Donna Frost

Chapter 6 184 out’, ‘place to rest’, ‘a bubble’, ‘an anchor point’, ‘lifting the weight’, ‘holding off the darkness’ and ‘keeping the darkness at bay’. These images and metaphors contain elements of the creation of a safe space bounded in some way, steady enough to create shelter, yet open enough to allow movement and connection. Actively working with the parts and the whole When practising with professional artistry the nurses in this study demonstrated a comprehensive grasp of both the big picture, ‘holding’ this throughout the practice encounter, and the salient details of the particular practice situation. They were alert and attuned to the whole even while focused on the parts, and vice versa, and able to maintain a balance in this. This meant, for example, that they could see the importance of the details, or changes in these, for the whole as well as acknowledging the influence of the whole on the details. Actively working with the parts and the whole included being able to help others, particularly patients, residents and their family members, to orient themselves within ‘the whole’ and to see how their particular experience fits into the larger picture. An everyday example dealt with almost continuously by the inquiry participants is the issue of being person centred in the immediate consultation while being aware of all the other patients that still need to be seen; keeping within the schedule so that other patients do not have to wait unduly. This time pressure is part of the bigger picture and when practising with artistry the nurse uses it to frame the practice situation instead of seeing it as a burden imposed by the organisation or the insurance company or ‘the system’. The nurse recognises such constraints on the present encounter are necessary if other patients are also to be seen and the timing becomes a part of the nurse’s rhythm. When professional artistry was not present the nurse’s own reaction to the pressure became a focus, for example, describing oneself as a victim of these circumstances, ‘ It feels terrible, but it’s not my fault, we don’t have enough time ’ (RosemarieRNI-CRC- 20111030 -p 1 ). In such situations the patient would also be bothered by the circumstances and express feelings such as, ‘I’m not getting adequate care’, ‘I’m being rushed along’, ‘poor nurses they are so overworked’. Another aspect to working with the parts and the whole was using the relationship between the two to experiment, as part of an active investigation of the practice situation: what is going on here, what needs my attention, which intervention is necessary and where should it aim? The following example is reconstructed from fieldnotes (NPI- 20130815 Obs) and the recordings (MargaretNPI-CRC- 20130815 - Rec 1 & 2 ) made from the critical reflective conversation which took place after the