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90 UNIT II Nursing Philosophies

nursing staff, and social worker. You stand close theory and carative factors/caritas can potentiate
as the neonatologist explains to Maria and her successful outcomes and an optimum state of
husband, through the interpreter, that Lilia will health for Maria, her husband, and their new-
receive exemplary care at the tertiary hospital. born daughter.
Maria is tearful, and her husband appears stressed After the routine postpartum exam, you address
as the interpreter translates that their newborn is Maria’s biophysical needs for rest and her emo-
being prepared for immediate transport to the tional concerns. You encourage the neonatologist
regional hospital for specialized assessment and and nursery staff to let the parents bond with Lilia
care. Maria is stable and her postpartum course before her transport. Then you consult the hospital
is normal, with the exception of her anxiety chaplain for visitation and request a Spanish-
related to the unknowns of Lilia’s condition, speaking priest and a hospital interpreter to be
separation from her newborn, delayed breast- available for patient teaching for instructions and
feeding, and language barriers that prevent a early discharge after her 24-hour stay. You speak
better understanding of events pertaining to her with the social worker since she can be a liaison
and Lilia’s care. between mother and newborn during Lilia’s trans-
You let the theory guide you as you assess port. Throughout the care of Maria, Daniel, and
Maria’s stress/anxiety related to her separation Lilia, you facilitate a practice of loving kindness
from her newborn, fear of her newborn’s progno- among the caregiving staff to achieve continuous
sis, inability to breastfeed, language barriers, and culturally sensitive care, as that guides your prac-
financial concerns. You know that if Maria does tice. You know that the nurse-midwife–patient
not have skin-to-skin touch, impairment of relationship has resulted in a therapeutic outcome
bonding may lead to oxytocin suppression and because Maria and Daniel report feeling some
delays in milk production. Her stress and lack of comfort after speaking to the priest and the nurses
rest also can hinder her normal recovery from a at the tertiary care hospital. Maria is able to rest the
spontaneous vaginal delivery and may lead to previous night, and her postpartum examination is
blood loss and delayed involution. Engorgement normal. Maria now has a breast pump, and the staff
or decreased lactogenesis may occur as the result nurses explain its use. The social workers have
of infrequent or interrupted breastfeeding. Maria arranged transportation for Maria and Daniel to
has limited family support, with the exception of visit their newborn at the Level III hospital after
her sister-in-law, who lives 3 hours away; she they are discharged today. Maria has spoken to her
lacks a friend network because of her immigra- sister-in-law, and she will continue to care for the
tion from Mexico, and she has no support group children for several more days. Maria and Daniel
to support coping. Although Maria has a Chris- tell you how grateful they feel that you have been
tian belief system, she has no church affiliation at their nurse-midwife throughout their experience.
this time for spiritual guidance/support or fellow- Valerie G. Taylor, MSN, CNM
ship of members. You know that Watson’s caring Hickory, North Carolina

CRITICAL THINKING ACTIVITIES
1. Review the values and beliefs in your own philos- how you might incorporate the characteristics
ophy of person, environment, health, and nursing into your style of nursing practice.
to discover if your beliefs fit with Watson’s 10 3. Create a list of caring behaviors in your own
carative/caritas assumptions. nursing practice. Review Measuring Caring:
2. Think of a time in your life when you felt that International research on caritas as healing
someone truly cared for you. Identify the major (Nelson & Watson, 2011), and compare with
characteristics of these interactions, and describe