Nursing Practice: The Intersection of Art and Science

By Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Health, Learning, Research and Practice, Wolters Kluwer
Twitter: @wkhealth

Healthcare’s shift from an episodic to a wellness model of care finally places patients where they should be—at the center of care. As current movements aim to elevate the patient experience, nurses play an important role as the front-line professionals who engage with patients most often.

Nursing practice has always been an intricate balance of art and science—one that applies the latest healthcare evidence to care delivery in a meaningful way based on a holistic patient view. One of my recent patient encounters illustrates how all nurses must always work to maintain this delicate equilibrium, requiring nurses to move outside the precise parameters of science and consider the collective needs of our patients. Admitted for an exacerbation of pneumonia, an elderly patient with stage four chronic obstructive pulmonary disease lay in a tangle of tubing supported by machines—advanced technology that the industry relies on daily to save lives. Yet, it was clear when I held her hand and spoke to her that she was ready to give up and die peacefully. I relayed this information to the attending physician, and we then spoke with the patient and family. My patient was later transferred to an inpatient hospice unit that evening to live out her final wishes.

More than ever, nurses need to demonstrate knowledge, confidence, competence, professionalism, empathy and kindness. Evidence-based practice sits at the heart of quality care, although the break-neck pace at which new evidence is introduced into care creates challenges to optimally merging all these areas. Nurses are flooded with new data and often find that they are overwhelmed trying to follow new protocols and keep up with science. Consequently, the “art” of nursing can sometimes get lost in the shuffle.

To elevate the nursing profession, the healthcare market must reflect on where it has been, how it has changed, and the importance of equipping nurses with the proper tools that can help them effectively build needed competencies along with confidence at the bedside–this while also simultaneously staying focused on the patient and their overall experience.

The Science of Nursing
Healthcare advances and best practices in care delivery are expanding at extraordinary rates, opening a multitude of opportunities to improve care delivery and outcomes. Nurses not only must comprehend the evolution of evidence discovery, but they must also translate and filter new evidence down into practical application with patients. Foundationally, the distillation of new research and its application at the point for care forms the basis of nursing “science.”

Technology plays an important role in the science of nursing as an enabler of workflow efficiencies and care best practices. Nurses increasingly must embrace technology as part of the science of practice and understand how to optimize use of advanced infrastructures to improve practice and outcomes. In particular, nurse leaders must be able to weed through the myriad of technology available to identify and deploy technology that truly brings value to care delivery.

The science of nursing is also reflected in accepted care delivery models and academic theories, such as the Virginia Henderson’s need theory which defines the function of nursing as one to assist the individual to achieve health or recovery. As part of any nursing practice framework, nurses must understand how to properly assess patients, apply nursing-specific diagnoses and problems, determine appropriate interventions to these problems and measure the outcomes of care.

The Art of Nursing
In tandem with science, nursing becomes an art-form where communication and critical thinking skills are paramount. The work of a nurse is very relational in nature, requiring that science is interpreted with the patient’s best interests in mind. For example, it’s how a nurse differentiates the needs of 92-year-old myocardial infarction patient with a 52-year-old patient presenting with the same condition. While the science may point to certain procedures as a best practice, the nurse must have the emotional intelligence to determine if a procedure would bring more detriment to the older patient than is warranted or desired.

The art of nursing is intuitive, creative and informed. It’s about being able to read a room and interpret what is happening outside the parameters of a clinical diagnosis. Nurses must hone skills related to active listening, discernment and caring without judgement. The aftermath of the 2018 Pittsburgh synagogue shooting is a good example of the latter. Treated at Allegheny General Hospital for wounds following the incident, the shooter later indicted on 44 counts, including 11 counts of murder, was treated without judgement by a Jewish nurse.

Simply put, nurses must rise above whatever challenges present to be the consummate patient advocate. Sometimes it might even mean bending the rules. For instance, when my 68-year-old neighbor found her way to the critical care unit I managed, I knew few things would improve her emotional health more than a visit from her 10-year-old miniature poodle—an important part of her social life following the death of her husband two years earlier. The hospital at that time had no animal-assisted therapy and did not allow pet visitation. Yet, I was able to smuggle in her pooch just in time for a final visit before my neighbor passed away the following day.

Merging Art and Science in Today’s Healthcare Environments
Critical thinking bridges the art and science of nursing. More than ever, nurses must rely on these skills to consider the biological, psycho/social and spiritual needs of the patient and make informed decisions.

In today’s fast-paced healthcare environments, clinical leaders are wise to equip nurses with all the necessary tools needed to hone critical thinking skills and help them effectively balance art and science in practice. Supportive environments backed by a culture of learning help nurses stay abreast of rapidly-changing care delivery models. For example, nurse leaders can employ forward-thinking techniques such as interactive case studies and virtual simulation supported by a strong preceptor program to improve a new nurse’s ability to apply new knowledge.

In addition, nurses need efficient access to the latest evidence (“science”) to ensure they can get back to the bedside to incorporate the proper care (“art”) into their nursing practice. Point-of-care clinical decision support tools improve efficiencies by providing immediate guidance needed to eliminate care variability and drive improved outcomes.

Healthcare is evolving, but the role of nursing stays the same as the clinical professionals closest to the heartbeat of patients. Today’s nurses must understand the delineation between science and art, as well as how to optimally merge these areas to elevate value in healthcare and improve all patient outcomes.