'Of All Mindfulness Meditation, That on Death is Supreme': A Dialogical Narrative Analysis with Palliative Care Nurses

Abstract

“Mindfulness gets thrown around all the time, but what does it actually mean in practice?” I interpreted this question posed by a nurse in this inquiry, as a statement of curiosity and concern. As conceptualizations, practices, and programs of mindfulness continue to diversify, there is a call to understand mindfulness as a socially and culturally embedded practice. Some critiques suggest mindfulness is moving too far from its ethical orientation and becoming instrumentalized as a tool. Therefore, the pervasive presence of ‘mindfulness’ across work and educational settings renders the question what does mindfulness actually mean in practice? an important one for nursing as a discipline, and within palliative care nursing practice.

Mindfulness is proposed broadly here as an approach to meet therapeutic and relational aims for nurses within palliative care practice. What it means to be mindfully present and compassionate in the midst of suffering, strong emotion and profound uncertainty is rarely discussed. Grounded in conversations with nine palliative care nurses (their words italicized), I explored how mindfulness shapes relationally engaged ways of being while caring for people with terminal disease and existential distress. Using a contemplative dialogical narrative approach, I analyzed nurses’ stories as units of data to explore multilayered narratives with personal, social, and cultural storylines. Using an emergent and iterative design, I dialogued across various aspects of the research process enacting an integrative approach. Metaphorically, this dissertation is structured as a contemplative walk within a classical seven-circuit labyrinth; readers are invited to walk a circuitous path while following along as stories take the lead.

Seven turns in the labyrinth outline a path conveying key recursive narratives of mindfulness. Turning in various directions three guiding story threads are woven together to create the path: 1) palliative care nursing as mindfulness is an embodied ethic creating space(s) for creativity and ‘connection’ through the ‘big stuff’; 2) such ‘space’ can be generated and accessed through somatic practices of ‘self-awareness’ and ‘self-care’; and 3) spaces of caring are continuously transforming within the communities in which they are practiced. Nurses’ stories foreground ways organizational and educational systems support or constrain how mindfulness as an embodied ethic of care can be enacted. This study adds to the ongoing conversation of mindfulness and its value when practiced/understood as palliative care nursing. As the historical Buddha was quoted to have said “of all mindfulness meditation, that on death is supreme.”