I practice in Watson’s theory by cultivating and activating intentional caring practice. I honor nursing as a biopsychosocial-spiritual practice and work to cultivate discernment in my daily life and work. I awaken and do centering ex-ercises, sitting silently for a few moments to receive the day and cultivate loving- kindness and equanimity for caritas consciousness. I incorporate self-care by walk-ing and stretchwalk-ing, by havwalk-ing a massage at least once a month, and by includwalk-ing time and attention to family and friends. This allows for my own sense of connect-edness and self-healing of the mind, body, and spirit, which is especially important because my practice on an oncology unit is very intense with many patients who are terminally ill.
I know very little about Debbie other than the brief report: “29-year-old mar-ried woman gravida 2 para 2 with stage V cervical cancer. Postoperative day 2 from radical hysterectomy, complains of postoperative pain and urinary retention,
110 PART 2 Application
nausea, poor appetite at 89 pounds (a 21-pound loss), and a heavy smoker. She has limited social support, two children, and outpatient radiation scheduled after discharge.” This report tells me little about how she is coping and feeling. I found myself wincing when several of the nurses described her husband as abusive and her kids as sweet and very young to be motherless. My immediate thoughts are of the tragedy of her situation. I ask my co-workers about their interactions with her husband, if Debbie has given permission for him to visit, and if security has been alerted; then I inquire if the social worker was contacted or if the family was aware of our services. No referral was considered and there was no note in the chart about the husband’s visitation. As we discuss Debbie further, I hear my co-workers’ con-cerns of little time to address Debbie’s social issues. I find out Debbie has gained 2 pounds in 3 days and knows little about self-catheterization. I empathize with what Debbie must be experiencing right now, how alone she must feel, and how scared her children and other family members may be. I wonder about her history of abuse and weight loss, when she discovered she had cancer, and what social support she may have. Even for brief moments, I use every opportunity to bring authentic, intentional caring presence into conversation with my colleagues and Debbie, using caring occasions to energetically repattern the environmental field with an awareness of the clinical caritas guiding my practice. As I knock and then enter her room, I remember the first three “caritas” processes: (1) practice loving-kindness and equanimity within a context of caring consciousness; (2) be authenti-cally present, and enable and sustain my belief system and subjective life world of self and the person being cared for; and (3) cultivate one’s own spiritual practices and transpersonal self, going beyond ego self. Caritas potentiates my attentiveness, listening, comforting, and patience. Incorporating these attributes into daily prac-tice has played a major role in my pracprac-tice as an oncology nurse to address the patient’s many physical, psychosocial, and spiritual needs.
As I go to Debbie’s room, I greet her and then wash my hands. I use this 30-second opportunity to be still, to consciously take a deep breath, and to cen-ter myself in the caring moment, remembering that intention, actions, words, be-haviors, cognition, body language, feelings, intuition, thought, and senses present themselves simultaneously. My energy field contributes to the transpersonal caring connection. As Watson suggests, I am awake with the intention of creating a deeper level of interaction by “being-the-caritas-field” (Watson, 2008, p. 48). I hold an awareness of my emotions so my judgment is not clouded as I care for Debbie. I am hopeful I will know what to offer her, not knowing her or even knowing what I will find as I meet her. I have no expectations, keeping myself open to receive each patient/client as a unique person, yet I have learned it is necessary to set flexible boundaries to avoid burnout; this is a professional nurse caring occasion rather than a personal caring relationship. I have confidence that the right words will somehow find their way to me. I know I can be present for her on several levels and be authentic if I stay true to who I am. As I turn toward her bed, I hear low, muffled sobs. As I quietly pull the curtain back and move into her space, I make an effort to “see” who the spirit-filled person is and hold caring thoughts as intent, as I relate with Debbie the person. Her fear and stress are evident and dominate over her frail physical presence.
She has her face turned away, but I can see enough to immediately sense her anguish and despair. She is only a few years younger than I am yet she seems much older. Her face is drawn and pale; her thin hand is at her mouth; and she holds a soggy tissue to her lips. I sense her vulnerability as she attempts self-control. A part of me just wants to immediately touch her, even though I hardly know her.
This frail young woman, lying in a fetal position with the sheet pulled up to her shoulders, meets my concerned gaze with reddened eyes and a sob. I gently touch her free hand, which is damp, cool, and bruised from a previous venipuncture. She does not withdraw from my touch but keeps her eyes on my face. I can feel myself consciously center, steady, and open. In a quiet, gentle voice I ask if I can be of any help. I reach for a fresh tissue, and I offer it to her but keep my eyes on hers. She looks briefly away and then returns my gaze. She apologizes for crying and says she hopes she is not disturbing the other patient in the room. I feel this is a releas-ing of disharmony and blocked energy that may interfere with her natural healreleas-ing processes. I tell her it is okay for her to focus on herself and her own healing. I smile gently, trying unobtrusively to show her that feelings are okay and that she can trust me. No words pass between us. She turns to lift herself up in the bed. I extend an arm to help her gain her balance. She grimaces as she frees the covers from her back and uses my arms for leverage as she tries to find a more comfortable position. She is obviously in discomfort.
I ask to see her dressing, carefully pull back the covers, and see that everything appears to be intact and dry. I ask her about the level and type of pain she is ex-periencing (using a pain scale) and when she last had some pain medication, as I continue watching her face. She says it feels like a sharp pain and an 8 on a scale of 1 to 10. She is unsure about the time she received her last pain medication. She looks over at the untouched breakfast tray and responds, “Sometime during the night, I guess. Perhaps it would calm me down some if I had another shot now. I just feel so teary and weak. This just isn’t me. I need to pull myself together for my kids. I am all they’ve got, yet I might not be here long.” Falling apart and pulling together, she seems to be feeling some dissonance between how she sees herself
“before” and how she is “now.” Her hope seems anchored firmly in her relationship with her children.
She glances down to the only personal thing in her hospital room—a small, framed photo of a healthier-looking Debbie smiling, her arms wrapped protectively around her two young children. She touches the photo from a happier time, as if to touch the young boy and girl there, a precious touchstone, and then lies back in bed with a sigh. She says, “I just don’t know what my children will do without me.” I hear fear and grief around the edges of her voice. What could—what should—I say?
I give her some space and remain silent. She goes on, “Maybe all of this is a pun-ishment for what I have done in the past, but they shouldn’t be punished too. My husband isn’t working right now, and he seems so removed from everything that is happening and is easily frustrated.” I reflect on what she has said as she continues to share more. Her husband, who lives with friends right now, is looking for work and going to a court-ordered anger management class, and lately he has been treating her and the children well. She has support from her mother and a church family, although right now she says, “My faith is being tested.”
112 PART 2 Application
I ask if she would like to speak with a social worker or a minister before dis-charge, and she agrees. I find out the foods that appeal to her and discover her tastes and a favorite soup. She agrees to see a nutritionist, a member of our oncol-ogy team. I quietly excuse myself, telling her I will be right back with some pain medication. I ask her if she will be okay alone for a few moments. She turns with a faint smile and responds, “Yes, and thank you.” I look back as I return the curtain to its place of privacy. Outside the room, I look down at my watch and am shocked to find only 10 minutes have passed. As I move quickly to get the medication for her pain, I sort through what has just happened to find a pattern in the words and gestures, in the look of a face, the untouched tray, the family, the pain, the dressing, the information from report. How can I be of help to Debbie? Where is the place of healing for her? Who will be there for her? Where is the harmony in it all? I know I cannot fix it for her, but maybe I can help her find her own sources for healing and resources for her family. I sense strength there beneath the surface and her appetite is returning. She certainly has a strong motive to heal and more resources than I had anticipated. I admire and am touched by the obvious love she has for her children, her determination to parent them well and to be there for them, and her willingness to receive support. I sense there are many complex issues here for Debbie, not the least of which must be her very own mortality and her relationship with her husband. How does she feel about what she is facing? What meaning does it have for her? Where does she get her own inner strength? What will the role of her husband be with her and their children? Who will care for her?
When I return in a few minutes, her hand is pressed slightly on her abdomen.
She thanks me for the medication, and her shaky smile makes me think she may be connecting with me as well. I let her know there are techniques to help her relax and potentiate the effect of the narcotic to relieve her pain. We review how to use breathing and visualization to decrease pain. I straighten her room, bring fresh wa-ter, and, with her permission, remove the wilted flowers. I ask if there is anything she needs. At the same time I am mindful of a healing environment by paying atten-tion to environmental factors such as light, sound, air quality, and space; promoting positive nutrition and lifestyle change; or using touch, imagery, music, humor, or meditation.
I leave, telling her I will check in with her later in the morning. Perhaps we can continue to get to know each other later. I want to hear more of her story, and we will talk more about her self-catheterization, smoking, aftercare, and her children.
I am grateful that I can write referrals to our nutritionist, the social worker with experience in grief counseling, and the minister, all members of our oncology team who will help Debbie with many issues before she is discharged. I breathe deeply and briefly talk with a co-worker before moving on to meet Zeke, a 30-year-old patient with colon cancer.
In her reflection-on-action in the hall, the nurse concedes to the need for ac-tive engagement in critical thought, in pattern seeking, priority setting, and mutual planning with Debbie to identify healing modalities that would best suit her needs.
She resists labeling and categorizing and she seeks instead Debbie’s own meaning related to care. She approaches her care in an open-ended way, recognizing the lim-its of human control in a universe with lim-its own grander purposes. We see evidence
of reframing and consideration of the larger consciousness. She is able to use her own subjectivity and history-in-care as foreground for this relationship with Deb-bie. She envisions possibilities in the relationship of herself and Debbie, conscious-ness to consciousconscious-ness, so that a new field of choices and advanced human capacity can be realized. She considers how their relationship evolved and stores that in memory for future caring opportunities.