1. Section Editor(s): Ferrell, Betty PhD, MA, FAAN, FPCN, CHPN

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Over the past 2 years, I have had the opportunity to participate in an international project supported by the Fetzer Foundation on the topic of love and forgiveness.1 The project has assembled professionals across disciplines and continents to explore the concepts of love and forgiveness with participants including fields of health professions, world religions, public policy, education, and others.


My project has been to explore the experiences of hospice and palliative care nurses as they witness patients and families express regrets and the need for forgiveness. My pursuit of this topic has evolved over my 35 years of observing death-bed confessions of the terminally ill, complex dynamics and relationships among the seriously ill and their loved ones, and the suffering associated with unresolved life events. My real intent in pursuing this area of research was borne of my observing so often in our profession the belief that simply coaching a patient to say "I'm sorry" or offering a simple "fix" (eg, "Just call your brother and apologize"; "I'm sure your daughter forgives you"; "Here, let me call your son for you") can resolve often decades of estrangement, hurt, and agony.


In pursuing this topic of forgiveness in end-of-life care during my return to school a few years ago, I came upon scholarly work in fields of psychology and theology offering a much deeper understanding of the topic of forgiveness.2,3 These scholars have written about the process of forgiveness describing essential steps such as assisting the person to acknowledge the harm that was done, to feel worthy of being forgiven, and to fully embrace the experience of the other who was involved. Leaders in this field have advanced understanding of forgiveness in that it "goes beyond a simple pardon," and is not the same as forgetting, diminishing the harm or condoning the behavior.


Nurses have also contributed significantly to understanding relationships at the end of life, communication in the final days of life, and suffering that is intensified when regrets are ignored or minimized.4


In my research, nurses have shared their stories of witnessing requests for forgiveness, and these stories are filled with heart-wrenching details of lives which have seen physical abuse, hurt, substance abuse, loss, sadness, and regret. Many of these narratives written by nurses have ended with the simple fix, "I told him to call his brother, and he did, and he died peacefully a few hours later." Other narratives have captured the depths of the process of forgiveness, often which began with the nurse silently listening to the story of the harm reinforcing a basic tenet of palliative nursing care-listening in silence.


My hope in this work is to advance nurses' understanding of forgiveness as a common phenomenon experienced by those we serve. As I complete this analysis in the months ahead, I would like to create ways of teaching nurses in palliative care how to facilitate forgiveness and to share what I have learned through this interdisciplinary and international project.


As the year comes to an end, we reflect on our lives and our professional practice. What are the areas of your clinical practice you would hope to develop and expand in the year ahead? Are there better ways to relieve pain and symptoms? What can you learn from your interdisciplinary colleagues? What aspects of your practice deserve deeper reflection? I hope that each of you can also pause to reflect on your practice and to recognize your sacred work in 2012. The year end is also a season of gratitude. I am deeply grateful for a career and life work that allows me to probe intimate aspects of life such as forgiveness and to be a part of the nursing profession, the finest art.



Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN






1. Fetzer Institute. Accessed August 16, 2012. [Context Link]


2. Worthington E. Handbook of Forgiveness. Kalamazoo, MI: Routledge; 2005. [Context Link]


3. Ashby HU. Being forgiven: toward a thicker description of forgiveness. J Pastoral Care Counsel. 2003; 57: 143-152. [Context Link]


4. Exline JJ, Prince-Paul M, Root BL, Peereboom KS, Worthington EL Jr. Forgiveness, depressive symptoms, and communication at the end of life: a study with family members of hospice patients. J Palliat Med. 2012; 15 (10): 1113-1119. [Context Link]