Module II: Care and Comfort

Outline

Agency

According to Webster, an agent is substance or person that performs an action or brings about a result, or is capable of doing so. Or, it may be one who is empowered to act for someone else.  Some synonyms are: advocate, provocateur, ambassador, broker, delegate, fiduciary, intermediary, minister, ombudsman, proctor, proxy, representative, steward, trustee.  By extension, the term agency refers to the active force or power through which the act is done; the instrumentality.   The Nurse is the health care delivery agent we are concerned about in this course.  As you can see, the role assumes considerable responsibility.  The practicing nurse must bring particularly acute skills aided by critical thinking to perform the job description of agent for care with regard to patient, family, and community. Comprehension and acceptance of this role is crucial to effective care.  When you consider nursing as a calling, the dimensions of caring and comforting naturally become clear.

Broad Dimensions of Care

Take a little journey with me in reflection and auditory stimulation.  Consider meaning-laden synonyms of caring that elicit deeper emotions; describe them on the canvas of your mind and stir some memories as examples:

Compassion
Passion
Impassioned
Pathos
Pathetique (a musical form)
Appassionato (another musical form)
Ministry

Now, visit your favorite online musical source Pandora, iTunes, etc.) and download the following musical and choral compositions to listen to in a quiet, undisturbed place, seeking an expression of these characteristics in sound:
Beethoven’s “Pathos”
Glinko”s “Pathetique” trio
Brahm’s “Requiem”

For your visual satisfaction, begin to create a Concept Map (How-tos: 1, 2, 3) with interactive hotspots on terms, definitions, comparisons, and theory in action as well as any other items that aid your learning.  On this map plot events and interventions from the Case Study.

Human Needs

Maslow may be the most referenced scientist concerning human needs prioritized on individualized satisfaction beginning with physiological needs, safety needs, love and belonging, esteem, and finally self-actualization needs.  eNotes gives an extensive explanation for health care providers.  Alderfer believes he has economized on the theory with an abbreviated ERG concept.  Yura and Walsh (Journal of Holistic Nursing. March 1986 vol. 4 no. 114-15) proposed a 36 human needs mediated by the problem-solving nursing process.  I invite you to read about them, because they characterize most, if not all, wholistic aspects of being.  And, while forgotten in this century, their re-appearance may be beneficial.

The Whole Person This concept has a foundation in Scripture in that the entities that compose a person are (supply examples):

physical,
mental/emotional,
social, and
spiritual.

Refer to an example of a whole person mission statement of a health care university.  The ministry of Christ was to make man whole.  Toward that end He ministered to physical, emotional, social, and spiritual needs of those he came in contact with (reference the Gospels).

Transformational Nursing: A Caring Theory
Jean Watson

Background: Psych. Nursing; Education-Psychology Doctorate; Taught at Univ. Colo. 27 yrs.

A theory demanding use of qualitative research.

Presented in her book “Nursing: Human Science and Human Care: A Theory of Nursing”  (1985).

She wrote it following 6 years of study into what she perceived as the problem of a lack of explanation of the work of nurses.  It is meant to bring new meaning and dignity and broadens the conceptual scope of nursing.  Rejects people as “objects.”

A middle range, explanatory theory—a world view.

Continues to evolve . . . In spite of her promotion of wholism, she often describes dualism.

The promise and scope of the theory:

  • Recognition each individual is a being inseparable from self, others, nature, and the universe.
  • There is healing potential for both caregiver and care recipient in a caring relationship

Admittedly, she draws on a range of dimensions:

  • Humanitarian
  • Metaphysical
  • Spiritual—existential
  • Phenomenological
  • Eastern philosophy

Refer to:

Her extensive philosophical claims on value  (Fawcett, p. 659)

Her elaboration on human life (Fawcett, p. 661)

She defines Health: “Health refers to unity and harmony within the mind, body, and soul.  Health is also associated with the degree of congruence between the self as perceived and the self as experienced.”  (p. 661)

Caring is a moral ideal of nursing. Protecting, enhancing, preserving human dignity.  Seek ways to enable individuals to reach a higher degree of harmony in the spheres of wholeness—body, mind, soul.

She purposely merges Christianity (Western thought) with Eastern beliefs (Buddhism).

Concepts:

  • Transpersonal caring relationship
  • Caring occasion/moment
  • Care (Healing) consciousness
  • Carative factors – 10 Dimensions  (Fawcett, p. 663)

Which are behavior guides for nurses  (Core of nursing)
Are hierarchical in nature, with each level contributing to the next
They are also interactive—holistic

Informed Moral Passion

Discussion here refers back to reflect on one’s “calling” to care.

What/Who calls me to care?

What is the root of my caring response?

How do I respond?      What if I don’t?

How will I sustain and nurture my caring consciousness?

Who will care for me?                        (Alligood & Tomey, p. 99)

“Caring and love are the most universal, the most tremendous, the most mysterious of cosmic forces . . .”  (Alligood and Tomey, p. 102)

Caring–“the ethical principle or standard by which caring interventions are measured.”  (p. 103)

She refers to technical nursing procedures/protocols as sacred acts conducted with a caring consciousness in a way that honors the person as an “embodied spirit.”  (p. 103)

There is a long quote on p. 104 about the nexus of proffered and accepted care.

Carative Factors (Caring-Healing Modalities) employ intention, conscious use of implements which appeal to imagination, senses, cognition, body movement (kinesis), and presence.  Also employed are comfort measures; emotional, expressive, and relational work; and teaching and learning.  To be implemented they need on the part of the nurse:

  • Intention
  • Caring values
  • Knowledge
  • A will to engage
  • A relationship
  • Actions
  • Commitment

______________

DIMENSIONS OF CARING

Concepts based on O’Brien’s Spirituality in Nursing (2003)

Being:  Also described as presencing, or being present physically, mentally, and emotionally for individuals in extreme need.  Conveying by attitude, tone, demeanor, or voice that you are attempting to join in the experience of need and are standing by.

Listening:  An accompanying behavior to Being. Tuning in to the spoken and unspoken word, attending to the individual with all one’s senses.

Touching:  “Loving, empathetic, compassionate touch is perhaps the most vital dimension of a nursing theology of caring.”  It may be in the form of holding one’s hand, stroking the face or hair, hand or arm, massaging therapeutically, and even with one’s voice with words of cheer or comfort.

Covenant Relationship

THE NURSE-PATIENT RELATIONSHIP: A Sacred Covenant

Based on mutual Trust.  “The presence of an understood covenant between a patient and nurse (health care provider) no only supports the concept of trust between the partners, but also sets up parameters for appropriate role behaviors and attitudes. . . Examining the term covenant from a spiritual/theological perspective also supports an understanding of the concept of nursing practice as involving a sacred covenant.”  It is a term used in the Bible often, particularly between God and His people, the children of Israel.  It established bonds of loyalty and responsibility of a mutual nature. In contrast to a contract that can be terminated by agreement when one party fails to fulfill the obligation, a covenant relationship has no condition put on the faithfulness in keeping it.  It is unconditional service that is expected.  God described it in this poignant promise:  “Can a woman forget the baby she feeds at her breast?  Will she not have compassion for the new life that has come from her womb?  Yes, it’s possible that she may forget or abandon her offspring, but I will never forget or abandon you.  You are mine. O Jerusalem, Jerusalem, how can I forget you?  I have engraved your name on the palms of my hands.  You are always in my thoughts.  How can I forget you?” (Isaiah 49:15, 16)

“Historically, nursing has been a discipline of service to others; the concern with one’s personal well-being, spiritual or otherwise, was secondary to meeting the needs of the ill.”

O’Brien elicited six key concepts from her qualitative study of nurses’ conversation about their relationships with their patients and their perceptions of their role:

  • Possessing a sense of mission
  • Being a messenger of good faith
  • Seeing some aspects of the relationship as almost sacred (the covenant)
  • In some way touching the hand of God when patients face death, as in walking through the valley with them
  • Sensing the vibrations of mental/emotional alterations and giving off vibrations of concern, compassion, and love
  • Recognizing that the nurse follows in the shoes of Christ during His ministry in teaching, modeling, intervening during illness—a healing ministry

More Resources

To complement this study, we have sought helpful internet videos and print sources for you to examine and discuss:

Books

Making Sense of Spirituality in Nursing Practice by Wilfred McSherry (2000)

Helping and Healing by Edmund Pellegrino & David Thomasma (1997)

Parish Nursing:  Promoting Whole Person Health Within Faith Communities by Phyllis Ann Solari-Twadell & MaryAnn McDermott (1999)  Link to online preview: http://books.google.com/books?id=J-v8KTcujaAC&lpg=PP1&ots=JwxUXs5dOa&dq=whole%20person%20health&pg=PP1#v=onepage&q&f=false

I Should be Burnt Out by Now . . . So How Come I’m Not? by Peg Neuhauser, Ray Bender, Kirk Stromberg (Wiley & Sons, Publ)  $26. 95  [eBook]  At www.ebooks.com

Articles

Comfort: A Value Forgotten in Nursing, Lin, Chia-Chin PhD, RN, Cancer Nursing:  November/December 2010 – Volume 33 – Issue 6 – pp 409-410

Kolcaba’s Comfort Theory – http://www.slideshare.net/davejaymanriquez/katherine-kolcaba-rn-phd-comfort-theory .  Her blog is http://comfortcareinnursing.blogspot.com/2010/07/comfort-fundamental-need.html

What Are the Main Points in Nursing Comfort Theory? | eHow.com http://www.ehow.com/list_6821213_main-points-nursing-comfort-theory_.html#ixzz1ANfCb1Q2

Videos

Making a World of Difference with Care- In Honor of Nurses Everywhere http://www.youtube.com/watch?v=AJViQ1-APWo&feature=related

“Faces of Caring” (Joy Adelman) http://www.youtube.com/watch?v=OvltNOJV3ec&feature=related

Tribute to Nurses – “These Hands” Music Video               http://www.youtube.com/watch?v=29fdVOqraQs&feature=related

Contribute your ideas, opinions, stories, examples in the comment box below.

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