A Spiritual Care Approach in Palliative Care Nursing: Finding Meaning in Suffering

Abstract

Palliative care patients experience existential suffering in terms of psychosocial and spiritual aspects as well as physical pain. If an individual finds meaning in suffering, his quality-of-life increases, and it becomes easier to cope with disease process. Nurses have an important role in providing spiritual support to patients. In this review, it is aimed to emphasize the importance of spiritual care in palliative care patients and to explain the methods that can help nurses working in this field for finding meaning in suffering. 

Keywords

• Logotherapy
• meaning
• nursing
• suffering
• palliative care

Palyatif Bakım Hemşireliğinde Bir Spiritüel Bakım Yaklaşımı: Acıyı Anlamlandırmak

Abstract

Palyatif bakım hastaları fiziksel ağrının yanı sıra psikososyal ve spiritüel yönlerden de varoluşsal düzeyde acı deneyimlemektedir. Birey, çektiği acıya anlam kazandırdığında yaşam kalitesi artmakta ve hastalık süreciyle baş etmesi kolaylaşmaktadır. Hemşireler, bireye spiritüel destek sağlamada önemli role sahiptir. Bu derlemede palyatif bakım hastalarında spiritüel bakımın önemini vurgulamak ve bu alanda çalışan hemşirelere, bireyin acısını anlamlandırmada yardımcı olabilecek yöntemleri açıklamak amaçlanmıştır.

Keywords

• Acı
• anlam
• hemşirelik
• logoterapi
• palyatif bakım
• Logotherapy
• meaning
• nursing
• suffering
• palliative care

References

1. 1. World Health Organization. Integrating palliative care and symptom relief into primary health care: a WHO guide for planners,implementers and managers. Geneva: Licence: CC BY-NC-SA 3.0 IGO. 2018
2. 2. Sekse RJT, Hunskår I, Ellingsen S. The nurse's role in palliative care: A qualitative meta-synthesis. J Clin Nurs. 2018 Jan;27(1-2):21-38. doi: 10.1111/jocn.13912.
3. 3. Aydemir Gedük E. Hemşirelik mesleğinin gelişen rolleri. Sağlık Bilimleri ve Meslekleri Dergisi. 2018; 5(2): 253-258.
4. 4. Yıldırım Y. Palyatif bakımda hemşirelik çalışmaları. Türkiye Klinikleri J Anest Reanim-Special Topics. 2017; 10(1):49-56.
5. 5. Nissen RD, Viftrup DT, Hvidt NC. The process of spiritual care. Front Psychol. 2021 Sep 7; 12:674453. doi: 10.3389/fpsyg.2021.674453.
6. 6. Green C. A Philosophical Model of the nature of nursing. Nurs Res. 2018 Mar/Apr;67(2):93-98. doi: 10.1097/NNR.0000000000000247.
7. 7. Bar-Sela G, Schultz MJ, Elshamy K, Rassouli M, Ben-Arye E, Doumit M, et al. Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses. Palliat Support Care. 2019 Jun;17(3):345-352. doi: 10.1017/S147895151800055X.
8. 8. Balboni MJ, Sullivan A, Enzinger AC, Epstein-Peterson ZD, Tseng YD, Mitchell C, et al. Nurse and physician barriers to spiritual care provision at the end of life. J Pain Symptom Manage. 2014 Sep;48(3):400-10. doi: 10.1016/j.jpainsymman.2013.09.020.

9. 9. Farahani AS, Rassouli M, Salmani N, Mojen LK, Sajjadi M, Heidarzadeh M, et al. Evaluation of health-care providers' perception of spiritual care and the obstacles to its implementation. Asia Pac J Oncol Nurs. 2019 Apr-Jun;6(2):122-129. doi: 10.4103/apjon.apjon_69_18.
10. 10. Adib-Hajbaghery M, Zehtabchi S, Fini IA. Iranian nurses' professional competence in spiritual care in 2014. Nurs Ethics. 2017 Jun;24(4):462-473. doi: 10.1177/0969733015600910.
11. 11. Tao Z, Wu P, Luo A, Ho TL, Chen CY, Cheng SY. Perceptions and practices of spiritual care among hospice physicians and nurses in a Taiwanese tertiary hospital: a qualitative study. BMC Palliat Care. 2020 Jul 1;19(1):96. doi: 10.1186/s12904-020-00608-y.
12. 12. Bandeali S, des Ordons AR, Sinnarajah A. Comparing the physical, psychological, social, and spiritual needs of patients with non-cancer and cancer diagnoses in a tertiary palliative care setting. Palliat Support Care. 2020 Oct;18(5):513-518. doi: 10.1017/S1478951519001020.
13. 13. Selman LE, Brighton LJ, Sinclair S, Karvinen I, Egan R, Speck P, et al; InSpirit Collaborative. Patients' and caregivers' needs, experiences, preferences and research priorities in spiritual care: A focus group study across nine countries. Palliat Med. 2018 Jan;32(1):216-230. doi: 10.1177/0269216317734954.
14. 14. Bonavita A, Yakushko O, Morgan Consoli ML, Jacobsen S, Mancuso RLL. Receiving spiritual care: experiences of dying and grieving individuals. Omega (Westport). 2018 Mar;76(4):373-394. doi: 10.1177/0030222817693142.
15. 15. Pearce MJ, Coan AD, Herndon JE 2nd, Koenig HG, Abernethy AP. Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients. Support Care Cancer. 2012 Oct;20(10):2269-76. doi: 10.1007/s00520-011-1335-1.
16. 16. Pujol N, Jobin G, Beloucif S. 'Spiritual care is not the hospital's business': a qualitative study on the perspectives of patients about the integration of spirituality in healthcare settings. J Med Ethics. 2016 Nov;42(11):733-737. doi: 10.1136/medethics-2016-103565.
17. 17. Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol. 2012 Apr;23 Suppl 3:49-55. doi: 10.1093/annonc/mds088.
18. 18. Chaar EA, Hallit S, Hajj A, Aaraj R, Kattan J, Jabbour H, Khabbaz LR. Evaluating the impact of spirituality on the quality of life, anxiety, and depression among patients with cancer: an observational transversal study. Support Care Cancer. 2018 Aug;26(8):2581-2590. doi: 10.1007/s00520-018-4089-1.
19. 19. Längle, A. From Viktor Frankl’s logotherapy to existential analytic psychotherapy. In Van Deurzen E, Craig E, Längle A, Schneider KJ, Tantam D, Plock S (Eds.), The Wiley world handbook of existential therapy (pp. 309–323). Wiley Blackwell. 2019
20. 20. Thir M, Batthyány, A. Logotherapy and existential analysis. Switzerland: Springer, 2016. s. 53-74.
21. 21. Kang KA, Han SJ, Lim YS, Kim SJ. Meaning-centered interventions for patients with advanced or terminal cancer: a meta-analysis. Cancer Nurs. 2019 Jul/Aug;42(4):332-340. doi: 10.1097/NCC.0000000000000628.
22. 22. Vos J, Vitali D. The effects of psychological meaning-centered therapies on quality of life and psychological stress: a metaanalysis. Palliat Support Care. 2018 Oct;16(5):608-632. doi: 10.1017/S1478951517000931.
23. 23. Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982 Mar 18;306(11):639-45. doi: 10.1056/NEJM198203183061104.
24. 24. Ellis J, Cobb M, O'Connor T, Dunn L, Irving G, Lloyd-Williams M. The meaning of suffering in patients with advanced progressive cancer. Chronic Illn. 2015 Sep;11(3):198-209. doi: 10.1177/1742395314565720.
25. 25. Laukhuf G, Werner H. Spirituality: the missing link. J Neurosci Nurs. 1998 Feb;30(1):60-7. doi: 10.1097/01376517-199802000-00007.
26. 26. Lepherd L. Spirituality: Everyone has it, but what is it? Int J Nurs Pract. 2015 Oct;21(5):566-74. doi: 10.1111/ijn.12285.
27. 27. Tanyi RA. Towards clarification of the meaning of spirituality. J Adv Nurs. 2002 Sep;39(5):500-9. doi: 10.1046/j.1365-2648.2002.02315.x.
28. 28. Lalani, N. Meanings and interpretations of spirituality in nursing and health. Religions 2020; 11(9), 428. doi: 10.3390/rel11090428
29. 29. Delgado C. A discussion of the concept of spirituality. Nurs Sci Q. 2005 Apr;18(2):157-62. doi: 10.1177/0894318405274828.
30. 30. Puchalski CM. Spirituality as an essential domain of palliative care: Caring for the whole person, Progress in Palliative Care, 2012;20(2), 63-65, doi: 10.1179/0969926012Z.00000000028
31. 31. Jasemi M, Valizadeh L, Zamanzadeh V, Keogh B. A concept analysis of holistic care by hybrid model. Indian J Palliat Care. 2017 Jan-Mar;23(1):71-80. doi: 10.4103/0973-1075.197960.
32. 32. Ramezani M, Ahmadi F, Mohammadi E, Kazemnejad A. Spiritual care in nursing: a concept analysis. Int Nurs Rev. 2014 Jun;61(2):211-9. doi: 10.1111/inr.12099.
33. 33. Sawatzky R, Pesut B. Attributes of spiritual care in nursing practice. J Holist Nurs. 2005 Mar;23(1):19-33. doi: 10.1177/0898010104272010.
34. 34. Egnew TR. The meaning of healing: transcending suffering. Ann Fam Med. 2005 May-Jun;3(3):255-62. doi: 10.1370/afm.313.
35. 35. Piedmont R. Spiritual transcendence and the scientific study of spirituality. J. Rehabil. 2001; 67(1):4-14.
36. 36. Caldeira S, Timmins F. Implementing spiritual care interventions. Nurs Stand. 2017 Apr 19;31(34):54-60. doi: 10.7748/ns.2017.e10313.
37. 37. Harrad R, Cosentino C, Keasley R, Sulla F. Spiritual care in nursing: an overview of the measures used to assess spiritual care provision and related factors amongst nurses. Acta Biomed. 2019 Mar 28;90(4- S):44-55. doi: 10.23750/abm.v90i4-S.8300.
38. 38. Ghorbani M, Mohammadi E, Aghabozorgi R, Ramezani M. Spiritual care interventions in nursing: an integrative literature review. Support Care Cancer. 2021 Mar;29(3):1165-1181. doi: 10.1007/s00520-020-05747-9.
39. 39. Czekierda K, Banik A, Park CL, Luszczynska A. Meaning in life and physical health: systematic review and meta-analysis. Health Psychol Rev. 2017 Dec;11(4):387-418. doi: 10.1080/17437199.2017.1327325.
40. 40. Martela F, Steger MF. The three meanings of meaning in life: distinguishing coherence, purpose, and significance, The Journal of Positive Psychology, 2016;11(5):531-545, doi: 10.1080/17439760.2015.1137623
41. 41. Landau I. Why has the question of the meaning of life arisen in the last two and a half centuries? Philosophy Today. 1997; 41(2):263-270.
42. 42. Gildea WL. On the meaning of life. Proceedings of the Aristotelian Society. June 1892; os2(1):65-77.
43. 43. Metz, T. The meaning of life (second revised edition). In Zalta EN (ed) The Stanford Encyclopedia of Philosophy. Metaphysics Research Lab, Stanford University, 2021 winter.
44. 44. Wellmon, C. Touching Books: Diderot, Novalis,and the Encyclopedia of the Future. Representations. 2011;114(1), 65–102. doi: 10.1525/rep.2011.114.1.65
45. 45. Debats DLHM. Measurement of personal meaning: the psychometric properties of the life regard index. In Wong PT, Fry PS, editors, The Human Quest for Meaning. Hillsdale, NJ: Lawrence Erlbaum Associates. 1998. p. 237 – 256
46. 46. Steger MF, Kashdan TB, Sullivan BA, Lorentz D. Understanding the search for meaning in life: personality, cognitive style, and the dynamic between seeking and experiencing meaning. J Pers. 2008 Apr;76(2):199-228. doi: 10.1111/j.1467-6494.2007.00484.x.
47. 47. Kimble MA, Ellor JW. Logotherapy: an overview, J. Relig. Gerontol. 2001;11(3-4): 9-24, doi: 10.1300/J078v11n03_03
48. 48. Costello SJ. The spirit of logotherapy. Religions. 2016; 7(1):3-14 doi:10.3390/rel7010003
49. 49. Längle, A. The Viennese school of existential Analysis. The search for meaning and affirmation of life. In Barnett L, Madison G (eds). Existential therapy: Legacy, vibrancy, and dialogue. New York: Routledge, 2012, 159-170.
50. 50. Frankl VE. Logotherapy and existentialism. Psychother.: Theory Res. Pract, 1967;4(3):138–142
51. 51. Frankl VE. Man's search for meaning: an introduction to logotherapy 4th ed. Boston: Beacon Press, 1992.
52. 52. Piccirillo RA. "Logotherapy and the Holocaust: Uniting Human Experience in Extremity and Normality." Inquiries Journal/Student Pulse, 2010;2(09). Retrieved from http://www.inquiriesjournal.com/a?id=289
53. 53. Sartre JP, Baskin W. Essays in existentialism: the humanism of existentialism. Secaucus, N.J.: Citadel Press, 1965.
54. 54. Längle A. The existential and fundamental motivations structuring the motivational process. In Leontiev DA (ed). Motivation, consciousness and self-regulation. NY: Nova science publishers, 2011, s. 27-42.
55. 55. Golomb, J. In search of authenticity: from Kierkegaard to Camus (The problems of modern European thoughts series). Taylor & Francis e-Library, 2005.
56. 56. Qutoshi SB. Phenomenology: A philosophy and method of inquiry. Journal of Education and Educational Development. 2018; 5(1):215-222
57. 57. Frankl VE. On logotherapy and existential analysis. The American Journal of Psychoanalysis. 1958; 18(1):28–37.
58. 58. Okan N, Ekşi H. Spirituality in logotherapy, spiritual psychology and counseling. 2017; 2(2):43-164.
59. 59. Beuselinck B. The meaning of suffering or the meaning of life despite suffering. In: Devos, T. (eds) Euthanasia: searching for the full story. Springer, Cham, 2021. doi:10.1007/978-3-030-56795-8_7
60. 60. Reitinger C. Viktor Frankl's logotherapy from a philosophical point of view. Existential Analysis. 2015; 26(2):344-355.
61. 61. Wong, PTP. From Viktor Frankl’s logotherapy to the four defining characteristics of self-transcendence. Paper presented at the research working group meeting for Virtue, Happiness, and the Meaning of Life Project, Columbia, SC. 2016 December.
62. 62. Schulenberg SE, Hutzell RR, Nassif C, Rogina JM. Logotherapy for clinical practice. Psychotherapy (Chic). 2008 Dec;45(4):447-63. doi: 10.1037/a0014331.
63. 63. Kim M. Finding meaning in life threatening illness. Korean J Hosp Palliat Care. 2020; 2(23):39-43.
64. 64. Boston P, Bruce A, Schreiber R. Existential suffering in the palliative care setting: an integrated literature review. J Pain Symptom Manage. 2011 Mar;41(3):604-18. doi: 10.1016/j.jpainsymman.2010.05.010.
65. 65. Devoe D. Viktor Frankl’s logotherapy: The search for purpose and meaning. Inquiries J Pulse.2012; 4(7):1-8.
66. 66. Indinger S.M.O.P. Meaning is what is meant-Victor Frankl’s logotherapy. InterAction 2010;2(1):21-47
67. 67. Deal B. Finding meaning in suffering. Holistic Nursing Practice, 2011; 25(4):205-210.
68. 68. Travelbee J. To find meaning in illness. Nursing: December 1972;2(12):6-8.