Scholarly Aesthetic
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Scholarly Aesthetic Appreciation Paper
Nursing Situation
My friend’s father had suffered a massive CVA two weeks earlier. He was in a vegetative state, and prognosis for any kind of rehabilitation was poor. The day before my visit, my friend and her three siblings had reluctantly decided not to install a feeding tube, and move him to in patient hospice. The room was dark and the four siblings were sitting away from the bedside in different parts of the room and looking miserable. Martin, the father was lying on his side with eyes wide open. I walked in and hugged each of them, asked them “what’s doing?” My friend asked if I thought they had made the right choice to put their father into hospice. “Isn’t that giving up? What if we put the feeding tube in and send him to rehab, and he gets better?” I asked her what his CT scan showed, what the two neurologists’ opinions were, and what the primary physician said over the course of an hour long conversation with all of them. As we spoke they seemed to respond to my logic, seemed to value what I was saying. They moved closer together. “Well you really had no choice, did you?” I said at one point. It seemed like at that moment, it clicked for them. They were not choosing to let him die, he was going to die as a result of his stroke, and they had just chosen the most comforting way for him to pass.
I then moved my chair over to Martin, in front of his face. I looked directly into his eyes, smiled, held his hand and massaged it and spoke calmly. I told him who was in the room, and called each of the siblings over, and encouraged them to move closer where they would be in his field of vision. I believe that when I made eye contact with him, he saw me, his eyes were not glazed over, and we connected on some primitive level.
Soon the floor nurse walked in to do some basic care, and she pulled the blanket off Martin and was starting to remove his gown in front of all of us! I actually saw him grimace. I quietly walked over and pulled the curtain and told the nurse we would wait outside until she was done, then I told Martin we would be back soon and reassured him that the nurse was just going to change and reposition him.
When we returned to the room, I encouraged all of Martin’s children to touch him, and hug him, they had seemed almost afraid to be near him. They each approached him, tentatively at first, and did indeed hug him. It seemed to be a meaningful moment for each of them. Before I left we discussed playing some of his favorite music in the room, and putting up pictures of the grandchildren and other family members within his field of vision.
The essence of caring in this nursing situation was providing comfort in an end of life situation.
Theoretical Perspective
Kolcaba’s comfort theory (1994) is based on two dimensions. The first dimension of comfort consists of relief, ease and transcendence. Relief refers to having a specific need met. This enables a return to a previous function or a peaceful death. Kolcaba defines ease as a state of calm or contentment, this enables adequate performance. Transcendence is the state in which there in enhancement or improvement. Kolcaba asserts that comfort is a desired result of nursing care because it leads to improvement in the physical or psychological aspect. She further claims this is crucial for a peaceful death, because of the psychological strength required by the dying person in order to accept and finally release. These states of comfort are continuous, overlapping and interdependent.
The second dimension refers to the context in which comfort occurs. They include the physical, or pertaining to the body; the second is psycho spiritual, which encompasses self awareness, esteem, and relationships with a higher being. The third is social, and refers to family and other interpersonal relationships. The fourth is environmental, which deals with light, noise, temperature, etc. of surroundings.
A nurse practicing from this theoretical perspective could give nursing care that addresses both dimensions of comfort theory. Her interventions could be based on an assessment of comfort states in each context. These could be providing oral care, giving information about upcoming tests or procedures, or holding their hand while they pray. Any shortfall in a context would lead to the providing of a comfort measure, and would result in relief, ease or transcendence.
Explication of Caring Essence
Comfort as a concept and goal of nursing care has been discussed since Florence Nightingale’s time. Usually it is discussed along with the concept of relieving pain. Gropper (1992) discusses comfort as a nursing action. These actions address physical, psychological, social, spiritual and environmental levels of comfort. She specifically addresses the value of “verbal and tactile exchanges as means of providing comfort; a calming voice and a warm touch help to alleviate distress” (p.7). In my nursing situation I was constantly touching and calmly speaking to Martin. This part of Gropper’s discussion is very similar to Kolcaba’s comfort theory. Gropper goes on to conclude that since discomfort or pain is often the reason most people seek health care, if the nurse teaches the patient appropriate ways of comforting themselves, it would lead to health promotion.
The decision to provide comfort in an end of life situation is often arrived at after much moral and ethical deliberation. Patients, families and health care providers do not always know when to transition from life — extending actions to providing comfort measures. Smith (2007) encourages use of the term “loving decision” (p.44). Often in an end of life situation, families must understand that it is the causative illness that will kill their loved one and not the removal of life support. Once they make their decision, it is easier to accept if they feel it came from a loving place. When I helped my friend and her siblings accept their decision to transfer their father to in patient hospice, I helped them realize they were making a “loving decision.” This also relates to Kolcaba’s (1994) comfort theory. The context was social, and provided relief. In this case by removing life support, Martin was at peace, and calm and his family felt they had made the right choice.
The focus of an article written by Morse, Bottorff & Hutchinson (1994) identifies nine themes