March 13, 2000
A Nursing Perspective on Cancer Supportive Care
Donna L. Michel, RN, BSN
In early February I learned that Kaiser's new Cancer Supportive Care Program (CSCP) was to have its own web page. At the same time I learned that I was to write an article about the event for Cancerlynx.com focusing on questions such as why this is important? Why is it exciting? Presently, as I sat with the questions, a surprising answer began to unfold.
For background material the reader is referred to Dr. Ernest H. Rosenbaum's December 20, 1999 article on Cancerlynx.com, The Reason for Establishing a Cancer Supportive Care Program (CSCP) is the Need for an Improved Quality of Life for Cancer Patients. As Dr. Rosenbaum writes in his article, the CSCP supports body and mind which in turn enhances the individual's coping ability from diagnosis to treatment including treatment side effects. For Kaiser Permanente the CSCP had its genesis a number of months ago when the nurses from the oncology clinic attended an evening dinner and lecture on cancer fatigue During the course of the evening we were introduced to the CancerSupportiveCare web site. Next I began exploring the site and found a wealth of valuable information. As something seemed particularly relevant I would print articles for our weekly Friday Cancer Group. After receiving positive feedback, I wrote a brief proposal to expand our present group which I presented to our oncology chief, Dr. Brian J. Lewis. As serendipity would have it the two oncologists had long been acquainted with each other, the result of which was a fact finding meeting with Dr. Rosenbaum. This meeting in turn led to his support and sponsorship of the CSCP coming to Kaiser.
Now back to the original questions....Clearly the CSCP supports body and mind, and it goes even further. From a nursing perspective it is this "further" which constitutes both the excitement and importance. The program's complete name is "The Cancer Supportive Care Program for Total Patient Care," and that is exactly what it does, it supports body, mind, and spirit. Although nursing has long called itself a holistic profession which cares for the whole person, body-mind-spirit, this has largely been lip service in recent years. It is true that the profession acknowledges the importance of the spiritual domain, but the subject receives at best passing attention in today's outcomes driven health care environment. A literature search that reveals prodigious information about body and mind will uncover scant material on the spiritual dimension.
There are many reasons for this situation. Probably the biggest barrier is that definitions are difficult and lacking in consensus. For instance, one definition of spiritual well-being is "a sense of harmonious interconnectedness between self, others, nature, and ultimate other, which exists throughout and beyond space and time." Such definitions are not suited to quantitative research. Another barrier is that until recently spiritual and religious have been used interchangeably.
So where's the spiritual in The Cancer Supportive Care Program for Total Patient Care? The obvious place is in the web site module on spirituality and chaplaincy, and although the module is largely religion based it does acknowledge the distinction between religious and spiritual. The rest of the answer lies in the weekly programs. For instance the forgiveness lectures/workshops and the meditation classes both address the spiritual dimension.
Forgiveness has long been accepted as a spiritual principle in the 12-Step Programs. Members of these programs maintain that addiction is a spiritual problem, and as such is amenable to spiritual treatment. Forgiveness of people, places, things as well as self-forgiveness is one of the cornerstones of recovery. Along this same line of thought, a recent article announced "Stanford Forgiveness Project's Dr. Frederic Luskin studies why learning to forgive might be good for the body as well as the soul."
The practice of meditation which has ancient roots dating back thousands of years is a relative newcomer to the West. Although meditation is frequently considered to be a mental practice it was originally understood to be a spiritual practice. Meditation is a key element of all 12-Step Programs where its importance is unquestioned in the maintaining of ones spiritual equilibrium.
It is unclear what impact The Cancer Supportive Care Program will have on nursing practice. If, as one nursing theorist posits, each individual is born with a spiritual energy life force which exists on a continuum from dormant to highly developed, and if a profound crisis will frequently cause an individual to turn within seeking answers then nursing needs to make spiritual care a nursing practice reality. There are hopeful hints. A current article in a nursing publication banners that meditation is "going mainstream." Introducing patients to meditation would be one concrete avenue of introducing spiritual care into nursing practice. In a not too distant future teaching forgiveness may be accepted as an important aspect of primary health care prevention.
As a profession we have wandered far from our spiritual heritage. Florence Nightingale was acutely aware of the need to provide spiritual care. Her spiritual perspective allowed her to combine scientific principles with the spiritual dimension in giving holistic care to her patients. In today's health care system the nurse is stretched to meet the patient's physical needs which means that there is rarely time to address spiritual issues. Yet the reality is that research indicates that many patients look to nurses for spiritual care. Consequently, difficult as this challenge may be, if nursing is to be a truly holistic profession, the challenge must be accepted. In failing to accept this challenge we fail not only our patients but ourselves.
Kaiser Permanente Medical Office Building
at 2238 Geary,
San Francisco, CA.
415-833-2860 or 415-833-3289