The 2 a.m. Moment and the Art of Our Science

Palliative nurses around the world have been emerging as health system leaders and advancing their scopes of practice for the past several decades—all while serving as key members of interdisciplinary clinical teams and in academic settings. The COVID pandemic has crystallized the power and privilege, as well as the predicaments, of palliative nursing. Serious illness care and health systems globally are forever changed since the 2020 onset of the pandemic. Yet, nurses have risen to the call to fulfill their professional obligations with a fierce commitment to quality care, safe practice, and confronting ethical dilemmas in daily practice. As the world confronts myriad humanitarian emergencies, such as the injustices resultant of the climate crisis and ongoing social inequities, nurses’ capacity as psychosocial and spiritual caregivers, pain and symptom management experts, conduits for empathic communication, and procurers of cultural safety are being increasingly recognized.

As the palliative nursing field grows, it becomes increasingly important to maintain consistent connection with our reason for being of service: promoting, preserving, and protecting the integrity of the relationships we have with people suffering from life-limiting illness and injury, their families and loved ones, and their broader communities of support. And for many we serve, that care will also include presence at the sacred time when life ends. So much of the sacred work of nursing can be found within the art that underlies our science: how we engage the human-to-human moments between nurse and patient, and their families. The ways that we understand and use these moments offer us endless lessons to drive our personal and professional growth, clinical practice, core values behind our teaching and education, and our research questions.1

These moments are epitomized in the 2 a.m. moment, when the bustle of the hospital or the home has settled, and it is just nurse and patient in solidarity. And there we are: human-to-human amid both suffering and hope with the full range of emotions possible. It is these moments when the patient might ask, “Am I dying?” Or there may be deep feelings shared:

“I am so afraid—so very, very afraid.”

“I’ve lived a good life. How blessed! I am ready to move on.”

“I have not been a good father. I am so sorry.”

“Why me? Why now? I have so much left to do.”

In her six-year study on the nurse and the dying patient, Jeanne Quint wrote that, “Sharing such a moment can be a poignant experience for both the patient and the [nurse]… When the [nurse] participates in this kind of communion with the dying patient, [they] make a significant human contribution… Some dying patients feel abandoned by everyone unless someone provides them with human contact” (Quint, 1967, p. 220). It has been over 50 years since Jeanne Quint wrote those words yet the issues of abandonment, and the ability of nurses to offer comfort remains.

How the nurse remains present, listens, internalizes, responds, uses the silences, and continues to bear witness can profoundly shape the next moments of living and dying. There is endless possibility and opportunity for nurses to be of value and to practice fully within the art and in their science. This 2 a.m. moment is the premise of palliative nursing—that there are always openings for healing, connection, and service. The 2 a.m. moment provides the time during darkness when all the chaos of the day is gone and what remains is the silence. It is within that silence that the nurse remembers what it means to be fully present. In recognizing the profound experience of the patient facing death, the nurse also holds up a mirror of reflection. What does it mean to be a nurse? What do I bring to this moment which is unique from my colleagues? Why do I do the work of palliative care? What am I learning in this moment, from this patient?

William Rosa
JHPN Editorial Board Member
Betty Ferrell
JHPN Editor in Chief

References 1. Rosa W, Ferrell B. The Nature of suffering and the Goals of Nursing. 2nd ed. New York, NY: Oxford University Press; 2023, in press. 2. Quint JC. The nurse and the dying patient. New York: The Macmillan Company; 1967.