Schweiger (2019) addressed the normative aspect of well-becoming research on the consequences of child poverty, emphasizing that it is not only for scientific knowledge but also is a matter of justice to expand inquiry beyond children’s current well-being to address structural factors that bear on future well-being of vulnerable children in adulthood. In comparison to this view of well-becoming, the nursing perspective of wellbecoming (unhyphenated) incorporates a multidimensional temporal view of human growth, development, and change to recognize that well-being is a dynamic process that occurs over not only decades of time, but over years, months, weeks, and even shorter moments in time.
Also, in naming this proposed aesthetic, health as wellbecoming, I purposely retained the word, health, even though the term, wellbecoming, is frequently used alone in the nursing literature. My rationale, in part, is that the wellbecoming of individuals, as embodied, sentient, and aging beings, necessarily involves health-related problems and challenges across their lifespan to the end of life. And importantly, a core disciplinary concern of nursing is human health processes and experiences, beyond but including healing after physical and emotional injury or illness.
As an aesthetic concept (Eaton, 2003), health as wellbecoming picks out properties of a person’s health-related experience that are valued or evaluated as good or significant in some way. It may give the person pleasure, but contemporary philosophical views allow for more complexity in aesthetic experiences including a continuum of experiences from positive to negative, beautiful, or sublime, difficult, painful, and even repulsive. Further, the experience may be perceptual or conceptual as, for example, taking pleasure in coming to know or understand something new through the experience or enjoying a special connection to others made possible by the aesthetic experience (Peacock, 2023). Moreover, from the unitary perspective of nursing (Phillips, 2019), health as wellbecoming is likely to be manifested and appreciated through many senses including bodily-oriented senses and cognitively-oriented senses (feelings, emotions, cognitions), and extended forms of awareness.
In sum, given this philosophical view of everyday aesthetics, the aesthetic of health as wellbecoming is understood in reference to a range of possible perceptions and evaluations of a person’s own health process—whether satisfying, pleasurable, difficult, appalling, or something in-between—that is gained through their sensibility, imagination, and interactions. For example, feminist application of everyday aesthetics regard the changes during pregnancy, birth, and the demands of parenthood as sources of aesthetic experience that may be evaluated as beautiful, sublime, unsettling, disgusting, or comforting. Each has aesthetic value. And just as these developmental events provide opportunities for aesthetic experiences, so do the demands of health-related events afford a person with potential aesthetic experiences. Further, philosophers emphasize that perception of the aesthetic experience is relational; while it is dependent in part upon the immediate aspects of the experience, it is also influenced by aspects (social, political, physical) of the surrounding environment and community (Kirby, 2012). Recognizing and appreciating the aesthetic of one’s health journey is facilitated by the support of others.
Inquiry for Health as Wellbecoming
If the aesthetic dimensions of everyday life are important to human welfare (and the philosophy of everyday aesthetics is based upon this belief), then it is important for nurses to include inquiry about patients’ aesthetic experiences in efforts to build nursing knowledge for practice. An area of epistemic concern is to balance the practice value for individuality of the aesthetic experience with the scientific value for understanding and justifying phenomena for scientific knowledge. By locating the aesthetic in an individual’s experiences rather than in a concrete object or specific kind of situation, Dewey (1934/1980) paved the way to understand the diverse aspects of people’s lives that they value. But this focus also raises epistemological concern to be able to acknowledge individuals’ aesthetic judgments while avoiding excessive subjectivity, relativism, or even triviality in everyday aesthetics practice and research (Shelley, 2022). Building knowledge in this area of practice requires a theoretical base that articulates the aesthetic value of health as wellbecoming as an “intersubjectively sharable experience” while valorizing the uniqueness of individuals’ health experiences. The philosophical perspective of everyday aesthetics is friendly for nursing since it supports discipline-specific theories while also searches for new theoretical foundations “that allow for intersubjective, intercultural, and interdisciplinary exchanges” (Saito, 2021).
Looking ahead to support future theorizing, there are two philosophical questions (Shelley, 2022) to address concerning the aesthetic value of health as wellbecoming experience:
The Aesthetic Question: What makes the experience aesthetic?
The Normative Question: What makes the aesthetic experience a value?
My brief overview of the philosophy of everyday aesthetics and the Deweyan pragmatist framework of the form of the experience viewed through the lens of feminist aesthetics suggests some initial responses to these questions. In reference to Question 1, an experience is aesthetic because of the form of the dynamic experience (referring to its temporal, rhythmic, and integrity attributes) and because of its perceptual and conceptual properties that motivate feelings and cognitions that are memorable and meaningful whether they be positive or negative. In addition, the experience does not depend upon a concrete form of expression taken in by the five senses.
In reference to Question 2, a response to the normative question is that the aesthetic event and the person experiencing it together have the capacity to generate worth and productivity in the person’s life. Pleasure typically grounds aesthetic value, but importantly for our health as wellbecoming aesthetic, contemporary philosophers explain that aesthetic value may be grounded in experiences other than pleasure, such as intrinsically valuable insights that help us appreciate the experience across the spectrum of desirability (Shelley, 2022).
Stop, Look, and Listen: Enhancing Nursing Knowledge
Our discipline is well positioned, given its extant research methods and theories on health and well-being, to engage in theorizing and inquiry into the aesthetic health as wellbecoming. Philosophical roots of everyday aesthetics include phenomenology, structuralism and poststructuralism, pragmatism, and critical theory, which align with the array of methodologies used by nurse researchers. Critical approaches to post-positivist methods are also relevant. And practicing nurses likely hold a fund of implicit theories and practice knowledge to appreciate patients’ health as wellbecoming aesthetic experiences, though perhaps by related names (adapting, coping, transcending, meaning-making, story-gathering, humanbecoming, thriving, integrating). My proposal here for a new nursing aesthetic is meant to build upon nurses’ extant knowledge related to health as wellbecoming by providing a more formal description to encourage theorizing and systematic inquiry into this important phenomenon.
The health as wellbecoming aesthetic has epistemic and ethical roles in nursing science and practice. Nursing epistemology as well as ethics incorporate patient values as constitutive of nursing knowledge. Practice-based phenomena such as this aesthetic are pivotal in the production of new knowledge for practice. Knowledge about health as wellbecoming can enlighten us about health experiences across situations, developmental changes, aging, and dying that hold aesthetic value for individuals and families. The characteristics of health in wellbecoming, as an everyday nursing aesthetic, align with the unitary nature of human-health-environment processes including rhythmic patterning, integrality of human-environment, and the human capacity for creativity that nurses witness in patients and families confronted with health challenges.
Stop, Look, and Listen is an expression used by artists to encourage aesthetic appreciation of their work. Individuals’ health as wellbecoming entails creative work, too. Part of their aesthetic experience comes from within, but part of it requires the person to share the “content of their imagination” with others (Eisner, 1985, p. 26). Aesthetic experience is a source of meaning distinct from scientific understanding, and connecting these different forms of meaning nurtures nursing knowledge.
In health as wellbecoming, the aesthetic agent is not the nurse. It is the person co-creating an aesthetic through their health-related experience. The final step in the formation of an aesthetic experience is to share it with others. For us, it is to stop, look, and listen as individuals reflect upon and appreciate their patterns of health as wellbecoming.
