For many pathophysiologic and metabolic reasons, a patient’s condition is unstable and a medication may not be warranted until the patient’s vital signs improve. During those times, the nurse may choose to delay medication administration, or decide not to give the medication altogether. “Deductive validity is a property of the inference (logic) from premises to conclusion.” 12 At these times, it would always best to call and collaborate with the physician and advice he/or she of the change in the patient’s status and to alert the physician that the nurse will not be administering the medication. Remember, to write down on a card or note-pad of these changes, then at the time of patient charting, document all changes include your deductive validity in detailing for both physician and hospital administration to see.

Advocate-

  One of the most important skills of a registered nurse is that of patient advocacy. The nurse with all his and/or her evidence-based practice must allow the ‘Art of Humanity’ i.e. ontology, the being and reality of nursing to step in and act on the patient’s behalf with other members of the multidisciplinary team caring for the whole patient. This art of nursing involves the sensory skills, and the systematic application of such skills and of knowledge in language, speech, reasoning, and motion in order to obtain the desired results. On an acute respiratory unit for example, the nurse alerts the respiratory team when a patient is having breathing issues.

 Also, this can mean acting as the patient’s advocate with the physician if the patient or nurse feels the treatment is unwarranted or dangerous to the patient. A registered nurse must have a strong back-bone at times when dealing with physicians and other medical professionals as he and/or she takes the proactive lead in advocating for the patient.

  If the patient is unable to speak or write then the nurse should have the ear of the family-members and find out the wishes and desires (after your full assessments) that would be in the best possible position for the patient.

Listener-

  As medical technology advancements present almost instant results over the monitoring systems for the registered nurses to review i.e. articulate with other medical professionals plus computerized templates for documentation, it is important remember that patient care is about nursing the patients and not machines alone. Frequently a medical devise may tell the nurse that the patient is stable, yet the patient is telling the nurse they are not. Medical devises can out-put false data and frequently present one picture of the patient, while the patient is presenting another.

  Listening to what the patient is saying, both verbal and non-verbal, is a very important tool in primary patient care and one that is frequently forgotten when new state-of-the-art devises make nursing care more convenient. Remember, without critical thinking, which includes the ‘art of listening’ both the physician and nurse risk quickly becoming simply mechanical practitioners of medical technologies.

Counselor-

  A registered nurse will perform the ‘art of triage’ or for this reason, administrate the act of counselor. A nurse counsels his and/or her patients at every meeting, i.e. whether an office visit or an in-patient admission to the hospital. Most patients will look to the nurse as an expert in healthcare. At times on or off her professional shift, the registered nurse will need to lead a simple counseling session. This will become an essential part of his and/or her routine duty and assess the patient for example on over-drinking that can lead to alcoholism or a teaching tutorial on newly diagnosed diabetic on how to check their blood sugar levels.

  Also, it is common for a registered nurse to sit down with the patient and go over all new medications, as well as to check the old medications for interactions. This ‘art of triaging’ does not start or end with the patient. The nurse will also, frequently need to counsel a patient’s family member or members in order to secure a stable and supportive environment for the patient. For the home health-care nurses and/or traveling nurses during times of extreme illness or an upset in the famiIly, the nurse will act as a counselor so that decisions for the patient can be made in a calm and informed manner. After all you do during the questions and answers from the patient and/or family member’s knowledge and experience will not be enough. You must allow a spiritual or metaphysical sense of reality to seep through your being; an unspoken act that allows the patient and/or family members to believe or have confidence in your thinking or judgment skills. For Schaffner, 13 the philosophy of evidence-based practice, including the ‘art of nursing’ requires strong communication and counseling skills, and should envelop knowledge, logic, methodology and metaphysics generated by and related to medicine.

Considerations-

  For many years nursing has been touted as being both an ‘art’ and a ‘science.’ In order for a nurse to succeed in his and/or her career today, you must perform all of the above duties as well as practice the art of nursing which is a more subtle tool learned over time. Part of this ‘art’ is in knowing when something is wrong, when though everything appears to be right. The old saying of “gut-feeling” is indeed an essential part of the nurse’s successful and safe practice with your patients. Wolpert, al 14 takes the old adage of “gut-feeling” and with the help of ontology re-defines the term intuition. Within the primary scope of nursing ‘intuition’ means the “quick perception of [possible] truth without conscious attention or reasoning…knowledge from within; instinctive knowledge or feeling.” It is an inherent part of a clinical or specialist nurse’s daily reasoning. Remember that good clinical intuition alone does not mean a free-floating mind. It must be grounded in clinical data and information.

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