Meaning and Purpose       

It is nearly impossible to discuss meaning outside the context of spirituality. Spirituality provides meaning to life, and meaning provides purpose when all that seems to remain in times of serious illness is personal identity and relationships (Tarumi, 2003). Illness has the capacity to break down self-concept and remodel perspective on life, relationships and role. This necessitates reconstruction of life’s purpose and meaning within the context of the experience. 

Meaning takes on a sense of immediacy at end of life, or when illness forces consideration regarding the possibility of end of life.  A life-threatening illness may force one to reassess beliefs regarding meaning, spirituality, life purpose and relationships, which may engender positive changes.  Some will arrive at this life crisis point with a sense of meaning and relevancy in their lives.  Others will require the crisis point and perceived loss of all that has provided meaning in the past in order to give conscious thought to meaning and the relevance of the current situation to the meaning of life.  Still others will choose not to dwell in the space of contemplation regarding meaning or purpose or relevance of their situation to a grander scheme (Rumbold, 2003). 

In Man’s Search for Meaning (1984), Victor Frankl wrote, “Man is not destroyed by suffering; he is destroyed by suffering without meaning.” Meaning provides a reference point within which to face the threat of depression and despair surrounding end of life. A person may turn to spiritual beliefs in times of suffering either because those beliefs have sustained them through life or because meaning is needed at a time when those things that have previously provided meaning no longer seem relevant. 

Barriers to finding meaning 

Lack of participation in religious community may cause guilt and initial reluctance to engage in spiritual support in times of significant need. Rejection of traditional religious practice but lack of subsequent resolution regarding connection with the spiritual on an individual level may cause difficulty with discernment of meaning when illness threatens life. Since spiritual beliefs assist facilitation of clarity regarding meaning in suffering and illness, lack of a construct within which to interpret life events and assign meaning to them may leave an individual with a sense of being adrift without purpose or hope.

Disbelief, anger and frustration surrounding an illness event may overwhelm a person when a connection to the spiritual and an accompanying sense of connectedness are lacking. Lack of an existing framework within which to place meaning on the presenting challenges may leave a person mired in negative emotions. 

Byock (1996) purports that end of life presents a developmental stage through which one must progress in order to complete the dying process. This progression requires a reframing of meaning. If a person is unable or unwilling to complete this life stage, a barrier to finding richer meaning in the experience arises. 

Facilitating meaning

Meaning creates structure within which to cope with depression and despair at end of life. Nurses, by nature of the comprehensive care provided, are well suited to assist patients who are struggling to find meaning within their illness. This necessitates spiritual assessment to determine the patient’s beliefs, sense of connection to the spiritual and resolution of feelings regarding illness. (Please see assessment page of Toolkit).  

Conscious awareness on the part of the nurse regarding the role meaning plays in alleviating suffering may facilitate healing. The spiritual beliefs of some religious traditions support the idea that there is meaning and purpose in suffering as regards the afterlife. As in all things, it is vital for the nurse to be sensitive to this need as attempts are made to facilitate healing. 

 Resources

Breitbart, W., Gibson, C., Poppito, SR, Berg, A.  (2004).   Psychotherapeutic interventions at the end of life: A focus on meaning and spirituality.  Canadian Journal of Psychiatry, 49, 366-372.

Byock, I.  (1996).  The nature of suffering and the nature of opportunity at the end of life.  Clinics in Geriatric Medicine, 12, 237-252. 

Frankl, V.  (1984).   Man’s Search for Meaning. New York, NY:Simon& Schuster. 

Puchalski, C.M.  (2002).    Spirituality and end of life care: A time for listening and caring.  Journal of Palliative Medicine, 5, 289-294. 

Rumbold, B.D.  (2003).    Caring for the spirit:  lessons from working with the dying.  Medical Journal of Australia, 179(6 Suppl), S11-S13. 

Tarumi, Y., Taube, A., Wantanabe, S.  (2003).   Clinical pastoral education: A physician’s experience and reflection on the meaning of spiritual care in palliative care.  The Journal of Pastoral Care and Counseling, 57, 27-31.

Caron, P. (2005)