Spiritual Pain Research Articles

Relaxation therapy with guided imagery for pain intensity and pain interference in patients with lung cancer: A case study

Background: Lung cancer is a malignant tumor originating from the bronchial epithelium or bronchial carcinoma which includes malignancy from the lungs themselves (primary) and malignancy from outside the lungs (metastasis) caused by several factors such as exposure or inhalation of a carcinogenic substance such as cigarettes over a long period of time. One of the clinical symptoms felt by lung cancer patients is chest pain with 50-70% of cancer patients experiencing pain dominated by neuropathic, psychological, social and spiritual pain, associated with nociceptive pain that is felt continuously so that it can reduce quality of life, physical function, increase fatigue levels, and interfere with daily activities. Efforts to reduce pain in lung cancer patients require appropriate, efficient and economical interventions, so that they can improve the patient's quality of life. One of the non-pharmacological nursing interventions that can be applied to lung cancer patients is guided imagery. Purpose: To prove the relaxation therapy with guided imagery for pain intensity and pain interference in patients with lung cancer. Method: The case report study used a nursing care approach by implementing evidence-based nursing practices in 5 lung cancer patients treated in the Flamboyan ward Dr. Moewardi Hospital. The instrument used in this nursing care report is a numeric scale to measure the intensity of patient pain with an interval of 0-10. A value of 0 indicates no pain, while 1-3 indicates mild pain, 4-6 indicates moderate pain and 7-10 indicates severe pain. Results: There was a significant change in the patient's pain scale after relaxation therapy with guided imagery for pain intensity and pain interference. Conclusion: Relaxation therapy with guided imagery can help reduce pain in lung cancer patients. In addition, it is considered a more efficient and economical therapeutic nursing intervention and does not cause complications. Suggestion: It is hoped that further researchers can apply it to other medical diagnoses to determine whether guided imagery has the same benefits or not in reducing pain felt by patients other than a medical diagnosis of lung cancer.

Psilocybin: Medicine for My Soul. Relief from Emotional and Spiritual Pain as a Hospice Nurse Diagnosed with Cancer.

Psilocybin: Medicine for My Soul. Relief from Emotional and Spiritual Pain as a Hospice Nurse Diagnosed with Cancer.

Implementation of Islamic Spiritual Guidance in Reducing Anxiety for Prenatal Patients at Muhammadiyah Metro General Hospital

Anxiety describes a person's emotional feelings that arise when facing an event or occurrence in his life. The anxiety experienced by pregnant women as prenatal patients is motivated by lack of knowledge and inexperience about the labor process, physical conditions that do not support suddenly, lack of emotional support from family and environment, inappropriate delivery schedule, or pain when contractions occur become one of the backgrounds of anxiety in prenatal patients. So, to reduce anxiety in prenatal patients, help from third parties is needed to provide a sense of calm through psychological assistance in the form of motivation. Muhammadiyah Metro General Hospital, is a hospital that provides these services through Islamic spiritual guidance services for each patient. So, the purpose of this study is to describe the Implementation of Islamic Spiritual Guidance in reducing anxiety for prenatal patients at Muhammadiyah Metro General Hospital. This research uses a type of field research with qualitative descriptive methods. Researchers directly carry out data collection and information related to the research location. Data collection techniques used by the author are interviews, observations and documentation using source triangulation and triangulation techniques to test the validity of research data. The results of this study stated that there were prenatal patients who experienced anxiety such as Reality or objective Anxiety, Neurotic Anxiety, and Moral Anxiety. Islamic Spiritual Guidance in reducing anxiety in prenatal patients at Muhammadiyah Metro General Hospital is implemented by providing psychological, spiritual and fiqh pain assistance and education to prenatal patients.

Do Spiritual Well-Being and Pain Intensity Predict Physical or Mental Components of Health-Related Quality-of-Life Scale in Patients With Multiple Myeloma?

BackgroundMultiple myeloma is a complex disease and supportive care is important for improving quality of life. Management of disease treatment symptoms, bone disease, renal dysfunction, infection, anemia, pain, and coagulation disorder are specific issues. Spirituality, or spiritual well-being, is one of the most fundamental and essential concepts for coping with the difficulties and stress caused by cancer. AimsThis study explores whether spiritual well-being, pain, and other demographic factors predict the physical and mental components of quality of life in MM subjects. MethodsThis cross-sectional descriptive study was conducted with 92 multiple myeloma patients registered with the Cancer Warriors Association in Turkey. The data were collected using the Personal Information Form, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12, the Numeric Rating Scale for Pain, and the Short Form-12 Health-Related Quality of Life Scale. ResultsThe mean age of the patients was 54.4 ± 10.7 years. It was found that the mean total pain score in the previous week was 3.9 ± 2.6, while the mean total The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 score was 28.1 ± 9.8. Their mean Short Form-12 total physical component score was 39.1 ± 25.4; whereas the Short Form-12 total mental component score was 45.5 ± 24.8. According to this model, 56.7% of the physical component score was explained by vertebroplasty, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 total score and subscale of peace and the pain intensity experienced in the previous week. According to multiple linear regression analysis, bone-sparing therapy and FACIT-Sp-12-Total and subscale peace significantly predicted the Mental component score (p < .05). ConclusionsCancer pain remains undertreated, and patients with myeloma are no exception. Pain and spiritual well-being scores were significant predictors of physical and mental component scores of quality of life in this group of patients. According to this result, pain-reducing practices should be implemented to improve the quality of life in MM patients and the spiritual needs of the patients should be met.

Compassion fatigue: A dramatic and unfavorable consequence in the nursing profession

Nurses are one of the most important pillars of the treatment department, who, according to their professional role, are responsible for important tasks such as mental and physical care of the patient, if the above activities do not follow the principles of safety, as well as peace and well-being at work, in the occurrence of physical disorders and the psychology of this group plays a significant role [1]. They are compassionate caregivers who take care of people who experience physical, mental, or spiritual pain, and due to the special conditions of their profession, they experience a lot of pressure and stress that this pressure and stress over time causes adverse consequences in nurses. One of the important and significant consequences is the exhaustion of nurses from compassion for patients [2].

Unlocking the Hidden Dimensions of Cancer Care: Cross-Cultural Adaptation and Feasibility Study of ESAS-FS, Assessing Spiritual Pain and Financial Distress in a Spanish-speaking Population with Advanced Cancer

IntroductionSpiritual pain and financial distress are two important dimensions of cancer care that are often overlooked. Both dimensions can have a significant impact on the quality of life of patients with cancer and their families. MethodsThis study conducted a cross-cultural adaptation, feasibility study, and psychometric properties of the Edmonton Symptom Assessment System-Financial and Spiritual (ESAS-FS) in a Spanish-speaking population with advanced cancer. The ESAS-FS is a patient-reported outcome measure that assesses 12 symptoms, including spiritual pain and financial distress. ResultsIn the cross-cultural adaptation process, the terms “spiritual pain” and “financial distress” were refined to “sufrimiento espiritual” and “preocupación por asuntos económicos” respectively, with strong professional consensus and high patients’ acceptancy (relevant questions 80%, appropriate terms 91%). A cohort of 100 onco-hematologic patients revealed that 70% experienced spiritual pain (mean 2.9/10), while 49% reported financial distress (mean 2.2/10). Symptomatic analyses illustrated significant associations of spiritual pain with various symptoms like fatigue, drowsiness, and depression. Similarly, financial distress correlated notably with drowsiness, depression, and anxiety. Moreover, a distinct correlation was observed between spiritual pain and financial distress. ConclusionThe findings of this study suggest that the ESAS-FS is a valuable tool for assessing spiritual pain and financial distress in Spanish-speaking patients with advanced cancer. The tool can be used to identify patients who are experiencing these dimensions of distress and to provide them with appropriate care.

Satisfaction and quality of palliative care in patients with neoplasms diseases

Introduction: The role of palliative care at the end of life is vital in alleviating suffering through comprehensive assessment and treatment of patients' physical, psychosocial and spiritual symptoms.Objective: argue the importance of the quality of palliative care in patients with neoplastic diseases.Methods: the research was carried out by collecting information in different scientific article search engines such as PubMed, Google Scholar, Medline, Scielo, Sciencia Direct, Elseiver, Medigraphic, ResearchGate. The search strategy was limited to articles ranging from 2019 to 2023, in Spanish and English, about palliative care in patients with oncological diseases and the importance of the satisfaction of users of outpatient services for such purposes. . The search terms used in the writing were verified with the MESH and DeCS descriptors, and were: “palliative care”, “oncological diseases”, “oncological patient”, “emotional support”.Development: palliative care improves the quality of life of patients despite the circumstances in which they may find themselves and supports families facing organizational problems associated with the suffering of the imminent loss due to the life-threatening illness of a loved one. Palliative care stands out through the relief of suffering through the early identification, evaluation and precise treatment of physical, psychological and spiritual pain; requires an interdisciplinary approach that involves the patient, family, and community in action; indeed, the practical and philosophical notion of an interdisciplinary team is crucial to providing quality palliative care

Spirituality in cancer

The aim of this article is to provide a detailed characterization of the spirituality in cancer patients. The great importance of this area, both for theoreticians and practitioners, results from patients' search for meaning in the experience of illness and the need to cope with it on various levels (including emotional). At the very beginning, the complexity of the described phenomenon was signaled and two components of spirituality in the context of the disease were presented: cognitive and emotional. Then, terminological inaccuracies related to the definition of spirituality and religiosity faced not only by researchers, but also by patients themselves were discussed. Next, research on the correlates of spirituality in cancer patients was reviewed. The results of many studies on its relationship with the mental health of patients were presented. Potential mechanisms of the positive impact of spirituality on this sphere, discussed in the scientific literature, were presented: self-regulation, giving new meaning to experiences and religious coping. The relationship between spirituality and the demoralization syndrome and the regulation of desired and undesirable emotions is discussed. Threats related to spirituality and mental health were also indicated. The purpose of this article was also to discuss the relationship between spirituality and physical health, which is much less frequently analyzed by researchers. The results in this area are ambiguous. Research on spirituality and quality of life of cancer patients was also reviewed. Both results indicating a positive relationship between spirituality and quality of life, as well as those proving a different outcome, were presented. Attention was paid to the importance of this relationship in patients at the end of life who often experience spiritual pain. Then, barriers related to raising spiritual issues in the patient-medical staff dyad were identified. The article also addresses the complex issue of spirituality in relation to cancer survivors. Finally, the results of research on the importance of spirituality among informal caregivers of cancer patients are presented. As in the case of patients, positive and negative aspects in this area were indicated.

Associations among spiritual pain and the frequency and intensity of physical and psychological distress in patients with advanced cancer evaluated in a supportive care center during COVID-19 pandemic.

284 Background: Patients with cancer are considered a highly vulnerable group, especially during the COVID-19 pandemic. There is limited literature describing the level of spiritual distress during the COVID pandemic and its association with the physical and psychological and distress in this population. Methods: Retrospective chart review of 1264 patients seen by the Outpatient Palliative Care Team from May 1st, 2020 to December 31st, 2020 (during COVID-19), 85% of the consults was delivered by Telemedicine. The association with ESAS-FS physical symptoms, Spiritual Pain (SP), anxiety and depression (none=0/10, the worst 10/10 were measured. Spiritual Pain was defined as “Pain deep in your Soul/Being that is not physical” (SP ≥1/10). Results: Spiritual Pain was present in 284/1264 (23%). Patients with Spiritual Pain were younger [Median years (Min-Max): 61 (21-90) vs. 62 (21-97), p=0.008], Hispanic [20% vs 16%, p&lt;0.001], more single [15% vs. 10%, p&lt;0.001], and divorced [13% vs. 9% p&lt;0.001]. There was no association with gender and race. The frequency (%) and median intensity (0-10/10, 95%CI) of symptoms in patients with and without Spiritual Pain were, pain [90% vs 81%, 5 (0-10) vs 4 (0-10), p=0.691], fatigue [96% vs 90%, 6 (0-10) vs 5 (0-10), p&lt;0.001], anxiety [90% vs 60%, 5 vs. 2 (0-10), (p&lt;0.001], depression [87% vs 44%, 4 vs 0 (0-10), p&lt;0.001], well-being [97% vs 81%, 5 (0-10) vs 3 (0-10), p=0.011], financial distress [78% vs 26%, 3 (0-10) vs 0 (0-10), p&lt;0.001], total ESAS-FS distress [51 (7-113) vs 30 (0-92), p&lt;0.001], respectively. 49% of patients with spiritual pain were evaluated by our psychological team vs. only 29% of those who did not have it (&lt;0.001). Multivariate analysis for Spiritual Pain was financial distress (OR:1.24, p&lt;0.001) and depression (OR:1.16, p&lt;0.001). Conclusions: Important percentage of patients living with cancer experienced Spiritual Pain during COVID pandemic, this spiritual distress affected the expression of physical, psychological symptoms and worse well-being. An inclusive interdisciplinary team approach including spiritual care is needed. More research is warranted.

Nursing Care for Spiritual Pain in Terminal Cancer Patients: A Non-Randomized Controlled Trial

ContextSpiritual well-being is important for terminal cancer patients; however, appropriate interventions remain to be established. ObjectivesTo evaluate the effectiveness of nursing care to alleviate spiritual pain in daily clinical practice using a Spiritual Pain Assessment Sheet-based spiritual care program for nurses (SpiPas-SCP-N). MethodsA nonrandomized controlled trial was conducted in five palliative care units in Japan. The intervention group received spiritual care based on SpiPas-SCP-N by ward nurses. The primary outcome was the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp). Secondary outcomes included: Hospital Anxiety and Depression Scale (HADS), Comprehensive Quality of life Outcome (CoQoLo), and the Japanese version of the M.D. Anderson Symptom Inventory (MDASI-J). Propensity score matching was used for adjustment. ResultsTerminal cancer patients were assigned to the control and intervention groups (n = 140 and 157, respectively); of whom, 97 (69.8%) and 106 (68.0%), respectively, completed two weeks. Seventy-three patients were matched in each group. The total score of FACIT-Sp increased in the intervention group and decreased in the control group; however, there was no significant difference (95% CI, -3.98, 1.41, P = 0.347). HADS total score significantly increased (95% CI, 0.15, 3.87, P = 0.035), whereas there were no significant changes in CoQoLo and MDASI-J scores. The effect size of changes in FACIT-Sp subscales were 0.25 in the meaning/peace subscale and 0.04 in the faith subscale. ConclusionSpiPas-SCP-N for spiritual pain may have a positive impact on terminal cancer patients. Future research using larger samples, randomized design, and the meaning/peace subscale of FACIT-Sp as the primary outcome is necessary as well as supervision and continuous training in daily nursing practice.

The Power of Spiritual Well-Being: Its Relationship with Pain Intensity, Pain Management, and Pain Catastrophizing in Individuals with Chronic Pain

BackgroundChronic pain negatively affects human life. Chronic pain is multidimensional. Therefore, a multidimensional approach that focuses on the biologic, psychological, sociologic, and spiritual needs of patients is required in pain management. AimThis study was conducted to determine the relationship of spiritual well-being with the level of pain catastrophizing, pain intensity, and pain management in individuals with chronic pain. MethodsThe snowball sampling method was used in the research and the data were collected by individuals with ankylosing spondylitis and rheumatoid arthritis who had chronic pain via an online survey form. The study was completed between March and May 2023 with the participation of 399 people. The data of the study were collected using the Descriptive Characteristics Questionnaire, Pain Catastrophizing Scale, Three-Factor Spiritual Well-Being Scale, and Numerical Rating Scale. ResultsThere was a negative, high-level correlation between the spiritual well-being and the Pain Catastrophizing Scale and its subscales. At the same time, there was a negative, weak level correlation between the levels of spiritual well-being and the pain intensity. Spiritual Well-Being Scale scores differ according to the method used in pain management. Spiritual well-being and pain intensity explain 68% of the total variance in pain catastrophizing. ConclusionsThe results of this research show that there may be a relationship between increased spirituality and reduced perceptions of pain in this population.

Pulled from the Shoreline in Search of Spacious Spirituality: Journeys of Spiritual Distress, Resilience, and Posttraumatic Growth for Women of Evangelical Christian Backgrounds in a Canadian Context

Religion and spirituality (R/S) provide possibilities for healing, resilience, meaning making, and posttraumatic growth (PTG) in the aftermath of trauma. Still, R/S may also be the precursors and/or sources of harm, resulting in experiences of spiritual distress (SD). While extensive research has examined the positive mental health impacts of R/S, its potential harms are under-investigated. Addressing this gap, this article draws on findings from an interpretative phenomenological analysis (IPA) study with four women of evangelical Christian (EC) backgrounds who have experienced SD. The women’s stories revealed SD as an isolating and profoundly tension-filled experience characterized by painful relational loss, fraught belonging, existential uncertainty, and acute spiritual pain. Several women used the term “trauma” to describe their experiences. This study evidences the tender and isolating complexity of SD. For the women, spirituality served as both a cause and a perpetuator of trauma, and as a vehicle for transcendent meaning making in response to wounding. Ultimately, spirituality is tangled in the women’s distress while also playing a role in their posttraumatic growth. Implications include a call for increased awareness and advocacy regarding SD, as well as a trauma-informed, spiritually sensitive, curious posture from practitioners supporting clients with SD to foster posttraumatic growth.

Assessing suffering of patients on cancer treatment and of those no longer treated using ESAS–Total Care (TC)

AimThe aim of the study was to assess the suffering of patients on oncologic treatment and of those no longer on treatment. Preliminarily, we aimed to confirm the psychometric properties of Edmonton Symptom Assessment System–Total Care (ESAS-TC) in different stages of the disease. The ESAS-TC screens physical and psychological symptoms, but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation.MethodsA sample of consecutive advanced cancer patients on oncologic therapies treated at the Internistic and Geriatric Supportive Care Unit (IGSCU) of Istituto Nazionale dei Tumori, Milano, and of terminal patients no longer on treatment and cared for by the Fondazione ANT palliative home care team were asked to fill the ESAS-TC. In order to strengthen the previous validation study of the ESAS-TC, 3-ULS (to assess social isolation), JSWBS (to assess spiritual well-being), COST-IT (to assess financial distress), and KPS (to assess functional status) were administered too.ResultsThe questionnaires were self-reported by 108 patients on treatment (52% >60 years old, female 53%, and 61% with KPS 90–100) and by 94 home care patients (71% >60 years old, female 51%, and 68% with KPS 10–50). The sound psychometric characteristics of ESAS-TC were confirmed. Patients on treatment showed lower total ESAS-TC score (19.3 vs 52.7, p<.001) after controlling for age and functional status, and lower financial distress (p.<001). Financial distress, spiritual suffering, and social isolation, after controlling for age, showed a significantly higher score in home care patients.ConclusionsOnly through an adequate routine assessment with validated tools is it possible to detect total suffering, the “Total pain” of patients, and treat it through a multidisciplinary approach. The study confirms the reliability and validity of the Italian version of ESAS-TC and the importance of supportive and early palliative care fully integrated with oncological treatment.

Effects of Music Therapy on Spiritual Well-Being among Patients with Advanced Cancer in Palliative Care: A Meta-Analysis of Randomized Controlled Trials

PurposePatients with advanced cancer in palliative care often experience physical and psychological symptoms that negatively impact their quality of life (QoL) and spiritual well-being. Music therapy can be used for symptom management in these patients. However, the effectiveness is uncertain. To determine the effectiveness of music therapy on spiritual well-being, QoL, pain, and psychological distress using randomized controlled trials (RCTs). Data SourceA systematic search was conducted in EMBASE, PubMed, Cochrane Library, CINAHL, Web of Science, and the ClinicalTrial.gov registry up to September 2022. ConclusionThe meta-analysis included seven RCTs with a total of 747 advanced cancer patients. Music therapy was found to significantly improve spiritual well-being with a mean difference of 0.43 (95% CI: 0.25 to 0.61, P < .001) in the intervention group compared to the control group. However, no significant group differences were found between the intervention and control groups for QoL (SMD: 0.53, 95% CI: –0.12 to 1.13, P = .11), pain (MD: –0.81, 95% CI: –2.06 to 0.44, P = .20), and psychological distress (SMD: –0.05, 95% CI: –0.41 to 0.32, P = .81). Music therapy can effectively improve the spiritual well-being of palliative care patients. However, its beneficial effects on QoL, pain, and psychological distress were minimal. Implications for Nursing PracticeMusic therapy interventions can be introduced to help patients deal with spiritual/existential needs. Future studies should identify optimal characteristics of music therapy interventions to aid in enhancing the quality of palliative care for patients with advanced cancer.

"Do you Really Believe that There is Something More?" - The Offer of Transcendental Communication by Pastoral Care Workers in German Hospices and Palliative Care Units: A Qualitative Study.

Palliative Care also encompasses the dimension of spiritual pain. Pastoral care workers and chaplains are specialists in the provision of spiritual care. Decreasing religious affiliation and increasing spiritual diversification in modern societies raise the question of the function of pastoral care. The goal of this study is to answer the question of what pastoral care workers can offer to dying residents in hospices and palliative care units. A qualitative interview study was designed to explore the specific perspective of pastoral care workers in a multidisciplinary environment. The study is based on differentiation theory which is particularly well adjusted to reveal differences in perspectives in so called 'holistic' care settings. The reporting follows the COREQ guidelines. Problem centered interviews were conducted at five hospices and two palliative care units. Eight pastoral care workers were interviewed (5 Catholic, 3 Protestant, mean age of 58years). The analysis of the interviews revealed three major themes: (A) Self-positioning in relation to the organization, (B) Offering conversations to patients and relatives, (C) Performing religious rituals. Minor themes were: mediating conflicts between patients, relatives and staff, sensing moods in silence with patients and organizing workshops for staff. In modern hospice care, pastoral care workers routinely address the problem of making death more tangible and of answering the unanswerable question of what comes afterwards. Through this, they support dying residents in hospices and palliative care units in dealing with the inexplicability of death.

Considerations for Pain Assessments in Cancer Patients: A Narrative Review of the Latin American Perspective.

Cancer incidence in Latin America is lower than in Europe or the United States but morbidity and mortality rates are disproportionately high. A barrier to adequate pain control is inadequate pain assessment, which is a relatively easy and inexpensive metric. The objective of this narrative review is to describe pain assessment for cancer patients in Latin America. Cultural factors may influence pain perception, including contextualizing pain as noble or natural suffering and aspects of what is now called "spiritual pain." Unlike other painful conditions, cancer pain may be strongly associated with existential fear, psychosocial distress, anxiety, and spiritual concerns. Pain assessment allows not just quantification of pain intensity but may elucidate pain mechanisms involved or psychosocial aspects that may color the pain. Many current pain assessment instruments capture only pain intensity, which is but one aspect of the pain experience; some have expanded to include functional assessments, mental health status evaluations, and quality of life metrics. A quality-of-life assessment may be appropriate for cancer patients since chronic pain can severely impact function, which can in turn create a vicious cycle by exacerbating pain. The incidence of cancer in Latin America is expected to increase in the ensuing years. Better pain assessment and clinician education are needed to help manage pain in this large and growing patient population.

"A Pain Deep in Your Soul (Being) that is Not Physical:" Assessing Spiritual Pain in Integrative Oncology Consultations.

Spiritual pain contributes to the suffering of cancer patients. However, it is unclear whether patients seen outside of palliative care report spiritual pain and its relationship with symptom burden. Characteristics of patients reporting spiritual pain were examined, as well as the association of spiritual pain with symptom burden and how spiritual pain affected the factor structure of the Edmonton Symptom Assessment System (ESAS). A retrospective chart review was conducted of integrative oncology patients who completed the PROMIS10 and a modified ESAS (ESAS-FS) including financial distress and spiritual pain (pain deep in your soul/being that is not physical). Multiple logistic regression was used to assess associations between demographics and spiritual pain. T-tests compared ESAS-FS symptoms and global health for patients endorsing spiritual pain (0 vs. ≥1). Principal component analyses (oblique rotation) were also used to determine ESAS-FS symptom clusters. The sample (N=1662) was mostly women (65%) and 39% endorsed spiritual pain at least ≥one. Men and older individuals were less likely to endorse spiritual pain (ps < 0.05). Presence of spiritual pain was associated with worse symptoms on the ESAS-FS and global health (ps < 0.001). The ESAS-FS had two symptom clusters, with the psychological factor including depression, anxiety, wellbeing, sleep, financial distress, and spiritual pain (Cronbach's alpha 0.78). Assessing spiritual pain and understanding the effects of its presence or absence in the context of other physical and psychosocial symptoms may provide additional opportunities for preventing exacerbation of symptoms, improving quality of life, and enhancing overall experience of care.

The 2 a.m. Moment and the Art of Our Science.

The 2 a.m. Moment and the Art of Our Science Palliative nurses around the world have been emerging as health system leaders and advancing their scopes of practice for the past several decades—all while serving as key members of interdisciplinary clinical teams and in academic settings. The COVID pandemic has crystallized the power and privilege, as well as the predicaments, of palliative nursing. Serious illness care and health systems globally are forever changed since the 2020 onset of the pandemic. Yet, nurses have risen to the call to fulfill their professional obligations with a fierce commitment to quality care, safe practice, and confronting ethical dilemmas in daily practice. As the world confronts myriad humanitarian emergencies, such as the injustices resultant of the climate crisis and ongoing social inequities, nurses’ capacity as psychosocial and spiritual caregivers, pain and symptom management experts, conduits for empathic communication, and procurers of cultural safety are being increasingly recognized. As the palliative nursing field grows, it becomes increasingly important to maintain consistent connection with our reason for being of service: promoting, preserving, and protecting the integrity of the relationships we have with people suffering from life-limiting illness and injury, their families and loved ones, and their broader communities of support. And for many we serve, that care will also include presence at the sacred time when life ends. So much of the sacred work of nursing can be found within the art that underlies our science: how we engage the human-to-human moments between nurse and patient, and their families. The ways that we understand and use these moments offer us endless lessons to drive our personal and professional growth, clinical practice, core values behind our teaching and education, and our research questions.1 These moments are epitomized in the 2 a.m. moment, when the bustle of the hospital or the home has settled, and it is just nurse and patient in solidarity. And there we are: human-to-human amid both suffering and hope with the full range of emotions possible. It is these moments when the patient might ask, “Am I dying?” Or there may be deep feelings shared: “I am so afraid—so very, very afraid.” “I’ve lived a good life. How blessed! I am ready to move on.” “I have not been a good father. I am so sorry.” “Why me? Why now? I have so much left to do.” In her six-year study on the nurse and the dying patient, Jeanne Quint wrote that, “Sharing such a moment can be a poignant experience for both the patient and the [nurse]… When the [nurse] participates in this kind of communion with the dying patient, [they] make a significant human contribution… Some dying patients feel abandoned by everyone unless someone provides them with human contact” (Quint, 1967, p. 220). It has been over 50 years since Jeanne Quint wrote those words yet the issues of abandonment, and the ability of nurses to offer comfort remains. How the nurse remains present, listens, internalizes, responds, uses the silences, and continues to bear witness can profoundly shape the next moments of living and dying. There is endless possibility and opportunity for nurses to be of value and to practice fully within the art and in their science. This 2 a.m. moment is the premise of palliative nursing—that there are always openings for healing, connection, and service. The 2 a.m. moment provides the time during darkness when all the chaos of the day is gone and what remains is the silence. It is within that silence that the nurse remembers what it means to be fully present. In recognizing the profound experience of the patient facing death, the nurse also holds up a mirror of reflection. What does it mean to be a nurse? What do I bring to this moment which is unique from my colleagues? Why do I do the work of palliative care? What am I learning in this moment, from this patient? William RosaJHPN Editorial Board MemberBetty FerrellJHPN Editor in Chief

Compassion in Silence: Reflections on the Art of Listening as a Medical Student in Palliative Care.

Recently I had the privilege to take a clinical elective on spirituality and palliative care. Now mid-way through my third year of medical school, I was surprised by how often I found myself caring for patients with great suffering—not only patients with terminal illness, but those struggling with emotional and spiritual pain brought on by the COVID-19 pandemic. During my first clerkship, surgery, I worked with a patient with an incurable cancer who struggled to understand her demise as the team worked to meaningfully extend her life. As the team talked about new scans, labs, possible resections and anastomoses, I kept wondering where her humanity fit into these discussions. Months later, I looked forward to this elective so I could better comprehend the spiritual dimensions of suffering by working with palliative care teams and shadowing chaplains over two weeks.

INTEGRATION OF PALLIATIVE CARE INTO MEDICAL SCHOOL CURRICULUM IN NEPAL – An analytical study among medical students in Nepal

Introduction The holistic approach of palliative care aims at improving the life of patients with life-threatening diseases and their families through early identification, assessment, and treatment of physical, psychological, or spiritual pain. Despite the recognition of palliative care as a human right and essential for the improvement of the quality of life of patients – and their families, many low-income countries either lack palliative care services or have limited access to it. The WHO suggests that one of the steps that countries can take to eliminate these barriers is to include palliative care into the core curricula of all new health professionals. A study in 2019 showed that 58,000 adults required palliative care in Nepal in 2012, and most of them lived in rural areas. Palliative care in Nepal is still new and training programs for doctors and nurses are not fully developed and in place in undergraduate medical schools. This study evaluates the working knowledge of palliative care among undergraduate medical students, and the presence of it in their academic curriculum. Methods This analytical study was designed during an internship at the Binaytara Foundation Cancer Center in Nepal. The study was conducted among undergraduate medical students between March 6th, 2020 to July 6th, 2020. The questionnaire results were entered on Microsoft Excel and then analyzed. Results Results showed that 63.2% of the respondents had heard of “Palliative Medicine”, but 68.4% did not know the WHO definition of Palliative Care (Table 2 (135189)). Among all the students from the different universities, 33.3% said that palliative care is part of their curriculum, while 66.6% said it is not (Table 5 (135192)). Conclusions The results from the study demonstrated inadequate knowledge and perception of palliative care among undergraduate medical students in Nepali institutions. The EAPC indications on a palliative care curriculum could be taken as a blueprint for developing a tailored one for medical schools in Nepal to set a strong base for the next generation of doctors to be able to appropriately meet the needs of patients and their families.