Transcending life: The practice wisdom of nursing hospice experts

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Abstract
In philosophy and theology, to transcend is to go beyond the limits of lived human experience. Hospice workers accompany people who are traveling beyond the limits. “Whoever would be a companion to the dying, therefore, must enter into their darkness, go with them at least part way along their lonely and frightening road.”1 This paper explores the requisite hospice practice competencies of caring spiritually and guiding letting go, as identified in a qualitative analysis of the practice stories of 32 hospice nurse experts working with people nearing death. Spirituality has been described as the essence of personhood, the longing for meaning in existence, experience of God, experience of ultimate values, and trust in the transcendent. Its ultimate end is union or connection with a reality more enduring than the individual self.2,3 In contrast, spiritual distress is manifested as alienation and disconnection.4 The reality of the dying process involves a progressive series of disconnections from life, which requires the process of letting go. Thus, transcending life involves both the need to detach and separate from life as it has been lived. One home visiting hospice nurse has described dying as a spiritual process of both reflecting and detaching.5 Nagai-Jacobsen and Burkhardt identify three goals of caring spiritually: • Fostering personal integrity; • Promoting interpersonal connection; • Supporting personal search for meaning.6 O ‘Connor describes hospice spiritual care promoted through the practice of presence, compassion, hopefulness, and the affirmation of life as fruitful.7 Stiles has completed the only published qualitative description of hospice nursing as spiritual care.5 She asked 11 hospice nurses and 12 bereaved families to describe their hospice experiences, which were then analyzed to name dimensions of the nurse-family spiritual relationship. Many of these dimensions parallel those of the current study and will be discussed below.

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