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CHAPTER 9 Patricia Benner 137

particular situation helped both family members morgue. The nurse took care of all intravenous
and nurses to be more satisfied and less anxious. lines and tubes while the children bathed her.
The family developed a close relationship with the The nurse provided evidence of how finely tuned
three nurses who consistently cared for Mrs. Walsh her skill of involvement was with this family
and shared with them details about Mrs. Walsh and when she explained that she felt uncomfortable
her life. at first because she thought that the son and
The nurse related that there was a tradition in daughter should be sharing this time alone with
this particular critical care unit not to involve their mother. Then she realized that they really
family members in care. She broke that tradition wanted her to be there with them. This situation
when she responded to the son’s and the daughter’s taught her that families of critically ill patients
helpless feelings by teaching them some simple need care as well. The nurse explained that this
things that they could do for their mother. They was a paradigm case that motivated her to move
learned to give some basic care, such as bathing into a CNS role, with expansion of her sphere of
her. The nurse acknowledged that involving family influence from her patients during her shift to
members in direct patient care with a critically ill other shifts, other patients and their families,
patient is complex and requires knowledge and and other disciplines.
sensitivity. She believes that a developmental pro-
cess is involved when nurses learn to work with Domain: The Helping Role of the Nurse
families. This narrative exemplifies the meaning and in-
She noted that after a nurse has lots of experi- tent of several competencies in this domain, in
ence and feels very comfortable with highly tech- particular creating a climate for healing and pro-
nical skills, it becomes okay for family members viding emotional and informational support to
to be in the room when care is provided. She patients’ families (Benner, 1984a). Incorporating
pointed out that direct observation by anxious the family as participants in the care of a criti-
family members can be disconcerting to those cally ill patient requires a high level of skill that
who are insecure with their skills when family cannot be developed until the nurse feels compe-
members ask things like, “Why are you doing this? tent and confident in technical critical care skills.
Nurse ‘So and So’ does it differently.” She com- This nurse had many years of experience in this
mented that nurses learn to be flexible and to reset unit, and she felt that providing care for their
priorities. They should be able to let some things mother was so important to these children that
wait that do not need to be done right away to give she broke tradition in her unit and taught them
the family some time with the patient. One of the how to do some basic comfort and hygiene mea-
things that the nurse did to coordinate care was to sures. The nurse related that the other nurses in
meet with the family to see what times worked this critical care unit held the belief that active
best for them; then she posted family time on family involvement in care was intrusive and
the patient’s activity schedule outside her cubicle totally out of line. A belief such as this is based
to communicate the plan to others involved in on concerns for patient safety and efficiency of
Mrs. Walsh’s care. care, yet it cuts the family off from being fully
When Mrs. Walsh died, the son and daughter involved in the caring relationship. This nurse
wanted to participate in preparing her body. This demonstrated moral courage, commitment to
had never been done in this unit, but after care, and advocacy in going against the tradition
checking to see that there was no policy forbid- in her unit of excluding family members from
ding it, the nurse invited them to participate. direct care. She had 8 years of experience in this
They turned down the lights, closed the doors, unit, and her peers respected her, so she was able
and put music on; the nurse, the patient’s daugh- to change practice by starting with this one
ter, and the patient’s son all cried together while patient-family situation and involving the other
they prepared Mrs. Walsh to be taken to the two nurses who were working with them.

Continued