Pellico, L., Friedlaender, L., & Fennie, K. P. (2009). Looking is not seeing: Using art to improve observational skills. Journal Of Nursing Education, 48(11), 648-653.


This quasi-experimental study examines the effects of an art museum experience on the observational and diagnostic skills of nursing students. Specifically the study compares the observational skills of nurses who participated in an education program at a local art museum called “Looking Not Seeing” (an experimental group), with those who did not participate in the program (a control group). The experimental group had a 90-minute experience with an artwork in small groups of five or six students. The experience involved close looking at a work of art independently, sharing rich description with group members, and finally interpreting the work as a group using visual evidence from the image. A museum docent facilitated the small group discussions. The control group received training in diagnostic strategies in a traditional classroom setting. To assess the efficacy of the program, the researchers showed both groups—a total of 66 students all enrolled in an accelerated nursing program culminating in a Master’s degree—patient photographs and asked them to record their observations of the photos in writing. Researchers found that students from the treatment group made significantly more written observations and noted a higher number of possible objective clinical findings. Additionally the treatment group offered more alternative diagnoses than the control group. The findings suggest that observational skills can be enhanced through the practice of viewing and discussing original works of art.

Key Findings:

  • Participants in the museum program, a total of 34 students, made significantly more written observations while observing six patient photographs for five of the six photographs—a range of 51 to 68 median observations as opposed to the range of 36 to 55 for the control group. The observations were in the forms of signs or symptoms derived from looking at the patient photographs.
  • Participants in the museum program also noted a significantly higher number of possible objective clinical findings for the same five patient photographs than the students in the control group.
  • Participants in the museum program also offered more alternative diagnoses when performing a differential diagnosis, a systematic procedure for identifying the most probable diagnosis among many, while observing the patient photographs than students in the control group.

Significance of the Findings:

Researchers cite an extensive literature underscoring the importance of observational skills in the medical profession. Good observational skills are essential for initial assessments and diagnosis of patients. The findings of this study are significant because they suggest that focused viewing and describing and interpreting original artworks in a museum setting can aid in developing the observational skills of nursing students thereby enhancing their skills as practitioners. The implications are that observational skills developed by looking at and discussing works of art can be useful in the sciences.


Sixty-six first semester nursing students in an accelerated program leading to a master’s degree were chosen for the study. Thirty-two students were placed in the control group, which received traditional classroom instruction and did not visit the museum. Thirty-four of these students were placed in the treatment group, which participated in the Looking is Not Seeing program at the art museum. The treatment group was not randomly assigned, but rather was a convenience sample. Students in the Looking Not Seeing program spent 90 minutes in small groups of five or six looking at a work of art and participating in a facilitated discussion with a museum docent that moved from observation to interpretation. The paintings that the students looked at were selected for their rich visual detail. The students participated in a single 90-minute session.

After receiving their respective forms of instruction, the researchers asked all sixty-six nursing students in the study to observe six patient photographs and make written notes on what they noticed. Students spent five minutes observing the photos and five minutes recording their comments. They were then give three minutes to use their written observations to make clinical interpretations.

To analyze the data, researchers counted the observations students recorded for each photo, as evidenced by the number of written words students recorded while observing the photographs. This was done in order to compare the number of observations students made. Researchers then categorized the types of comments made into possible objective clinical findings and added these up to measure the number of reasonable objective clinical findings. The researchers also tallied the number of possible diagnoses students made that were supported by visual evidence. The researchers entered the data into Microsoft Excel and performed univariate statistics using SAS software to determine distribution and variance. Researchers coded the observations made about each photograph, not the observations made by each individual student, therefore, six analyses were performed in total.

Limitations of the Research:

Because the research design was a post-test only there is no way to measure the extent to which the skills of the students in the treatment group may have changed from before to after their museum experience.

Questions to Guide New Research:

Future research might focus on evaluating an art museum program with nursing students at different levels, with different types of preparation (e.g. bachelors of science v. a bachelors of arts). Studies might also examine the efficacy of the intervention with reproductions of artworks for those who do not have a local art museum, and identifying the role of the museum docent or educator in contributing to the results.