Science, Art, Aesthetics and Ethics; The Necessity of Openness and Compassion in Nursing

Patricia Benner, R.N., Ph.D., FAAN
EducatingNurses.com
Copyright February, 2020

With the next two EducatingNurses.com articles in February and March, we hope to re-invigorate the dialogue about the art and science of nursing with contributions by two outstanding Norwegian scholars, Dr. Kari Martinsen and Dr. Eva Gjengedal. Nursing as art and science might have once been framed as an either/or choice, with contentious arguments from both sides—but no longer. All practice disciplines depend on science, art, ethics, aesthetics, poetry, literature and more. No single discourse can capture all that is inherent in any complex practice discipline, such as nursing, medicine, social work, teaching and so on.

Two nursing scholars, Dr. Kari Martinsen and Dr. Eva Gjengedal, have influenced my thinking on this single method/paradigm versus a pluralism dialogue for the past 30 years. This month we feature Dr. Kari Martinsen and her considerable contributions to this discourse. In March, we will focus on the contributions of Dr. Eva Gjengedal. I had the privilege of participating in two doctoral seminars with both scholars in Molde, and Bergen, Norway this past September 2019. The two-part interview with Dr. Martinsen resulted from the doctoral seminar discussions and with a wonderful conversation that enabled me to catch up with her current work. She has two notable books published in English: From Marx to Logstrup (1993), and Care and Vulnerability (2006) Oslo Akribe (English original). Many will be familiar with Dr. Martinsen as a noted nursing theorist, with a chapter in the book, Nursing Theorists and Their Theories (Alvsvag, 2018). Her most recent book, Sensation and Restraint, published in Norwegian by Fagbokforlage, is currently being translated for publication in English. I’ve had the privilege of reading portions of her manuscript in English. It is a stunning book, one that enlarges and reframes the separation of art, science, the human lifeworld, and practice. With her and her publisher’s permission, I give you this sneak preview from the introduction of her most recent book (English translation and publication are in-progress).

The word ‘sacred’ can cause upset because it has connotations of religion, and is often associated with specific and fixed practices of such. The word ‘sacred’ can also evoke feelings of embarrassment. Nevertheless, it is worth asking the counter-question: Do we want to live in a culture and with a public health service where nothing is sacred and everything can be reduced to social constructions? Is it worth considering whether, in the encounter with another vulnerable human being, and also in relation to nature, there may be something sacred in the sense of not created by human beings? Something that calls for reverence, respect, care, and consideration, whereby the individual—the patient, their family, the nurse— is not reduced to a small cogwheel in a health service characterized by time pressure? Would a society and a health service where nothing is sacred not be shameless?

The book addresses these issues. It critically discusses how the sacred can be understood, and how sacred experiences can take place in a busy hospital room and around the hospital bed, as recounted retrospectively. Literary and practice-based examples are used to illustrate how experiences of the sacred can be interpreted, described and analyzed from a purely phenomenological perspective. In doing so, the sacred is universally ‘accessible’, regardless of a person’s faith or attitude to life.

Sensation and Restraint (English translation in-progress) Fagbokforlaget, Norwegian Publisher).

I hope educators and students will use these two conversations between Dr. Kari Martinsen and myself as an introduction to the thinking of Dr. Martinsen, and also enlarge their understanding of how her work has impacted nursing internationally. The interview models thoughtful exploration of complex ideas that must be teased out and clarified during the process of the discussion. These two interviews can be used as triggers for discussion in nursing theory and issues classes.

Dr. Martinsen is a philosopher and a nurse, and this is evident in the interview segments. She draws on the work of Knud Logstrup (1997; 2007) to consider pre-cultural life expressions such as trust, openness, mercy/compassion and hope (K.E. Logstrup, 2007). Logstrup, a creation theologian, focuses on what is given in a created world. For example, language itself is given as a gift that no language speaker created, along with the life manifestation of the usual desire to be clear, not to confuse another by misuse or devious use of language. In this view, it is natural to try to communicate clearly, one has to have a reason not to; for example, when someone seeks to hide something or cover over the truth of the matter. In mercy or compassion as a sovereign expression of life, the embodied, sentient person responds to the suffering of other human beings, animals, or plants. There has to be an impediment to mercy and compassionate responses for this sovereign life manifestation to be thwarted. We live in a world where bigotry, racism, and enmity do rob many of their compassionate responses. But the most natural human response to the suffering of others is not dismissal or enmity—it is mercy. It is helpful to remember this because it is an unalienated, natural response to suffering. I embrace this common human experience of compassion because I have experienced it firsthand, where I meet another through my openness, curiosity, respect, and attentiveness (even as I have witnessed hatred and enmity). It resonates with my experience as a nurse, where my care is a response to the needs and concerns of others, rather than an alienated, self-focused, willed moral response. Sometimes caring is fraught with tensions, pressures, and rejection of my attempt at caring practices. In that case, a willed, even effortful moral response may be the only available response. But this ‘effortful caring’ is always more difficult and fraught with inauthenticity and conflict. This understanding that, as human beings, we are capable—even prone to compassion—means that caring need not be an alienated act, motivated by responses that are distanced or foreign from the self. Caregiving is often generated by concern and the life manifestation (gift) of compassion.

In these interviews, you will find an honest struggle with understanding the notion that we have pre-cultural, unwilled, sovereign life manifestations such as mercy, hope, and truth-telling. They come naturally or as pre-given impulses, in response to a created or given life and world. Those who reject the notion of religion or creation may find this stance objectionable. But this is not a ‘mandated’ or even a rational argument or decree. It is non-rational (not irrational) and each person can only follow their discernment and beliefs about the experience of common humanity and sovereign life manifestations. Over time, I have come to believe that we do have aspects of existence and expressions in life that are gifts available to all human beings. But clearly, this view or understanding will not be shared by all. It cannot be mandated or willed. We acknowledge in this dialogue that some cultures give more ready access to hope, compassion, clear communication than others, but the impulse is always there and available. We do not plan or will compassion, it is just given to us as part of our common humanity. I hope that this conversation will stimulate more discussion and exploration.

Dr. Martinsen’s description of a sensuous understanding of the other through listening, respecting, touching and not judging the other follows the Taylor and Dreyfus (2015) explication of the human capacity to meet, encounter and understand others directly without a representational mind filled with conceptual frameworks, templates, or pre-judgments. This makes it possible to meet and come to understand another’s concerns and immediate experience through perceptual grasp. Martinsen has critiqued assessment approaches in nursing that meet the other with prejudgments, a diagnostic gaze, and lack of openness and acceptance of the other, directly sensing their concerns and plight. These interviews with a notable nursing thinker are presented to stimulate exploration, thinking, debate and curiosity. Her account of the travesty of our accelerated lives, where we focus primarily on efficiency and how much we can do in the least amount of time, presents a tyranny. This usurps our ability to be open and respond to the other with compassion and attuned care. Cynicism, distrust, disengagement, time pressure and a quest for efficiency over effectiveness, erode our ability to respond with compassion. We must find ways to create work environments that are more respectful, allow for meeting the other and allow us to notice the sacred spaces in our caregiving.

References:

Alvsvag, H. ‘‘Kari Martinsen: Philosophy of Caring’’ In: Nurse Theorists and their Work. (2018) (Editor: Alligood, Martha, Raile) St. Louis, MO: Elsevier.

Dreyfus, H.L., Taylor, C. Retrieving Realism. (2015) Cambridge, Mass: Harvard Univ. Press

Logstrup, K.E. The Ethical Demand with Introduction by Hans Fink and AlisdairMacIntyre. (1997) Notre Dame, IND: The University of Notre Dame Press.

Logstrup, K.E.. Beyond the Ethical Demand. with Introduction by Kees vanKooten Niekerk (2007) ) Notre Dame, IND: The University of Notre Dame Press.

Martinsen, K. Sensation and Restraint. FAGBOKFORLAGET (Translation to English and English Publication, In-Progress)

Martinsen, K. Caring and Vulnerability. (2006) Oslo: Akribe (English original).

Martinsen, K. (1993). Fra Marx til Løgstrup. Om moral, samfunnskritikk og sanselighet i sykepleien. Oslo: Tano Forlag. [From Marx to Løgstrup. On morality, social criticism and sensuousness in nursing. Oslo: Tano Forlag.].

Hartmut, Rosa (2014)  Alienation and Acceleration.  Kobenhavn, Hans Reitzels forlag.      

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