In this weeks’ blog Hazel Cowls, Adult Nurse lecturer, University of Plymouth (Hazel.cowls@plymouth.ac.uk), highlights the use of the creative arts in nurse education.
What is resilience?
Resilience is recognised as the ability to ‘bounce back’ from adversity. Nursing literature suggests that there are three broad categories of resilience in nursing, these are wellbeing, social support, and self-care1. Examples are being able to maintain good physical and mental health, developing friendships and professional relationships, family support and focusing on activities to promote positive wellbeing. Working in health and social care has never been so challenging, so it is important for all nurses to engage in activities that help ensure they are in good physical and mental health. The practice of mindfulness is about paying attention to the present moment, to our thoughts and feelings and the world around us.
The art of nursing
Nursing has been defined as a safety critical profession that is based on four pillars: clinical practice, education, research and leadership2. However, nursing is also about developing observation skills, reflective practice and empathy3. As a registered nurse, I believe that nursing is at times spontaneous, for example, if we think about a time when our words offered hope or reassurance to another person. This is the human connection of empathy and compassion that makes nursing an art form. It was Florence Nightingale4 who first described the art of nursing, as she developed standards of nursing practice in the 19th Century. Over the years, the art of nursing has been explored in literature, and generally refers to the relationship between the nurse and patient such as gaining patient trust5 or providing spiritual care6. Yet the literature also suggests that the art of nursing refers to pedagogical strategies in nurse education, for example, the use of journaling to increase understanding of nursing 7, or using poetry to enhance reflective practice8.
So why introduce creative arts into nurse education?
Creative arts and art education have an important place in every society, to help people comprehend the world in which they live in, and to contribute to the development of people’s physical, mental, and social needs. Art can stimulate reflection, creativity, critical thinking, observation and fosters empathy. Think about the last time you read some poetry or viewed a painting or sculpture; did this raise any questions for you? For example, what do the words mean, or what is the writer describing, and where is the image in the painting or what does it represent? Art classes often bring people together, and for nursing students can provide a safe space for them to explore their creativity, encourage critical thinking, discussion and problem solving9, all of which are essential skills to nursing.
If student nurses are offered opportunities to engage in the creative arts this may help sharpen their attention to detail and their interpretation of cues that are essential to patient assessment. Providing creative learning opportunities such as role-play may help students to step into the shoes of the people they are looking after and deepen their understanding of health and ill-health. A small study exploring nursing students’ experience of being creative through art, concluded that the space and time enabled students to articulate and process their emotions that in turn helped them to develop resilience10.
So how do we as nurse lecturers provide this safe creative space?
The creative arts include activities such as drawing, painting, creative writing, poetry, journalling and drama. Currently in pre-registration nursing education, lecturers and students will often use artwork within teaching and learning,11 and sometimes nursing students may submit a creative piece of work for assessment. However, utilising the arts within the nursing curriculum could support students personal and professional development. Providing a creative space for nursing students to practice drama, literacy, music or the visual arts has been shown to encourage student interaction, providing a sense of community and comfort amongst nursing students12. In addition, providing a safe creative space for students to practice artistic skills may encourage them to develop a community of practice where students feel welcomed, supported and empowered13.
In summary, including the creative arts in nurse education may provide opportunities for nursing students to develop their creativity, mindful practice and resilience. Not all nursing students will understand the value of providing time and space to be creative, but that does not mean we do not try to create something meaningful that may support them. One suggestion for the nurse lecturer could be to arrange small group tutorials, bringing the arts into the tutorial to promote observation, reflective practice, and general well-being. There is growing interest in supporting nursing students and enabling them to develop resilience, maybe the solution is through the inclusion of creative arts in nurse education.
References
1. Thomas, L.J., and Asselin, M. (2018) Promoting resilience among nursing students in clinical education, Nurse Education in Practice, Volume 28, 2018, 231-234, ISSN 1471-5953,https://doi.org/10.1016/j.nepr.2017.10.001.
2. Royal College of Nursing (2023) RCN launches new definition of nursing. Available online https://tinyurl.com/29bk4tyc (accessed 21 February 2025)
3. Henry, D. (2018) Rediscovering the Art of Nursing to Enhance Nursing Practice. Nursing Science Quarterly. 2018;31(1):47-54. doi:10.1177/0894318417741117
4. Nightingale, F. (1946). Notes on nursing. Philadelphia, PA: J. B. Lippincott. (Original work published in 1860)
5. LeVasseur, J. J. (2002). A phenomenological study of the art of nursing: Experiencing the turn. Advances in Nursing Science, 24(4), 14-26. doi:10.1097/00012272-200206000-00007
6. Bailey, M. E., Moran, S., & Graham, M. M. (2009). Creating a spiritual tapestry: Nurses experiences of delivering spiritual care to patients in an Irish hospice. International Journal of Palliative Nursing, 15(1), 42-48. doi:10.12968/ijpn.2009.15.1.37952
7. Schaefer, K. M. (2003). Caring behaviors of advanced practice nursing students. Journal of Holistic Nursing, 21(1), 36-51. doi:10.1177/0898010102250274
8. Hahessy, S. (2016). Reflections on the use of poetry in nurse education: Speaking a credible language of care. Nurse Education in Practice, 16(1), 140-143. doi:10.1016/j.nepr.2015.05.012
9. Taşdelen Baş M, Özpulat F, Molu B, Dönmez H. (2022) The effect of decorative arts course on nursing students’ creativity and critical thinking dispositions. Nurse Educ Today. 2022 Dec;119:105584. doi: 10.1016/j.nedt.2022.105584. Epub 2022 Oct 1. PMID: 36279658.
10. Frost, CK. (2019) Art in debrief: a small-scale three-step narrative inquiry into the use of art to facilitate emotional debriefing for undergraduate nurses Journal of Research in Nursing 2019, Vol. 24(3–4) 197–209
11. Srei, J., Alvarez, S. E., & Alexander, M. B. (2010). Ways of seeing: Using the visual arts in nursing education. The Journal of Nursing Education, 49(12), 672-676. doi:10.3928/01484834- 20100831-04
12. Perry, B. and Edwards, M. (2021) Using arts-based instructional strategies in e-learning. Teaching and learning innovation in higher education, pp.173-194
13. Terry, D.R., Nguyen, H., Peck, B., Smith, A., Phan, H. (2020) Communities of practice: A systematic review and meta-analysis of what it means and how it really works among students and novices. Journal of clinical nursing 2020-02, Vol. 29 (3-4), p.370-380