some times people do things for others that they are not aware of sometimes they get an idea of how important some act of service was but usually not. two things for me was in this last week two members of our family shared their insight and talent that helped me enormously.

first on Saturday i asked Felicia a question and her response helped to bring me back to reality. you see as i have been in school i have studied harder than i ever had before. when i was a young man i did not try that hard some classes were easy so i did well in those and didn't worry a lot about about the rest. so my absolute obsession with grades and classes and all that encompasses was busted up a little when she told me that she felt like she knew very little when she arrived at her new job as a nurse, and that since then her real education has begun in earnest. that humbled me.

as this week progressed i read articles that were in research for a "short no big deal" paper that counted as 25% of my grade in a nursing class. and in those experiences i learned a few things:

1; i have a lot to learn in both the near and distant future.

2; i know a lot more than i thought i did.

here is the paper, and thank you Scott and Kenz for your timely and important help i could not have completed it with out you...

The Art and Science of Nursing

Have you ever watched another person go about their work? As you observe, this person is demonstrating the effort and power necessary to accomplish the tasks that daily work demand. I once watched something like this that amazed me.

As a boy growing up in Idaho, I often walked the Payette River with my father, fishing and talking. The river at that time was also used by the Boise Cascade Lumber Company to move raw timber downstream to the saw mill at Horseshoe Bend in the mountains of Idaho. We’d watch as the cut trees would float downstream for a period of time in the summer. These trees were tended by river men whose job it was to keep the logs moving and keep them from jamming in the water.

My father and I approached one of these jambs on a summer day and saw a man walk out across the logs as they floated in the water. The logs were unable to move forward because they’d become tangled. My father drew my attention to what he was doing and told me to observe what would happen next. For a few minutes this man worked with a pole, pushing and pulling logs one way or another at or near where to problem was occurring. He then simply walked back across the log jam to the shore, sticking his pole in the ground and leaning on it for a moment as he watch the tangled mess in the steam. I wondered what he was doing or had done to fix the situation. Suddenly, there were a few noises in the log jam and one by one they began to move again as if by magic. My father told me he had gone to where the focus of the tangle was and moved one or two logs, then let the stream slowly pull them apart and the lumber continued the journey to the mill, downstream. I learned that one person in the right place at the right time with experience and knowledge can make all the difference in obtaining success.

The skill and knowledge that this river man possessed was the science of his job and the way he used that skill and knowledge was his art. He made it seem effortless because the work he did was an extension of himself. My dad told me of the many times he’d seen far more men working on a similar problem without success, instead resorting to explosives to lose the tangle, damaging the river and destroying the lumber in the process. He admired the conservation of effort and the gentle way this man did his job. This is the way I want to do my job when I work as a nurse. Therefore, to work in this way I need to ask myself “how?”

Knowing How

There are many types of knowing in the world of nursing and many ways to learn them. One of the best is to simply exchange information person-to-person in the narrative; stories about real life and imagined experience as shared by teachers and professionals have tremendous value in the lives of the students of the nursing profession. Some of the types of knowing that can be taught by storytelling are referenced in Linda Hunter’s article “Stories of Integrated Patterns of Knowing” as published in International Journal of Nursing Education Scholarship in 2008.

Hunter quoted something in the opening paragraph of her article that has stayed with me:

Excellence in nursing practice has long been defined as the delicately

balanced movement between both art and science (Peplau, 1988). This synthesis

of art and science has been more recently referred to as holistic practice, or seeing

people as ‘whole persons’ (Yorks & Sharoff, 2001). Transforming theoretical knowledge and clinical practicum experiences into thoughtful nursing care that is the benchmark of holistic practice has led to the development of a number of innovative teaching strategies. Many of these strategies have involved some measure of self-reflection, which not only allows students to assimilate their own lived experiences, but also better prepares them to think critically from multiple perspectives. (Baker, 1996; Diekelmann, 2001; Heath, 1998; Nehls, 1995; Scheckel & Ironside, 2006)

I have become acutely aware of the stories told by those who I work with as both a nurse’s aid and as a student. These stories affect the way I approach my job and my education. I was grateful to read the above-mentioned article because it validated my preferred learning medium: storytelling. It is through the personal stories I hear that I learn more detail in the work I do now and the work I plan to do. Hunter also stated that “Sharing [nurse’s] stories with faculty and each other stimulated the collective reflection necessary to move them beyond the empirical world and into the inside aspects of practice that a textbook could not teach them” (Hunter 2008).

I love my textbooks. I love my classes. In them I learn vernacular, formula, theory, and practicum. This is the science of nursing. The art, however, is something different. It’s painted in the lives of those who I listen to. In their stories are etched their successes and failures, their realities and ideals, as well as the setting of standards of excellence and at times the exceeding of them. In these stories are found the many aspects of knowing. Below is a brief summary of some of the ways of knowing:

Empirical knowing: This is the scientific aspect, i.e. the things we love to learn in the lab and the lecture.

Ethical knowing: This entails the critical “what if” situation learned by first listening to a scenario explained by the storyteller, and then placing yourself in this situation. This provides the opportunity to walk an imaginary pathway and choose how you would act in a similar situation.

Personal knowing: This is to me one of the most important ways of knowing. In your relationship with the patient this type of self knowledge gives an authenticity to the caregiver’s work that can be obtained in no other way.

In order to enter into a therapeutic relationship with patients, Carper (1978) stated nurses must first understand themselves. This process of “knowing self” or self-actualization allows the nurse to enter into authentic interpersonal relationships with patients that promote wholeness and integrity. Patients are then seen holistically as unique individuals. While Carper felt this pattern was the most difficult to teach and master, she also stressed its crucial importance in understanding another’s sense of well being. Jacobs-Kramer and Chinn (1988)

suggested that through reflection and response, nurses gain insight and develop congruence between their private authentic self with their public disclosed self. Consequently, as nurses gain more awareness of their own being they can then begin the healing process of another (Yorks & Sharoff, 2001). This leads to a place where we, as healers, need to be whole ourselves or we will perhaps lose the credibility to help other achieve their goals of wellness.

In another article written in Rev. Latino-Am. Enfermagem vol.16 no.2 Ribeirão Preto Mar./Apr. 2008 by Dezorzi; Crossetti:

The history of nursing essentially converges to care delivery to other people, which justifies its existence. However, lately, a different idea has been discussed, stating that, in order to care for the other, one must be aware that, first, it is essential to take care of oneself. Nursing professionals are now awakening, from times of self–abandonment, to this condition. In this movement, subjects expressed their daily practices that included spirituality in care for themselves, which became habits for a healthy life. (Crosetti and Dezorzi)

Self knowledge cannot be faked and we must be authentic representations of our field of work and study, which requires a relative level of health and adherence to the standards we ask of others.

Esthetic Knowing: shown primarily through empathy and understanding the

subjective experience of others. If you can put yourself in their situation you are better able to express what you would need to hear in order to deal with what is happening to your patient today.

I feel like all these things are important to nursing both the art and science we should focus our goals on becoming filled with these types of knowledge to more effectively aid in the recovery and improvement of our patients.