PubMed HealthSearch

Biomedical subjects

J M Morse

Publications and source records attributed to J M Morse.

At least 19 recordsLinked to original sources

Preserving self: from victim, to patient, to disabled person.

Open-ended, unstructured interviews were conducted with patients who had survived serious traumatic injury, and their experiences from impact to recovery analysed using grounded theory. A four-stage process of 'vigilance', 'disruption', 'enduring the self', and 'striving to regain the self' was delineated. The basic social psychological process of 'preserving self' explained the strategies used in each stage, and required deliberate action, focused energy and tremendous effort and will. The strategies used to preserve self changed in each stage of the model. At the beginning, when physical survival was in jeopardy, the strategies were primarily physical. Protecting self was a process of 'taking time out' and of shutting down, in the stage of disruption. In the stage of enduring the self, it was passively learning to 'take it' and to bear the treatments. Finally, in the stage of striving to regain the self, preserving the self was the work of regaining and redefining the self as a disabled person.

Adaptation, Psychological

Strategies of enduring and the suffering of loss: modes of comfort used by a resilient survivor.

In this case study, the narrative of a young mother who survived multiple losses and excruciating and prolonged pain in the treatment of burns is explored to develop and contrast the concepts of enduring and suffering. Joan survived an explosion that resulted in the death of her three children, disfiguring thermal injuries, the loss of her husband through divorce, and, as a consequence, the loss of her home, church, and community. Strategies of enduring--surviving the immediate impact of trauma, the long-term medical treatment and rehabilitation, and social adjustment--are described and contrasted with the experience of suffering. The article describes how Joan ultimately reformulated an acceptable sense of self and of the future. Her capacity to endure pervaded both physical and emotional dimensions of healing. Nursing care that did not assist her to endure, and therefore increased her suffering, and care that was perceived to be comforting, and therefore enhanced her ability to endure and reduced her suffering, are described.

Adaptation, Psychological

Exploring the theoretical basis of nursing using advanced techniques of concept analysis.

In this article, the traditional methods of concept development are critiqued, and alternative methods that use qualitative methods of inquiry are presented. Variations of concept development techniques appropriate to the maturity of the concept being explored are then described, including methods for concept delineation, concept comparison, concept clarification, concept correction, and concept identification. To illustrate the application of concept development methods to nursing theory, a research program to delineate the construct of comfort is described.

Concept Formation

The role of comfort in nursing care: 1900-1980.

A total of 621 journal articles and 17 textbooks written by nurses between 1900 and 1980 were coded for the key words comfort, comfortable, comforting, uncomfortable, discomfort, and pain. A content analysis revealed 12 categories explicating differing roles of comfort in nursing and comfort strategies for the provision of nursing care. The emphasis on comfort and the role of comfort changed throughout the eight decades. From 1900 to 1929, comfort was the central focus and moral imperative of nursing; from 1930 to 1959, comfort was considered a strategy for achieving fundamental aspects of nursing care; and from 1960 to 1980, comfort became a minor nursing goal. Although in this last period the physical aspects of care dominated, emotional comfort became increasingly important. Comfort was only significant throughout the entire period for patients for whom there was no medical treatment. The changing role of comfort over time could account for advances in nursing education, medicine, medical technology, and the adoption of theoretical frameworks into nursing.

Empathy

Tolerating reality: the experience of parents of HIV positive sons.

In this study, the experience of parents as they discover that their son is HIV+ or has AIDS, witness their deterioration and death, is described. Using the methods of grounded theory, 13 parents (8 mothers and 5 fathers) were interviewed and a model depicting the basic social psychological process (BSSP), keeping reality at a tolerable level, was developed. Six stages of tolerating reality are: Suspecting, Taking it in, Going along with the changed reality, Being swept along with symptoms, Beating down the denial, and learning to live with it. Parents engaged in a number of strategies aimed at keeping reality at a tolerable level, so they could function in their 'comfort zone' and cope with day-to-day horror, fear and uncertainty while attending to their son.

Acquired Immunodeficiency Syndrome

The phenomenology of comfort.

From patient narratives, the phenomenological literature and reflection of patients' autobiographical accounts of illness, nine themes reflecting the phenomenological concept of corporeality were used to identify the ways patients achieve comfort. The themes were: the dis-eased body, the disobedient body, the vulnerable body, the violated body, the resigned body, the enduring body, the betraying body and the betraying (neurotic) mind. The process of achieving comfort is based on the patients' needs to live with illness or injury without being dominated by their bodies. The authors argue that while the role of nursing is to provide comfort to the sick, the goal of total comfort is unattainable in patient care. However, if the goal is to enhance comfort, to ease and to relieve distress, comfort remains central to the role of nursing.

Adaptation, Psychological

Identifying types of attending: patterns of nurses' work.

Verbal and nonverbal behaviors of nurses during interactions with cancer patients were examined by analyzing videotapes of caregiving. Using techniques of qualitative ethology, four types of attending were identified: doing more, doing with, doing for, and doing tasks. The findings provide support for an alternative method of classifying nurse-patient interactions that captures patterns of caring.

Communication

"Sensing" patient needs: exploring concepts of nursing insight and receptivity used in nursing assessment.

Nursing assessment utilizes skills that enable the nurse to "sense" the patient's needs and the patient's condition, and that provide a humanistic dimension to the provision of nursing care. The explanatory concepts describing these processes include intuition, emotional empathy, inference, knowing, counter transference, compathy and embodiment. In this paper these concepts are defined, and the more commonly used concepts (i.e., intuition, empathy, and inference) are compared. The underlying assumptions and characteristics are identified and the antecedents or prerequisites, mechanisms, and outcomes of each concept are explored. While some overlap and blurring of boundaries are evident, these concepts are diverse and were developed to apply to different contexts and non-nursing situations. When used alone, none is comprehensive enough to account for nurses' ability to sense patient needs. We conclude that, given the unique aspects of nursing, we must consider using innovative methods to examine this phenomenon (e.g., the use of ethology to examine intuitively perceived changes in the patient's condition), to increase efforts to explore the newer concepts (i.e., embodiment, compathy and "knowing"), and to develop new concepts or models that better represent this complex phenomenon that better fits nursing contexts and situations.

Cognition

Caregiver-infant interaction--comforting post-operative neonates.

Analysis of 40 h of videotaped caregiving to four male infants was conducted using ethology. All infants were full term and had major chest surgery 12 h previously. All incidents of caregiver-infant interaction were examined, and the verbal and tactile comforting behavior of the caregiver was coded for duration, context, infant cue and infant state prior and following the interaction. A total of 191 comforting incidents occurred during the study. Stroking was the most common form of touch used. Most of the comforting (60%) was given in the context of caregiving; sleeping infants were touched often (38%); 25.3% of the touches were given to acutely distressed infants, and wide awake infants relatively little. Most of the infants showed no change in infant state after the relatively brief comforting incidents, but in 15.7% of the incidents the infants 'settled' after comforting. The authors conclude that this is a relatively strong effect considering the short duration of the comforting actions.

Caregivers

Toward a theory of touch: the touching process and acquiring a touching style.

Methods of grounded theory were used to explore the questions: How do intensive care nurses perceive touch and the process of touching? How do intensive care nurses learn to touch? Data were collected by in-depth interviews with eight experienced intensive care nurses from the same intensive care unit of a large urban Canadian hospital. Findings revealed two substantive processes, the touching process and acquiring a touching style, neither of which has been previously reported. The stages and phases of these processes are described as well as cueing, the core variable. Based on the data analysis, touch was conceptualized as a gestalt with multiple dimensions, suggesting that valid operational definitions of touch must incorporate more than skin-to-skin contact.

Adult

Beyond empathy: expanding expressions of caring.

In this paper, a model describing nurses' responses to patients who are suffering is presented. The nurse's level of engagement with the patient is affected by whether the caregiver is focused on him-/herself or on the sufferer (i.e. embodied with the patient) and whether the caregiver is responding reflexively or with a learned response. Four types of communication patterns are identified: engaged responses (first-level) are used in a connected relationship; when the nurse responses reflexively and is focused on him-/herself, the response is reflected; when the caregiver is patient-focused, a learned response is labelled a professional response; and a self-focused, learned response is labelled detached. Examples of each type of response are provided.

Communication

Exploring empathy: a conceptual fit for nursing practice?

After three decades, the efficacy of empathy in the clinical setting remains undocumented. Recently, concerns have been raised that the concept may be inappropriate and even harmful to the nurse-patient relationship. An analysis of the concept indicates that empathy consists of moral, emotive, cognitive and behavioral components. By tracing the integration of this concept into nursing, we suggest that empathy was uncritically adopted from psychology and is actually a poor fit for the clinical reality of nursing practice. Other communication strategies presently devalued, such as sympathy, pity, consolation, compassion and commiseration, need to be reexamined and may be more appropriate than empathy during certain phases of the illness experience. Directions for future research are suggested.

Behavior

Comfort: the refocusing of nursing care.

Caring is an inadequate concept for nursing practice. Rather, if comfort is used as the central paradigm for nursing, the focus of nursing research changes from the nurse to the patient. The components, limitations and relevance of comfort are discussed in this article. Preliminary results of a study exploring the usefulness of comfort in emergency rooms identified eight types of comforting. The characteristics of each type are described.

Caregivers

Releasing restraints: providing safe care for the elderly.

To examine the behavioral effects of releasing restraints and the feasibility of caring for patients considered at risk if unrestrained, two patients were continuously videotaped using surveillance cameras for 1 week with and 1 week without restraints. The videotapes were coded and analyzed using nonparametric and parametric statistics. In Patient #1, motor behavioral changes with a decrease of restless behaviors, as well as changes in sleeping position, were observed. There were no changes in verbal behavior. For Patient #2, no changes in motor or verbal behavior were observed. Nursing care showed a non-significant decrease in nursing care time and an increase in the number of nursing contacts. The implications of the findings and the use of videotapes as a method for collecting observational data in the clinical area are discussed.

Aged

Cree Indian healing practices and western health care: a comparative analysis.

In this article, Cree Indian methods of treating disease are compared with the treatment process and procedures used in the Western health Care system. Ethnographic data permitted the identification of the five components of Cree healing: the ritual, contract, treatment, didactic, and closure components. These components are compared with equivalent phases in the physician-patient and nurse-patient relationship. In particular, the process of comparison permits the identification of incongruities that the Cree may encounter when using the Western system. These include the inability to identify one's own state of health and abnormalities; a passive, rather than a participatory role in healing; the incomprehensible notion of "silent" diseases and preventative treatment; the specialization of the caring, curing, and counselling roles of practitioners and the limited perspective of "holism" in health care.

Attitude to Health