Donna Frost

Nature of professional artistry 195 6 compass and professional standards, what he knows he is capable of achieving and that which the patient wishes to achieve. The nurse practising with professional artistry does not shy away from the complexity of a practice problem or challenge. The challenge is not, and does not have to be, over simplified so that the nurse can deal with it. Instead of simplifying the problem down so that it fits the routine or his own expectations, the nurse is alert to the ‘problem behind the problem’, seeing the patient as a person with human interests. Practice goals are necessarily therefore more complex than when practice is viewed in a more instrumental or task focused way. The nurse works towards the ideal instead of merely the acceptable. For example, when Floortje (RNI-Mtg 4 -Rec 1 of 5 ) was working with a person considered a ‘demanding’ client by the South Side community nursing team and allied health professionals she was less focused on working out ‘how to keep him happy’ and more concerned with understanding his perspective and what he specifically wanted help with. She was then able to focus her attention there where it was helpful for the client, and ultimately the community care team and associated allied health professionals, by working out what was necessary to help this client achieve his goals. She took the client and his plans seriously and focused her energy there, rather than ‘trouble shooting’ to avoid a complaint. Integral to this pattern of engagement is the holistic view the nurse has of the immediate practice situation and wider process, and of the challenges they may contain. Framing the present situation, practice goals and potential future scenarios holistically means that the goal of the immediate practice situation has less to do with getting a particular task finished andmore to dowithmeeting the broader goals of contributing, for example, to wellness and flourishing. When seeing a patient with chronic back pain, for example, Margaret, a NP working in a general practice, could have talked to the patient about causes of back pain and potential ways to cope with it, directed the patient to the relevant patient information websites and pamphlets and let him know which symptoms should prompt him to come back. This would have ‘ticked all the boxes’. Instead, she used the appointment time to explore the meaning, impact and triggers of the back pain with the patient, coming to understand something about his world and the meaning the back pain hadwithin it, helping the patient, over a number of visits, to understand this himself, to take control over how he managed his back pain and work towards improved wellbeing (MargaretNPI-Mtg 4 -Rec 1 of 5 ). The difference is perhaps a subtle one. Directing the patient to the resources he needs to work out how to cope with his chronic