The essence of nursing care continually exposes nurses to suffering. Although they bear witness to the suffering of others, their own suffering is less frequently exposed. This slim volume attempts to give voice to the suffering that nurses witness in patients, families, colleagues, and themselves. By making this suffering visible, the authors wish to honor it and to learn from it. The audience includes nurses in all phases of training and practice - from students to educators to clinicians - in the wide array of settings and specialties in which nurses care for patients. The book offers nurses' colleagues in other professions - social workers, psychologists, chaplains, ethicists, and physicians - a rare window onto what it means to practice nursing. Drs. Ferrell and Coyle are also the editors of Textbook of Palliative Nursing, 2nd ed (Oxford, 2006). Independently, they have worked more than 50 years in oncology nursing, caring for patients and working to improve the quality of care that patients receive.
This is a revised and expanded edtion of a classic in palliative medicine, originally published in 1991. With three added chapters and a new preface summarizing our progress in the area of pain management, this is a must-hve for those in palliative medicine and hospice care. The obligation of physicians to relieve human suffering stretches back into antiquity. But what exactly, is suffering? One patient with metastic cancer of the stomach, from which he knew he would shortly die, said he was not suffering. Another, someone who had been operated on for a mior problem--in little pain and not seemingly distressed--said that even coming into the hospital had been a source of pain and not suffering. With such varied responses to the problem of suffering, inevitable questions arise. Is it the doctor's responsibility to treat the disease or the patient? And what is the relationship between suffering and the goals of medicine? According to Dr. Eric Cassell, these are crucial questions, but unfortunately, have remained only queries void of adequate solutions. It is time for the sick person, Cassell believes, to be not merely an important concern for physicians but the central focus of medicine. With this in mind, Cassell argues for an understanding of what changes should be made in order to successfully treat the sick while alleviating suffering, and how to actually go about making these changes with the methods and training techniques firmly rooted in the doctor's relationship with the patient. Dr. Cassell offers an incisive critique of the approach of modern medicine. Drawing on a number of evocative patient narratives, he writes that the goal of medicine must be to treat an individual's suffering, and not just the disease. In addition, Cassell's thoughtful and incisive argument will appeal to psychologists and psychiatrists interested in the nature of pain and suffering.
The Nature of Suffering underscores the change that is taking place in medicine from a basic concern with disease to a greater focus on the sick person. Cassell centers his discussion on the problem of suffering because, he says, its recognition and relief are a test of the adequacy of any system of medicine. He describes what suffering is and its relationship to the sick person: bodies do not suffer, people do. An exclusive concern with scientific knowledge of the body and disease, therefore, impedes an understanding of suffering and diminishes the care of the suffering patient. The growing criticism that medicine is not sufficiently humanistic does not go deep enough to provide a basis for a new understanding of medicine. New concepts in medicine must have their basis in its history and in the development of ideas about disease and treatment. Cassell uses many stories about patients to demonstrate that, despite the current dominance of science and technology, there can be no diagnosis, search for the cause of the patient's disease, prognostication, or treatment without consideration of the individual sick person. Recent trends in medicine and society, Cassell believes, show that it is time for the sick person to be not merely an important concern for physicians but the central focus of medicine. He addresses the exciting problems involved in such a shift. In this new medicine, doctors would have to know the person as well as they know the disease. What are persons, however, and how are doctors to comprehend them? The kinds of knowledge involved are varied, including values and aesthetics as well as science. In the process of knowing the experience of patient and doctor move to center stage. He believes that the exploration of the person will engage medicine in the 21st century just as understanding the body has occupied the last hundred years.
Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
Spirituality and healthcare is an emerging field of research, practice and policy. Healthcare organisations and practitioners are therefore challenged to understand and address spirituality, to develop their knowledge and implement effective policy. This is the first reference text on the subject providing a comprehensive overview of key topics.
"Suffering is an unavoidable reality in health care. Not only are patients and families suffering but also the clinicians who care for them. Commonly the suffering experienced by clinicians is moral in nature, reflecting the increasing complexity of health care, their roles within it, and the expanding range of available interventions. Moral suffering is the anguish experienced in response to various forms of moral adversity including moral harms, wrongs or failures, or unrelieved moral stress. Confronting moral adversity challenges clinicians' integrity: the inner harmony that arises when their essential values and commitments are aligned with their choices and actions. The most studied response to moral adversity is moral distress. The sources and sequelae of moral distress, one type of moral suffering, have been documented among clinicians across specialties. Recent interest has expanded to include a more corrosive form of moral suffering, moral injury. Moral resilience, the capacity to restore or sustain integrity in response to moral adversity, offers a path designing individual and system solutions to address moral suffering. It encompasses capacities aimed at developing self- regulation and self-awareness, buoyancy, moral efficacy, self-stewardship and ultimately personal and relational integrity. Moral resilience has been shown to be a protective resource that reduces the detrimental impact of moral suffering. Clinicians and healthcare organizations must work together to transform moral suffering by cultivating the individual capacities for moral resilience and designing a new architecture to support ethical practice. Used worldwide for scalable and sustainable change, the Conscious Full Spectrum Response, offers a method to solve problems to support integrity, shift patterns that undermine moral resilience and ethical practice, and source the inner potential of clinicians and leaders to produce meaningful and sustainable results that benefit all"--
In August, 1985, the 2nd International Conference on Illness Behaviour was held in Toronto, Ontario, Canada. The first International Conference took place one year previous in Adelaide, South Australia, Australia. This book is based on the proceedings of the second conference. The purpose behind this conference was to facilitate the development of a single integrated model to account for illness experience and presentation. A major focus of the conference was to outline methodological issues related to current behaviour research. A multidiscipl~nary approach was emphasized because of the bias that collaborative efforts are likely to be the most successful in achieving greater understanding of illness behaviour. Significant advances in our knowledge are occurring in all areas of the biological and social sciences, albeit more slowly in the latter areas. Marked specialization in each of these areas has lead to greater difficulty in integrating new knowledge with that of other areas and the development of a meaningful cohesive model to which all can relate. Thus there is a major need for forums such as that provided by this conference.
"Palliative Care Nursing: Caring for Suffering Patients explores the concept of suffering as it relates to nursing practice. This text helps practicing nurses and students define and recognize various aspects of suffering across the lifespan and within various patient populations while providing guidance in alleviating suffering. In addition, it examines spiritual and ethical perspectives on suffering and discusses how witnessing suffering impacts nurses' ability to assume the professional role. Further, the authors discuss ways nurses as witnesses to suffering can optimize their own coping skills and facilitate personal growth. Rich in case studies, pictures, and reflections on nursing practice and life experiences, Palliative Care Nursing: Caring for Suffering Patients delves into key topics such as how to identify when a patient is suffering, whether they are coping, sources of coping facades, what to do to ease suffering, and how to convey the extent of suffering to members of the health care team.Palliative Care Nursing: Caring for Suffering Patients helps practicing nurses and students define and recognize various aspects of suffering across the lifespan and within various patient populations while providing guidance in alleviating suffering"--
A handy guide to tackling difficult patient and professional interactions with confidence and compassion In this age of increasing reliance on technology, it is essential that the fundamentals of compassion and good communication—the art of patient care—remain at the heart of health care. This clear, concise guide to professional communication strategies helps nurses and other health care clinicians to build effective patient relationships and navigate a wide variety of difficult patient and professional interactions. Written by a practicing psychotherapist who has devoted nearly 30 years of study to clinician—patient relationships, the book tackles such complex issues as dealing with demanding patients, maintaining professional boundaries, overcoming biases and stereotypes, managing clinician emotions, communicating bad news, challenging a colleague’s clinical opinion, and other common scenarios. The book guides the reader through a conceptual framework for building effective relationships that is based on the principles of mindfulness. These principles are embedded in discussions of the fundamental elements of interpersonal effectiveness, such as hope, empathy, and listening. Chapters apply mindfulness principles to specific challenging situations with concrete examples that describe effective clinical behaviors as well as situations depicting pitfalls that may impede compassionate care. From a focus on everyday manners in difficult situations to beneficial approaches with challenging populations, the guide helps health care professionals confidently resolve common problems. Brief, to-the-point chapters help clinicians channel their clinical knowledge and good intentions into caring behaviors that allow the patient to more fully experience empathy and compassion. With the guiding theme of “using words as precision instruments,” this is a resource that will be referred to again and again. Key Features: • Helps health care professionals and nurses communicate effectively in challenging clinical and professional situations • Uses the principles of mindfulness to build satisfying relationships and resolve problems • Addresses such difficult issues as demanding patients, maintaining boundaries, overcoming biases, managing clinician emotions, and much more • Provides special tips for communicating with family members and caregivers • Authored by a practicing psychotherapist specializing in clinician—patient relationships for nearly 30 years
Palliative Care is the first book to provide a comprehensive understanding of the new field that is transforming the way Americans deal with serious illness. Diane E. Meier, M.D., one of the field's leaders and a recipient of a MacArthur Foundation "genius award" in 2009, opens the volume with a sweeping overview of the field. In her essay, Dr. Meier examines the roots of palliative care, explores the key legal and ethical issues, discusses the development of palliative care, and presents ideas on policies that can improve access to palliative care. Dr. Meier's essay is followed by reprints of twenty-five of the most important articles in the field. They range from classic pieces by some of the field's pioneers, such as Eric Cassel, Balfour Mount, and Elizabeth Kübler-Ross, to influential newer articles on topics such as caregiving and cost savings of palliative care. The reprints cover a wide range of topics including: Why the care of the seriously ill is so important Efforts to cope with advanced illness Legal and ethical issues Pain management Cross-cultural issues Philosophical perspective The demand for palliative care has been nothing short of stunning largely because of palliative care's positive impact on both the quality and the cost of care provided to seriously ill individuals. By providing a wide-ranging perspective on this growing field, this book will serve as a guide for developing meaningful approaches that will lead to better health care for all Americans.
