Abstract
Introduction
The Italian scientist Carlo Rovelli (2016) suggests that ‘our culture is foolish to keep science and poetry separated: they are two tools to open our eyes to the complexity and beauty of the world’ (p.88). In this editorial, I will argue that poetry is a valuable but neglected mode of expression that can open our eyes to the complexity and beauty of the human encounters that make up the practice of nursing. I will suggest that a more poetic form of discourse can help practitioners, patients, researchers and academics to understand themselves and each other, not only by providing them with a mode of expression that transcends everyday communication, but by instilling what Heidegger (1966) called a sensibility of ‘meditative thinking’ which allows meaning to emerge intuitively from practice without the intervention of calculative rationality.
As soon as we begin to think about using poetry as a means to some external end, we run into all sorts of difficulties. Many would argue that poetry is not for anything, that it is an end in itself. Others would point out that a poem has no external referents, it points to nothing outside of itself and that, as Harold Bloom put it, ‘the meaning of a poem can only be another poem’ (Bloom, 1997: 95). And when it comes to evaluating its usefulness, it is hard to avoid making aesthetic judgements and asking the question: can bad poetry serve good purposes? Furthermore, it is extremely difficult to define what is meant by poetry, particularly once we move beyond the constraints of regular meter and rhyming schemes.
In an attempt to avoid some of these difficulties, I will, for the time being, focus on the idea of ‘the poetic’, which is a far broader concept than that of poetry, but which is somewhat more straightforward to identify and discuss. Whereas poetry is an art form, with all the cultural, aesthetic and conceptual baggage that this implies, the poetic is a mode of expression and communication that is usually held in contrast to the prosaic. Thus, whilst the aim of prosaic communication is the straightforward and often formulaic transmission of factual information, poetic communication aims to express what cannot clearly be described in words, through the evocation of images, sounds, feelings and memories.
An instrument to measure spring with: poetry and research
It strikes me as extraordinary that the poetic expression of the experience of nursing and being nursed should be so rare that it requires a special edition of a journal. A great deal of the everyday discourse of nurses and nursing is poetic rather than prosaic, concerned with matters that cannot be expressed in any other way. When a patient attempts to describe the nature and intensity of her or his pain, when a nurse tries to comfort a dying patient and when nurses talk together about the emotional labour of their work, they often speak in the poetic language of metaphor and analogy: dry prosaic terminology simply cannot do justice to the nuances of their discourse. And yet an exploration of the modes, methods and impact of poetic expression is rarely found in the published nursing literature. Poetic inquiry has yet to be recognised as a legitimate way of examining what it means to be the giver or recipient of nursing care. Quantitative research studies generally attempt to translate suffering into a numerical value such as a pain scale or a depression inventory, so that it can be compared and monitored. Qualitative studies, which are ostensibly concerned with the unique experiences of individual patients, often reduce those experiences to general themes and categories and present them in the ‘scientific’ style demanded by many high-impact academic journals.
This antipathy, both towards a more poetic methodology for researching our discipline and towards a poetic mode of expressing the nature of our understanding of nursing practice, is fuelled by the evidence-based practice movement. Since poetic expression is rarely admissible as ‘gold-standard’ (or even as silver- or bronze-standard) evidence and is extremely resistant to being formulated into rules and guidelines for practice, it has little or no currency in the academy. Despite the fact that the practice of nursing is concerned predominantly with the communication of emotional and somatic feelings that defy straightforward measurement and prosaic description, we continue to promote and exalt pseudo-scientific research methods that regard the expression of these feelings as something to be eliminated as a threat to the pursuit of objective scientific facts.
Scientific research in nursing is concerned largely with enumerating, categorising, objectifying and generalising; with developing methods and techniques for removing the individual subject from descriptions of the world in the name of objectivity. In contrast, what poetry offers is a return to the primacy of experience and capturing how it feels to be a singular person in a specific situation at a particular moment. The poet EE Cummings (1960: 18) puts it thus: While you and i have lips and voices which are for kissing and to sing with who cares if some oneeyed son of a bitch invents an instrument to measure Spring with?
Some mysterious art herein: heuristics and intuition
Finding new ways to hear the individual experiences of patients and care providers is only half the story. Nursing is not a science, it is not even an art: nursing is a practice in Schön’s (1983) meaning of the term, which demands a continuous and reflexive interplay between knowing and doing; between knowledge creation and knowledge application. Despite what the various hierarchies of research evidence might suggest, the most important and useful knowledge for responding to the individual and unique challenges of nursing practice is not found in books and journals, but by reflecting on our own individual and unique experiences.
Chuang Tzu, a Chinese philosopher from the 3rd century Let me take an illustration from my own trade. In making a wheel, if you work too slowly, you can’t make it firm; if you work too fast, the spokes won’t fit in. You must go neither too slowly nor too fast. There must be co-ordination of mind and hand. Words cannot explain what it is, but there is some mysterious art herein. I cannot teach it to my son; nor can he learn it from me. Consequently, though seventy years of age, I am still making wheels in my old age. If the ancients, together with what they could not impart, are dead and gone, then what your Highness is studying must be the dregs. (Giles, 1980: 140, emphasis added)
We might make a similar case for nursing. No amount of technical knowledge will, in itself, turn me into a good nurse; at best, I will become a very good novice (Benner, 1984), but a novice nevertheless. In addition to knowing that a certain intervention has been found to be most effective for a certain general medical condition, I also need to know how to apply this intervention to specific, messy real-life situations with particular individual people. For example, empirical research might indicate that Mirtazapine is the drug of choice for depression, but there is no research study that will help me to persuade my depressed patient that this little yellow pill will not poison her. Furthermore, if we apply Ryle’s chess example, it should be possible through guided practice and critical feedback on our actions (perhaps in the form of clinical supervision) to learn how to nurse without prior theoretical or technical knowledge of nursing.
Chuang Tzu presents this distinction between practical knowing how and theoretical knowing that as an impasse, suggesting that tacit know-how cannot be expressed through language and therefore cannot be passed on through the written word. Modern writers have suggested that whilst knowing how cannot be transmitted in the formal language of science and technology, it can nevertheless be passed on in the form of heuristics or ‘rules of thumb’. Heuristics points us towards a strategy for the expression of that which cannot be expressed in any other way. Rather than outlining a series of precise and straightforward steps which, if followed, will result in the successful resolution of a practical problem, an heuristic approach creeps up on the problem obliquely through a series of sideways movements; it makes helpful suggestions such as ‘try drawing a picture’ or ‘try explaining the problem as if to a young child’; it points us towards a deeper appreciation of the problem together with some strategies for resolving it.
This, of course, is also the aim (insofar as it has one) of poetry. As the critic Meena Alexander (2013) tells us, ‘poetry takes as its purview what is deeply felt and is essentially unsayable’ (p. 18). The musician John Cage (1978) puts it more pithily: ‘I have nothing to say and I am saying it, and that is poetry’ (p. 109). Poetry does not tell; it does not even show. Rather, it nudges us, through metaphor, simile and allusion, towards ways of understanding that transcend straightforward prosaic description. As practitioners, academics and researchers in a discipline where, to use Michel Polanyi’s (2009) phrase, we know more than we can say, poetic discourse can help us to communicate more clearly with our colleagues and patients.