The tray was set up and the nurse was about to feed her but Karina surprised her by shaking her head to say no thank you and proceeded to pick up the cup with the stumps of her lower forearms and brought it to her lips and proceeded to drink without spilling a drop. In like manner she used silver ware and was able to wield a fork effortlessly with great ease to the amazement of the staff in the rehab dining room. This demonstrates carative factor nine which is assistance with the gratification of human needs. On afternoon rounds, the nurse found Karina crying quietly in her room. With great difficulty because of the language barrier, the nurse was able to detect that Karina’s foster mother, actually church surrogate mother, had gone for the day and she was trying to call her birth mother in San Salvador using a calling card, but was having difficulty dialing. She needed to make the call because her mother did not have a phone at home and had a designated time to receive a call from a neighbor’s house. Karina was scheduled for surgery the next day and appeared frightened with no on by her side. The nurse assessed the situation and noted there was only emotional pain. With a calm voice, caring gestures and the gentle touch of the nurse’s hands to Karina’s lower forearms the nurse was able to abate the tears. Using Watson’s carative factor number 4, the nurse established a helping-trust relationship. The Nurse used the calling card