If asked to describe palliative nursing in a single sentence, I would say that palliative care nurses are specialists in attention to suffering. The daily work of our field involves the topics reflected in this issue of the journal. Palliative care nurses respond to the vast physical, psychological, social, and spiritual needs of patients and families. Treating difficult symptoms, responding to needs of complex diseases such as pancreatic cancer, and supporting the intense personal relationships of dying patients as discussed in these articles are incredibly difficult work. How do nurses sustain their efforts in care that can be so overwhelming and in which witnessing intense suffering is inherent in daily work?

Much has been written about strategies to support palliative care nurses. This often includes advice regarding balancing work and personal demands and self-care. One strategy that has gained attention in recent years is the development of a sense of gratitude by palliative care professionals.

The concept of gratitude as a response to our professional challenges has been described by Emmons1 in his book, Thanks: How Practicing Gratitude Can Make You Happier. Emmons says that "gratitude is an affirmation of goodness." We recognize how fortunate we are to be engaged in such important and meaningful work in care of the seriously ill and dying. Emmons makes several points relevant to palliative care. He says that gratitude allows us to celebrate the present, to have a higher sense of self-worth, and very importantly "Gratitude goes against our need to feel in control of our environment." How often do we experience distress in palliative care in attempting to control the uncontrollable?

Emmons1 has made suggestions for fostering a sense of gratitude in his "10 Ways to Become More Grateful." This includes the following:

1. Keep a Gratitude Journal. Establish a daily practice in which you remind yourself of the gifts, grace, benefits, and good things you enjoy.

2. Remember the Bad. To be grateful in your current state, it is helpful to remember the hard times that you once experienced.

3. Ask Yourself 3 Questions. "What have I received from __?", "What have I given to __?" and "What troubles and difficulty have I caused?"

4. Learn Prayers of Gratitude. In many spiritual traditions, prayers of gratitude are considered to be the most powerful form of prayer, because through these prayers people recognize the ultimate source of all they are and all they will ever be.

5. Come to Your Senses. Through our senses-the ability to touch, see, smell, taste, and hear-we gain an appreciation of what it means to be human and of what an incredible miracle it is to be alive.

6. Use Visual Reminders. Because the 2 primary obstacles to gratefulness are forgetfulness and a lack of mindful awareness, visual reminders can serve as cues to trigger thoughts of gratitude.

7. Make a Vow to Practice Gratitude. Research shows that making an oath to perform a behavior increases the likelihood that the action will be executed.

8. Watch your Language. Grateful people have a particular linguistic style that uses the language of gifts, givers, blessings, blessed, fortune, fortunate, and abundance.

9. Go Through the Motions. If you go through grateful motions, the emotion of gratitude should be triggered. Grateful motions include smiling, saying thank you, and writing letters of gratitude.

10. Think Outside the Box. If you want to make the most out of opportunities to flex your gratitude muscles, you must creatively look for new situations and circumstances in which to feel grateful.

An additional source of inspiration to me in cultivating my own sense of gratitude has been the work of a priest, Fr Gregory Boyle.² He is known for his work in Los Angeles in gang violence and reconciliation. His book, Tattoos of the Heart: The Power of Boundless Compassion, describes his ministry with gang members and ex-convicts and the challenges of finding meaning in work fraught with sadness. Father Boyle writes,

You need protection from the ebb and flow of three steps forward, five steps backward. You trip over disappointment and recalcitrance everyday, and it all becomes a muddle. God intends it to be, I think for once you choose to hang out with folks who carry more burden than they can bear, all bets seem to be off. Salivating for success keeps you from being faithful, keeps you from truly seeing whoever's sitting in front of you. Embracing a strategy and an approach you can believe in is sometimes the best you can do on any given day. If you surrender your need for results and outcomes, success becomes God's business.

Palliative nursing is a profession dedicated to suffering. Through strengthening our sense of gratitude in our profession, we better serve patients and families.

Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN

Editor-in-Chief

[email protected]

References