Donna Frost

Nature of professional artistry 199 6 Taking or enabling transformative action The previous patterns of engagement create the conditions for this final pattern: taking and / or enabling transformative action. This is not to say that the various patterns build in a consecutive fashion on each other. Rather that they work together, each reinforcing and creating room for the other. Within this fifth pattern of engagement the nurse effects change or transformation within the clinical situation, or within the dialogue or relationship, or both. Poor clinical outcomes may be averted or prevented, for example. New understandings, new insights or new ways of facing a difficult situation may be coached or nurtured into being. New strategies, behaviours and actions may be enabled and supported. The goal of the nurses’ actions within this inquiry, when related to this pattern of engagement, were dependent on the context and goal of the encounter or series of encounters. At times it was important to change the course of events so that a particular scenario would be prevented by being well prepared for eventualities or acting decisively for example. Nurses within this study acted wisely and decisively to influence clinical outcomes for individual patients in many different ways in the course of their everyday work. They were also alert to lacunas in the quality of care and took action to tackle these when they fell within their sphere of influence. Sometimes ‘taking transformative action’ involved raising and discussing issues with colleagues or other members of the multidisciplinary team, or supporting colleagues to talk things over with each other so that issues of care quality for particular patients or residents could be resolved. Members of the NP inquiry in particular observed each other, and narrated experiences of, using their clinical expertise and knowledge of the patient and their wishes to influence decision making within the multi-disciplinary team. On other occasions it was necessary to create the conditions in which a potential for transformation, a possibility, could become reality. In describing the third pattern of engagement, attention was paid to the way in which the nurses in this study worked with ‘the now and the not yet’ and how this way of working was experienced by colleague observers and patients themselves. Here the attention turns to the actions necessary to enable the ‘other’, the patient, resident, family member, student or colleague to themselves take transformative action or experience a change in perspective. Commonly, the patient or other person in the encounter was supported by the nurse practising with professional artistry to take the next step and exercise their own potential to exert influence on the outcome.