Based substantially on his valuable input, I made the decision to transfer my father to hospice. The hospice doctor also demonstrated carative nursing in his sensitive response to my sister's concerns that placing our father in hospice and directing that medical intervention efforts be withheld was tantamount to just allowing him to die prematurely. He explained to her the clinical significant objective scientific basis upon which it was clear that even the most aggressive medical intervention would be unable to prolong his life for more than a few weeks and that the relative value of those extra three weeks from his perspective were just not worth the amount of discomfort and confusion just to slightly prolong the same inevitable end of his life.

The nursing staff allowed me to assist with his care and I was able to stay with him and to sleep by his bedside while they took over his care. I was still able to sleep and rest in between while the staff cared for him. During this period, my sister expressed that she always had been afraid to care for our mother this way and felt guilty about not being there for her in this way when she was dying. The next morning, I knew that my father was likely close to the end and I called my sister, asking her to bring some of Dad's things. When she arrived, I showed her how to turn him and we washed him together and we gave him a haircut, and turned him on his side. He became a little restless, and I explained that he needed morphine. She was fearful and asked how I could know this and I showed her that his heart rate and respiratory rate were elevated, that his facial expressions were stressed, and his hands were tightly gripped into fists. The nurse came in, did an assessment, concurred, and administered some medication. He immediately relaxed, and was able to speak to us briefly and express that he was comfortable and appreciative before drifting off to sleep and then onward to his peaceful place.

Personal Reflection

The sensitive application of several important carative factors through the input of the ICU specialist and of the hospice physician had helped me reconcile my personal sense of loss with my desire to do the right thing for my father, and to recognize that natural death is not tragic, but can actually be the only possible relief from prolonged discomfort with the same eventual end. The experience also taught me how important a part in carative nursing it is to devote sufficient attention and care to family members of the patient as well as to the patient. Sometimes, because of our clinical training, we focus exclusively on the patient's clinical needs and not on the holistic needs of the entire family unit.

If I could have done anything differently to enhance the transpersonal relationship, it would have been to try to understand my sister's perspective more objectively in terms of her reality and all the factors that made it so different from mine in...

I learned that carative nursing would have allowed me to recognize that my sister's reluctance to assist with my father's care earlier was a function of her personal reality that included fear and unfamiliarity with nursing and that my defensiveness and resentment were functions of my failure to appreciate her perspective in the way taught by Watson.
While there was comparatively little we could provide for my father from a clinical perspective, we were able to share in his care at the end of his life in a manner that will allow both of us move on with our lives. We both know that we did the right thing for my father and that we were able to share an important experience that reinforced our identities as caring people, good daughters, nurses and caretakers, sisters, friends.

In retrospect, Watson's carative factors and having gone through this experience will provide gave me valuable guidance in my future practice and motivate me to observe the effects of my caring, as well as to operationalize caring into measurable outcomes. Watson's approach to nursing helps me think of caring as an intentional, planned nursing action that support harmony of self and others and is as important to comprehensive patient care as clinical care. Ultimately, it is an approach that allows me to better understand and empathize with others and to provide nursing care that is supportive, spiritual, and conducive to acceptance, growth, and the promotion of health through building trusting beneficent relationships with patients, family, coworkers, and with ourselves.

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