Donna Frost

Chapter 6 186 The nurses emphasized that their attention and action must necessarily be focused and that it is not possible to deal with ‘it all’ at the same time. Finding the right focus was a variable process: Sometimes a particular problem is right in your face, it has your attention. (JanNPI-Mtg 6 -Rec 2 of 3 ) Focus sometimes presents itself, sometimes it has to be found, uncovered – gently or pointedly. (AnnaNPI-CRC- 20140405 -Rec 1 of 1 ) Like a kaleidoscope – parts and whole. You can see both at once but you can’t focus on both at once. Nevertheless, you can’t let your knowledge of one or the other go. [...] It’s all there but some things are background for the moment. (AafjeNPI-Mtg 5 -Rec 2 of 4 ) Priorities can shift within a practice encounter, and sometimes fairly quickly. The nurse practising with professional artistry is generally not fazed by this. He or she is able to change gears quickly and change focus as well, partly because of the awareness of the whole picture: Yes, but to be able to do that [shift focus quickly] you are already aware of the other parts. You don’t have to ‘discover’ them at that moment. They are already known to you, although perhaps not in all their detail. (LilianNPI-Mtg 7 -Rec 2 of 4 ) A particular expression of this pattern of engagement is when the nurse practising with artistry helps the other to see how their experience fits into the larger picture. This may involve helping the other, first of all, to see the bigger picture, and then to discover, uncover or see how their question, experience or struggle fits into that. Sometimes the nurses were clear and somewhat directive about where the current focus lay, for example: “ Yes, there are a lot of ‘what-if’s?’, as you say. First, right now, we will work out how you can get to the clinic tomorrow. Then we’ll take the next step ” (LilianNPI-Obs- 20140227 -p 11 ). This could also be done using metaphorical language, for example, “ This is not so much about the details, about a particular path, but about the landscape in general” (RosemarieRNI-Obs- 20121014 -p 9 ). The nurses were in any case clear about what was happening in the moment, put effort