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At sundown, spirit rises

Author: Diana Price

If you have ever spent the night in a hospital, you know that there is a distinct shift in the energy of the place when the sun goes down. The noise and the shuffle of the day subsides—visitors head home and take the business of the outside world with them; regular visits with physicians are replaced by intermittent monitoring by night staff; sleep can be disrupted; anxieties and deeper emotional issues can rise to the surface. Meanwhile the physical needs and concerns of patients present in daylight hours continue their course, paying no heed to any schedule or rhythm. It is a time that can be simultaneously subdued and intense for patients and those who care for them.

It is in this environment that oncology nurses who work the night shift spend time engaged with their patients and their patients’ families, not only attending to physical needs but also, often, offering critical spiritual and emotional support. At Cancer Treatment Centers of America® (CTCA) in Philadelphia, Pennsylvania, Supervisor of Pastoral Care Reverend Wendell Scanterbury says that nurses who work this shift operate in a unique environment. “At night, nurses can be much more exposed to the personal lives of their patients and often have more time to interact with them,” he says. “They get to know them up close and personal—they hear about their homes and their children, what was going on before cancer, what other struggles they are dealing with, about their joys and anxieties.” It is natural in this intimate environment, he says, for nurses to develop close relationships with patients and relate on a personal level.

Verna Carson, PhD, CNSPMH-BC, is an advanced-practice, board-certified clinical nurse specialist in psychiatric/ mental health nursing and co-author of several books on the role of spirituality in nursing, including Spiritual Caregiving: Healthcare as a Ministry and Spiritual Dimensions of Nursing Practice. Carson says that the deep connections that develop between oncology nurses and their patients in this setting allow nurses to provide critical emotional support, but they can also take an emotional toll. “Oncology nurses deal with emotional, physical and spiritual pain in both patients and families,” she says. “This role means they have the privilege of sharing in the anticipation and the excitement when treatment works as well, but it also means sharing in the despair and the disappointment that occurs when research and medications fail to produce the desired result.”

As they repeatedly accompany patients and families through these experiences, Dr. Carson says, oncology nurses are at risk of experiencing fatigue and burnout if they don’t take care to process their own emotions and engage in spiritual self-care. By seeking spiritual support themselves, nurses bolster their spiritual foundation and are able to gain perspective on the intense work they do, allowing them to find meaning in their work and continue to support patients. “When the nurse is taking care of his or her own spiritual well-being, that nurse is more attuned to spiritual struggles and breakthroughs experienced by patients and their families,” she says. With this awareness, Dr. Carson adds, nurses can be “excellent facilitators of open spiritual communication with the patient and the family and can help them work through issues such as forgiveness, love, gratitude and saying good-bye—all important spiritual issues that are more easily introduced by a nurse who has a strong spiritual foundation and is comfortable with initiating and participating in such discussions.”

Ensuring that nurses who provide care in this environment have the support they need to serve patients and families is the goal of the Sundown Program, a weekly spiritual support group for night-shift nurses at CTCA in Philadelphia. The group, led by Reverend Luis Centeno, offers nurses the opportunity to share their feelings about their work and personal lives in a safe, confidential environment. Rev. Scanterbury says that participants are invited to open up about their lives and benefit from the support of the other participants and the spiritual facilitator. “They can discuss whatever is going on in their lives, whatever is on their minds,” he says. As facilitator, Rev. Centeno helps guide the discussion, but the focus and the flow of each session is largely dictated by the needs of the group.

Rev. Scanterbury says that the benefits of the Sundown Program are wide-ranging. “For the nurses it’s a huge relief that someone recognizes the intensity of their workload and the toll it takes on them emotionally and spiritually, that someone recognizes that they do need support,” he says. The confidential nature of the group allows them to speak freely and feel supported. “The program really does help with the whole process of stress relief,” he adds. “They have a channel to relieve that stress and express grief.”

This opportunity to relieve stress and feel spiritually supported translates into a benefit for patients and other staff, says Rev. Scanterbury. “To the degree that an individual feels a reduction in their stress level, it allows them to interact more effectively with others— their coworkers as well as the patients they’re caring for.” The entire enterprise is buoyed by the program. “We’ve seen the level of bonding, camaraderie and morale experience a boost from the support the program provides.”

The commitment on the part of CTCA to support its nurses in this manner speaks to the critical role that nurses play in the organization. “Our nurses are the backbone of our organization,” Rev. Scanterbury says, “and we need to continue to support them because the more they receive that kind of support, the more it will have a ripple effect into their own sense of well-being and their capacity to provide a high level of service and support to patients and caregivers.”

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