346 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration
comprehensive history and physical exam was unremarkable with the exception of her abdomen, which revealed a small,
palpable, nontender mass in the right lower quadrant. I ordered blood tests, all of which were unremarkable with the ex-
ception of the Ca125, which was 625, well above normal parameters. My suspicion for ovarian cancer was confirmed.
Three days after our initial visit, I asked her to return to the office so we could discuss the results. She did so, and with
her she brought a gift. She said I had done so much for her in our visit, she wanted to share with me a precious gift the
Lord had given her—her voice.There, in the office, I sat with her labs in my lap as she serenaded me with a song. I don’t
remember the name of the song, but the verse told me Jesus was calling her home and she was not afraid.
When she was done, we discussed the findings. I advised her that although the blood test was not diagnostic, the pos-
sibility of cancer did exist and she needed to see an oncological gynecologist. She cried and we hugged.
After a month of invasive testing at the family’s prompting, exploratory surgery and biopsies confirmed the diagno-
sis of ovarian cancer with extensive metastasis. The patient underwent a total abdominal hysterectomy and bilateral
salpingo-oophorectomy with debulking, and she died shortly thereafter.
There is a lot one can learn from a case presentation such as this one, but it does not reflect the essence of
what occurred between the nurse and the one nursed. The reader is left wondering what the nurse did that
prompted such a special present in return.
Nursing as Caring Case Presentation
As the morning rolled along, I began to dream. I dreamed I was a tree. My roots entwined deep within the foundation
upon which I stood. I took from the Earth what I needed to nourish and strengthen me. My roots drank from the spring
of knowledge beneath me. I felt strong. I grew tall. My arms outstretched, reached for the sun, found the sky, and in it, a
gentle breeze that surrounded and calmed me. I stood in awe of the sun’s beauty as its rays poured over me and warmed
my spirit. I felt connected. I felt whole.
I saw a glow on the horizon, unlike the sun and different from the moon and stars. An ember, the residual of a fire
that has burned through the night, tirelessly, to provide warmth. I was drawn to it. Unafraid that my branches might catch
fire and burn, I reached for her abdomen. I searched. As my hands pressed on, I began to feel the Earth slipping from the
sky. I reached upward, grasping for the restoration of harmonious interconnectedness, but in the sky, there is nothing to
grab onto.You may grow into it, enjoy its beauty, bask in its breezes, and breathe in its life-giving oxygen, but you cannot
hold on to it or possess it.
My arms grew weary, my leaves were wilted, so I drank from the spring beneath my foundation. My roots nourished
me with courage, patience, trust, and humility. She reached for my hand. Her spirit filled me and strengthened me as she
ascended toward the sky. I began to feel stronger and reached toward the sky, hoping to catch one last glimpse of her
ember and saw her reflection in the sun. Her rays poured over me and warmed my spirit. I felt whole once again.
This nursing story is a reflection of a nursing situation grounded in caring. It demonstrates the perspective of
enhancing other as one lives and grows in caring, which subsequently results in the enhancement of self as the
nurse lives and grows in caring.
Ways of Knowing
I chose this story as the medium with which to share. Boykin and Schoenhofer encourage nurses to choose var-
ious art forms as media for sharing and reflection. This is aesthetic knowing. It is the artful integration of all the
ways of knowing to create a meaningful, caring moment that is born in a nursing situation.
Personal knowing is that which is known intuitively by encountering self and other. Authentic presence is a
key component for my intuitive experiences when I just know. The patient trusted me and humbled herself to
ask me to validate her concern that the mass in her belly was of grave concern.The patient knew, intuitively, be-
fore I laid my hands on her.There is a lot to be gained by learning to trust our intuition, and we can “know” more
by engaging in authentic presence. Authentic presence, for me, removes all physical boundaries to my coming to
know other. It is a spiritual connectedness that has no time limits or physical boundaries. It is a feeling of inter-
connectedness with the patient that reverberates beyond the room, city, state, country, world, and galaxy. It brings
with it the wisdom of the universe.
The first three basic assumptions inherent in nursing as caring facilitate the lived experience of authentic pres-
ence in this moment. The assumption that this person is a caring person by virtue of her humanness, complete
in that moment, gave me the courage to enter into authentic presence to come to know her as a complete, car-
ing person in that moment. As the moment unfolded, our mutual trust enhanced and supported who we were
as we lived and grew in that caring encounter.
The patient’s need to share with me a special gift was validation that she felt it, too. The fifth basic assump-
tion of the theory of nursing as caring is personhood, which is enhanced through participation in nurturing