1. Fowler, Susan B. PhD, RN, CNRN, CRRN, FAHA, FCNS

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Nursing is both an art and science. We base our practice on best evidence, clinical expertise, and patient preferences/values. The art of nursing might be depicted in our caring practices that show respect, responsibility, and empathy.


Dufault and Martocchio1 define hope as a multidimensional dynamic life force characterized by a confident yet certain expectation of achieving good, which is realistically possible and personally significant. Hope is inherent in alterations in health and healthcare services. Nurses inspire hope; it is part of our caring practices. Fowler2 interviewed critical care nurses on their perceptions of hope and found hope was inspired through "communication." Can nurses inspire hope by engaging family members in art because art is a form of communication?


Engaging in art has been found to inspire hope. Although art therapy is performed by an art therapist, nurses can facilitate an art-based hope intervention, much like a music intervention. Nurses might consider collaborating with art therapists or art educators.


Research findings have demonstrated that engaging in art can enrich participants' life experiences. Larsen et al3 used a personal hope-based collage in adults with chronic pain and found that hope was increased by persons coming together in hope and internalizing hope. Individuals were able to focus on more than their chronic pain.


Adults with multiple sclerosis engaged in a 4-week creative arts program including watercolor, collage, beading, and knitting. Hope significantly increased after program participation.4


Terminally ill persons participated in various art projects such as placing their hope on a hope tree5 and a variety of other art forms.6 Qualitative analysis identified such themes as peace, dreams, total well-being, pride, achievement, and sense of purpose, all expressions of hope.


Art has been used to enhance hope and personhood in individuals with mental illness. Specially, Kim et al7 used Mandala art in South Korea, and Page8 created an Art in Minds program in the United Kingdom.


In Canada, Yohani9 used art-based and hope-focused programs that use art- and hope-based discussions to inspire hope in inner-city refugee children. The Hope Project involved collages, drawings, paintings, and photography. In addition, the children created a hope story quilt.


This review on the use of art to promote hope and well-being is further strengthened by the fact that art enhances brain function. Renee Phillips,10 founder of the Healing Power of ART and ARTISTS, writes that "research has proven the arts develop neural systems that produce a broad spectrum of benefits ranging from fine motor skills to creativity and improved emotional balance. Quite simply, the arts are invaluable to our proper functioning individually and as a society."


In 2019, I launched a maiden voyage of hope by creating a wall of hope from pictures drawn by families of critically ill trauma and neuroscience patients that expressed their hope. I would often see artwork crafted by cancer patients displayed at our cancer hospital and thought about approaching art in other healthcare populations, such as family members.


I provided them with multiple art mediums such as paint, crayons, markers, glitter, and so forth as well as a mobile desk to facilitate ease of the activity. I asked them to "draw me a picture of your hope." A variety of family members agreed to engage in this art activity including old and young children and spouses. I left the materials with the families for approximately 1 to 2 hours. After I collected their artwork, I asked them to tell me about what they crafted-in their own words, in which they wrote their words themselves or I transcribed their verbal comments. This activity provided them the opportunity to confirm their hope as well a diversion from sitting and waiting while their loved one recovered from an injury and/or illness. Although their art depicts a moment in time, it inherently addresses their past, present, and future thoughts and directives.


In 2020, the pandemic hit, and visitation was limited so the project was halted. Some of their pictures are shared hereinafter. What do you see? Do you see their hope? Is it multidimensional, dynamic, good, and personal?


"Never lose hope-there is always someone to give them hope-there is always an opportunity in life."

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

"Hope is like heaven with a name. I hope for my mom. The hearts are all the love I have for her. The sun means it is going to be brighter. Faith can move mountains."

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"A butterfly necklace is her favorite[horizontal ellipsis]she likes to look good[horizontal ellipsis]pink is her favorite color."

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"For my family member to get to see many more sunrises and many more sunsets and night falls."

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"Hope is about healing[horizontal ellipsis]if you love her hard enough during this process, she will heal fast[horizontal ellipsis]the feather represents peace[horizontal ellipsis]love has the power to heal."

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

This depiction, with feathers, aligns Emily Dickinson poem:


"Hope is the thing with feathers


That perches in the soul,


And sings the tune without the words,


And never stops at all,


And sweetest in the gale is heard;


And sore must be the storm


That could abash the little bird


That kept so many warm.


I've heard it in the chilliest land


And on the strangest sea;


Yet, never, in extremity,


It asked a crumb of me"


(quote by Emily Dickinson: "Hope is the thing with feathers that perches in...." []).


In the future, I plan on securing the pictures together on a stable foundation for display in one of the critical care waiting rooms. A qualitative research approach will be used to explore visitors' and nurses' perceptions of the pictures by asking "What do you see when you look at these pictures?" Data will be collected through use of a tape recorder and/or response book. Perceptions of visitors and nurses will be compared begging the question: Do they "see" the same thing?




1. Dufault K, Martocchio BC. Symposium on compassionate care and the dying experience. Hope: its spheres and dimensions. Nurs Clin North Am. 1985;20(2):379-391. [Context Link]


2. Fowler SB. Critical-care nurses' perceptions of hope: original qualitative research. Dimens Crit Care Nurs. 2020;39(2):110-115. doi:. [Context Link]


3. Larsen DJ, Stege R, King R, Egeli N. The hope collage activity: an arts-based group intervention for people with chronic pain. Br J Guid Counsel. 2018;46(6):722-737. doi:. [Context Link]


4. Fraser C, Keating M. The effect of a creative art program on self-esteem, hope, perceived social support, and self-efficacy in individuals with multiple sclerosis: a pilot study. J Neurosci Nurs. 2014;46(6):330-336. doi:. [Context Link]


5. Collins A, Bhathal D, Field T, Larlee R, Paje R, Young D. Hope tree: an interactive art installation to facilitate the expression of hope in a hospice setting. Am J Hosp Palliat Care. 2018;35(10):1273-1279. doi:. [Context Link]


6. Kennett CE. Participation in a creative arts project can foster hope in a hospice day centre. Palliat Med. 2000;14(5):419-425. doi:. [Context Link]


7. Kim H, Kim S, Choe K, Kim JS. Effects of mandala art therapy on subjective well-being, resilience, and hope in psychiatric inpatients. Arch Psychiatr Nurs. 2018;32(2):167-173. doi:. [Context Link]


8. Page G. Finding hope and peace of mind through art and creativity. Mental Health Pract. 2011;14(10):28-29. [Context Link]


9. Yohani SC. Creating an ecology of hope: arts-based interventions with refugee children. Child Adolesc Soc Work J. 2008;25:309-323. doi:. [Context Link]


10. Phillips R. Art enhances brain function and well-being. Accessed September 17, 2021. [Context Link]