CASE STUDY

Mr. Jones is a 65-year-old man whose wife died 6 months ago after a long illness. The couple had been married 45 years, and they were devoted to each other. They had three children who are now in their 30s. Two of the children live several hundred miles away, but one son lives with his wife and two preschool children less than 1 mile from Mr. Jones’s home.

Mr. Jones provided much of the care for his wife during her illness. Although her care was time-consuming and fatiguing and kept him at home much of the time, he was grateful that he could care for her. He now is alone in their home, is very lonely and uninterested in preparing meals or eating, and lacks energy to return to his former community and social activities or even to interact with his son and family.

The hospice nurse contacted Mr. Jones for follow-up bereavement counseling. She told him that although he had “passed” a routine physical examination the week before, she was concerned about his continuing sadness and lack of energy. The nurse reassured him that it was not uncommon to grieve for many months after a major loss. She asked him if he thought his wife would have had a similar experience if he had been the first to die. His response was that his wife would have had an even more difficult time adjusting. The nurse and Mr. Jones then spent some time reflecting on his loss and feelings, and talking about his response. The nurse’s initial question and Mr. Jones’s resulting insight that his grief was not as bad as his wife’s would have been helped him transcend his immediate experience of loss and find some meaning in his grief.

This illustration is an example of an inward expansion of self-boundaries indicative of self-transcendence. Other expressions of self-transcendence might help Mr. Jones facilitate his own healing and regain a measure of well-being.

In terms of outward expansion, Mr. Jones, with some encouragement, might reach out to his son’s family to begin to reconnect to the world outside himself. Walking to and from his home to theirs could expand his sensory world and provide opportunities to interact with other people and with nature along the way. Spending time with his grandchildren could be enlivening through the joy young children can bring to an older person, as could a sense of satisfaction derived from being helpful to his son and daughter-in-law.

Offering at a future time to use the skills he learned while caring for his wife through volunteering with hospice would be an example of transcending temporally. Integrating his memories of Mrs. Jones into his current life would be another example of temporal self-transcendence.

Transpersonal self-transcendence is another important experience for Mr. Jones. Although he was unable to attend church services for several years, he had in the past found worshiping with others a source of comfort. His spiritual life might even be expanded to consider new spiritual dimensions such as that found in the possibility of “being with” his wife again someday or in some way experiencing her presence in the present. Returning to church or to addressing spiritual dimensions outside of organized worship that relates Mr. Jones’s understanding of death to some greater or divine design is another example of transpersonal self-transcendence.

· Learning outcomes:

4. Relate selected nursing theories to transcultural and holistic care
5. Interpret nursing theories and their utilization in nursing education, practice, and research
6. Include theories and concepts from liberal education in providing safe and effective care

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Case Study 13. NT
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