Donna Frost

Discussion and conclusions 253 8 and came to the most appropriate and particularized course of action, as is also described by Titchen ( 2009 ; 2019 ). Nurses with expertise and who strive for excellence and meeting the ideals of nursing practice, are sometimes considered risk-takers (Hardy, Titchen, Manley & McCormack, 2006 ; Hardy et al., 2009 b) and described, among other things, as creative problem solvers (Benner, 1984 ; Austgard, 2006 ; Dickson, McVittie & Kapilashrami, 2018 ). Such characteristics were also evident within this study, where an active, ongoing inquiry on the part of the nurse practising with professional artistry was necessary. The most effective course of action or the most appropriate response was not always immediately apparent to the nurses within the CCCI: when practising with professional artistry they were able to stay in connection, able to maintain the sheltered and shared space, while working through the process of refinement and coming to the most appropriate action. They were at times engaged in pushing the boundaries of what was known to them. Similar processes are spoken of by Henderson and Keeson ( 2009 ), Austen ( 2010 ) and Titchen ( 2018 ), when describing howworking with professional artistry enables the creation of new knowledge and newways of looking at or understanding the practice world. The patterns of engagement described as ‘Actively working with the parts and the whole’, ‘Working with both the now and the not yet’ and ‘Taking or enabling transformative action’ are particular ways of perceiving and responding holistically to the practice situation. These patterns are congruent with the fifth element described within the concept analysis of professional artistry (Chapter 2 ). In the concept analysis, however, it was not clear exactly how this holistic response ‘looked’ in practice. Neither was it clear in what way the nurse ‘held’ the situation while coming to understand it. Within the CCCI an attention for both the finer details and the larger brush strokes of the clinical encounter were evident, along with an ability to deal with the ‘parts’ while remaining open to the changing meaning of the whole encounter. As well, it became clear that the nurses, when practising with professional artistry, were present, focused and intentional in the present, while simultaneously taking account of future scenarios, preparing the patient for them, working to prevent them in some cases and in others to help them into being or creating the space inwhich they can become. The active experimentation described above was also present in this pattern of engagement, but in this case it had more to do with energy and possibilities than with physical, perceptible aspects of the care encounter.