Response to "The Comforting Interaction: Developing a Model of Nurse-Patient Relationship"
Chinn, Peggy L. Rn, PhD, Faan, Scholarly Inquiry for Nursing Practice
The model of comforting interaction of nurse-patient relationship that Morse, Havens and Wilson propose represents an important effort to make sense of nursing's literature, and to bring together two conceptually related threads of investigation. Their work represents nursing's consistent tradition of seeking to know and understand more than isolated facts and events. There are three aspects of their work around which I would like to focus my response to challenge and to question their proposal. My challenges and questions are not meant to diminish in any way the value of their proposed model, but to point to some ideas that also bear serious scholarly attention within the discipline.
First, the stance that Morse, Havens and Wilson have taken in defining comfort as the fundamental purpose of all nurse-patient interactions raises important questions that contribute to the disciplinary discourse focused on clarifying the nature of nursing. I personally take issue with the idea that the central purpose of all nurse-patient interactions is to make the patient comfortable. Certainly many nurse-patient interactions are focused around this goal. It is possible that comfort can be conceptualized very broadly to embrace all forms of health and healing, but in this event I would prefer a different term.
Aside from my personal preference for choice of word label, the idea of comfort implied in the examples and illustrative phrases associated with this idea in the proposed model tends to portray nursing in a manner that I feel diminishes the meaning of our human interactions and societal purpose. The idea of comfort, as important as I believe it is, does not necessarily imply, for example, Nightingale's much broader idea of placing the person in the best position possible for the reparative process of healing. In my view, the proposed model could be strengthened conceptually if comfort were explicitly defined and the situations to which the model applies were limited to those interactions and relationships where comfort, so defined, is indeed the purpose of the interactions. But beyond the consideration of this conceptual component of the model, the larger question is again before those of us in the discipline who are concerned with various conceptualizations of nursing itself.
The second challenge that I pose is related to the larger issue of how we conceive of nursing. The person of the nurse, and the person(s) of those receiving care, are implicitly portrayed in the model from a stimulus-response frame of reference. The patient gives a signal; the nurse responds. Many of the traits or descriptions of nurse-patient relationships that are mentioned in the review of the literature simply do not fall within this frame of reference. Consider, for example, the ideas of developing trust, mutual connectedness, or common ground. Responding to someone's distress can contribute to trust, connectedness and common ground, but this stimulus-response frame seems inadequate to alone account for these and other deeper aspects of relationship.
Perhaps the model of nurse-patient relationship that Morse, Havens and Wilson propose is not as encompassing of relationship as it is presented here; this model might be best used to explain and explore those situations where nurses do respond to an explicit distress message. Relationship, in its broader conceptualization, might better be addressed from a different frame of reference. Hall and Allan (1994), for example, describe a frame of reference for self-in-relation that transcends the medical aspects of disease and in which nursing becomes a joint quest for wellness of mind, body and spirit (p. 110). Hall and Allan's conception of self-in-relation incorporates holistic interactions, and the interactions are grounded within a frame of traditional Chinese medicine, which departs dramatically from a stimulus-response frame of reference. …