Contributor: Kunta Gautam

My clinical practice as a pediatric nurse practitioner resides in an outpatient urgent care setting next to the hospital’s emergency department. In this blog post, I will share  a clinical encounter that inspired reflection on the meaning of my practice as a nurse .

A 14-year-old girl came to the clinic because she was experiencing  twitching of her eyes. I will call her Maya.

Before seeing Maya, I looked at her chief complaint and thought I would not be able to do much as an urgent care nurse practitioner. I searched her records and found no related history consistent with the current problem. I then thought, let me see her first. Maya was sitting on the exam table, frequently moving her head to the right side, which appeared to be involuntary, jerky movements. The eyelids of both eyes were twitching often. She seemed very uncomfortable. I asked Mom, “How long has Maya been having these problems? Mom stated that Maya started high school three months ago. In the first month of school, she would have those episodes occasionally only during school but had no issues at home. Gradually, these movements became frequent, lasted longer, and affected her school performance. And this time, she has been experiencing these twitching movements at home for two days. Maya said, “These movements are on their own, and I cannot stop them.”  She was experiencing difficulty in eating, not sleeping well, and feeling restless. There were no known neurological or psychiatric problems and no history of falls or trauma.

Her physical exam was completely normal. I asked her about her school. She looked worried and said balancing schoolwork and other activities was stressful. I then asked her mom if she gets adequate sleep at night. Her mom said she is on the phone or working on schoolwork and usually sleeps late. She skips her breakfast and does not take a water bottle to school. She has two extracurricular activities after school. As part of a complete physical exam, I asked her to lie down on the table. To help her relax, I placed my left palm on her forehead as I tried to get a comprehensive history from her mom. Without any concurrent problems, I concluded that these abnormal movements were related to stress, overstimulation, and lack of adequate rest. I started explaining to Mom about avoiding skipping meals, increasing water intake, avoiding caffeine and junk foods, reducing extracurricular activities after school, playing relaxing music at home or making the home environment peaceful and quiet, and scheduling a 30-minute meditation time every evening and practicing breathing exercises. Mom looked convinced. I also recommended that if the problem does not seem to improve after following these steps, follow up with her primary care provider and consider a child psychologist and/or psychiatrist or neurology consultation.

After finishing my explanation to Mom, I looked at Maya. My left hand was still on her forehead. Tears were rolling down her eyes. She looked calm, relaxed and reassured. She was not moving her head or neck. There were no eye-twitching movements. This made me realize that my hand on her forehead was healing her during my conversation with Mom. She got up and wiped her face. She did not have any further abnormal movements. I was pleasantly surprised and overwhelmed. Could that be the healing touch of my hand on her forehead? I felt that experience so intensely, and it felt magical. Dr. Watson stated, “It is possible to read, study, and learn about, even teach and research the caring theory; however, to truly “get it,” one has to personally experience it.” This led me to go back and review Jean Watson’s extensive work on the theory and philosophy of human caring. I was able to understand this from Watson’s perspective.

Historically, Watson introduced the idea of caring science in her book “Nursing the Philosophy and Science of Caring, ” published in 1979. Her theory of human caring was developed between 1975 and 1979. The theory was designed to bring meaning and a distinct focus to nursing. From this emerging perspective, Dr. Watson developed unique caring and healing arts that individuals require for inner healing with the help of a framework called carative factors, which contrasted curative factors of conventional medicine.

The major concepts that constitute Watson’s theory are:

1.   Caring moment/ caring occasion

2.   Caring (healing) Consciousness

3.   Transpersonal caring relationship that includes self, phenomenal field, and intersubjectivity.

Watson’s caring theory intersects science, spirituality, humanity, the arts, and the new dimensions of nursing and mind-body-spirit medicine, forming a human phenomenon.

The occasion of caring happens when nurse and patient come together and form a human-to-human connection, shedding the differences and connecting to a common focal point. The nurse, transcending in the form of humanity, seeks to understand from the patient’s perspective and recognizes herself in her patient.

Caring consciousness occurs through intentionality. The caring occasion is consciously heart-centered in the caring moment, transcending into spirituality, combining energies of caring, healing, and loving. There is profound healing when one who is caring and one who is cared for are interconnected by these cosmic energies of caring, healing, and loving. It transcends time and space and can exceed the dimension of physicality.

The transpersonal caring relationship is the interaction of caring occasion and healing consciousness. Hands are used as a conduit of care. The process is intersubjective and goes deeper than physical interaction.

Watson’s work has evolved over the years. In 1985, the goal was to help individuals attain harmony with their minds, bodies, and souls. This helped generate self-healing, self-knowledge, and self-reverence.

Diving deep into the model of Unitary Caring Science, I discovered an article by Smith & Reed (2023) on the Theory of Healing through Touch. This theory was developed within Rogers’ Science of Unitary Human Beings (SUHB). Based on Rogers’ theory, human beings are viewed as energies. Smith & Reed developed three themes from their qualitative study findings related to the experience of healing through touch: sensing, reflecting, and connecting.

Sensing- “Touch is a sensory experience; it goes beyond sensing a particular area of the body to an experience of our whole being. Touch is a reminder of our pan-dimensional unitary nature, and in this way relates to healing: re-membering our integral nature. It is a reminder of our wholeness, human-environment integrality,” (Smith & Reed, 2023). Sensing relates to wholeness within Rogers’ SUHB.  Sensing is described as tingling, warmth, relaxation, blanketed, and out-of-body sensation, which goes into the pan-dimensional energy field promoting healing.

Reflecting—It transforms information collected by sensing. Reflecting is parallel to the concept of awareness within the SUHB. Touch enhances awareness so that perceptions, expressions, and experiences are accessed, considered, and reexamined. Touch has the potential to awaken our pan-dimensional awareness. Touch can communicate past, present, and future and can be assigned meanings and interpreted differently.  The spatial-temporal reflection during simple touch provides space for reflection, integration of information, or expanding awareness. The person receiving the touch may experience unexpected thoughts and feelings.

Connecting- It refers to the concept of presence within the SUHB. Touch breaks down the experience of isolation and barriers of perceived separateness. The person providing the touch conveys a message to the person receiving the touch that they are not alone and that the giver can understand the receiver’s feelings.

Smith & Reed summarize the themes of sensing, reflecting, and connecting, which are not exclusive of one another but overlap in meaning. The process is nonlinear, and the patient might experience all three themes at one time. Sensation by touch can act as a medium for communication and connection together.

References

Rogers M.E. (1992). Nursing Science and the Space Age. Nurs Sci Q, 5(1), 27–34. https://doi.org/10.1177/089431849200500108

Smith, M. C., & Reed, S. M. (2023). A unitary theory of healing through touch. Advances in Nursing Science, 46(2), 219-232. https://doi.org/10.1097/ANS.0000000000000487

Watson, J. (1979). Nursing: The philosophy and science of caring. Boston, MA: Little, Brown. [Second printing, 1985. Boulder, CO: Colorado Associated University Press.]

Watson, J. (1985). Nursing: Human science and human care. Norwalk, CT: Appleton-Century-Crofts. [Second printing, 1988. Boulder, CO: Colorado Associated University Press. Third printing, 1988. New York, NY: National League for Nursing. Reprinted, 1999. Sudbury, MA: Jones and Bartlett].

Watson, J. (2015). Jean Watson’s theory of human caring. In M. C. Smith & M. E. Parker (Eds.), Nursing theories and nursing practice (4th ed., pp. 321-339). Philadelphia, PA: F. A. Davis.

About Kunta Gautam

Dr. Gautam earned a Bachelor of Science in Nursing from B.P. Koirala Institute of Health Sciences in Nepal, followed by a Master of Science in Nursing with a specialization as a pediatric nurse practitioner and a Master of Public Health in community health practice from the University of Texas Health Science Center at Houston (UTHealth) system. Her academic journey culminated in a Doctor of Philosophy in Nursing Science from Texas Woman’s University.

Dr. Gautam is an Adjunct Faculty member at Prairie View A&M University and a Clinical Preceptor for Nurse Practitioner students at her clinical practice sites. She is a dedicated pediatric nurse practitioner with 16 years of experience as an NP and 5 years as an RN.

Dr. Gautam is passionate about teaching/ learning and writing activities that stem from philosophy, nursing science, public health, and conscious thinking. Looking ahead, Dr. Gautam is working on building a service model to help children and families with autism spectrum disorder.