The art of nursing, the craft of writing

Abstract

As nurses, our enduring discourse on the art of nursing runs paradoxically in the inverse to our consideration of the craft of writing. We love to contemplate and discuss the art of nursing. We think and talk about what it is, what it means, how it is expressed, and whom it affects. Conversely, writing is something we are encouraged to do throughout much of nursing, including here in our specialty. But we do not think or talk about the craft of writing much at all. Frequently, the expectation of writing—for academic coursework, for documents like institutional policies, and for publication in journals like this one—is simply set forth without preamble. Few guidelines, resources or tools are typically offered to novice or more experienced nurse authors. Tools using artificial intelligence (AI) offer a seductive false promise for nurses faced with expectations for and pressures of writing. The advantages and disadvantages of AI tools like ChatGPT (https://chatgptonline.net) for authors of all sorts of materials, including manuscripts sent here to the International Journal of Older People Nursing, are both interesting and important. We are certain to see every publisher and teacher and most authors, having considered the implications, take up personal and institutional stances on use of ChatGPT and similar tools. Those considerations are clearly critical to ensure ethical and effective education, authorship and publishing. But stances aside, AI tools, no matter how novel, are sure to distract us from what lies at the heart of our relationship as nurses with writing. In truth, I think focusing our attention on ChatGPT or the next tool that goes viral—rather than on the craft of writing—promises only to ultimately add disenchantment to this current era in which we live where so much is already characterised by disconnection, unease, and dissatisfaction. Our consideration of the art of nursing sustains us as we surmount challenges and evolve as a discipline and as a profession. The full scope, debates and effects of our discourse on the art of nursing are expansive. Patterns of relational knowing and aesthetics lie at the heart of understanding our art for many scholars. Connections to our relationships with those in our care are central. Reflections on our comportment, too, are key to delineating the art of nursing. Debates about the precise nature of our art are longstanding and not infrequently heated. The lack of agreement, the arguments, and the evolution inherent within our collective contemplation of the art of nursing do not dissuade us from further considering this central tenet of nursing in our current circumstances. Rather, that energy seems to spur advancement and to highlight the salience of our discussions. Over time, we have worked hard at knowing and practicing the art of nursing and continue to do so. The art of nursing is argued by some to be more akin to craft. While I remain in the nursing as art camp, I respect those who see it as craft and value their written dissertations on that position. Likewise, I stand with those who identify writing as craft but respect those who know it as art. Craft and art have much in common—skill, practice, dedication, aesthetics, resilience, and joy. Applied within our profession, we can easily see those qualities in nursing practice, research and education. We can also see those habits and rewards in writing if we look. Why then do we not work at our craft of writing with the same intensity that we do the art of nursing? In a bizarre post-modern turn, contention around the use of ChatGPT in writing and propositions to replace nurses with robots are remarkably alike in one primary respect. ChatGPT and robotic nurses open consideration of wholesale replacement of writers and of nurses, respectively, an aim unlikely to satisfy any of those involved. Whether in nursing or in writing, those who receive what is produced—our patients and our readers—desire and even demand another person, seeing both care and reading as relational. Nurses and writers enter their professions with the imaginary of the other, the people to whom they address their work. Removing one of the people in the relationship shifts the fundamental nature of that work. Far be it for me to decry use of sophisticated tools, including those relying on AI, in either nursing or writing. Robots that assist with care like Moxi (https://www.diligentrobots.com/moxi) have more in common with tools like Visual Thesaurus (https://www.visualthesaurus.com), a tool I am using to improve what I write for you today. While the technologies are different, the aims are similar. With either tool to hand, the person who is fulfilling the role—nurse or writer—recaptures time and energy to do the primary job of nursing or writing. The relational nature of nursing and writing is preserved with judicious use of selected tools. Critically, the person receiving the benefit of the art or the craft remains able to know the other person in the relationship, whether that be nurse or writer. Propositions to use AI and robotics to replace the person in the art of nursing or in the craft of writing are substantively different than the use of tools intended to augment or support an art or craft. Former dehumanises, stripping art and craft from the maker, the doer and the practitioner by taking the inherent relationship out of the equation. The latter can, used well, help focus the relationship by making better use of time. Visual Thesaurus helps me say what I wish to say more precisely by providing synonyms for me to consider, for example. So too can Moxi, when used effectively, return time and energy for human connection to nurses who use the device. In both cases, the focus is on the people involved—writer, reader, nurse, patient—and the context, situation and time in which their relationship occurs. Gerontological nurses know the salience of the relationship that undergirds the art of nursing. We realise the power of the nurse–patient relationship and see it in how care is made personal every time we guide, coach and conserve the personhood of that individual in our care. A shared joke is not just a moment to laugh, it is a way to find the person still there beyond the dementia. Celebrating the moment someone first gets out of bed after a serious illness is profoundly symbolic. Recovering some small element of daily function means the person and the nurse hope differently than they did the moment before. Nursing's foundations lie in human relationships, no matter how brief. We nurses know the relationship that supports the craft of writing, too, both personally and professionally. Who among us has not read the author notes on the flyleaf of a novel's dustjacket, eager to know more about the person who wrote the story we just devoured? Many of us do the something similar as we read nursing texts, research reports, and even the odd editorial. We might search for more information about the author online, trying to know their story in nursing better, or even write to an author with an email or a letter. Whether in a fraught clinical encounter or in silent musings apropos a provocative essay, what grounds our understanding and shapes our reaction to nursing and to writing is the human being on the other side of a relationship. Knowing the relationship and honouring the intertwined notions of human connection and expression of care that is the very essence of nursing leads me back to writing. Writing is a skill fundamental to nursing and to our nursing roles as communicators and educators. AI might produce patient education materials, but it cannot imbue those materials with the sensibility brought by nurses who know precisely what, how, and when to educate people about as they navigate a change in health or a journey through treatment. Similarly, AI can likely already produce nursing articles that look acceptable to the naïve reader. Deeper examination will undoubtedly reveal a soulless stance within. Those articles, produced without human experience, are sure to be bereft of pertinent illustrative anecdotes and arguments contextualised by individual interpretations of historical events or contemporary controversy. Whether in care or in writing, using AI to replace the maker risks removing what people care about most: each other. Human beings write and read for precious reasons. We do so to know each other, to share what we have learned and to find our common humanity both in specific moments in time and in experiences that span history. I urge us to remember these human truths at a time where we are all, everywhere around the world, exhausted, scared and sometimes hopeless. Pressures for productivity, ambition and fatigue may drive us to look for ways to automate writing. I urge us all to resist that pressure, returning to the art of nursing and seeing the clear parallel with the craft of writing. Philosophically, these two pursuits are more similar than they are different. Each deserves our dedicated energy as we build knowledge and skill, practicing and expanding it over time. We all know the joy of a nursing action with a person, a family or a community that succeeds. The joy of writing echoes that of nursing. The joy that comes in producing something aesthetic pleasing is matched only by knowing that somewhere out there is perhaps just one other person—that is all it takes—who experienced comfort, insight, knowing, or direction in reading what we wrote. To all current and future IJOPN authors, I say make an investment of time, energy and spirit in your craft. Despite the hard work involved, I have yet to meet a person who regretted such an investment having made it. Study writing the way you study nursing. Use your tools wisely and build your skill over time. No one is born writing well and that is doubly true for those who write across English and one or more other languages. You know your capacity to acquire and refine the skill of writing through the skills of nursing that you now possess, having polished them over time. Now is the time to make the leap and approach writing in the same fashion. Here are some of my favourite ways to build skill in writing. If you want to write better, read, and read widely! Reading, and not just in nursing and healthcare, helps build writing skill. Read in English if your first language is not English and you aim to write in English. See every moment spent writing as an opportunity. Use that email you need to send as a chance to polish your grammar and syntax. Form a writing group with colleagues. When you write something like a research report or an essay, ask your writing group to read and comment on it. Some of us are better editors than others. Learn who among your writing group members have greater editing skills and learn from them. Ask them for notes on your articles. Practice building your own editing skills at every opportunity. Start by stepping back from your draft work and reading it as though it is not your work. Reading it aloud will help you hear gaps in logic and see word choices needing improvement. Becoming your own best editor and serving as an editor for others makes for better writing. The craft of writing grows with good habits. Adopt the habit of starting as you mean to go on. For me, that means opening a new document and formatting it as I wish it to look when I finish. For example, I begin any new manuscript with the font, margins and other elements that make an manuscript look polished. Outlines help keep that draft manuscript in order, aiding readability from the start. Find and use tools that help you be a stronger writer. Always use the spellcheck, grammarchecker and editor functions built into WORD™ and other word processing applications. Find external tools like Visual Thesaurus and Grammarly (https://www.grammarly.com) that provide you ways to expand and refine your written language. Bookmark writing resource centres and guidance on publishing that work for you. Among my favourites are the Purdue Online Writing Laboratory (https://owl.purdue.edu) and the Publication Coach (https://www.publicationcoach.com). All but Visual Thesaurus are free to use. Those with dyslexia and dysgraphia along with others who are neurodiverse are likely to find most writing tools helpful and can benefit from using other technologies like specialist fonts such as OpenDyslexic (https://opendyslexic.org) and using different ways of writing including handwriting and dictation. Keep in mind, too, that some of the tools and resources I note here are generally more suited to writing in North American English. Seek out other dependable sources more aligned with writing in British English when the need arises. Returning to the parallel I drew between the art of nursing and the craft of writing, I encourage nurse authors to be kind and patient with themselves. Nurses are not made in a day and nor are writers. The support we should show our colleagues as they enter and develop their nursing practice is that we must return to ourselves to become the nurse authors we aspire to be. In remembering that writing is as relational as nursing, we keep our intended audiences in mind. Imagining our readers, like our patients, creates a connection to them and prompts us to write in ways we believe they understand. That connection is why every author who receives a decision letter from me as IJOPN Editor in Chief that indicates revisions to a manuscript are necessary is admonished to address the interests of our global community of readers. We are never simply writing; we are always writing for someone, somewhere. We nurses cherish the art of nursing. Let us savour the craft of writing with the same reverence. As nurses, we do work utterly fundamental to the health and well-being of any society. We gerontological nurses help ensure daily function and thus support the meaning and purpose our elders find in their lives. Our writing craft is a vital part of those contributions. We must treat our writing as we do our nursing then, knowing our care makes writing, like nursing, stronger and better over time. Enjoy putting your words on the page and your story in the manuscript. I anticipate my joy at reading what you have written.

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