In researching moral courage and nursing, I came across a paper by Thorup et al which discussed courage as having three distinct aspects:-
- The courage to help patients face their own vulnerability and suffering
- The courage to trust oneself in advocating for patients and providing quality care
- The courage to bear witness
Whilst, my research focuses on the second aspect, the development of moral courage, I hadn’t given much thought to the third aspect – the courage to bear witness. The more I reflect on this concept, the more I realise its importance and the overwhelming impact this can have not only on our patients, but also ourselves. The concept was illustrated brilliantly with this brief narrative from one of the nurses interviewed:-
“I remember the first really sick lung patient I saw here; she could not get enough air so she was absolutely blue in the face. I really had to force myself to…..I literally had to hold on to the guard rail to stay there because it’s almost impossible to endure that terrible craving for air and the desperation, but……well, you learn little by little. For a patient in that kind of situation, it’s really important that the people around them can bear to stay there and by present”. (p. 432)
In nursing, we witness many significant moments in people’s lives. We witness first and last breaths. We witness first hellos and last goodbyes. We witness tremendous grief and incredible joy. We also witness the moments in between, moments of intense suffering and extreme vulnerability. To bear witness in these situations takes an amazing amount of strength and resilience. Yet, having someone to bear witness can have a profound impact on our patients.
It is one of the hardest aspects of nursing but, at the same time, one of the many privileges of our profession. I hope we all have the courage to perform this role when needed and, crucially, also have access to support networks (both professional and personal) that keep us strong enough to endure it.
It is also one aspect of clinical practice that I am not sure we prepare our student nurses to face. In my opinion, this is why we need to share our stories and experiences with them*. Allowing our students to bear witness through our eyes, to hear our own emotional responses, to first witness our vulnerability before that of our patients is a critical part of nursing education. Offer a diluted experience in a safe space prior to a potentially overwhelming experience in the clinical setting. To do this, to open ourselves up as educators, also takes courage – a courage I hope we can all find.
Ref:- Thorup, C., Rundqvist, E., Roberts, C. & Demar, C. (2012). Care as a matter of courage: vulnerability, suffering and ethical formation in nursing care. Scandinavian Journal of Caring Sciences, 26; 427-435. DOI: /j-1471-6712.201100944.x
*whilst obviously maintaining confidentiality