Working with difficult symptoms
Rather than providing a toolkit for working with difficult symptoms as in many other palliative care texts, a critical view of symptom management is offered here, as well as some different ideas about approaches that may be adopted while working with people facing physical, emotional or practical problems as a result of life-limiting illness. I have chosen to adopt a critical and reflective stance, since this seems to be a more fruitful avenue to finding ways of working with some of the most challenging problems faced in caring practice. I have chosen not to offer a set of solutions or guidance on the management of difficult symptoms, since these are unlikely to be addressed through this kind of approach; the problems are both complex and bound up in the particular contexts in which people with life-limiting illness live. I do, however, draw out some ideas that might be used to guide the development of caring practice.
Cribb (2001), in writing about knowledge and caring, identifies two worlds, the world of science and the 'human world'; that is, there is scientific knowledge and there are 'lay beliefs'. He argues that the human world is being displaced and colonized by the natural and human sciences, so that personal and common sense knowledge is being displaced by 'expert' knowledge. Cribb argues that alongside this knowledge there is also what he calls 'real knowledge'; that is, knowledge about how to do things that cannot be gained through textbooks – how to ride a bike, conduct a conversation, be a good listener, for example. It is this real knowledge that is primary, as it provides the frame of reference on which all other knowledge rests or is made use of. Other authors have outlined ways of knowing in the context of nursing practice (see, for example, Carper 1978; Johns 1995; Nolan and Lundh 1998). Like the 'real' knowledge of Cribbs, these authors argue that there is knowledge that comes from direct involvement with situations or experiences.
Cribb (2001) argues that 'the stories that weave our domestic lives indicate a reality just as substantial as the stories which tell us about the material