Attending to Humanities in Nursing Education

Jessica Vaughn argues for the use of the humanities in nursing education, urging fellow practitioners to empower patients through the medical humanities.

As I approach my final year as a student nurse and reflect on my first few years in the trenches, I realise that many of my preconceptions about nursing practice were wrong. Having previously studied a social sciences degree, I was comfortable with subjectivity, uncertainty, and questions with no answers. The arts and humanities were my familiar stomping grounds. However, I told myself that in order to do a science degree and become a ‘real nurse’ I would need to completely rewire my brain. No more long-winded essays stuffed with literary quotes or abstract philosophical ideas. Cold, hard, objective facts were all I would need. I focused on memorising anatomy, vital signs and the steps for clinical procedures. However, it now seems ignorant of me to have believed that the humanities would be rendered useless in nursing, a deeply human profession. As a nurse, I work daily with people who are dangling between life and death. This job is never a purely scientific endeavour. It demands attention to the ‘humanness’ implicated in the pursuit of health.

Being a student nurse is hard. Being a student nurse during a global pandemic is even harder. Due to the pandemic, I learned most of the theory virtually and therefore did not have many face to face sessions before being flung into my clinical placements. My real teachers were my patients, whose stories and experiences taught me how to nurse. I experienced the absolute lows and highs of their encounters with illness, and I discovered myriad ways of understanding many walks of life. Pain, fear, hope, bravery, solidarity, sometimes even joy: I saw all these in my encounters. I am daily confronted with ethical dilemmas, questions of spirituality and of existentialism, which has usefully foregrounded the knowledge I gained in my previous social science education.

The humanities, philosophy, sociology, theology, literature, music, art – all these subjects delve into the mysteries of being a human. Now, I find that I turn to these ways of understanding the world more than ever. Scientific data can show how the body works but it cannot explain what really makes up the fabric of existence. Working in healthcare brings alive all the philosophy I once read in lecture halls. Existential questions matter more after spending time with the dying. I was a philosopher on the day my patient asked me if I thought there was something more after death. I was a sociologist during the weeks I watched a bay of female patients create their own community, witnessing social constructions and inequalities crumble away. I was an ethnographer during the months I immersed myself in the lives of care home residents locked away from the outside world and its virus. I was a therapist the day I held a sobbing woman as her husband shouted from his hospital bed that he wanted to die. And I turned to spirituality for explanations on the day my first patient passed away, as I gently washed her still and pale body.

In this job, practitioners see death and witness harrowing events. They are therefore forced to confront the reality of their own mortality. Nurses are the ones at the bedside. They are the ones holding the hands of the sick. It is hard. Music, literature and poems are tools I have always used to help me to get through life, and now they help me to get through my nursing practice. As Jennifer Lapum and colleagues write:

Nurses often experience difficult emotions in their practice which is intertwined with illness, suffering, and grief. The potential of the arts to provide a fitting container for these deep and often hidden emotions is important. (Lapum et al. 2013, p. 173)

Experiencing difficult emotions is especially true for nursing students, who encounter many distressing situations for the first time in their clinical placements. Students must build emotional resilience as they progress. I suggest that including the arts in nursing education may help enrich this process. For example, the tasks that helped to prepare me most for the reality of life as a nurse included drama and role play, which simulated scenarios I would come across in practice.

Advocates for the inclusion of the arts in healthcare education argue that they can enrich students thinking, provide understanding of the shared human condition, and promote respect for differences (Scott 2000). Including humanities in healthcare curriculums can develop more insightful, reflective and critical thinking practitioners as it can help them to process their own emotional experiences and understand the common threads that bind humans together (Rieger 2020; Jack 2021). The burgeoning field of medical humanities highlights the holistic nature of healthcare and shows that it is not necessary to pick between science and the arts – because they co-exist in practice. Macnaughton (2011) argues that the humanities should not be treated as simply an add on to nursing education. They should be incorporated throughout healthcare practice because they have the potential to transform the way medicine is approached and how it impacts patients’ lives.

Healthcare practitioners need to recognise the influence of the arts on their practice. The arts can do more than just provide comfort. They can also challenge. For example, literature and stories allow readers to experience the lives and perspectives of others, fostering empathy. This is why patient stories are also important. A narrative-based focus in nursing is growing (Scott 2000), including the realisation that an individual’s health is a complex and multi-faceted picture. Healthcare involves much more than just knowledge of biology. Michael Marmot demonstrates in The Health Gap (2016) how health problems are caused by a multitude of determinants: social, psychological, cultural, environmental and economic. Without taking the time to understand these, practitioners only scratch the surface of their patients’ realities. Practitioners must adopt a patient-centred focus to avoid the dehumanising effects of what Michel Foucault called the ‘medical gaze’ (1963). This term refers to the way practitioners often ‘modify the patient’s story, fitting it into a biomedical paradigm’ (Misselbrook 2013, p.312). Listening to patients’ stories ensures that individuals’ truths are not forgotten amongst evidence-based practice.

Rita Charon and Peter Wyer suggest that there is a risk when using an evidence-based medical approach that the personal nuances of patients’ narratives as well as practitioners’ judgements can get lost. They argue that in order to prevent healthcare being reduced to a one size fits all, tick box approach, the personal experiences of patients must also be valued. They write:

For years now, the fields of narrative medicine and literature and medicine have reminded doctors that illness unfolds in stories, that clinical practice transpires in the intimacy between teller and listener, and that physicians are as much witnesses to patients’ suffering as they are fixers of their broken parts. (Charon & Wyer 2008, p. 297)

In clinical encounters, nursing is more than just assessment of the patient’s physical condition. It is important to remember that patients’ realities are formed by an array of interwoven and dynamic factors. Nurses must look deeper to gather this qualitative and subjective information which is often forgotten in healthcare. When I was an arts student my philosophy teacher once set my class the task of taking a walk in the woods to look at the trees, instead of doing more reading. I didn’t understand at the time, but I do now. By reflecting and looking beyond textbooks and guidelines, so much wisdom can be gained. This can also be applied to nursing.

The best way to learn from a patient and to discover what they really need is by truly seeing and listening to them. Arthur Frank reminds practitioners the importance of giving patients a voice:

But telling does not come easy, and neither does listening. Seriously ill people are wounded not just in body but in voice. They need to become storytellers in order to recover the voices that illness and its treatment often take away. (Frank 2013, p. xx)

As a student I am new to this role. My patients’ stories often tug on my heartstrings, and I experience lessons in humanity on every corner of the ward. I hope I never become desensitised to them. However, with the huge pressures the healthcare system is under it can be hard for practitioners to just get through a busy shift, let alone to stop and ponder the human experience. However, during these difficult times I have witnessed astounding perseverance from the patients, the relatives, and the staff. The arts have always been associated with resistance and I see this everywhere on the wards. From the patients escaping with their heads buried in books, or blocking out the hospital with their headphones, to the nursery rhymes I have sung with dementia patients, or the pretty pictures patients stick haphazardly onto the walls around them, to the songs I sometimes cry to on the drive home after a difficult shift. The arts can foster resilience. They can motivate and reassure. They offer an escape from reality and a doorway into another world, which is something many students and nurses need right now.

I would urge fellow student nurses and practitioners not to limit themselves to objectivism and scientific rationality in their encounters with patients. Patients are not simply problems to be fixed and healthcare professionals are not just cogs in a machine. To truly advocate for and empower patients, nurses need to take a human approach. Nurses must ask the deep questions, listen to patients’ stories and be with them in their despair and also their joy.  Sociological and philosophical questions abound in healthcare. Therefore, the arts and humanities are a crucial way to inform and improve practice. These disciplines can produce more empathetic and resilient nurses and they can also promote a more holistic approach to healthcare. With the healthcare system still reeling from the pandemic, times can seem dark for many right now. Practitioners must remember that art is made for the wounded. The humanities and the sciences are in fact intertwined, and both of these disciplines help nurses not only to do their job, but also to make sense of it.

About the Author:

Jessica Vaughan is a second-year student nurse at Coventry University and holds a degree in Sociology and Education Studies from Durham University. Jessica is a student editor for Nursing Times, where she enjoys discussing compassion in nursing, the social determinants of health, and how to improve the health of marginalised groups through patient education and empowerment.

References:

Charon, R. and Wyer, P. 2008. Narrative evidence based medicine. The Lancet 371(9609): 296-297. https://doi.org/10.1016/S0140-6736(08)60156-7

Foucault, M. 1963. The Birth of the Clinic: An archaeology of medical perception. 3rd ed. London: Routledge.

Frank, A. 2013. The Wounded Storyteller. 2nd ed. Chicago: University of Chicago Press.

Jack, K. 2021. “Putting the words ‘I am sad’, just doesn’t quite cut it sometimes!”: The use of art to promote emotional awareness in nursing students, Nurse Education Today 32(7): 811-816. https://doi.org/10.1016/j.nedt.2012.04.020

Lapum J., Yau, T., Church, K., Ruttonsha, P., & David. 2013. Un-earthing emotions through art: facilitating reflective practice with poetry and photographic imagery. Journal of Medical Humanities, 36(2): 171-176. https://doi.org/10.1007/s10912-013-9258-0

Macnaughton, J. 2011. Medical humanities’ challenge to medicine. Journal of Evaluation in Clinical Practice. 17(5): 927-932. https://doi.org/10.1111/j.1365-2753.2011.01728.x

Marmot, M. 2016. The Health Gap. London: Bloomsbury

Misselbrook D. 2013. Foucault. The British journal of general practice: the journal of the Royal College of General Practitioners 63(611): 312. https://doi.org/10.3399/bjgp13X668249

Rieger, K., Chernomas, W., McMillan, D., & Morin, F. 2020. The arts as a catalyst for learning with undergraduate nursing students: findings from a constructivist grounded theory study. Arts & Health 12(3): 250-269. https://doi.org/10.1080/17533015.2019.1608569

Scott, P. A. 2000. The relationship between the arts and medicine, Medical Humanities, 26(1): 3-8. https://mh.bmj.com/content/26/1/3

One thought on “Attending to Humanities in Nursing Education

  1. Dear Ms Vaughan,

    My name is Jan B. W. Pedersen, and I am senior lecturer at University College Diakonissestiftelsen, Frederiksberg, Denmark. Like you I have a history with Durham University and indeed the Medical Humanities where I did my doctorate.

    I really enjoyed your reflection, and I was wondering if you would be interested in giving an online talk at the college where I work on ‘attending to humanities in nursing education’?

    If interested, please contact me either via Twitter (I am following you) or the email provided.

    Thank you very much for your time

    Kind regards

    Jan

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