BMC Nursing | |
The challenge of consolation: nurses’ experiences with spiritual and existential care for the dying-a phenomenological hermeneutical study | |
Venke Sørlie1  Kari Kvigne3  Lars Johan Danbolt2  Kirsten Anne Tornøe2  | |
[1] Lovisenberg Diaconal University College, Lovisenberg gt. 15B 0456, Oslo, Norway;Religionspsykologisk Senter (Center for the Psychology of Religion) Innlandet Hospital, Ottestad, Norway;Department of nursing Nesna University College, Nesna 8700, Norway | |
关键词: Phenomenological hermeneutical; Hospitals; Dying patients; Care; Existential; Spiritual; Nurses’ challenges; | |
Others : 1234053 DOI : 10.1186/s12912-015-0114-6 |
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received in 2015-05-14, accepted in 2015-11-19, 发布年份 2015 | |
【 摘 要 】
Background
A majority of people in Western Europe and the USA die in hospitals. Spiritual and existential care is seen to be an integral component of holistic, compassionate and comprehensive palliative care. Yet, several studies show that many nurses are anxious and uncertain about engaging in spiritual and existential care for the dying. The aim of this study is to describe nurses’ experiences with spiritual and existential care for dying patients in a general hospital.
Methods
Individual narrative interviews were conducted with nurses in a medical and oncological ward. Data were analyzed using a phenomenological hermeneutical method.
Results
The nurses felt that it was challenging to uncover dying patients’ spiritual and existential suffering, because it usually emerged as elusive entanglements of physical, emotional, relational, spiritual and existential pain. The nurses’ spiritual and existential care interventions were aimed at facilitating a peaceful and harmonious death. The nurses strove to help patients accept dying, settle practical affairs and achieve reconciliation with their past, their loved ones and with God. The nurses experienced that they had been able to convey consolation when they had managed to help patients to find peace and reconciliation in the final stages of dying. This was experienced as rewarding and fulfilling. The nurses experienced that it was emotionally challenging to be unable to relieve dying patients’ spiritual and existential anguish, because it activated feelings of professional helplessness and shortcomings.
Conclusions
Although spiritual and existential suffering at the end of life cannot be totally alleviated, nurses may ease some of the existential and spiritual loneliness of dying by standing with their patients in their suffering. Further research (qualitative as well as quantitative) is needed to uncover how nurses provide spiritual and existential care for dying patients in everyday practice. Such research is an important and valuable knowledge supplement to theoretical studies in this field.
【 授权许可】
2015 Tornøe et al.
【 预 览 】
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【 参考文献 】
- [1]Costello J: Dying well: nurses’ experiences of ‘good and bad’deaths in hospital. J Adv Nurs 2006, 54(5):594-601.
- [2]Ellershaw J, Neuberger RJ, Ward C: Care of the dying patient: the last hours or days of lifeCommentary: a “good death” is possible in the NHS. BMJ 2003, 326(7379):30-4.
- [3]Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA: Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA 2000, 284(19):2476-82.
- [4]Steinhauser KE, Voils CI, Clipp EC, Bosworth HB, Christakis NA, Tulsky JA: “Are you at peace?”: one item to probe spiritual concerns at the end of life. Arch Intern Med 2006, 166(1):101-5.
- [5]Balboni TA, Paulk ME, Balboni MJ, Phelps AC, Loggers ET, Wright AA, et al.: Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. J Clin Oncol 2010, 28(3):445-52.
- [6]Swinton J, Pattison S: Moving beyond clarity: towards a thin, vague, and useful understanding of spirituality in nursing care. Nurs Philos 2010, 11(4):226-37.
- [7]Gibson C, Tomarken A, Breitbart W. Meaningcentered group psychotherapy for cancer patients. A Time for Listening and Caring: Spirituality in End-of-Life Care(ed. C.M. Puchalski). New York: Oxford University Press; 2004. p. 89–96
- [8]Back AL, Rushton CH, Kaszniak AW, Halifax JS: “Why are we doing this?”: clinician helplessness in the face of suffering. J Palliat Med 2015, 18(1):26-30.
- [9]Boston P, Bruce A, Schreiber R: Existential suffering in the palliative care setting: an integrated literature review. J Pain Symptom Manage 2011, 41(3):604-18.
- [10]Bruce A, Schreiber R, Petrovskaya O, Boston P: Longing for ground in a ground (less) world: a qualitative inquiry of existential suffering. BMC Nurs 2011, 10(1):2. BioMed Central Full Text
- [11]Kristjanson LJ, Aoun S: Palliative care for families: remembering the hidden patients. Can J Psychiatry 2004, 49(6):359.
- [12]Tanyi RA: Spirituality and family nursing: spiritual assessment and interventions for families. J Adv Nurs 2006, 53(3):287-94.
- [13]Kisvetrová H, Klugar M, Kabelka L: Spiritual support interventions in nursing care for patients suffering death anxiety in the final phase of life. Int J Palliat Nurs 2013, 19(12):599.
- [14]Balboni MJ, Sullivan A, Amobi A, Phelps AC, Gorman DP, Zollfrank A, et al.: Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. J Clin Oncol 2013, 31(4):461-7.
- [15]Johansson K, Lindahl B: Moving between rooms–moving between life and death: nurses’ experiences of caring for terminally ill patients in hospitals. J Clin Nurs 2012, 21(13–14):2034-43.
- [16]Nolan S, Saltmarsh P, Leget C: Spiritual care in palliative care: working towards an EAPC Task Force. EJPC 2011, 18:86-9.
- [17]Tan H, Wilson A, Olver I, Barton C: The experience of palliative patients and their families of a family meeting utilised as an instrument for spiritual and psychosocial care: a qualitative study. BMC Palliat Care 2011, 10(1):7. BioMed Central Full Text
- [18]Tornøe KA, Danbolt LJ, Kvigne K, Sørlie V: The power of consoling presence-hospice nurses’ lived experience with spiritual and existential care for the dying. BMC Nurs 2014, 13(1):25. BioMed Central Full Text
- [19]WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en/
- [20]Udo C: The concept and relevance of existential issues in nursing. Eur J Oncol Nurs 2014, 18(4):347-54.
- [21]Christensen KH: Spiritual care perspectives of Danish registered nurses. J Holist Nurs 2008, 26(1):7-14.
- [22]McSherry W, Jamieson S: The qualitative findings from an online survey investigating nurses’ perceptions of spirituality and spiritual care. J Clin Nurs 2013, 22(21–22):3170-82.
- [23]Noble A, Jones C: Getting it right: oncology nurses’ understanding of spirituality. Int J Palliat Nurs 2010, 16(11):565-9.
- [24]Rushton CH, Sellers DE, Heller KS, Spring B, Dossey BM, Halifax J: Impact of a contemplative end-of-life training program: Being with dying. Palliative Supportive Care 2009, 7(04):405-14.
- [25]Henoch I, Danielson E: Existential concerns among patients with cancer and interventions to meet them: an integrative literature review. Psycho-Oncology 2009, 18(3):225-36.
- [26]Swinton J: Identity and resistance: why spiritual care needs ‘enemies’. J Clin Nurs 2006, 15(7):918-28.
- [27]Pesut B, Fowler M, Taylor EJ, Reimer-Kirkham S, Sawatzky R: Conceptualising spirituality and religion for healthcare. J Clin Nurs 2008, 17(21):2803-10.
- [28]Reimer-Kirkham S: Lived religion: implications for nursing ethics. Nurs Ethics 2009, 16(4):406-17.
- [29]Kalish N: Evidence-based spiritual care: a literature review. Curr Opin Support Palliat Care 2012, 6(2):242-6.
- [30]Creswell JW: Research design: qualitative, quantitative, and mixed methods approaches. Los Angeles, SAGE; 2009.
- [31]Ricœur P: Interpretation theory: discourse and the surplus of meaning. Texas Christian University Press, Fort Worth, Tex; 1976.
- [32]Swinton J, Mowat H: Practical theology and qualitative research. SCM Press, London; 2006.
- [33]Dehlholm-Lambertsen B, Maunsbach M: Qualitative methods in empirical health research. III. The individual in-depth interview. Nord Med 1997, 112(3):94-8.
- [34]Lindseth A, Norberg A: A phenomenological hermeneutical method for researching lived experience. Scand J Caring Sci 2004, 18(2):145-53.
- [35]Sørlie V. Being in ethically difficult care situations: narrative interviews with registered nurses and physicians within internal medicine, oncology and paediatrics. PhD thesis. Umeå, Sweden: Umeå University, Medical Dissertations; 2001.
- [36]Rasmussen BH, Jansson L, Norberg A: Striving for becoming at-home in the midst of dying. Am J Hosp Palliat Med 2000, 17(1):31-43.
- [37]Persson C, Sundin K: Being in the situation of a significant other to a person with inoperable lung cancer. Cancer Nurs 2008, 31(5):380-8.
- [38]Lindqvist O, Rasmussen BH, Widmark A, Hydén L-C: Time and bodily changes in advanced prostate cancer: Talk about time as death approaches. J Pain Symptom Manage 2008, 36(6):648-56.
- [39]Ricæur P: From text to action: essays in hermeneutics, II. Continuum, London; 2008.
- [40]Thompson JB. Paul Ricoeur Hermeneutics and the human sciences: Essays on language, action and interpretation. New York: Cambridge University; 1981.
- [41]Geanellos R: Exploring Ricoeur’s hermeneutic theory of interpretation as a method of analysing research texts. Nurs Inq 2000, 7(2):112-9.
- [42]World Medical Association: World medical association declaration of Helsinki. Ethical principles for medical research involving human subjects Bull World Health Organ 2001, 79(4):373.
- [43]Ruyter KW, Førde R, Solbakk JH: Medisinsk og helsefaglig etikk (Ethics in Medicine and Healthcare). 2007.
- [44]Mishler EG: Research interviewing: context and narrative. Harvard University Press, Cambridge, Mass; 1986.
- [45]Van Manen M: Researching lived experience: human science for an action sensitive pedagogy. Althouse Press, London, Ont; 1997.
- [46]Riessman CK: Narrative analysis. Sage, Newbury Park, Calif; 1993.
- [47]Gadamer H-G: Truth and method. Sheed & Ward, London; 2004.
- [48]Schmidt U, Botvar PK: Religion i dagens Norge: mellom sekularisering og sakralisering. Religion in contemporary Norway Between secularization and sacralization). Universitetsforlaget, Oslo; 2010.
- [49]Cassell EJ. The nature of suffering and the goals of medicine. New York: Oxford University Press; 1991.
- [50]Norberg A, Bergsten M, Lundman B: A model of consolation. Nurs Ethics 2001, 8(6):544-53.
- [51]Håkanson C, Öhlén J. Connectedness at the end of life among people admitted to inpatient palliative care. American Journal of Hospice and Palliative Medicine. 2014;1049909114554077.
- [52]Torjuul K, Elstad I, Sørlie V: Compassion and responsibility in surgical care. Nurs Ethics 2007, 14(4):522-34.
- [53]Claxton J: Paving the way to acceptance. Psychological adaptation to death and dying in cancer. Prof Nurse (London, England) 1993, 8(4):206-11.
- [54]Zimmermann C: Denial of impending death: a discourse analysis of the palliative care literature. Soc Sci Med 2004, 59(8):1769-80.