Fluent Essays

message for instructionsJAOA • Supplement 7 • Vol 107 • No 12 • December 2007 • ES33Bruce • Helping With the Grieving Process When addressing pain, it is impor-tant to recognize an inextricable relationship between physical experi- ences of the body and those that are emotional, cognitive, and spiritual. Feeling pain is paradoxical: both unde- niably real and exclusively subjective in measurability. Whether specific phys- ical contributors to a given experience of pain can be judged to be neuropathic, nociceptive, or visceral in origin, all psy- chogenic components of pain—psy- chological, social, spiritual, and emo- tional—will be added to the physiologic register and mediated through the cen- tral nervous system. The effect will be reverberating, greatly influencing the ability of patient, family, and the care- giving team to cope with the patient’s ill- ness and gain the comfort and hope that is so necessary to maintaining quality of life. The pain of grief is no exception, and can be a powerful factor in the total pain experience that must be managed not only by the patient, but also by all those involved in the patient’s care. Grief can be defined as the neu- ropsychobiological response to any kind of significant loss, with elements both typical and unique to each individual or situation. The grief response is gen- erally associated with degrees of suf- fering, at times intense or even unbear- able, and of widely variable duration. Grief is a systemic event, whether the system is an individual or a larger group of individuals thrown out of equilibrium through changes brought on by loss. Mourning is the shared expression of a grief experience, important in gaining a new equilibrium following any manner of deficit, including decreased function or role, loss of assumed health, and diminished dreams of the future. Grief and mourning together constitute the grief process, rep- resenting movement from life through death and back into life again. A grief process for the patient with cancer and all those related in the system of care may begin at the time of a prognosis of terminal illness, but more often even before that point, at the onset of any life- limiting or life-altering condition. Every change in status will alter the ensuing grief trajectory to some degree. In the medical arena, the team that has focused its efforts on healing often drops out when a patient becomes ter- minally ill. Patients and family mem- bers may experience this “dropping out” as abandonment at the moment of their greatest need by the experts to whom they have entrusted their hope. They are left to traverse the landscape of approaching death on their own, with all its emotional intensity, often without knowing what to expect or how to inter- pret what is happening to the patient physically. How can medical profes- sionals become personally prepared to assist in this often intense and very inti- mate passage of life into death and in its aftermath? The best preparation is both didactic 164 JCN/Volume 30, Number 3 journalofchristiannursing.com Gail E. Pittroff, PhD, RN, is an Assistant Professor at St. Louis University in St. Louis, Missouri, and a Commissioned Lay Minister in the United Church of Christ. She has experience in ICU, maternal newborn, hospital administration, hospice, and inpatient palliative care. The author declares no conflict of interest. Accepted by peer review 1/9/13 DOI:10.1097/CNJ.0b013e318294e8d3 By Gail E. Pittroff Humbled Expert: An Exploration of Spiritual Care Expertise ABSTRACT: This interpretive phenomenological study explored how inpatient palliative care nurse consultants provide spiritual care and how they acquired these skills. Humbled experts describes the nurses’ personhood and spiritual care practices, offering insight for skilled spiritual care in any setting. KEY WORDS: chaplaincy, end-of-life, nursing, palliative care, spiritual care N ic k Si nc la ir / A la m y The Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. http://www.journalofchristiannursing.com journalofchristiannursing.com JCN/July-September 2013 165 component of quality end-of-life care, yet there is a paucity of research on spiritual care in the inpatient setting at the end of life. The purpose of this study was to better understand how inpatient palliative care nurse consultants provide spiritual care and how they acquired these skills. Additional aims included discovering the personhood of nurses providing spiritual care for dying patients. A purposeful sample of 10 experi- enced palliative care nurse consultants working in inpatient palliative care in the Midwestern United States were recruited for two recorded semi structured interviews to produce 20 transcripts. Institutional review board approval was obtained from the author’s institution, and informed consent was obtained from all partici- pants. A historical self-awareness, nurs- ing process, and expertise in practice interview guide were utilized to obtain narrative data (Benner, Tanner, & Chesla, 2009). Transcripts were decoded, checked for accuracy, and analyzed by the primary investigator (PI). Themes were identified by the PI and verified by a team of experi- enced interpretive phenomenological researchers as well as validated by participants. Interpretive phenomenology, which seeks holistic understanding and illumination of phenomena, was the methodology used for this study. This is an appropriate research method for examining the everyday practice and skill of providing spiritual care. As nurses presented narratives about caring for patients and families at end of life, they described the lived experience of providing spiritual care in concrete situations where meaning and shared experiences were uncovered and skills and practices explicated. A CHORUS OF HUMBLED EXPERTS Ten female nurses actively employed as inpatie