The power of consoling presence - hospice nurses’ lived experience with spiritual and existential care for the dying

Abstract

BackgroundBeing with dying people is an integral part of nursing, yet many nurses feel unprepared to accompany people through the process of dying, reporting a lack of skills in psychosocial and spiritual care, resulting in high levels of moral distress, grief and burnout. The aim of this study is to describe the meaning of hospice nurses’ lived experience with alleviating dying patients’ spiritual and existential suffering.MethodsThis is a qualitative study.Hospice nurses were interviewed individually and asked to narrate about their experiences with giving spiritual and existential care to terminally ill hospice patients. Data analysis was conducted using phenomenological hermeneutical method.ResultsThe key spiritual and existential care themes identified, were sensing existential and spiritual distress, tuning inn and opening up, sensing the atmosphere in the room, being moved and touched, and consoling through silence, conversation and religious consolation.ConclusionsConsoling existential and spiritual distress is a deeply personal and relational practice. Nurses have a potential to alleviate existential and spiritual suffering through consoling presence. By connecting deeply with patients and their families, nurses have the possibility to affirm the patients’ strength and facilitate their courage to live a meaningful life and die a dignified death.

For Their Patients

“…Prior studies indicate that working with suffering patients negatively impacts the nurse. 7,9,16,17,20,25 Feelings of distress, sadness, failure, and ''being overwhelmed'' are common experiences accompanied by a difficulty maintaining boundaries between caring for their suffering patients and engaging in their own personal lives. 7,9,20,25 The current study findings are congruent with the previously mentioned studies regarding nurses' coping strategies in the sense that there is the same awareness of being overwhelmed at times, and the same coping strategies were repeatedly identified.…”

“…7,9,16,17,20 In essence, each aspect of suffering is seen as a separate issue instead of one component of the larger issue of ''suffering.'' For example, pain is considered a physical issue until declining functional status and resultant role changes are factored in as part of the larger relational context of what the pain means and is doing to the patient.…”

“…7,[16][17][18]20,21 In this study, the participants identified their main goals as optimizing their patients' QOL and orchestrating a peaceful death for the patient. Bounded by the context of the nursepatient relationship, the participants observed, assessed issues, identified suffering, and intervened to relieve their patients' suffering.…”

“…2,[16][17][18][19][20][21] Interestingly, these studies revealed that participants did identify suffering at times, but when they did, they did not know what to do to alleviate it. Findings also revealed that the participants were affected by their patients' suffering and had difficulty coping with it.…”

“…Although the relief of suffering is a core skill in caring for dying patients, [6][7][8]16 only a few studies have addressed how nurses identify and respond to patient suffering. 2,[16][17][18][19][20][21] Interestingly, these studies revealed that participants did identify suffering at times, but when they did, they did not know what to do to alleviate it.…”