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

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Parker Palmer is an educator and leader who has made major contributions in understanding human relationships, communication, and many other area central to our field of palliative care. He has written numerous books including "A Hidden Wholeness: The Journey Toward an Undivided Life" and he is the founder of the Center for Courage and Renewal ( I have found his work to be profoundly relevant to the world of palliative nursing.


Palmer recently wrote a column ( on the topic of "The Gift of Presence, The Perils of Advice." In it, he describes a common truth I find in palliative nursing, which is the importance of listening attentively and offering our presence to patients, and I would also add, to family members.


In this essay, some of his words struck a chord for me. He described being with a person who was terminally ill and after a time of listening to him, the man voiced having a sense of peace. Palmer observed that the man had peace that came "within him" rather than anything he had done for the man. He wrote, "I'd simply helped clear some rubble that blocked his access to his own soul."


The major theme of this particular article written by Palmer was about avoiding giving advice. As he pointed out, as a society, we are all skilled at giving others advice even when, or perhaps especially when, it is not asked for. Reading Palmer's words about the need to avoid advice-giving and instead focus on simply being present reminded me of other important literature by authors such as Rachael Naomi Remen and that we need to be less focused on "fixing".1 As health care professionals, we are intensely wired to fix the broken. Yet both Palmer and Remen remind us that people who are seriously ill or dying are not broken and our role is not to fix.


Beyond this article's reminding me of the value of listening and presence, it also raised in me new thoughts about giving advice. While we in palliative care are likely not so inclined to be giving advice about second opinions or new treatments, my hunch is that we, too, are guilty of advice-giving. Palliative care nurses give advice because we think we have knowledge and experience about things patients and families should know. And so, we give a patient advice about how to deal with her estranged son instead of listening to the pain in her soul about that separation. We give advice to the husband within seconds of his mentioning that he can no longer care for his wife with dementia at home, because, after all, we know about the best facilities. But should we instead be listening deeply to his suffering, as he feels he is abandoning his soulmate?


As Palmer wrote: "Here's the deal. The human soul doesn't want to be advised or fixed or saved. It simply wants to be witnessed - to be seen, heard and companioned exactly as it is. When we make that kind of deep bow to the soul of a suffering person, our respect reinforces the soul's healing resources, the only resources that can help the sufferer make it through." Every article in this journal is a reminder of the need for less advice-giving and more listening.



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






1. Remen RN. Kitchen Table Wisdom: Stories that Heal, 10th Anniversary Edition. New York, NY: The Berkley Publishing Company, Published by The Penguin Group; 2006. [Context Link]