571603
research-article2015
NSQXXX10.1177/0894318415571603Nursing Science QuarterlyBaumann et al. / Global Perspectives
Global Perspectives
A Study of Graduate Nursing Students’ Reflections on The Art of Tibetan Medicine
Nursing Science Quarterly 2015, Vol. 28(2) 156–161 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318415571603 nsq.sagepub.com
Steven L. Baumann, RN; PhD,1 Denise C. Murphy, RN; DrPH,2 and Christine Anne Ganzer, RN; PhD3
Abstract This global perspective column focuses on a humanbecoming hermeneutic study of first semester graduate nursing students’ reflections on an art museum exhibit titled; Bodies in Balance: The Art of Tibetan Medicine. The research question that guided the study was “what is the emerging meaning of living balance as depicted in the exhibit? The students’ essays were interpreted in light of the humanbecoming perspective. The essays were summarized and yielded four themes; surprising and amazing, interconnectedness of all things, unexpected elements and commonalities, and attention to daily living. Parse’s three core knowings of living quality (fortifying wisdom, discerning witness and penetrating silence) were considered with the emergent meanings from the students’ essays on living balance as depicted in The Art of Tibetan Medicine exhibit. This study showed the use of art in the teaching about global health in graduate nursing education. Keywords art, hermeneutics, humanbecoming, nursing, Tibetan medicine A study of graduate nursing students’ reflections on The Art of Tibetan Medicine at The Rubin Museum of Art in New York City seeks to create “a dynamic environment that stimulates learning, promotes understanding, and inspires personal connections to the ideas, cultures, and art of Himalayan Asia” (Rubin Museum, 2014). From March 15, 2014, to September 9, 2014, the museum hosted an exhibit titled Bodies in Balance: The Art of Tibetan Medicine. Reported here is a humanbecoming hermeneutic study of the reflective essays of 13 graduate nursing students on the exhibit. The nurse students were asked to write brief personal essays on what living balance means as depicted in the Tibetan art and artifacts. Nineteen of the 25 students in the class handed in the extra-credit writing assignment, and 13 of these gave consent to have their essays included in this research study. These 13 participants were first semester graduate nursing students and registered nurses. Artwork in this exhibit is seen here as a window to another time, culture, and worldview, related to what Parse’s (2014) calls “living quality.” In her words, “living quality refers to the individual’s core whatness, the stuff of a life” (Parse, 2014, p. 28). A class assignment to visit an art exhibit like The Art of Tibetan Medicine is a teaching-learning opportunity about divergent worldviews, including values and beliefs about human beings, health, and healing. In other words, visiting such an exhibit can be both a window and a mirror. Reflective writing on works of art invites a dialogue between artwork and the viewer, which can give rise to new meaning and understanding.
Balance is a concept that is central to the exhibit as well as to the science and practice of Tibetan medicine (Gerke, 2014; Hofer, 2014). According to Begley (1994) the art of healing in Tibetan medicine requires maintaining balance both within oneself and between the self and the artwork and historic artifacts of the exhibit. The humanbecoming (Parse, 2007, 2014) paradigm was the frame of reference for the study. The idea for this study was inspired in part by the work of Amy Herman, the head of education at the Frick Art Museum, in New York City. She also teaches law enforcement professionals and health professionals to enhance their observation skills and ability to shift their perspective by looking at and talking about art (Herman, 2007). Marshall (2013) has written about her use of artwork to complement the natural science component in nursing education. She had undergraduate nursing students create and write about mandalas, a Buddhist artform, to enhance their self-awareness, communication and therapeutic relationship skills. The assignment that generated the reflective essays used in this
1
Professor, Hunter College of the City University of New York Program Advisor, Hunter College of the City University of New York 3 Assistant Professor, Hunter College of the City University of New York 2
Contributing Editor: Steven L. Baumann, RN, PhD, Professor, Hunter College, City University of New York, 82 Sherman Avenue, Williston Park, New York 11596. email: [email protected]
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Baumann et al. / Global Perspectives study was part of graduate course on theories in nursing in the spring of 2014.
The Researchers’ Stance The researchers’ stance is the humanbecoming paradigm (Parse, 2014). This perspective holds that humanuniverse is indivisible, unpredictable, and everchanging and holds that individuals are beings that choose meanings based on their values and beliefs in situations and are responsible for the consequences of their choices (Parse, 2014). The assumptions of the humanbecoming perspective are based in part on Dilthey’s (1883/1988) notion of the human sciences, existential phenomenology (Heidegger, 1962; Merleau-Ponty, 1962), and hermeneutics as ontology (Gadamer, 1960/1993; Heidegger, 1962). Hermeneutic inquiry from a humanbecoming perspective focuses on uncovering the meaning of living experiences as captured in works of art, literature, and other documents. Seven humanbecoming hermeneutic studies have been conducted; they have enhanced understanding about later life (Baumann et al., 2002), wisdom, compassion and courage (Baumann, 2008), weathering the storm (Baumann, 2014), being human (Cody, 1995), mendacity (Cody, 2001), lingering presence (Oritz, 2001), and hope (Parse, 2007).
The Humanbecoming Hermeneutic Method Hermeneutics was initially developed to study sacred and classic texts. Dilthey (1883/1988) suggested that hermeneutics could be used as a method to explore lived experiences. Heidegger (1962) applied hermeneutics to the process of understanding being. Gadamer (1974/1994) stated that understanding arises from the coming together of the interpreter’s perspective with the work of text, a process he called the fusion of horizons. The hermeneutic humanbecoming method (Cody, 1995; Parse 2014) shares much with the above referenced Heidegger-Gadamerian sources. The assumptions of the humanbecoming hermeneutic method are: 1. Meaning is a personal humanuniverse creation. 2. Creations and interpretations of texts and artforms are perspectival. 3. The researcher-text and researcher-artform dialogue coconstructs meaning moments with the becoming visible-invisible becoming of the emerging now. 4. New understandings of living experiences arise with interpretations of texts and artforms. 5. Understandings transfigure the researcher’s living experiences (Parse, 2014, p. 77-78)
Processes of the Method The hermeneutic humanbecoming method (Parse, 2014) was used to discover emergent meanings of universal living
experiences (p. 78). It involved the following processes, discoursing with penetrating engaging, interpreting with quiescent beholding, and understanding with inspiring envisaging (Parse, 2001). Discoursing with penetrating engaging was used to “untangle the knots” (Parse, 2014, p. 78), that is to say uncover the obvious and not-so-obvious in an artform or text. Here the text is the students’ reflective essays on their visit to the Bodies in Balance: The Art of Tibetan Medicine exhibit. The authors also had access to the exhibit and the published catalogue. It is a rigorous attending to and reflecting upon that which arises when reading the text of the students’ reflective essays, viewing the images and text of the art exhibit, and reading the exhibit catalogue in light of the humanbecoming paradigm (Parse, 2014). Because the concept of living balance is from a different paradigm from the humanbecoming paradigm, which highlights change and unpredictability rather than stability and equilibrium, the art and the reflective essays are considered in light of Parse’s (2014) notion of living quality. Interpreting with quiescent beholding in this study involved silent pondering and dwelling with the essays written by the graduate student nurses, while reading and rereading them, as well as recalling and recollecting the authors’ experiences of the exhibit, Bodies in Balance: The Art of Tibetan Medicine, and reading the published catalogue (Gerke, 2014; Hofer, 2014). According to Parse (2014) this is a process of “explicitly-tacitly immersing in the appropriating-disappropriating of the surfacing meanings” (p. 78). It is a rigorous rational- intuitive considering of the meanings that arise in the researcher-text dialogue. Parse (2014) described this process as a “rhythmical expanding of understanding and at once coconstructing meaning in contemplative moments with texts and artforms in the emerging now” (p. 78-79). According to Parse (2001), understanding with inspiring envisaging involved bringing forth new views from the dialogue between the researchers and the students’ essays, as well as from the artwork included in the display and in the exhibit catalogue (Gerke, 2014; Hofer, 2014). It is exploring with deep contemplation the meanings that arise while challenging the researchers’ previous understandings of living balance in Tibetan and Western medicine from the humanbecoming perspective. It is a reflective questioning of the researcher-text dialogue that generates new questions, changing the researchers in the process (Parse, 2001).
The Hermeneutic Text The participants’ reflective papers on the exhibit Bodies in Balance: The Art of Tibetan Medicine, were the primary source available to the researchers for the study. The researchers also saw the exhibit and were able to refer to the exhibit catalogue that contained images of the exhibit’s major pieces with a discussion about the pieces by the exhibit curator Theresa Hofer (2014), and others (Gerke, 2014). The principal
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investigator (SB) read and reread the students’ reflective essays many times, searching for the meaning of living balance as they interpreted it, and he uncovered four themes. These themes were then considered in light of the humanbecoming paradigm. With penetrating engaging, quiescent beholding, and inspiring envisaging, the researchers engaged with the text and artwork and reflected on meaning in the words, images, statues, historic artifacts, and exhibit space, particularly those that were relevant for living quality. New understandings arose fusing the humanbecoming horizon with the participants’ reflective essays and the Tibetan artworks and artifacts.
Research Ethics In the spring of 2014 first semester graduate nursing students taking a course on theories in nursing were asked to write a brief reflection paper on their visit to the Bodies in Balance: The Art of Tibetan Medicine. This was a pass/fail extra-credit class assignment to see the exhibit and write a brief reflection essay. The Hunter College Institutional Review Board approval was obtained. The faculty member who graded the students (SB) did not know which of the students had consented to participate until after all grades were submitted and all students who did the assignment got the extra-credit.
The Circumstance and Setting Before their visits to the exhibit participants were given a brief introduction to Tibetan Medicine by one of the researchers (DM) who is a docent at the Rubin Museum. The point was made that the exhibit wove together art, Buddhism and Tibetan medicine. Thirteen of the 19 students who did the assignment gave consent to allow their essays to be included in the study. Of these 13 students, five were enrolled in a GNP/ANP (Gerontological Nurse Practitioner/Adult Nurse Practitioner) program; three in the nursing administration/ public administration program; two in the mental health nurse practitioner program; and one in the CNL (Clinical Nurse Leader), Adult CNS (Clinical Nurse Specialist), and community health nursing/public health programs. As a group they had an average of 4.3 years of experience as a nurse. Four of the participants were born outside of the United States (US); one each was from Russia, Nigeria, the United Kingdom (UK), and Haiti.
Themes from the Essays The reflective essays surfaced four themes: surprising and amazing, interconnectedness of all things, unexpected elements and commonalities, and attention to daily living.
Surprising and Amazing All of the participants described their initial impression of the museum and exhibit. In various ways they said that they
Figure 1. Wheel of Life (black & white version). Tibet; early 20th century; pigments on cloth.
(Rubin Museum of Art; purchased from the collection of Navin Kumar, New York. C2004.21.1 [HAR 65356]. Used with permission.)
found it surprising and amazing. One wrote, “It was a windy April day, but once inside it was calm and peaceful.” One was surprised to find that even the museum café had charts recommending which beverages and foods they should eat to be in balance in light of their unique constitution. Participants found it fascinating and one, shocking. They found it surprising that they were encouraged to participate in the exhibit by taking a quiz of 16 questions commonly asked new patients by practitioners of Tibetan medicine. Many were surprised to discover what there dominate force was according to the science of Tibetan medicine; either wind, bile, or phlegm. They enjoyed this discovery about themselves and reading about what foods, herbs, behaviors, environments, and medicines they would benefit from, based on their dominant force, as they pondered how to use such knowledge with their patients. From the exhibit they learned that Tibetan medicine was focused on helping persons maintain the right balance, correct attitude, and avoiding the three great poisons; desire, hatred, and delusion. The three poisons were depicted in the artwork title The Wheel of Life (see Figure 1) in the very center as a snake, a cock, and a pig (Hofer, 2014). One participant said it was comforting to navigate the exhibit of foreign medical beliefs and practices in this personalizing way. The participants found the exhibit was
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Baumann et al. / Global Perspectives instructive and satisfying. They found it surprising to see how relevant very old ideas could be. Several said that their experience of the exhibit was going to help them be less judgmental of persons who used Chinese herbs and that they were going to be more attuned to their everyday thinking and behaviors. The participants found the amount of information illustrated in the art amazing. They were impressed to see how individualized Tibetan medicine was and how it was focused on underlying causes of illness and suffering rather than on symptoms or organs. Many appreciated that Tibetan medicine sought to honor each person’s beliefs and wishes. They found it “eye-opening,” “intriguing,” and “exciting” to learn about a medical system different from what they knew about health and illness as well as seeing commonalities. The exhibit pieces that they were particularly surprised by were Similes of the Human Body (20th century), Tree of the Body in Health and Illness (17th century) and Tree of Treatment (17th century). They could also see the value of the visual arts in education and as aids to patient teaching.
The Interconnectedness of All Things The participants discovered in Tibetan medicine less of a split between the mind and the body than in traditional Western medicine. They talked about how the mind and body were seen as interconnected, with paintings including spiritual, environmental and cosmological elements. One participant wrote that the goal of Tibetan medicine was “to help the destitute and sick by better appreciating the interconnectedness between the individual and the infinite universe.” Another admired the symmetry in the art, and connected this with a view of the world in its natural state as balanced. The physical and the mental, as well as the philosophical and medical traditions were explained in the exhibit as interdependent. The pieces of art that reflected this interconnectedness best for the students were the Medicine Buddha Bhaisajyaguru on Lotus Seat, Buddha Palace and Surrounding Medicinal Forces, and the Medicine Buddha Mandala.
Unexpected Elements and Commonalities Certain aspects of the exhibit were particularly unexpected for the graduate nursing students who contributed their essays for this study. For example, images of fierce wrathful deities alongside peaceful healing ones were not expected. Pieces such as the Red Wolf-Headed Protectress, ZombieRiding Protectress, and Vulture-Headed Chief Corpse Eating Demoness paintings were mentioned. These angry threeeyed creatures on scary multi-headed animals took time and thought for the students to understand. One participant said it made sense to her on reflection after she thought about how important it was to protect children, traditions or beliefs, and she added that we in the West could learn to benefit from such notions. Another was impressed by a silver statue of Daka in which you would put medications into the mouth
and then pour the medications into the mouth of a patient. Daka was believed to consecrate the medicine. Also new to the participants was the notion that the Buddha could appear in various forms, some neither human nor animal, and that Tibetan medicine practitioners strove to emanate the Medicine Buddha, suggesting to them the importance of beliefs and myths in healthcare. Another difference that impressed the participants was that those training to become Tibetan doctors had to memorize and recite the Four Tantras, the key text of the science, philosophy, and practice of Tibetan Medicine, and that many of the medical illustrations in the exhibit were designed to assist them in this memorization. Some did not expect that Moxibustion (the burning of herbs over certain points of the body) and bloodletting charts were included. Yet there were also things in the exhibit that the participants could see as commonalities with the Western medical view. The importance and skill of pulse taking by palpation and urine examination by inspection and smell impressed the students as a lost art in the United States (US) today. One participant saw in the artwork the symbolic representations of acid/base and electrolyte balance as understood in his work as a nurse. There were items in the exhibit that struck participants as very relevant today, such as the notion of patient-centered healthcare team. Religious practitioners were also members of the Tibetan medicine team.
Attention to Daily Living The last theme in the participant’s essays about the exhibit regarded the importance placed on attention to daily living, including diet, herbs, behaviors, and external treatments. The art and science of digestion and eating certain food sand herbs, such as nutmeg to ease digestion and the benefits of cinnamon were mentioned as things that the participants thought they might try themselves. One participant recalled how some parents try to reduce hyperactivity in their children by restricting certain foods. Participants reflected upon their observation that many Tibetan medicine approaches take time to work, rather than offering an immediate fix, as often expected in the West. They also mentioned exercise, sleep, and meditation treatments, for calming the mind and ridding the person of desire, hatred, and ignorance. Tibetan medicine recommendations struck the participants as simple but important.
The Hermeneutic Engagement The principal researcher (SB) immersed himself in multiple reading of the contributed reflective essays by the graduate students to generate a summary and again to engage the summary to uncover new knowledge and understanding about health and healing as depicted in the Bodies in Balance: The Art of Tibetan Medicine. The central meaning of balance as depicted in the exhibit invited individuals to equalize the activity of the three forces in their lives and environment; wind, bile, and phlegm. Because the Tibetan Medicine concept of balance
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Nursing Science Quarterly 28(2) encourages viewers to consider their own core assumptions, discernments, and meaning systems, inviting them to recall the original inspirations and ethos of their own lives and work.
Discerning Witness
Figure 2. A living quality mandala.
is not congruent with the humanbecoming paradigm, Parse’s (2014) notion of living quality is used here instead. The meaning of balance in Tibetan Medicine and living quality in humanbecoming paradigm while incommensurable both pertain to what the exhibit refers to as health, happiness, and enlightenment. Living quality (Parse, 2014) is described as the “core whatness, the stuff of life” (p. 28). Parse further explicated living quality in terms of three core knowings; “fortifying wisdom, discerning witness and penetrating silence” (Parse, 2014, p. 28). The reflections of the participants are here considered in light of these three core knowings in order to explore the meaning of the students’ experiences of The Art of Tibetan Medicine exhibit from a humanbecoming perspective. An artistic rendering of this hermeneutic engagement is depicted as a mandala (see Figure 2, A Living Quality Mandala), at its center is an image of a Medicine Buddha.
Fortifying Wisdom According to Parse (2014), the first core knowing of living quality is fortifying wisdom, which she described as “invigorating sagacity living with the individual as community who is cocreating what is important in the moment.” (p. 28). As odd as many of the images and objects in the exhibit were for the students, they recognized that the exhibit represented a treasury of the knowledge and beneficial practices developed over centuries by many well-educated and holy people, in other words its sagacity. In other words, the Tibetan medicine illustrations, mandalas and images of the Medicine Buddhas are very colorful aesthetic products of careful discernment and judgment dating back hundreds, if not thousands of years. Well preserved copies of the Four Tantras and paintings such as The Medicine Buddha Palace of Sacred City of Tanadug also speak to the reverence to the fortifying wisdom they contain both secular and sacred, scientific and poetic (Hofer, 2014). Exposure to such beliefs and truths in other traditions
Discerning witness is the second core knowing of living quality. Parse (20014) has described it as, “cautiously attending to and distancing from that which enables and at once limits opportunities in choosing the whatness of personal living” (p. 28). She discussed it as “savoring the treasured and sacrificing the desired in choosing living quality (Parse, 2014, p. 28). Living quality can be seen in the exhibit, as a journey that involves discipline, knowledge, and sustained effort. It is appreciating that having more of something is not necessarily better nor is desiring what is new, since neither is likely to bring lasting satisfaction or happiness. Some classics of western spirituality, such as that of St. Francis de Sales who is quoted as saying, “desire nothing, ask for nothing, refuse nothing” (as quoted by McDonnell, p. 238) recommends a similar attitude of detachment. While appreciating the differences in the two worldviews, the languaging of the paradox “cautiously attending to and distancing from” and “sacrificing the desired” (Parse, 2014, 28) is somewhat similar with some of the philosophy and practice of Tibetan medicine and Buddhism which suggest that desire is a poison that brings suffering. Discernment is valued in both perspectives, as a deep honoring of the other. According to Gerke (2014) motivation of the clinician is very important to the ethical conduct of Tibetan medicine, and that one should treat each person as your own parent, because in Buddhism which purports that in reincarnation, any person may very well have been your parent in another life (p. 19). What is not explicit in humanbecoming, although could be, is the honoring of animals, herbs, trees, and rocks, all things in the universe. Parse’s (2014) concept of true presence to describe being with in an intensive loving manor share elements with the practice of meditation in Tibetan medicine.
Penetrating Silence The third and last core knowing of living quality described is penetrating silence. In Parse’s (2014) words, “Penetrating silence is piercing quiet in solemn stillness. It is the perfect intimacy of the unutterable that permeates the whatness of being. In the depth of being the echoes of stillness penetrates the reality of the moment” (Parse, 2014, p. 29). The participants in this study were impressed with the paintings of the Medicine Buddha, often a blue Buddha man or women sitting on a lotus flower with the palm of one hand up, sometimes holding a small bowl, and the other palm forward as if inviting or blessing the viewer. The exceptional practitioner of Tibetan medicine is said to be able to rid self of the three great poisons, desire (lust or attachment), hatred (or anger) and delusion (or ignorance), by means of sustained study and practice,
Baumann et al. / Global Perspectives characterized by discipline, meditation, and compassion, and is able to live solemn stillness and guide other in the practice of silence. As mentioned above, true presence (Parse, 2014) and mindfulness also involve being in the moment, open to more than meets the eye or ear in the other. While it is a mistake to equate similar words in two different paradigms as having the same meaning, these three core knowings of living quality provide some points open for respectful dialogue.
Meaning Moments for Nurse Education The 13 graduate nurse students who contributed their essays make up the text of this summary narrative, which is here considered as living quality in humanbecoming paradigm. These reflective essays represent a successful use of the arts in graduate nurse education as a way to have students explore a worldview different from their own, and see the limits of their prior understanding of the world. In other words it broadens viewpoints and encourages a global perspective. As an educational assignment it encourages students to practice critical reflection and writing and to gain cultural knowledge and competence. As developing clinicians it facilitates understanding of healthcare practices enhanced from multiple cultures and worldviews. The essays suggested that the students gained appreciation for the importance of ethics and beliefs in healthcare practices in general. The authors found resonance between some elements of Tibetan Medicine and the three core knowings of living quality as articulated by Parse (2014). While not part of this study it will be interesting to see how these students do in their programs as compared to their classmates who did not do the assignment.
Three Emergent Meanings from this Study 1. Unexpected connections with wisdom in other traditions can give rise to new discernments and meaning. 2. Living quality is an arduous journey that gives rise to more restrained attending to and distancing from. 3. Nursing is best practiced from a silent reverent place inviting others to live their own unfolding purposefulness. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this editorial.
Funding The authors received no financial support for the research, authorship, and/or publication of this editorial.
References Baumann, S. L. (2008). Wisdom, compassion & courage in the Wizard of Oz: A humanbecoming hermeneutic study. Nursing Science Quarterly, 21, 322-329.
161 Baumann, S. L. (2014). Weathering the storm: Nurses stories about hurricane Sandy. Nursing Science Quarterly, 27, 248-253. Baumann, S. L., Carroll, K. A., Damgaard, G. A., Millar, B., & Welch, A. J. (2001). An international human becoming hermeneutics study of Tom Hegg’s, “A cup of Christmas tea.” Nursing Science Quarterly, 14, 316-321. Begley, S. S. (1994). Tibetan Buddhist medicine: Transcultural nursing experience. The Journal of Holistic Nursing, 12, 323342. Cody, W. K. (1995). Of life immense in passion, pulse, and power: Dialoguing with Whitman and Parse–A hermeneutic study. In R. R. Parse (Ed.), Illuminations: The human becoming theory in practice and research (pp. 269-307). NY: National League for Nursing Press. Cody, W. K. (2001). Mendacity as refusal to bear witness: A human becoming hermeneutic study of a theme from Tennessee William’s “Cat on a Hot Tin Roof.” In R. R. Parse, Qualitative inquiry: The path of sciencing, (pp. 205-220). Sudbury, MA: Jones and Bartlett. Dilthey, W. (1988). Introduction to the human sciences (R. J. Betanzos, Trans.). Detroit: Wayne State University Press. (Original work published 1883) Gadamer, H.-G. (1993). Truth and method (2nd rev. Ed.) (J. Weinsheimer & D. G. Marshall, Trans.). NY: Continuum. (Original work published 1960) Heidegger, M. (1962). Being and time (J. Macquarrie & E. Robinson, Trans.). NY: Harper & Row. Herman, A. (2007). The art of observation: How the long arm of the law is reaching the Frick Collection. Museum News, May/ June, 2007, downloaded at http://www.artfulperception.com/ amy-herman.pdf Gerke, B. (2014). The art of Tibetan medical practice. In T. Hofer’s (Ed.), Bodies in balance: The art of Tibetan medicine, (pp. 16-31). Rubin Museum of Art, New York, NY, NY: Rubin Museum of Art. Hofer, T. (Ed.). (2014) Introduction: Tibetan medicine, Buddhism, and the visual arts. In T. Hofer’s (Ed.) Bodies in balance: The art of Tibetan medicine, (pp. 2-13). Rubin Museum of Art, New York, NY, NY: Rubin Museum of Art. Marshall, M. C. (2003). Creative learning: The mandala as teaching exercise. Journal of Nursing Education. 42, 517-519. McDonnell, E. (2009). The Concept of Freedom in the Writings of St Francis de Sales. NY: Peter Lang International Academic Publishers. Merleau-Ponty, M. (1962). Phenomenology of perception (C. Smith, Trans.). NY: The Humanities Press. Ortiz, M. R. (2001). Lingering presence: A study using the human becoming hermeneutic method. Nursing Science Quarterly, 16, 146-154. Parse, R. R. (2001). Qualitative inquiry: The path of sciencing. Sudbury, MA: Jones and Bartlett. Parse, R. R. (2007). Hope in “Rita Hayworth and Shawshank Redemption”: A human becoming hermeneutic study. Nursing Science Quarterly, 20, 148-154. Parse, R. R. (2014). The humanbecoming paradigm: A transformational worldview. Pittsburgh, PA: Discovery International Publications. Rubin Museum (2014). Mission and values. Home webpage downloaded on July 26, 2014 at http://www.rubinmuseum.org/ pages/load/346
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research-article2015
NSQXXX10.1177/0894318415571603Nursing Science QuarterlyBaumann et al. / Global Perspectives
Global Perspectives
A Study of Graduate Nursing Students’ Reflections on The Art of Tibetan Medicine
Nursing Science Quarterly 2015, Vol. 28(2) 156–161 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318415571603 nsq.sagepub.com
Steven L. Baumann, RN; PhD,1 Denise C. Murphy, RN; DrPH,2 and Christine Anne Ganzer, RN; PhD3
Abstract This global perspective column focuses on a humanbecoming hermeneutic study of first semester graduate nursing students’ reflections on an art museum exhibit titled; Bodies in Balance: The Art of Tibetan Medicine. The research question that guided the study was “what is the emerging meaning of living balance as depicted in the exhibit? The students’ essays were interpreted in light of the humanbecoming perspective. The essays were summarized and yielded four themes; surprising and amazing, interconnectedness of all things, unexpected elements and commonalities, and attention to daily living. Parse’s three core knowings of living quality (fortifying wisdom, discerning witness and penetrating silence) were considered with the emergent meanings from the students’ essays on living balance as depicted in The Art of Tibetan Medicine exhibit. This study showed the use of art in the teaching about global health in graduate nursing education. Keywords art, hermeneutics, humanbecoming, nursing, Tibetan medicine A study of graduate nursing students’ reflections on The Art of Tibetan Medicine at The Rubin Museum of Art in New York City seeks to create “a dynamic environment that stimulates learning, promotes understanding, and inspires personal connections to the ideas, cultures, and art of Himalayan Asia” (Rubin Museum, 2014). From March 15, 2014, to September 9, 2014, the museum hosted an exhibit titled Bodies in Balance: The Art of Tibetan Medicine. Reported here is a humanbecoming hermeneutic study of the reflective essays of 13 graduate nursing students on the exhibit. The nurse students were asked to write brief personal essays on what living balance means as depicted in the Tibetan art and artifacts. Nineteen of the 25 students in the class handed in the extra-credit writing assignment, and 13 of these gave consent to have their essays included in this research study. These 13 participants were first semester graduate nursing students and registered nurses. Artwork in this exhibit is seen here as a window to another time, culture, and worldview, related to what Parse’s (2014) calls “living quality.” In her words, “living quality refers to the individual’s core whatness, the stuff of a life” (Parse, 2014, p. 28). A class assignment to visit an art exhibit like The Art of Tibetan Medicine is a teaching-learning opportunity about divergent worldviews, including values and beliefs about human beings, health, and healing. In other words, visiting such an exhibit can be both a window and a mirror. Reflective writing on works of art invites a dialogue between artwork and the viewer, which can give rise to new meaning and understanding.
Balance is a concept that is central to the exhibit as well as to the science and practice of Tibetan medicine (Gerke, 2014; Hofer, 2014). According to Begley (1994) the art of healing in Tibetan medicine requires maintaining balance both within oneself and between the self and the artwork and historic artifacts of the exhibit. The humanbecoming (Parse, 2007, 2014) paradigm was the frame of reference for the study. The idea for this study was inspired in part by the work of Amy Herman, the head of education at the Frick Art Museum, in New York City. She also teaches law enforcement professionals and health professionals to enhance their observation skills and ability to shift their perspective by looking at and talking about art (Herman, 2007). Marshall (2013) has written about her use of artwork to complement the natural science component in nursing education. She had undergraduate nursing students create and write about mandalas, a Buddhist artform, to enhance their self-awareness, communication and therapeutic relationship skills. The assignment that generated the reflective essays used in this
1
Professor, Hunter College of the City University of New York Program Advisor, Hunter College of the City University of New York 3 Assistant Professor, Hunter College of the City University of New York 2
Contributing Editor: Steven L. Baumann, RN, PhD, Professor, Hunter College, City University of New York, 82 Sherman Avenue, Williston Park, New York 11596. email: [email protected]
157
Baumann et al. / Global Perspectives study was part of graduate course on theories in nursing in the spring of 2014.
The Researchers’ Stance The researchers’ stance is the humanbecoming paradigm (Parse, 2014). This perspective holds that humanuniverse is indivisible, unpredictable, and everchanging and holds that individuals are beings that choose meanings based on their values and beliefs in situations and are responsible for the consequences of their choices (Parse, 2014). The assumptions of the humanbecoming perspective are based in part on Dilthey’s (1883/1988) notion of the human sciences, existential phenomenology (Heidegger, 1962; Merleau-Ponty, 1962), and hermeneutics as ontology (Gadamer, 1960/1993; Heidegger, 1962). Hermeneutic inquiry from a humanbecoming perspective focuses on uncovering the meaning of living experiences as captured in works of art, literature, and other documents. Seven humanbecoming hermeneutic studies have been conducted; they have enhanced understanding about later life (Baumann et al., 2002), wisdom, compassion and courage (Baumann, 2008), weathering the storm (Baumann, 2014), being human (Cody, 1995), mendacity (Cody, 2001), lingering presence (Oritz, 2001), and hope (Parse, 2007).
The Humanbecoming Hermeneutic Method Hermeneutics was initially developed to study sacred and classic texts. Dilthey (1883/1988) suggested that hermeneutics could be used as a method to explore lived experiences. Heidegger (1962) applied hermeneutics to the process of understanding being. Gadamer (1974/1994) stated that understanding arises from the coming together of the interpreter’s perspective with the work of text, a process he called the fusion of horizons. The hermeneutic humanbecoming method (Cody, 1995; Parse 2014) shares much with the above referenced Heidegger-Gadamerian sources. The assumptions of the humanbecoming hermeneutic method are: 1. Meaning is a personal humanuniverse creation. 2. Creations and interpretations of texts and artforms are perspectival. 3. The researcher-text and researcher-artform dialogue coconstructs meaning moments with the becoming visible-invisible becoming of the emerging now. 4. New understandings of living experiences arise with interpretations of texts and artforms. 5. Understandings transfigure the researcher’s living experiences (Parse, 2014, p. 77-78)
Processes of the Method The hermeneutic humanbecoming method (Parse, 2014) was used to discover emergent meanings of universal living
experiences (p. 78). It involved the following processes, discoursing with penetrating engaging, interpreting with quiescent beholding, and understanding with inspiring envisaging (Parse, 2001). Discoursing with penetrating engaging was used to “untangle the knots” (Parse, 2014, p. 78), that is to say uncover the obvious and not-so-obvious in an artform or text. Here the text is the students’ reflective essays on their visit to the Bodies in Balance: The Art of Tibetan Medicine exhibit. The authors also had access to the exhibit and the published catalogue. It is a rigorous attending to and reflecting upon that which arises when reading the text of the students’ reflective essays, viewing the images and text of the art exhibit, and reading the exhibit catalogue in light of the humanbecoming paradigm (Parse, 2014). Because the concept of living balance is from a different paradigm from the humanbecoming paradigm, which highlights change and unpredictability rather than stability and equilibrium, the art and the reflective essays are considered in light of Parse’s (2014) notion of living quality. Interpreting with quiescent beholding in this study involved silent pondering and dwelling with the essays written by the graduate student nurses, while reading and rereading them, as well as recalling and recollecting the authors’ experiences of the exhibit, Bodies in Balance: The Art of Tibetan Medicine, and reading the published catalogue (Gerke, 2014; Hofer, 2014). According to Parse (2014) this is a process of “explicitly-tacitly immersing in the appropriating-disappropriating of the surfacing meanings” (p. 78). It is a rigorous rational- intuitive considering of the meanings that arise in the researcher-text dialogue. Parse (2014) described this process as a “rhythmical expanding of understanding and at once coconstructing meaning in contemplative moments with texts and artforms in the emerging now” (p. 78-79). According to Parse (2001), understanding with inspiring envisaging involved bringing forth new views from the dialogue between the researchers and the students’ essays, as well as from the artwork included in the display and in the exhibit catalogue (Gerke, 2014; Hofer, 2014). It is exploring with deep contemplation the meanings that arise while challenging the researchers’ previous understandings of living balance in Tibetan and Western medicine from the humanbecoming perspective. It is a reflective questioning of the researcher-text dialogue that generates new questions, changing the researchers in the process (Parse, 2001).
The Hermeneutic Text The participants’ reflective papers on the exhibit Bodies in Balance: The Art of Tibetan Medicine, were the primary source available to the researchers for the study. The researchers also saw the exhibit and were able to refer to the exhibit catalogue that contained images of the exhibit’s major pieces with a discussion about the pieces by the exhibit curator Theresa Hofer (2014), and others (Gerke, 2014). The principal
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investigator (SB) read and reread the students’ reflective essays many times, searching for the meaning of living balance as they interpreted it, and he uncovered four themes. These themes were then considered in light of the humanbecoming paradigm. With penetrating engaging, quiescent beholding, and inspiring envisaging, the researchers engaged with the text and artwork and reflected on meaning in the words, images, statues, historic artifacts, and exhibit space, particularly those that were relevant for living quality. New understandings arose fusing the humanbecoming horizon with the participants’ reflective essays and the Tibetan artworks and artifacts.
Research Ethics In the spring of 2014 first semester graduate nursing students taking a course on theories in nursing were asked to write a brief reflection paper on their visit to the Bodies in Balance: The Art of Tibetan Medicine. This was a pass/fail extra-credit class assignment to see the exhibit and write a brief reflection essay. The Hunter College Institutional Review Board approval was obtained. The faculty member who graded the students (SB) did not know which of the students had consented to participate until after all grades were submitted and all students who did the assignment got the extra-credit.
The Circumstance and Setting Before their visits to the exhibit participants were given a brief introduction to Tibetan Medicine by one of the researchers (DM) who is a docent at the Rubin Museum. The point was made that the exhibit wove together art, Buddhism and Tibetan medicine. Thirteen of the 19 students who did the assignment gave consent to allow their essays to be included in the study. Of these 13 students, five were enrolled in a GNP/ANP (Gerontological Nurse Practitioner/Adult Nurse Practitioner) program; three in the nursing administration/ public administration program; two in the mental health nurse practitioner program; and one in the CNL (Clinical Nurse Leader), Adult CNS (Clinical Nurse Specialist), and community health nursing/public health programs. As a group they had an average of 4.3 years of experience as a nurse. Four of the participants were born outside of the United States (US); one each was from Russia, Nigeria, the United Kingdom (UK), and Haiti.
Themes from the Essays The reflective essays surfaced four themes: surprising and amazing, interconnectedness of all things, unexpected elements and commonalities, and attention to daily living.
Surprising and Amazing All of the participants described their initial impression of the museum and exhibit. In various ways they said that they
Figure 1. Wheel of Life (black & white version). Tibet; early 20th century; pigments on cloth.
(Rubin Museum of Art; purchased from the collection of Navin Kumar, New York. C2004.21.1 [HAR 65356]. Used with permission.)
found it surprising and amazing. One wrote, “It was a windy April day, but once inside it was calm and peaceful.” One was surprised to find that even the museum café had charts recommending which beverages and foods they should eat to be in balance in light of their unique constitution. Participants found it fascinating and one, shocking. They found it surprising that they were encouraged to participate in the exhibit by taking a quiz of 16 questions commonly asked new patients by practitioners of Tibetan medicine. Many were surprised to discover what there dominate force was according to the science of Tibetan medicine; either wind, bile, or phlegm. They enjoyed this discovery about themselves and reading about what foods, herbs, behaviors, environments, and medicines they would benefit from, based on their dominant force, as they pondered how to use such knowledge with their patients. From the exhibit they learned that Tibetan medicine was focused on helping persons maintain the right balance, correct attitude, and avoiding the three great poisons; desire, hatred, and delusion. The three poisons were depicted in the artwork title The Wheel of Life (see Figure 1) in the very center as a snake, a cock, and a pig (Hofer, 2014). One participant said it was comforting to navigate the exhibit of foreign medical beliefs and practices in this personalizing way. The participants found the exhibit was
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Baumann et al. / Global Perspectives instructive and satisfying. They found it surprising to see how relevant very old ideas could be. Several said that their experience of the exhibit was going to help them be less judgmental of persons who used Chinese herbs and that they were going to be more attuned to their everyday thinking and behaviors. The participants found the amount of information illustrated in the art amazing. They were impressed to see how individualized Tibetan medicine was and how it was focused on underlying causes of illness and suffering rather than on symptoms or organs. Many appreciated that Tibetan medicine sought to honor each person’s beliefs and wishes. They found it “eye-opening,” “intriguing,” and “exciting” to learn about a medical system different from what they knew about health and illness as well as seeing commonalities. The exhibit pieces that they were particularly surprised by were Similes of the Human Body (20th century), Tree of the Body in Health and Illness (17th century) and Tree of Treatment (17th century). They could also see the value of the visual arts in education and as aids to patient teaching.
The Interconnectedness of All Things The participants discovered in Tibetan medicine less of a split between the mind and the body than in traditional Western medicine. They talked about how the mind and body were seen as interconnected, with paintings including spiritual, environmental and cosmological elements. One participant wrote that the goal of Tibetan medicine was “to help the destitute and sick by better appreciating the interconnectedness between the individual and the infinite universe.” Another admired the symmetry in the art, and connected this with a view of the world in its natural state as balanced. The physical and the mental, as well as the philosophical and medical traditions were explained in the exhibit as interdependent. The pieces of art that reflected this interconnectedness best for the students were the Medicine Buddha Bhaisajyaguru on Lotus Seat, Buddha Palace and Surrounding Medicinal Forces, and the Medicine Buddha Mandala.
Unexpected Elements and Commonalities Certain aspects of the exhibit were particularly unexpected for the graduate nursing students who contributed their essays for this study. For example, images of fierce wrathful deities alongside peaceful healing ones were not expected. Pieces such as the Red Wolf-Headed Protectress, ZombieRiding Protectress, and Vulture-Headed Chief Corpse Eating Demoness paintings were mentioned. These angry threeeyed creatures on scary multi-headed animals took time and thought for the students to understand. One participant said it made sense to her on reflection after she thought about how important it was to protect children, traditions or beliefs, and she added that we in the West could learn to benefit from such notions. Another was impressed by a silver statue of Daka in which you would put medications into the mouth
and then pour the medications into the mouth of a patient. Daka was believed to consecrate the medicine. Also new to the participants was the notion that the Buddha could appear in various forms, some neither human nor animal, and that Tibetan medicine practitioners strove to emanate the Medicine Buddha, suggesting to them the importance of beliefs and myths in healthcare. Another difference that impressed the participants was that those training to become Tibetan doctors had to memorize and recite the Four Tantras, the key text of the science, philosophy, and practice of Tibetan Medicine, and that many of the medical illustrations in the exhibit were designed to assist them in this memorization. Some did not expect that Moxibustion (the burning of herbs over certain points of the body) and bloodletting charts were included. Yet there were also things in the exhibit that the participants could see as commonalities with the Western medical view. The importance and skill of pulse taking by palpation and urine examination by inspection and smell impressed the students as a lost art in the United States (US) today. One participant saw in the artwork the symbolic representations of acid/base and electrolyte balance as understood in his work as a nurse. There were items in the exhibit that struck participants as very relevant today, such as the notion of patient-centered healthcare team. Religious practitioners were also members of the Tibetan medicine team.
Attention to Daily Living The last theme in the participant’s essays about the exhibit regarded the importance placed on attention to daily living, including diet, herbs, behaviors, and external treatments. The art and science of digestion and eating certain food sand herbs, such as nutmeg to ease digestion and the benefits of cinnamon were mentioned as things that the participants thought they might try themselves. One participant recalled how some parents try to reduce hyperactivity in their children by restricting certain foods. Participants reflected upon their observation that many Tibetan medicine approaches take time to work, rather than offering an immediate fix, as often expected in the West. They also mentioned exercise, sleep, and meditation treatments, for calming the mind and ridding the person of desire, hatred, and ignorance. Tibetan medicine recommendations struck the participants as simple but important.
The Hermeneutic Engagement The principal researcher (SB) immersed himself in multiple reading of the contributed reflective essays by the graduate students to generate a summary and again to engage the summary to uncover new knowledge and understanding about health and healing as depicted in the Bodies in Balance: The Art of Tibetan Medicine. The central meaning of balance as depicted in the exhibit invited individuals to equalize the activity of the three forces in their lives and environment; wind, bile, and phlegm. Because the Tibetan Medicine concept of balance
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Nursing Science Quarterly 28(2) encourages viewers to consider their own core assumptions, discernments, and meaning systems, inviting them to recall the original inspirations and ethos of their own lives and work.
Discerning Witness
Figure 2. A living quality mandala.
is not congruent with the humanbecoming paradigm, Parse’s (2014) notion of living quality is used here instead. The meaning of balance in Tibetan Medicine and living quality in humanbecoming paradigm while incommensurable both pertain to what the exhibit refers to as health, happiness, and enlightenment. Living quality (Parse, 2014) is described as the “core whatness, the stuff of life” (p. 28). Parse further explicated living quality in terms of three core knowings; “fortifying wisdom, discerning witness and penetrating silence” (Parse, 2014, p. 28). The reflections of the participants are here considered in light of these three core knowings in order to explore the meaning of the students’ experiences of The Art of Tibetan Medicine exhibit from a humanbecoming perspective. An artistic rendering of this hermeneutic engagement is depicted as a mandala (see Figure 2, A Living Quality Mandala), at its center is an image of a Medicine Buddha.
Fortifying Wisdom According to Parse (2014), the first core knowing of living quality is fortifying wisdom, which she described as “invigorating sagacity living with the individual as community who is cocreating what is important in the moment.” (p. 28). As odd as many of the images and objects in the exhibit were for the students, they recognized that the exhibit represented a treasury of the knowledge and beneficial practices developed over centuries by many well-educated and holy people, in other words its sagacity. In other words, the Tibetan medicine illustrations, mandalas and images of the Medicine Buddhas are very colorful aesthetic products of careful discernment and judgment dating back hundreds, if not thousands of years. Well preserved copies of the Four Tantras and paintings such as The Medicine Buddha Palace of Sacred City of Tanadug also speak to the reverence to the fortifying wisdom they contain both secular and sacred, scientific and poetic (Hofer, 2014). Exposure to such beliefs and truths in other traditions
Discerning witness is the second core knowing of living quality. Parse (20014) has described it as, “cautiously attending to and distancing from that which enables and at once limits opportunities in choosing the whatness of personal living” (p. 28). She discussed it as “savoring the treasured and sacrificing the desired in choosing living quality (Parse, 2014, p. 28). Living quality can be seen in the exhibit, as a journey that involves discipline, knowledge, and sustained effort. It is appreciating that having more of something is not necessarily better nor is desiring what is new, since neither is likely to bring lasting satisfaction or happiness. Some classics of western spirituality, such as that of St. Francis de Sales who is quoted as saying, “desire nothing, ask for nothing, refuse nothing” (as quoted by McDonnell, p. 238) recommends a similar attitude of detachment. While appreciating the differences in the two worldviews, the languaging of the paradox “cautiously attending to and distancing from” and “sacrificing the desired” (Parse, 2014, 28) is somewhat similar with some of the philosophy and practice of Tibetan medicine and Buddhism which suggest that desire is a poison that brings suffering. Discernment is valued in both perspectives, as a deep honoring of the other. According to Gerke (2014) motivation of the clinician is very important to the ethical conduct of Tibetan medicine, and that one should treat each person as your own parent, because in Buddhism which purports that in reincarnation, any person may very well have been your parent in another life (p. 19). What is not explicit in humanbecoming, although could be, is the honoring of animals, herbs, trees, and rocks, all things in the universe. Parse’s (2014) concept of true presence to describe being with in an intensive loving manor share elements with the practice of meditation in Tibetan medicine.
Penetrating Silence The third and last core knowing of living quality described is penetrating silence. In Parse’s (2014) words, “Penetrating silence is piercing quiet in solemn stillness. It is the perfect intimacy of the unutterable that permeates the whatness of being. In the depth of being the echoes of stillness penetrates the reality of the moment” (Parse, 2014, p. 29). The participants in this study were impressed with the paintings of the Medicine Buddha, often a blue Buddha man or women sitting on a lotus flower with the palm of one hand up, sometimes holding a small bowl, and the other palm forward as if inviting or blessing the viewer. The exceptional practitioner of Tibetan medicine is said to be able to rid self of the three great poisons, desire (lust or attachment), hatred (or anger) and delusion (or ignorance), by means of sustained study and practice,
Baumann et al. / Global Perspectives characterized by discipline, meditation, and compassion, and is able to live solemn stillness and guide other in the practice of silence. As mentioned above, true presence (Parse, 2014) and mindfulness also involve being in the moment, open to more than meets the eye or ear in the other. While it is a mistake to equate similar words in two different paradigms as having the same meaning, these three core knowings of living quality provide some points open for respectful dialogue.
Meaning Moments for Nurse Education The 13 graduate nurse students who contributed their essays make up the text of this summary narrative, which is here considered as living quality in humanbecoming paradigm. These reflective essays represent a successful use of the arts in graduate nurse education as a way to have students explore a worldview different from their own, and see the limits of their prior understanding of the world. In other words it broadens viewpoints and encourages a global perspective. As an educational assignment it encourages students to practice critical reflection and writing and to gain cultural knowledge and competence. As developing clinicians it facilitates understanding of healthcare practices enhanced from multiple cultures and worldviews. The essays suggested that the students gained appreciation for the importance of ethics and beliefs in healthcare practices in general. The authors found resonance between some elements of Tibetan Medicine and the three core knowings of living quality as articulated by Parse (2014). While not part of this study it will be interesting to see how these students do in their programs as compared to their classmates who did not do the assignment.
Three Emergent Meanings from this Study 1. Unexpected connections with wisdom in other traditions can give rise to new discernments and meaning. 2. Living quality is an arduous journey that gives rise to more restrained attending to and distancing from. 3. Nursing is best practiced from a silent reverent place inviting others to live their own unfolding purposefulness. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this editorial.
Funding The authors received no financial support for the research, authorship, and/or publication of this editorial.
References Baumann, S. L. (2008). Wisdom, compassion & courage in the Wizard of Oz: A humanbecoming hermeneutic study. Nursing Science Quarterly, 21, 322-329.
161 Baumann, S. L. (2014). Weathering the storm: Nurses stories about hurricane Sandy. Nursing Science Quarterly, 27, 248-253. Baumann, S. L., Carroll, K. A., Damgaard, G. A., Millar, B., & Welch, A. J. (2001). An international human becoming hermeneutics study of Tom Hegg’s, “A cup of Christmas tea.” Nursing Science Quarterly, 14, 316-321. Begley, S. S. (1994). Tibetan Buddhist medicine: Transcultural nursing experience. The Journal of Holistic Nursing, 12, 323342. Cody, W. K. (1995). Of life immense in passion, pulse, and power: Dialoguing with Whitman and Parse–A hermeneutic study. In R. R. Parse (Ed.), Illuminations: The human becoming theory in practice and research (pp. 269-307). NY: National League for Nursing Press. Cody, W. K. (2001). Mendacity as refusal to bear witness: A human becoming hermeneutic study of a theme from Tennessee William’s “Cat on a Hot Tin Roof.” In R. R. Parse, Qualitative inquiry: The path of sciencing, (pp. 205-220). Sudbury, MA: Jones and Bartlett. Dilthey, W. (1988). Introduction to the human sciences (R. J. Betanzos, Trans.). Detroit: Wayne State University Press. (Original work published 1883) Gadamer, H.-G. (1993). Truth and method (2nd rev. Ed.) (J. Weinsheimer & D. G. Marshall, Trans.). NY: Continuum. (Original work published 1960) Heidegger, M. (1962). Being and time (J. Macquarrie & E. Robinson, Trans.). NY: Harper & Row. Herman, A. (2007). The art of observation: How the long arm of the law is reaching the Frick Collection. Museum News, May/ June, 2007, downloaded at http://www.artfulperception.com/ amy-herman.pdf Gerke, B. (2014). The art of Tibetan medical practice. In T. Hofer’s (Ed.), Bodies in balance: The art of Tibetan medicine, (pp. 16-31). Rubin Museum of Art, New York, NY, NY: Rubin Museum of Art. Hofer, T. (Ed.). (2014) Introduction: Tibetan medicine, Buddhism, and the visual arts. In T. Hofer’s (Ed.) Bodies in balance: The art of Tibetan medicine, (pp. 2-13). Rubin Museum of Art, New York, NY, NY: Rubin Museum of Art. Marshall, M. C. (2003). Creative learning: The mandala as teaching exercise. Journal of Nursing Education. 42, 517-519. McDonnell, E. (2009). The Concept of Freedom in the Writings of St Francis de Sales. NY: Peter Lang International Academic Publishers. Merleau-Ponty, M. (1962). Phenomenology of perception (C. Smith, Trans.). NY: The Humanities Press. Ortiz, M. R. (2001). Lingering presence: A study using the human becoming hermeneutic method. Nursing Science Quarterly, 16, 146-154. Parse, R. R. (2001). Qualitative inquiry: The path of sciencing. Sudbury, MA: Jones and Bartlett. Parse, R. R. (2007). Hope in “Rita Hayworth and Shawshank Redemption”: A human becoming hermeneutic study. Nursing Science Quarterly, 20, 148-154. Parse, R. R. (2014). The humanbecoming paradigm: A transformational worldview. Pittsburgh, PA: Discovery International Publications. Rubin Museum (2014). Mission and values. Home webpage downloaded on July 26, 2014 at http://www.rubinmuseum.org/ pages/load/346
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