Nurses' responses to requests for forgiveness at the end of life.

CONTEXT: Patients or family members facing serious illness often express regrets over life events or the need for forgiveness. Professionals, including nurses as the prominent discipline at the bedside, witness these expressions of regret or needs for forgiveness but may not be adequately prepared to optimally address patient concerns regarding forgiveness. OBJECTIVES: The objectives of this descriptive study were to 1) identify contexts in which nurses have witnessed expressions of regret or the need for forgiveness and 2) describe nurses' responses to these clinical experiences related to forgiveness. METHODS: Nurses attending palliative care educational programs shared narratives of their experiences in caring for patients who expressed regret or the need for forgiveness. Study narratives were analyzed qualitatively, using content analysis. Themes were identified. RESULTS: Narratives were provided by 339 nurses from courses throughout the U.S. and Belize, India, the Philippines, and Romania. CONCLUSION: Nurses provide clinical care for patients with advanced illness who struggle with issues of forgiveness. Nurses would benefit from additional education regarding how best to address these concerns.

An overview of the ACE Project-advocating for clinical excellence: transdisciplinary palliative care education.

BACKGROUND: Excellence in palliative care demands attention to the multidimensional aspects of patient and family suffering, yet too few psycho-oncology professionals report adequate preparation in this vital area. METHODS: A total of 148 competitively selected psychologists, social workers, and spiritual care professionals participated in intensive educational courses to enhance their palliative care delivery, leadership, and advocacy skills. Extensive process and outcome evaluations measured the effectiveness of this educational program. RESULTS: To date, 2 national courses have been completed. The courses received strong overall evaluations, with participants rating increased confidence in defined palliative care skills. CONCLUSIONS: The initial results of this innovative National Cancer Institute-funded transdisciplinary training for psycho-oncology professionals affirm the need and feasibility of the program. See the Advocating for Clinical Excellence Project Web site (www.cityofhope.org/ACEproject) for additional course information.

An integrated psychosocial-spiritual model for cancer pain management.

PURPOSE: Cancer pain is known to be a multidimensional and complex experience that can cause severe suffering and can lessen quality of life. The psychosocial and spiritual aspects of cancer pain play an important role in this phenomenon. This article describes a multidisciplinary model for cancer pain management that focuses on the psychosocial and spiritual aspects of cancer pain and the needs of patients. DESCRIPTION OF PROGRAM: This multidisciplinary model has been organized to provide the most effective pain management to a variety of patients within a comprehensive cancer center. Our model includes multiple oncology mental health professionals, including psychologists, social workers, spiritual care providers, and psychiatrists. Each discipline provides a unique assessment and an evaluation of the needs of patients with cancer pain and their support system that is integrated into a comprehensive treatment plan. Regular collaboration occurs between disciplines to ensure that the patients receive optimal pain management. CLINICAL IMPLICATIONS: This model provides a framework from which treatment interventions can be implemented. The emphasis on consistent collaboration between disciplines is a vital component in providing effective cancer pain management. This multidisciplinary psychosocial-spiritual model can be replicated, modified, or both, to become standard practice in other comprehensive cancer centers.