Looking Is Not Seeing

Michelle Brenner, Head of Education, and Mariko Tu, Manager of Youth and Family Programs
May 5, 2020

For nurses on the frontline, making close observations is key to saving patients’ lives. To help with building this critical skill, the Norton Simon Museum hosts nursing students from Mount St. Mary’s University in Los Angeles each winter and spring for “Looking Is Not Seeing.” This innovative training program was developed in 2008 by the Yale School of Nursing in partnership with the Yale Center for British Art. Looking at art in a museum helps nursing students slow down and notice how they might jump to conclusions about a given situation before having all of the necessary information.

Together with Sarah Shealy, Assistant Professor of Nursing at Mount Saint Mary’s, Michelle Brenner, Head of Education at the Norton Simon, identified several figurative paintings from the collections that met the criteria for the program. They include works with ambiguity—those for which the “story” of the painting is not immediately clear—works that are well-suited to close looking and interpretation.

In each session, groups of five to six students are paired with trained educators from the Norton Simon. The educator begins by asking their group to spend three minutes looking at the painting in silence, noticing as much detail as possible, and then ten minutes making an objective visual inventory (noninterpretive observations) of the work of art. At this stage, students may find it easy to slip into subjective interpretations. In Jean-Honoré Fragonard’s Happy Lovers, for example, a subjective interpretation would be “I see a happy couple,” but an objective view would be “I see two figures.”

Then the group is invited to share their subjective interpretations based on their objective observations for ten minutes. By this point, they have looked at the painting in depth—suspending judgment—for much longer than most museumgoers, and this affects their final interpretations. Students begin to relax as they can finally share their views of the “stories” behind the paintings.

Nursing students observing Karel Dujardin’s Denial of Peter, c. 1663

Nursing students observing Karel Dujardin’s Denial of Peter, c. 1663

For example, one student interpreted the narrative in Karel Dujardin’s Denial of Peter as that of a husband who has been caught leaving his wife and child. She made this hypothesis based on the man’s (Peter’s) defensive body language, the woman’s (a maid’s) accusatory gesture, and the downward stare of the little boy behind her.

Nursing students observing Van Gogh's Portrait of a Peasant (Patience Escalier),

Nursing students observing Van Gogh's Portrait of a Peasant (Patience Escalier), August 1888

Interestingly, some students apply their clinical backgrounds to their interpretations. For instance, the “reddish skin” in Vincent van Gogh’s Patience Escalier becomes evidence of sunburn, owing to extended periods of time outside.

Nursing students observing Edgar Degas’s Women Ironing, Begun c.1875–1876; rewor

Nursing students observing Edgar Degas’s Women Ironing, Begun c.1875–1876; reworked c.1882–1886

To understand Edgar Degas’s Women Ironing, students have gotten up from their seats to mimic the pose of the laundress as she hunches over the table, pressing down on an iron with all of her strength. Students pointed out that this kind of repetitive action would lead to chronic pain in the back and neck, and that her hands may be pink from iron burns.

Finally, the educator spends two minutes sharing some background about the artwork.

Each group of students repeats the process for a total of three paintings. As they move on to the second and third artworks, students become more comfortable with the process and even begin to stop themselves when they realize that they were about to share a subjective observation too early, as opposed to an objective one.

After discussing the last artwork, students come together to apply the same process of close-looking, objective observation and then subjective interpretation to images of hospital patients. They begin to understand the purpose of their time in the galleries and noticeably show improvement in their ability to distinguish objective observations from subjective interpretations. They also share stories from their own experiences of working in hospitals and seeing senior nurses point out something that everyone else had missed and that saved a patient’s life.

When nursing students slow down and look at an artwork together, they understand how several people can look at the same image (or patient) and observe different things. They see firsthand how one person can pick up on something that everyone else has missed, and they gain the confidence to speak up when they notice something amiss in a clinical setting. Studies have shown that this kind of museum training for nurses results in an improved ability to provide objective assessment, which leads to improved outcomes for patients.

The nursing students that have participated in the program leave the Museum feeling inspired, knowing that their observations matter. The program has also been extremely rewarding for our educators, many of whom have family and friends whose lives have been impacted by a nurse’s sharp eyes and know all too well how important they can be.

Michelle Brenner is Head of Education, and Mariko Tu is Manager of Family and Youth Programs at the Norton Simon Museum.