Abstract
Dear Editor,
I read with interest a recent article published in this journal titled “The Role of Forgiveness for Aging and Advanced Illness: An Integrative Systematic Review” (Rossy et al., 2025). The authors conducted an integrative systematic review to synthesize findings from original peer-reviewed research articles among adults receiving treatment for advanced illness and/or older adults from selected electronic databases. The findings identified the commonalities in the attributes underlying forgiveness, benefits of forgiveness on physical and mental health, and the forgiveness interventions relevant to aging and advanced illness. In conclusion, the authors guided holistic nurses to promote forgiveness as an essential part of holistic healthcare in aging and advanced illness. This study is a valuable contribution in strengthening the commitment of nurses to enhance the bio-psycho-socio-spiritual well-being of patients, especially those in need of palliative care. Several studies have validated the various benefits of forgiveness in the selected population. On the contrary, it is also important to consider the possibility of a scenario where the patient is not granted forgiveness. With this, it is crucial to respond with the questions, “What will be the effects of this unfortunate circumstance?” and “How can nurses help the ‘unforgiven’ patient?”
Patients who are aging and terminally ill usually have a final wish and desire to fix everything in place before their last breath—to forgive and be forgiven. Forgiveness can reduce patients’ suffering and improve their quality of life, including that of their families. The health benefits that are associated with it include lower levels of depression, decreased blood pressure, positive mental health, and physical and emotional well-being (Silva et al., 2020). A forgiving person is motivated to treat the other(s) well; tries to reduce negative thoughts and to see the inherent worth in the other as a person; reduces negative feelings and develops more positive affect such as compassion and empathy toward the other(s); and deliberately reduces negative behaviors and acts more positively towards the other(s), which can include respect, kind actions, and even loving gestures (Nisar et al., 2025). These benefits contribute to the overall well-being of the patient.
On the other hand, there are possible instances where forgiveness remains elusive for the patient who is hesitant to offer it, and similarly, on the part of the other parties refusing to offer it to the patient. Unforgiveness should be avoided because it is connected with the central value of health. It is conceptualized as a stress reaction. Direct empirical research suggests that forgiveness is related to health outcomes and to mediating physiological processes in such a way as to support the conceptualization that forgiveness is an emotion-focused coping strategy (Worthington & Scherer, 2004). Thus, health professionals must facilitate forgiveness interventions to promote an improved and less stressful quality of life in palliative care.
Healthcare providers can play an essential role in helping patients and families through facilitating interventions that promote the virtue of forgiveness. People receiving forgiveness interventions were shown to help address mental/emotional health. They are reported to be more forgiving than those who had no intervention and be more hopeful and less depressed/anxious than those who did not receive (Recine, 2015). One popular intervention model is narrative therapy. It is an approach that involves exploring and reauthoring an individual's narrative through the processes of: identifying and challenging negative narratives and emotions; reauthoring their personal stories, incorporating forgiveness and healing; and developing a greater sense of control and empowerment. This can be a powerful tool in facilitating forgiveness, allowing patients and families to reframe their experiences and find new meaning (Lee, 2025). The REACH model is another popular approach. It includes five broad steps: Recall (remembering and expressing the painful emotions associated with the offense), Explore (developing the offender's perspective and motivations, and building empathy), Acknowledge (recognizing times when the victim has received forgiveness from others; giving an altruistic gift of forgiveness), Commit (engaging publicly to forgiveness; making a formal commitment to forgive), and Hold (working to maintain forgiveness over time; holding onto the gains achieved in times of difficulty) (Worthington, 2001). Another model was developed by Enright and Fitzgibbons (2000). They have developed a 20-step forgiveness model divided into four broad phases (UDWD): Uncovering (presence of negative feelings about the offense), Decision (realizing the need for an alternative resolution in which the client might begin to have a “change of heart” toward the offender), Work (understanding and empathizing with the offending person), and Discovery (finding meaning and universality). Lastly, another model that focuses on the patient's psychosocial needs was crafted for social workers and healthcare professionals. These needs describe the interplay between the psychological and social factors in shaping the patient's behavior, thoughts, and well-being. The model is pivotal in attaining peaceful closure in end-of-life care. Thus, a continuous skill development that enhances the health professional's ability to target this aspect is highly encouraged (Baker, 2006).
In conclusion, nurses who render holistic care to aging and terminally ill patients must develop a multidisciplinary approach to facilitate different forgiveness interventions effectively. This will benefit the patients, their families, and themselves by reducing the psychological symptoms affecting their working conditions.
