Nursing revolves around the pivotal concept of care, forming the bedrock of patient satisfaction and well-being. Beyond just a duty, it is the cornerstone that upholds healthcare quality. The absence of genuine care substantially risks the overall patient support and treatment standard. At its core, the essence of nursing lies in the moments of real connection between a nurse and a patient. These instances, known as “caring moments,” are pivotal in ensuring effective healing. They signify the convergence of compassion, dedication, and clinical expertise within nursing. It is crucial to recognize that care is not merely a task but a blend of compassion and skill (Costello & Barron, 2017). Nurses must embody benevolence, commitment, and clinical competence throughout patient interactions. Understanding care as the linchpin of advanced nursing practice is imperative. It goes beyond routine procedures, forming the foundation for exceptional healthcare. The depth of this understanding enriches not just the practice itself but also enhances patient outcomes and experiences.
Nursing Situation
When I accepted the job in the ICU, I was determined to learn critical care and to provide family support and education as needed. Every shift is unique. My workday usually begins with a huddle and the new policy review. At the beginning of my shift, once I am assigned two patients, I begin to learn about my patients’ conditions, treatment plans, and future prognoses. My recent patient was Ms. O, an 80-year-old Haitian female who was admitted to the hospital five days previously for productive cough, shortness of breath, slurred speech, and altered mental status, as per the emergency room (ER) physician noted. Stroke code was the first exam ruled out by ER providers. Then, the history and physical (H&P) were obtained, as well as blood work and more radiology scans, and the decision was made for admission for the critical results, further work-ups, and observations. Ms. O was placed in contact isolation and admitted to a step-down unit with the diagnosis of COVID-19, a urinary tract infection (UTI), and acute renal failure. On day two of her admission, rapid response was called. Ms. O was restless, lethargic, tachypneic, tachycardic, and struggling to breathe, which contributed to rapid intubation in order to protect the airway. She was sedated and transferred to higher care ICU.
I received an assignment on day three of Ms. O’s admission. At the beginning of each shift in the ICU, I received a report from day or night shift nurses, performed physical assessments, checked doctors’ orders, lab work, radiology or pathology reports, and other consult notes. After receiving the report, I assessed my patient by entering the room and checking the medication drips, tubes, and intravenous lines. I noticed that Ms. O was on medications such as Propofol, Fentanyl, ½ Sodium Chloride, Norepinephrine, Albumin, and Vancomycin, which were infused via a right femoral central line. An arterial line was present next to a femoral central line with a transducer at the level of the phlebostatic axis. My physical assessment began with a neurology exam. Ms. O was intubated and on minimal sedation. She did not open her eyes spontaneously nor respond to my voice. There were only painful stimuli obvious when she was woken up. She had a weak cough, a gag, and corneal refluxes with brisk and reactive pupils. She was in normal sinus rhythm on the cardiac monitor. Her heart rate was in the 50’s to 70’s with a core temp of 36.9 Celsius. Her blood pressure was supported by pressure that was titrated according to protocol. Ms. O’s pulmonary status was supported by a ventilator with assist control settings, which indicated that the patient could not breathe on her own. The lung sounds were coarse crackles that produced a creamy, thick secretion that needed to be frequently suctioned. Port-a-cath was under the skin in her upper right chest wall. Ms. O had a feeding tube extending from her left nostril to post-pyloric with a continuous renal formula to meet nutritional goals as the dietician recommended. Her abdomen was soft on palpation, with bowel sounds present. The foley was inserted with a scant yellow urine output. Ms. O was on complete bedrest with turn and reposition orders every two hours. Ms. O’s skin was thin, fragile, and cool.
I checked all orders for Ms. O. These required complex medical interventions, such as mechanical ventilation, continuous medication administration, and advanced medical procedures. One of my first orders was to check the code status and know who the primary team was to contact in case of an emergency. Ms. O was a complete code and under intensivist care. As I was going through the chart, I learned that Ms. O had a previous medical history of breast cancer with bilateral mastectomies and had undergone radiation and chemotherapies. Radiological reports described the lesions that had spread from her breast to her lungs and now were in her bones. According to the cat-scan result, there was no ischemic or hemorrhagic stroke. There was a metastatic disease in the calvarium with a poor prognosis. On the chest x-ray, there were multiple lesions, infiltrates throughout the lungs, and bilateral pleural effusions. Blood work showed elevated electrolytes such as calcium, phosphorus, sodium, creatinine, and blood urea nitrogen (BUN) and a significant drop in carbon dioxide. The urinalysis report showed elevated leukocytes and the presence of the bacteria, which confirmed the UTI. Respiratory culture results showed the growth of Candida Albicans. Few consult orders were placed by intensivists for specialists to assess the patient’s condition and intervene appropriately. The consulted neurologist signed off the case as no interventions were needed. Dr. L, the renal physician, advised against traditional hemodialysis and recommended fluid resuscitation to treat electrolyte imbalances. Infectious disease specialists recommended antifungal and antiviral intravenous medication to be infused around the clock. An oncologist consult was in to follow up when extubated. The last order was placed by an intensivist to arrange an ethics committee to ensure the rights and welfare of the patient according to ethical guidelines.
I took care of Ms. O for three days. I managed multiple medication drips, drew blood, checked frequent neurological status, adjusted the ventilator settings, checked the cardiac monitor, and performed spontaneous breathing trials. I followed all the doctors’ orders and planned care, initiated and modified during the rounds. The goal was to take Ms. O off the ventilator and initiate palliative care. According to the overall prognosis and the physical assessments, the doctors decided it was time to make life decisions. Balancing medical interventions with the patient’s wishes and quality-of-life considerations requires careful navigation. Ms. O had no written Living Will, according to the family. Life decisions needed to be made by a family member or assigned power of attorney (POA). Ms. O has a son who lives in New York and a daughter who lives in Haiti. Ms. O lives in West Palm Beach with a cousin who has been taking care of her daily. A case manager set up a meeting to appoint a POA and to meet with an ethics committee for treatment decisions. By providing emotional support, empathy, and comfort, the medical team educated the family on her life-limiting condition and enhancement of her final days while addressing Ms. O’s physical, emotional, and spiritual needs.
A few days passed, and I returned to work. I checked on Ms. O’s progress and a preference for care made by the family. Ms. O’s orders stated full resuscitation and aggressive care continued. I have come to know her family and their religious beliefs, and they feel that this decision needs to be in “God’s hands.”
According to Roach, human caring comprises the Six Cs: compassion, competence, confidence, conscience, commitment, and comportment. Compassion is the ability to connect with patients on an emotional level, understanding their fears, concerns, and hopes. Every time I glanced at Ms. O, I made sure that all the adjustments in sedation were made to enhance the healing process. I created an environment of trust and openness with every bath by making Ms. O feel valued and understood. I spent a great deal of time in her room, listening to the beeps and sounds to understand what was happening with Ms. O. I then sat next to the room and continued to check the monitors to provide safe and effective care. Ms. O relied on my competence in critically analyzing situations, making informed decisions, and executing interventions. When the family was at her bedside, I made sure that comprehensive medical procedures were understood. Confidence is crucial in critical situations. It ensures the patient and family are in capable hands, resulting in the best patient outcomes. My goals were to advocate for Ms. O by communicating her needs and trying to understand the family’s feelings. By listening to her family, I realized my morals were different. I was faced with an ethical dilemma that needed careful consideration and decision-making. The family needed time to respond appropriately. I called them every day with progress and updates. I was committed to building a trusting relationship with the family to be there during the crisis. I collaborated with pastoral care, who played a vital role in easing family members’ concerns during challenging times. I prioritized Ms. O’s well-being above all else. Professionalism, empathy, and respect are the cornerstones of positive comportment. By being professionally dressed and using effective communication, the atmosphere of mutual respect fosters a positive relationship. The family believed in me as a professional caregiver. These Six Cs of Roach are the core principles that elevate nursing care to an art that nurtures the body, mind, and spirit.
Mayeroff, M. (1971) explores the essential components he calls “caring ingredients.” They are knowing, alternating rhythms, patience, honesty, trust, humility, hope and courage. When I received the report about Ms. O, her prognosis was poor due to metastatic disease. I knew that cancer had invaded her whole body. Ms. O’s mind, body, and spirit were battling this for years before admission. She did go through cancer treatment and was patiently waiting for a positive outcome. The oncology team provided a total mastectomy as an alternative treatment. The family had shared this information with me. Honesty and trust are critical elements of a medical team to build a caring relationship. I was honest by providing facts based on evidence-based practice and reviewed doctors’ notes with Ms. O’s family, which contributed to a sense of safety and openness. They recognized me as a trusted caregiver because I was consistent in the care of Ms. O. They trusted my care when I adjusted a vent setting or titrated a drip. Humility was recognized when I learned that everyone had their own perspectives and needs. This is why a POA needed to be appointed. This family taught me a life lesson. As a nurse, I must set my perspectives aside and adapt to each patient’s culture, religion, and wholeness to give hope and courage to my patients and their families. I hope I fostered courage for the family by arranging pastoral care to empower their strengths, face their challenges, and decide on a path for a better future.
Theoretical Perspective
Watson’s Theory of Human Caring stands as a seminal concept in nursing theory, delving deeply into the relationship between humans and the nursing paradigm. At its core, this theory challenges the notion that patients or humans can be perceived merely as objects to be fixed or cured. Instead, Watson emphasizes the profound importance of recognizing and treating patients with genuine compassion, understanding that such care alleviates their suffering (Clark, 2016). Central to Watson’s philosophy is a unique perspective on health. Unlike the conventional view that health equates to the absence of disease, Watson’s definition transcends the physical realm. It encompasses a subjective experience that harmonizes the mind, body, and spirit, aiming for a delicate equilibrium. For Watson, genuine health is a holistic state that incorporates emotional, mental, and spiritual well-being alongside physical wellness.
Furthermore, this theory is about how nurses should execute their duties and how they should exist within their roles. It goes beyond the technical aspects of caregiving to emphasize the actualization and expansion of the nurse’s humanity. Watson’s theory posits that nurses undergo personal growth through compassionate care, finding fulfillment and meaning in their profession. The crux of Watson’s theory revolves around the intricate dynamics within the nursing realm, particularly highlighting the interpersonal connections forged between nurses and their patients. It accentuates the significance of these relationships as a crucial aspect of healing. Within this framework, the nurse is not just a medical aid provider; they become an integral part of the patient’s journey toward recovery, offering expertise, genuine empathy, and understanding (Costello & Barron, 2017). The theory’s emphasis on the interpersonal process underscores the importance of therapeutic communication, empathy, and creating a healing environment that transcends the mere treatment of physical ailments. By recognizing the interconnectedness of mind, body, and spirit, Watson’s theory underscores the profound impact of holistic caring in fostering well-being and recovery.
Within nursing, the cultivation of profound relationships centered on assistance, trust, and compassionate care is a cornerstone. These relationships form part of the Caritas processes, integral to fulfilling fundamental human needs within a healthcare setting. Implementing these processes aims to foster a nurturing environment transcending medical treatment. One crucial facet of the Caritas processes involves establishing a trusting relationship between nurse and patient. This bond meets the basic human need for connection and creates an atmosphere where patients feel empowered to make informed decisions about their well-being. Within this environment, patients are encouraged and supported in making choices that align with their best interests, fostering autonomy and a sense of agency in their care journey.
Acknowledging and validating patients’ positive and negative emotions is another essential step in the Caritas process. Being a sympathetic listener and supporter is a role that nursing embraces, enabling people to express their emotions without fear of rejection. This acknowledgment can facilitate deeper relationships, allowing patients to explore their emotional landscape and building mutual trust and understanding between the nurse and patient. Furthermore, the Caritas framework’s central idea of a healing environment has resonance in nursing practice. In order to promote patients’ overall well-being, nurses actively participate in creating environments that go beyond the hospital’s physical boundaries. This environment encompasses emotional, psychological, and spiritual support, aligning with the carative factors that facilitate healing at all levels—body, mind, and spirit (Pajnkihar et al., 2017).
Nursing practices that embody the Caritas processes enable the creation of an atmosphere that not only fosters recovery but also protects patients from needless stressors. Patients can move through their healing process with confidence and comfort in this haven, knowing they are surrounded by caregivers committed to their general well-being (Costello & Barron, 2017). As a facilitator, the nurse ensures that an environment that supports healing on all levels is provided. It is essential to attend to the emotional and spiritual aspects of care in addition to the physical. The Caritas factor acts as a guiding principle for the nurse, steering them to create an atmosphere that promotes the patient’s healing, growth, and overall well-being. This holistic approach emphasizes that the care delivery environment is as crucial as the treatments. It underscores the significance of a nurturing and supportive context that enables the patient to heal comprehensively—physically, emotionally, and spiritually. By integrating these Caritas processes, nurses elevate their practice beyond conventional caregiving, fostering a space where true healing and growth can flourish.
The Essence of Caring in the Nursing Situation
The idea of the “caring moment”—a profound exchange in which patients and caregivers form heart-centered connections—is central to the nursing profession. A cornerstone of Watson’s Theory of Human Caring, this crucial moment encompasses a comprehensive consciousness embracing care, healing, and love (Watson & Woodward, 2010). It gives nurses a unique chance to perform their responsibilities as licensed caregivers and attend to the patient’s requirements. In order to create a caring moment, nurses must connect with the patient’s soul and go deeper into their spirits. This connection strikes a chord at that precise moment, enabling nurses to acknowledge and value the individuality of every person. In this exchange, the nurse exhibits deep respect by standing up for the patient’s dignity. Watson’s idea states that providing care entails a comprehensive strategy that gives the person’s bodily, emotional, and spiritual needs top priority. Watson’s focus on the nurse-patient relationship and the nurse’s duty to protect the patient’s autonomy, dignity, and rights is echoed by the concept of advocacy. This is consistent with the practice shown in the scenario, in which the nurse actively advocates for the patient’s wishes and general well-being and attends to the patient’s medical needs. Without a doubt, the tender moment creates an atmosphere favorable to the development and upkeep of genuine, sincere relationships between the nurse and the patient.
The significance of these moments in the healing process cannot be overstated. Within these moments, nurses can demonstrate attentiveness, responsibility, competence, and responsiveness in patient care. Attentiveness is crucial—it enables nurses to perceive the patient’s needs keenly. The significance of the caring moment may be compromised if these demands are not acknowledged. During this time, a perceptive nurse pays close attention to the patient’s signs and signals to better understand their requirements and preferences. This openness enables nurses to customize their care to fit each patient’s needs. As a result, this degree of focus raises the standard of care given and improves the patient and caregiver’s entire nursing experience.
In addition, the caring moment facilitates the expression of accountability and proficiency in nursing practice. A patient’s emotional and spiritual well-being is as important as physical care. This level of involvement gives the patient a sense of security and trust, both essential elements in the healing process. These moments encapsulate the essence of nursing, facilitating a space where genuine connections, empathy, and understanding flourish. It is a profound intersection where the nurse’s attentiveness, responsibility, and responsiveness converge to provide holistic, personalized care, nurturing not just the body but the spirit and soul of the patient.
Personal Relevance
From the analysis, I understand that as a nurse, I should strive to be with every patient I take care of. The notion of advocacy deeply resonates with personal relevance, weaving through the intricate fabric of nursing practice and professional ethos. As a nurse, encountering situations akin to Ms. O’s case sparks a profound personal connection and underscores the significance of advocacy not just as a theoretical concept but as a lived experience in caregiving—the pivotal role of advocacy surfaces as a profoundly personal tenet within the nursing practice. Ms. O’s story mirrors the complexities and nuances inherent in healthcare, prompting a reevaluation of personal beliefs, ethical considerations, and the core values driving patient care. The intimate involvement in decisions regarding a patient’s end-of-life care evokes a sense of responsibility, empathy, and an acute awareness of the significance of advocating for the patient’s wishes.
Nursing becomes a crucible where theoretical underpinnings align intimately with personal beliefs and values. As the nurse navigates through the intricacies of Ms. O’s care, the significance of advocating for her autonomy and dignity becomes profoundly personal. The essence of advocacy merges with the innate desire to honor and respect the patient’s voice, choices, and inherent rights.
Furthermore, the personal relevance of advocacy extends beyond the clinical realm, permeating into the emotional and spiritual aspects of caregiving. Engaging with Ms. O’s family to comprehend their beliefs and values respecting their cultural and religious preferences, becomes an intrinsic part of advocating for comprehensive patient-centered care. Moreover, the theoretical perspective of Watson’s Theory of Human Caring amplifies the personal relevance of advocacy. This theory, which emphasizes the importance of the nurse-patient relationship and the holistic nature of care, resonates deeply with my values. It reinforces the idea that nursing is not just about treating ailments but about fostering genuine connections and championing the patient’s rights and wishes. In my practice, I continually strive to ensure patients are actively involved in care decisions, advocating for their preferences, or facilitating open communication between patients, families, and healthcare teams; the core tenets of advocacy remain at the forefront of my approach to nursing.
References
Clark, C. S. (2016). Watson’s human caring theory: Pertinent transpersonal and humanities concepts for educators. Humanities, 5(2), 21. https://www.mdpi.com/2076-0787/5/2/21
Costello, M., & Barron, A. M. (2017). Teaching compassion: Incorporating Jean Watson’s caritas processes into a care at the end of life course for senior nursing students. International Journal of Caring Sciences, 10(3), 1113-1117. https://www.internationaljournalofcaringsciences.org/docs/1_costello_original_10_3.pdf
Mayeroff, M. (1971). On carrying. NY: Harper.
Pajnkihar, M., McKenna, H. P., Štiglic, G., & Vrbnjak, D. (2017). Fit for practice: analysis and evaluation of Watson’s theory of human caring. Nursing Science Quarterly, 30(3), 243-252. https://journals.sagepub.com/doi/abs/10.1177/0894318417708409
Roach, M. S. (2002). Caring: The human mode of being (2nd rev. ed. ed.). Canadian Hospital Association Press
Watson, J., & Woodward, T. K. (2010). Jean Watson’s theory of human caring. Nursing theories and nursing practice, 3, 351-369. https://sociadrive.com/file/1PC5/Nursing_Theories_and_Nursing_Practice_(webofinfo.com).pdf#page=341
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