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Communication vignettes
  1. Helen Scott
  1. Helen Scott is Editor, End of Life Journal, and Vicky Robinson is Consultant Nurse in Palliative and End of Life Care, Guy’s and St Thomas’ NHS Foundation Trust. Email:

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Patients who ask ‘What have I done to deserve this?’ are usually articulating spiritual distress. However, nurses often feel uncomfortable discussing spiritual concerns and have difficulty recording spiritual assessments (The Marie Curie Palliative Care Institute and Royal College of Physicians, 2009). That may be due, in part, to the fact that spirituality is a difficult concept to understand (Wright, 2002). The terminology used to define spirituality can be confusing, e.g. existential (pertaining to existence) and transcendence (extending beyond the limits of ordinary experience) (Scott and Speck, 2010).

Spirituality is often confused with religion. However, they are distinct concepts. In simplistic terms, spirituality is the search for the meaning of existence and the purpose of, and value in, life (Kearney, 1990; Speck, 2003). Some definitions of spirituality refer to a power other than self, expressed as ‘God’ or nature (Speck, 2004; National Institute for Health and Clinical Excellence (NICE), 2004). Religious practice, which is a system of faith and worship, is just one expression of spirituality, as is atheism, existentialism and humanism. Everyone has spiritual needs, regardless of world-views and belief systems (Wilkinson and Coleman, 2010). Conversations relating to ‘spirituality’ and ‘spiritual’ needs in palliative and end-of-life care are considered to be the responsibility of all members of the multiprofessional team, including nurses (NICE, 2004; World Health Organization, 2008).

The search for life’s meaning becomes particularly pronounced when faced with life-threatening illness (Grant et al, 2004; Murray et al, 2004). That can lead to patients asking questions such as ‘Why me?’, ‘What have I done to deserve this?’ and ‘Does God hate me?’ (Saunders, 1987). Struggling with such questions has been termed ‘spiritual pain’ (Kearney, 1990). Saunders (1987) described spiritual pain as feelings of failure, worthlessness and bewilderment in the face of death. People facing death …

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