NSG/416 Week 2: Applying Theory in Nursing Practice, sample paper

A Father Who Would Not Touch His Son: Watson's Caritas Processes Applied at the Bedside of a 26-Week Infant

[Student Name]

University of Phoenix

NSG/416: Theoretical Development and Conceptual Frameworks

Week 2 Assignment

[Instructor Name]

[Date]

The family, the infant and the unit are a composite written for a model paper.

In Week 1, I argued that theory shapes what a nurse notices. This paper applies one theory, Jean Watson's theory of human caring, to a situation from my neonatal intensive care unit that ordinary care did not solve: a father who, for four days after his son's birth at 26 weeks, came to the unit every evening and stood at the doorway of the room without coming to the bedside.

Watson's Theory in Brief

Watson describes caring as the moral foundation of nursing and the source of its contribution to healing. Her theory rests on the idea that a caring relationship between nurse and patient, which she calls a transpersonal caring relationship, affects both people and can open a space in which healing becomes possible even when cure is not. In her later work, Watson expressed the practice of caring as ten caritas processes, among them loving-kindness and equanimity, authentic presence, a helping-trusting relationship, support for the expression of both positive and negative feelings, and the creation of a healing environment (Watson, 2008). The theory's person includes the family, and its environment includes the physical and emotional space the nurse helps create.

Watson's theory is broad, and critics note that it is hard to test. Its value in this situation is that it directs attention to the relationship, which is where the problem lay.

The Situation

The infant, Noah, was born by emergency cesarean birth at 26 weeks and 810 grams. By day four, he was on noninvasive ventilation, receiving small tube feedings of his mother's milk and stable. His mother was still admitted to the postpartum unit and visited twice a day in a wheelchair. His father, Marcus, came every evening after work, washed his hands at the sink outside the room and then stood in the doorway for ten or fifteen minutes. When nurses invited him in, he said he was fine where he was, asked whether Noah had "a good day" and left.

Nurses had charted "father visited" each evening. The care plan listed parent education as complete because the mother had been shown the monitor and the feeding pump. By standard measures, nothing was wrong. By Watson's measures, a relationship that should have been forming was not, and the unit had not noticed.

Research supports the concern. A systematic review of fifteen studies found that fathers find the neonatal intensive care environment stressful, more so than fathers of healthy term infants, and named the alteration of the parental role, the infant's appearance, the environment and communication with staff as the main stressors (Prouhet et al., 2018). The same review observed that nurses often focus on the mother and overlook the father's stress. Earlier interview research with parents of infants in intensive care had already described the loss of the expected parenting role, being unable to hold, feed or protect one's own child, as among the most painful features of those weeks (Obeidat et al., 2009).

Applying the Caritas Processes

Authentic presence. On the fifth evening, I asked another nurse to cover my second patient for twenty minutes and went to stand beside Marcus in the doorway instead of inviting him in. I did not start with information. I said that many fathers find the first days hard to walk into, and I waited. Watson describes being authentically present as enabling a deep belief system of the other person, which in practice meant meeting him where he stood rather than where the unit wanted him to be (Watson, 2008). The first caring act was not an invitation but a change in where the nurse stood.

Supporting the expression of feelings. After a long silence, Marcus said that Noah looked "like he could break if I breathed on him" and that he was afraid the alarms went off because of something he did. He had seen an alarm sound the first time he came to the bedside, on the night of the birth, and had not come close since. The caritas process of supporting the expression of positive and negative feelings meant letting that fear be spoken without rushing to correct it.

A helping-trusting relationship. Only then did I offer information, and I offered it as a response to his fear rather than as a lesson. I explained that the alarm he heard was almost certainly a routine oxygen dip that Noah's own breathing corrected, and that such alarms happen many times a day with or without visitors. I asked whether he would like to watch the monitor with me from the doorway for a few minutes, which he did, and he saw two alarms that resolved on their own.

Creating a healing environment. The next evening, I dimmed the room lights, silenced nonessential monitor sounds within the unit's safety limits and set a chair beside the incubator before he arrived. When he came to the doorway, the room looked less like the one from the night of the birth.

Assisting with basic needs as sacred acts. I then offered him a specific, safe task: containment holding, one hand cupped around Noah's head and the other around his feet, without stroking. I held my hands over his for the first minute. Noah's heart rate and saturation stayed steady, and Marcus stayed at the bedside for forty minutes.

What Changed

Over the following week, Marcus visited the bedside every evening, learned to take Noah's temperature and to change his diaper through the incubator portholes and, on day twelve, held him skin to skin for the first time. The unit changed too: at my suggestion, the charge nurses added a line to the evening handoff asking whether each father or second parent had come to the bedside, not only to the room.

What the Theory Added

Standard care had delivered accurate information to this family and had documented it correctly. What it had not done was notice that a parent was stuck, because nothing in the routine looked for it. Watson's theory directed attention to the relationship and to the father as a person in the care, and its caritas processes suggested an order of action, presence and listening first, information and tasks after. That order was the opposite of the unit's habit, and it worked.

Conclusion

Applied to one father at one doorway, Watson's theory of human caring explained why routine education had not helped, suggested what to do instead and gave the nurse a language to teach the change to colleagues. The next two weeks turn to Patricia Benner's model, which asks a different question: how a nurse learns to notice situations like this one at all.

References

Obeidat, H. M., Bond, E. A., & Callister, L. C. (2009). The parental experience of having an infant in the newborn intensive care unit. The Journal of Perinatal Education, 18(3), 23-29. https://doi.org/10.1624/105812409X461199

Prouhet, P. M., Gregory, M. R., Russell, C. L., & Yaeger, L. H. (2018). Fathers' stress in the neonatal intensive care unit: A systematic review. Advances in Neonatal Care, 18(2), 105-120. https://doi.org/10.1097/ANC.0000000000000472

Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). University Press of Colorado.