The experience of suffering: conceptual clarification and theoretical definition

Abstract

This paper is concerned with the phenomenon of human suffering and is an attempt to justify and begin theoretical development of this phenomenon for nursing science. The paper is divided into three sections. The first section describes the interest of nursing science in the phenomenon and critically examines relevant literature in order to further conceptualize development and clarification. This section concludes with a theoretical definition of suffering derived from this critique. Suffering is defined as an individual's experience of threat to self and is a meaning given to events such as pain or loss. The second section elaborates on this definition and examines how it can inform theoretical discussion in two areas with import for nursing--the patient's experience of suffering and the nurse's experience of patient suffering. The final section briefly considers some implications for clinical research.

Spouses' grief before the patient's death: Retrospective experiences related to palliative home care in urban Sweden

“…Suffering in itself is without meaning, but by experiencing it every person can, eventually, attach a meaning to it. In their definition of suffering, Kahn and Steeves (1986) concluded that it is an individual experience of threat to one's personal identity. In addition to this, Younger (1995) suggests that suffering destroys the ability to communicate, and is therefore often accompanied by loneliness and alienation.…”

Suffering: a relatively unexplored phenomenon among family caregivers of non‐institutionalized patients with cancer

“…pam and suffenng of pahents Addressed even less is the But no one, mdudmg the anthropologist, soaologist and "°*'°" °^ ^^^V caregivers' suffenng psydrologist, has markedly ennched our awareness of the ^^ P°^^'^^^ ^^^O" ^°f t^ ^«^h of explorahon of this phenomenon of sufifenng the course is almost uncharted phenomenon may reside m the asserhon by Copp (1974) (Copp 1974) that suffermg like death is often not studied because it is mtrmsically linked to one's own existence, once acknowledged it becomes a persortal threat It is well documented Suffenng IS a phenomenon which has been grappled with that the expenence of a diagnosis of cancer is not confined over time and has generated a body of bterature onented to the pahent alone and that its impad is also felt by family mainly to rebgion and philosophy However, efforts by caregivers who provide a large porhon of their care health care providers to explore the phenomenon of sufferSeveral studies (Hinds 1985, Obwst etal 1989 have not been substantial To date, much of their efforts 1989, Woods et al 1989, for example), have drawn attenhave berai to view the phencnnenon withm the context of hon to the needs of and demands placed on frurubes who provide care at home for pahents with a diagnosis of cancer In a sense, family members are doubly vulnerable since they face the patient's emotionai readions as well as their own (Shckney & Garcber 1984), and are ludden sufferers' withm the cancer expenence Despite their vulnerability, few researchers have looked at their expenences from a perspective of suffenng Considermg the mcreasmg madence of cancer m the populahon and the key role played by families m caregivmg at home, it is important that expenences which contnbute to their suffermg are recognized This paper is an attempt to lUummate the phenomenon of suffenng as it relates to the expenences of family caregivers of pahents with a diagnosis of cancer LITERATURE REVIEW Weisman (1972) identified two types of suffermg, 'primary suffenng' which comes from an affeded organ, and 'secondary suffenng' which represents the demoralizmg significance of total distress (expenenced by both pahents and family members) Charmaz (1983) discussed suffenng m terms of loss of self which develops out of one's daily life expenences She delineated four sources of suffenng which produce loss of self among senous chronically ill mdividuals These are (a) bvmg a restnded life, (b) existmg m soaal isolation, (c) expenenang cbscrecbted definitions of self, and (d) becommg a burden Suffermg is viewed as a subjechve phenomenon which is based on the affedive response of the sufferer and the observer who shares the mdividual's suffermg empathehcally by Wilson et al (1976) These authors dassify the affedive states of suffermg as depression, anger, fear and aruciety, and other emohons mcludmg disgust, confusion, etc Attempts to define suffermg vary, and efforts to amve at a comprehensive defintion have failed (Battenfield 1984) Copp (1974 defined suffenng as a state of anguish of one who bears pain, mjury or loss It has also been defined as an mdividual's expenence of threat to self and the mearung given to events such as pam or loss (Kahn & Steeves 1986) Others define suffenng as ph...…”

O sofrimento no contexto da doença

“…Mas o foco do sofrimento não se deve propriamente à causa mas ao risco que representa para a identidade da pessoa (Gameiro, 1999). Apesar de não conseguirmos identificar a amplitude e o significado do sofrimento pelo qual a pessoa está a passar, normalmente conseguimos perceber quando a pessoa está a sofrer (Kahn & Steeves, 1986). Sendo que "O ser humano é o único dotado de um sentimento intrínseco, decorrente do excesso de algo, que incomoda, perturba ou provoca insatisfação" (Berlink cit.por Malavolta, 2000).…”

“…Os enfermeiros devem respeitar o espaço da pessoa, na medida em que esta pode sentir necessidade de estar só (Flaming, 1995 Mas, é inevitável que quando se fala em sofrimento ligado à doença, não só se pense na pessoa doente e família, mas também nos profissionais de saúde nomeadamente nos enfermeiros. Estes são confrontados na sua prática diária com diversas formas de sofrimento humano (Kahn & Steeves, 1986). Jaspard (2004) estudou como estes profissionais convivem constantemente com o sofrimento, considerando a sua orientação religiosa.…”