THE ART AND SCIENCE OF NURSING
The Art of Nursing
The art of nursing is integrally tied to the caring aspect of nursing. For many years, nursing was defined as both an art and a science. As nurses began to give more attention to establishing a scientific basis for nursing practice, they thereby gained greater acceptance in the scientific community and the art or caring aspect of nursing received less attention. In practice settings, for example, nurses focused more attention on the high technology used in caring for individuals with complex health problems. Nonetheless, the public has sustained its attachment and desire for caring interventions, such as massage, therapeutic touch, listening, guided imagery, and aromatherapy, to name a few. A number of reasons for which people seek nonpharmacologic complementary therapies have been proposed: (a) they wish to be treated as a whole person by health professionals; (b) they wish to be active participants in their care; (c) they desire that the treatment not be worse than the disease; and (d) they feel that Western health care does not meet all of their needs. Therefore, it is important that APRNs consider how they can integrate the art of nursing, which includes traditional and nontraditional nursing interventions, into their practice.
The essence of the APRN is the caring relationship with the patient. Through sharing knowledge and providing support through communication, caring, and relationship building, the APRN fosters health with patients and communities.
Caring is a critical element of nursing practice. Leininger (1990), Watson (1988), and Gadow (1980) have each put forth definitions of caring. Watson defined the art of caring as a human activity consisting of the following: a nurse consciously, by means of certain signs, passes on to others feelings he or she has lived through, realized or learned; others are united to these feelings and also experience them. (p. 68)
Newman, Sime, and Corcoran-Perry (1991) noted that the focus of nursing is "caring in the human health experience" (p. 3). The National Organization of Nurse Practitioner Faculties (NONPF) has identified patient- and family-centered care as a core competency (NONPF, 2012).
Caring requires that a nurse be competent in assessing and intervening. Benner (1998) noted that a caring attitude was not sufficient to make an action a caring practice. The practice must be implemented in an excellent manner in order to be viewed as caring. Caring and the art of nursing convey very similar meanings, but caring nurses also seek the scientific basis for their practice and continue to update their expertise and knowledge. APRNs possess the knowledge and ability to critique research about specific therapies and determine their applicability to specific individual populations.
In 1993 Schoenhoefer and Boykin proposed that the nursing process-based care models, including nursing diagnoses, did not truly address what nurses ought to be doing. Their grand theory of nursing has a framework based on caring that is specific to each nurse, person, and situation, requiring personal individual knowledge of each patient, as well as including empirical knowledge of each patient's situation. They acknowledge that all humans care and that nursing is a discipline that requires knowing and developing advanced nursing knowledge. Nursing is also a profession, in which nursing knowledge is applied and used in response to the individual's human needs while still being a dynamic, evolving, creative, and caring process (Schoenhoefer & Boykin, 1993; Zaccagnini & Waud White, 2014). APRNs are well prepared to practice from a theory-driven human caring basis. A theory-based advanced nursing practice defines and exemplifies many attributes of the APRN.
Hagedorn and Quinn (2004) proposed a theory of primary caring specific to the APRN that includes five domains: connection, consistency, commitment, community, and change. The domain connection describes the APRN's effectiveness based on relationship-centered caring with the patient, family, and community. Consistency describes the importance of evidence- and theory-based care in advanced nursing practice. Commitment describes how the nurse practitioner (NP) is committed to serve each patient and family to his or her best ability. Community illustrates the role of the NP in facilitating full access to health care for all persons and strives to meet unmet community health needs. The fifth domain, change, explains how APRNs introduce innovative models of health care and share decision making with patients.
Basic human needs are to be viewed as a whole person and cared for. It is the role of the APRN to support and assist the patient in being cared for in a holistic manner. APRNs incorporate the empiric aspects of medicine but practice within a nursing framework. The APRN's qualities and actions of presence, empowerment, reflection, listening, touch, empathy, humor, and knowing the community, as well as the APRN's ability to access care and to directly provide care, ensure patient satisfaction, and provide quality evidence-based outcomes (Hagedorn & Quinn, 2004).
The Science of Nursing
Significant progress has been made in developing the knowledge base that underlies nursing practice, revealing that nursing is characterized by both art and science (ANA, 2004). Although nursing is guided by standards of practice based on clinical evidence and research, additional research is always needed to further develop evidence-based practices so that APRNs will have a sound scientific basis from which to choose specific interventions for individuals or populations (ANA, 2010). The clinical guidelines developed by professional and governmental agencies—available through the National Guideline Clearinghouse—exemplify the work that has been done, and that continues to be done, in identifying "best practices" based on research findings. APRNs play a key role in helping nurses review research and develop clinical guidelines that incorporate existing knowledge bases.