FEATURES

TOWARD REFLECTIVE PRACTICE

Nursing: A sacred, healing dance

by Francis C. Biley and Nancy M. Chiocchi

Fran Biley

Nancy Chiocchi

Walk into almost any clinical environment and you are likely to witness a scene that might appear, at least to the untrained observer, almost chaotic. Any number of nurses, domestic staff, physiotherapists, phlebotomists and medics are rushing about, singly, in pairs or in larger groups, going about their everyday business. They are talking to patients, preparing for the next procedure, writing up case notes or participating in the morning’s ward round. Patients might sit alone in quiet contemplation, waiting for news or anticipating the arrival of a relative. Or, they might talk with others about their hopes and joys, their dreams and sorrows.

Although the scene may appear chaotic, the reality of the situation is far from that. Just about all of the actions, movements and interactions have been carefully planned, rehearsed and practiced. Even movements that appear spontaneous have been carefully choreographed and refined, perhaps over many years.

What you, or the untrained observer, are witnessing could be expressed metaphorically as a “healing dance.” Viewing clinical scenes in this way may lead to richer and deeper understanding (Russell, Phillips, Cromwell, & Gregory, 1999) of the art or act of nursing and caring-healing praxis. It may lead to greater insights into the “expression and representation of the inner emotional world” (Pistole, 2003, p. 232) and, of course, revelation of the real “heart” of nursing practice.

In carrying out everyday activities, nurses, or for that matter any other health care professionals, are not merely completing physical tasks. They are participating in a healing dance, albeit unconsciously, through which they express their caring presence, their “empathy, compassion and optimism” (Michalis, 2002, p. 5). Nurses who exhibit and experience true and authentic presence unconsciously have transformed their inner selves into a vehicle for universal healing consciousness (Watson, 1999).

For some, this might sound a little far-fetched. However, the metaphor can be used more commonly than might be expected to reveal the beauty of caring-healing praxis. Lane (2005) has suggested that dance, in its simplest form, is nothing more than “intended, creative movement” (p. 124).

Try to visualize, for example, a nurse or physiotherapist gently, or perhaps not so gently, encouraging a patient to perform critical postoperative exercises. See it not as torture, as it is often called by patients, nor as a euphemistically painful and unwanted event, where limbs and muscles are stretched and faces grimace. See it more as a dance, a sacred dance in which nurses “coax patients into safely extending themselves, inviting them like dance partners to engage in ... fluid movement” (Lane, 2005, p. 124). See it as two people working—or dancing—together in long-practiced, perfect harmony. See it “as a ritual of being with another within the caring situation” (Johns, 2001, p. 8). With this shift of consciousness, the caring-healing praxis—the very heart of nursing—begins to reveal its identity and true beauty. The use of metaphor may bring new meanings to the experience (Pistole, 2003).

A perfect walking meditation and self-affirmation for nurses is to transform themselves—visualize themselves—as dancers when providing care in a clinical environment. You can do this by paying careful attention to your proxemics and movements in relation to others, to how gently you walk and interact with the environment, and to the kinesthetic component of the art of nursing—that is, the “facial expressions, posture, touch, silences, gestures, timing, intent” (Mallison, 1993, p. 7) of your practice, your awareness of self (Johns, 2001).

According to Lane (2005), “the most ungainly of us can be transformed through even occasionally envisioning ourselves as coordinated, precise, flexible, vitally creative beings” (p. 125). Again, with this shift of consciousness, inner beauty will begin to manifest outwardly. Ordinary and routine health care encounters may transform into more authentic and effective caring-healing praxis. Listen to Johns (2001), who called for nurses to “listen to the drum of your own heartbeat” and to “dance your dance” (p. 12).

Nursing can not only be expressed as a sacred healing dance between two people, or by one person alone—as has been suggested here—there are also more complex situations. Larger groups of health care professionals may congregate to respond to a clinical emergency such as a cardiac arrest, or to complete a clinical ward round. Take the latter as an example.

Ward staff members, or the corps de ballet, start to assemble prior to the arrival of senior nursing and medical staff; the premiere danseuse or prima ballerina, the ward sister; and the premier danseur, the consultant. Many will be dressed in white, perhaps reminiscent of a ballet blanc, or ballet classique, where the emphasis will be on technical prowess, form and line rather than emotional content. There may not be a precise or explicit plot as in, for example, Fokine’s Les Sylphides, a dance that expresses the search for the ideal, but all of the moves will have been carefully rehearsed. The ward round progresses; the exhibition is underway; stories begin to emerge.

The search in the case of this “dance” or ward round is not a search for the ideal as portrayed in Les Sylphides, but for optimum health, a cure or healing perhaps. Instead of using precise steps or other physical movements, the “dancers” in the ward round invoke protocols, tests and treatments. Dynamics are revealed. The premier danseur may be seen to have clear control over the proceedings. Although perhaps appearing passive, the premiere danseuse holds center stage, without needing to call for the attention of the audience. This metaphor could be extended considerably to explore and understand hidden dynamics, or simply to appreciate more fully the artistry of the caring-healing act as manifest in a ward round.

The use of such dance metaphor has been described elsewhere. For example, Russell et al. (1999) used a dance perspective and metaphor to reveal insights and gain an enhanced understanding of “the complexity of human interaction” (p. 297), particularly in relation to the way that elders negotiate their care, calling this a “dance of dependency” (p. 296). Similarly, Pistole (2003) used dance as a therapeutic metaphor to understand and modify the processes at work in singles, couples and family therapy. Finally, Mather (2005) briefly and rather more abstractly used the metaphor of “dancing with the porcupine” (p. 1323) to understand and describe the potentially difficult and rather dangerous relationship among physicians, the drug industry and gift-giving.

Dance is, of course, much more than a metaphor. It can be a pastime, exercise, ritual, performing art or therapy. It can be solitary or engaged in as a social activity. It can be spontaneous or highly stylized (Pistole, 2003). It possesses “a variety of purposes including artistic, entertainment, social, spiritual, cultural and health” (Pistole, 2003, p. 233).

Dance can be defined as an “expression or communication that is composed of movement and shapes that are defined by a rhythmical structure, a design, and a special pattern involving distance, range, and rate of movement” (Pistole, 2003, p. 233). It doesn’t take a great leap of imagination to see how this definition can also be applied to the ward round, which then becomes a dance in its own right. Viewing the ward round as a metaphorical dance may reveal new insights into group dynamics and interpersonal power plays and provide a way to see previously hidden caring-healing praxis. But, it might also be seen as a caring-healing dance in its own right.

Nurses, dance your caring-healing praxis! RNL

Francis C. Biley, RN, PhD, is senior lecturer at Bournemouth University, Bournemouth, Dorset, United Kingdom. Nancy M. Chiocchi, RN, MSN, clinical instructor at New York University in New York, New York, USA, is also an emergency department staff nurse at Newark Beth Israel Medical Center in Newark, New Jersey, USA.

References
Johns, C. (2001). The caring dance. Complementary Therapies in Nursing and Midwifery, 7, 8-12.

Lane, M.R. (2005). Creativity and spirituality in nursing: Implementing art in healing. Holistic Nursing Practice, 19( 3), 122-125.Mallison, M.B. (1993). ‘Begat’ of a nurse. American Journal of Nursing, 93(7).

Mather, C. (2005). The pipeline and the porcupine: Alternative metaphors of the physician-industry relationship. Social Science and Medicine, 60, 1323-1334.

Michalis, R. (2002, January-March). Nursing as an art. ICUs and Nursing Web Journal, 9. Retrieved August 25, 2007, from http://www.nursing.gr/Artnursing.pdf

Pistole, M.C. (2003). Dance as a metaphor: Complexities and extensions in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 40(3), 232-241.

Russell, C.K., Phillips, L.R., Cromwell, S.L., & Gregory, D.M. (1999). Elder-caregiver care negotiations as dances of dependency. Scholarly Inquiry for Nursing Practice, 13(4), 283-298.

Watson, M.J. (1999), Postmodern nursing and beyond. Edinburgh, Scotland: Churchill Livingstone.