Listed in Issue 20


GEORGESEN and DUNGAN, Evansville Cancer Center, Indiana USA write that cancer threatens our very existence and that pain compounds suffering, leading to spiritual distress. The authors present a nursing strategy to deal with the responses of patients and their families in these complex situations.



Using an approach based upon the Dungan model of dynamic integration, 4 case studies were analysed to describe its methodology and applicability. The goal of the first appointment was to teach patients how to deal effectively with their advanced cancer pain. The hallmarks of nursing modalities used were presence, caring, genuine concern and active listening, which facilitated the therapeutic relationship. While patients were treated by the medical staff, daily appointments with the nurse continued for 610 days, where trust was established by reaching the mutual goal of providing the patient control over pain. Spiritual assessment confirmed the diagnosis. Grief, a characteristic of spiritual distress, was experienced by all patients, therefore grief counselling was implemented early and reinforced daily. Used selectively were spiritual counselling, cognitive reframing, crisis intervention and reminiscence. Multi-disciplinary referrals were required by all patients, due to the complexity of problems faced by families.


The outcomes were evaluated positively by participants. All patients showed increased hope, participated in the grief process and integrated the possibility of death in a manner as to promote personally defined "quality of life" in their waning days.



Georgesen J and Dungan JM. Managing spiritual distress in patients with advanced cancer pain. Cancer Nurs 19(5): 37683. Oct 1996.

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