Contributor: Peg Hickey, MSN, RN
For three years, I have been an adjunct clinical instructor. And thanks to a recent course on nursing theory, I have been able to closely examine my own understanding of nursing knowledge and my commitment to the nursing profession. The most extraordinary part about teaching is having the opportunity to impart this knowledge to the future generation of nurses. Students’ primary goal is to focus on the empirical aspects of nursing; however, my unwritten objective for the students is to define nursing by their connection to the human spirit. As an educator, this involves integrating learning experiences related to the patterns of knowing (Chinn & Kramer, 2018).
One-by-one, I greeted my six students as they arrived in the lobby on their very first day of their clinical rotation for Fundamentals of Nursing. Their nerves were palpable: they didn’t speak to me or each other and nobody smiled (yes, I have learned to recognize a masked grin by observing the eyes and foreheads). I have never been accused of being a threatening presence in any way, shape, or form, yet the students stood before me with fear in their eyes. (Flashback to my own experiences in nursing school from the early ‘90’s). I was able to discern the truth of this moment and acknowledge the impact of feelings on their very first clinical experience. My aesthetic knowing of being able to recognize a deeper meaning to their human experiences of anxiety and fear laid the foundation for an enriching nursing experience for all of us. I was helping to build the future of nursing (Nursology.net, 2021).
First experiences are memorable for students. Some may consider their initial attempts at nursing to be insignificant and only equate success with tasks: starting an IV, changing a wound dressing, or administering medication. Of course, on our first day we didn’t perform any of those tasks, but one student did display an intangible act of commitment: she followed through with a patient’s request for tissues. Keep in mind, this was her first clinical exposure; we were only minutes on the unit in and in the midst of a tour. Yet during those moments, this student spoke to a patient, asked a staff member where the tissues were, located them, and carried them with her until the tour ended, when she brought the tissues to the patient. At face value, simplicity. Yet it was important for her to know that she performed critical acts of nursing in this seemingly simple task: communication, commitment, and caring. Baillie (2007) reminds us of Henderson’s definition of commitment: Nurses who “responded to patients’ needs in a timely manner were perceived as caring; patients were dissatisfied when nurses apparently forgot patients and their needs” (p.6). I complimented my student, and her smile was beaming beneath her mask.
The following week, my students were assigned to obtain a patient history, a conventional start to the development of communication and interpersonal skills. During post-conference, one student reported that she was unable to complete the assignment; instead, she had connected with a young woman with a terminal disease who requested a foot rub. She decided to fulfill the wishes of the patient and put off asking about her medical history, demonstrating an appropriate and meaningful prioritization of care. The lesson in post-conference focused not on an incomplete assignment, but on the ability of nurses to recognize significant and meaningful moments and to take action (Chinn & Kramer, 2018). This student completed a patient history the following week and that was OK with me.
During an attempt at a physical assessment, my student and I encountered a Mandarin-speaking patient who was visibly distressed. While using an audiovisual interpreter, our patient kept repeating a phone number over and over and over. The interpreter told us “she wants to call her husband.” Recognizing that nothing else mattered to this patient at that moment, we stopped our assessment, dialed the number, and the patient spoke to her husband. Following their conversation, she was smiling, grabbing to hold our hands, and visibly relieved that we understood. This encounter allowed us to distinguish between the science and art of nursing and to feel how the experience of being understood is both inspiring for the patient and gratifying for the nurse.
What better way to introduce the aesthetic pattern of knowing by calling it out in the clinical setting and defining what it is: “An intuitive sense that detects all that is going on and calls forth a response, and you act spontaneously to care for the person or family in the moment” (Chinn & Kramer, 2018, p. 142). Another idea for incorporating the meta-paradigms in nursing education is to change the course titles “Fundamentals” and “Foundations” to “Aesthetic Knowing in Nursing” so beginning students feel empowered by authentic nursing actions of communication, commitment, and caring behaviors.
The first introduction to a clinical experience lays a crucial foundation for nursing students. My hope is to impart a meaningful impression about the interpersonal nature of nursing; one they will be reminded of when they miss that first IV or administer a medication late. My students are off to a great start and I hope they know that every week when our clinical day ends, I am smiling beneath my mask.
Bailie, L. (2007). An exploration of the 6Cs as a set of values for nursing practice. British Journal of Nursing, 26(10), 558–563. https://doi.org/10.12968/bjon.2017.26.10.558
Chinn, P. L., & Kramer, M. K. (2018). Knowledge development in nursing: Theory and process (10th ed.). Elsevier.
Henderson, A., Van Eps, M. A., Pearson, K., James, C., Henderson, P., & Osborne, Y. (2007). “Caring for” behaviours that indicate to patients that nurses “care about” them. Journal of Advanced Nursing, 60(2), 146–153. https://doi-org.ezproxy.cul.columbia.edu/10.1111/j.1365-2648.2007.04382.x
About Peg Hickey
Peg lives in Queens, NY and has been a nurse since 1993. She is currently a nurse educator at Columbia University Medical Center working on a program designated to incorporate diabetes-related simulation into the curriculum for medical and nursing students. Peg is also an adjunct instructor at Hunter-Bellevue and Pace University Schools of Nursing.