Suffering revisited: Tenets of intensive caring

Suffering revisited: Tenets of intensive caring 
Psychiatric Times; by Harvey Max Chochinov, MD, PhD, FRCPC 
Patients approaching death experience many losses, including losing a sense of self. This is perhaps one of the most substantive existential challenges dying patients face, as they find the essence of who they are—along with who they were or who they want to be—under assault. This notion of disintegration or fractured sense of personhood often lies at the heart of human suffering, which Eric Cassell, MD, MACP, defined as a person’s severe distress at a threat to their personal integrity. Although suffering can often lead to feelings of hopelessness and therapeutic nihilism for patients and health care professionals, it is important for those of us who care for the dying to understand the nature of suffering and how to be most responsive and therapeutically effective. [This author's Tenets of Intensive Caring include the following:]

• Nonabandonment ...
• Taking an interest in the patient as a person ...
• Holding/containing hope ...
• Dignity-affirming tone of care / therapeutic presence ...
• Therapeutic humility ...

Editor's note: Share this superb article with your clinical leaders. Ask your direct care staff about these tenets, as--likely--they will validate these as being core to their best practices for providing care.