SUFFERING 2.0
In 2008, I coedited, with my colleague Dr Nessa Coyle, the first edition of The Nature of Suffering and the Goals of Nursing. As nurses and researchers who had spent many years observing suffering in cancer patients and their families, Nessa and I hoped to describe the unique role of nursing in responding to suffering. The first edition of this book on suffering was also a part of my midcareer return to school to complete a master's degree in theology, ethics, and culture. In that first edition, we drew from our combined experiences to describe the nature of suffering, and we concluded the book with 10 tenets of suffering from the lens of nursing.1
Much has happened in the world since the book was published in 2008 that makes understanding suffering even more central to the scope of nursing practice-and I believe even more significant in our field of hospice and palliative nursing. In just this 15 years of time, we have witnessed widening gaps in access to care; an aging population with multiple sources of suffering; the effects of war, poverty, and immigrant health; and new treatments for chronic illnesses that prolong life and often invoke suffering, just to highlight a few current realities. We have lived through a pandemic that brought images of suffering to our cell phone screens and to our health care systems near the brink of collapse from the pandemic burden. We also experienced profound personal suffering in our own COVID illnesses and the lives of our family and colleagues.
In the third year of the pandemic, in 2022, my colleague Dr Billy Rosa and I decided it was time for a second edition of The Nature of Suffering and the Goals of Nursing.2 In writing this second edition, we recognized the need to bring together many nursing voices spanning the broad spectrum of nursing care from pediatrics to geriatrics and across all settings of care.
The authors of the second edition brought recognition of the suffering of newer areas of palliative care focus, such as in the perinatal and neonatal population:
When suffering and joy coincide, as they sometimes do during the perinatal and neonatal period, it is both a professional duty and a profound privilege for nurses to be present for both. Suffering and hope are not incompatible-it is the ability to hold space for the full spectrum of human experiences that defines the very nature of nursing. This work is challenging, necessary, admirable, and rewarding. It is also worthy of respect and continued research as to the best approaches to relieve suffering in patients, families and those who care for them. May all nurses who have held a dying infant, comforted a devastated parent, or reframed hope for a family in despair know that they have done sacred work. May all patients and their families be fortunate enough to be cared for by that nurse.2
The authors also helped expand our awareness that suffering people are in all settings of care where nurses provide care:
From the labor ward to the hospice, and from the trauma center to home care, the art and science of nursing becomes known through the nurse's abilities to give comfort; demonstrate empathy, caring, and compassion; and deliver high-quality, evidence-based care in a manner that humanizes patients and fosters trusting relationships. Nurses are sojourners with those who suffer in all circumstances, both in spaces where wellbeing is nurtured and sustained, and in those places where dignity is degraded or threatened. The skills and capacities needed for nurses to identify suffering, sit with it, allow for it, and meet people wherever they may be with whatever emotions they may be feeling is a practice calling for constant growth and development.3
After compiling this second edition, Billy and I revisited the original tenets and identified a few new insights from these last 15 years that continue to inform our understanding of the nature of suffering and the goals of nursing. The tenets are shown in Table 1.
Our field of hospice and palliative nursing is recognized for speaking of suffering and responding to it. One of our second edition authors said that nurses are "first responders to suffering."
Each author in this second edition recognized the suffering of nurses, made so very apparent by the pandemic. My dear friend and colleague Nessa Coyle wrote a preface to this second edition with words of advice for our profession as we continue to do this sacred work:
We need to be able to sit with uncertainty-with struggle, loss and grief-to recognize it-and to learn from it. We need to be able to ground ourselves and learn "to be there in grief" but not swallowed up by it....
[horizontal ellipsis]And finally, we need to learn to forgive ourselves and move on-Sometimes you will feel like weeping-allow the tears to flow-the grief to pour out-we are all healers, wounded healers-we are both frail and strong.
References