Suffering

Concept of Suffering

Based on his experience as a physician, Cassell (1992) defined suffering as a distressful state induced by the possibility of losing one’s sense of living as an integrated being. Cassell stressed that it is the person that suffers, not the body. A theoretical definition of suffering proposed by two oncology nurses, Kahn and Steeves (1986), stated that “suffering is experienced when some crucial aspect of one’s self, being, or existence is threatened” (p. 626). Whether suffering occurs or not depends on the meaning that the person gives to the threat to personal integrity.

Suffering involves frustrated purposes and unrealized possibilities (Rawlinson, 1986). If illness, deprivation, pain, or disability obstructs one’s access to the world and constricts one’s horizons, suffering occurs. Suffering also attacks one’s sense of meaning and purpose. According to Frankl (1986), suffering can also protect a person from apathy and make him or her stronger. “Suffering and trouble belong to life as much as fate and death” (p. 111). Suffering is not necessary to find meaning, but even in the face of suffering, meaning is possible. The way in which one bears suffering is a measure of human fulfillment. (Frankl, 1985).

The suffering of oncology patients can be of a physical, psychological or spiritual nature, but it is always unique to each individual.  In addition to physical pain, there can be a sense of loss, especially a loss of autonomy. Other examples are feelings of loneliness, fear of death or disfigurement, and threats to the manner in which meaning and purpose are found in patients’ lives.

How can nurses help?

Patients need to feel supported, experience minimal symptom distress, and maintain as much control over their lives as possible (Lewis, 1982; Taylor, 1993). Patients have reported finding meaning and thus having their suffering at least temporarily relieved when they were able to accept help, assist others, find pleasure in their environment, practice their religion, maintain an attitude of hopefulness, and if terminally ill, accept the inevitability of death (Coward, 1990; Steeves, 1992; Steeves & Kahn, 1987). Nursing actions that address the above patient needs provide caring amid the suffering experience.

The need to experience meaning is a spiritual need that touches the core of one’s being and is intensified during the illness experience. Some nursing interventions that can enhance meaning-making include listening to patients, employing insightful questioning, asking patients to tell their stories, and maintaining a compassionate presence (Taylor, 1993). Nurses must not run from their feelings of helplessness in the presence of patient suffering. Nurses can assist patients to give voice to their suffering and expression to the ways that the suffering can be relieved.

Some religiously affiliated patients may find it difficult to pray when they are suffering themselves or watching a loved one suffer. It may be helpful to listen to music, pray a brief, repetitive prayer such as "the Jesus Prayer" (Lord Jesus Christ, have mercy on me, or to paraphrase, Lord Jesus Christ, you are merciful). Writing anguished or angry letters to God may relieve the stress associated with suffering for some individuals.

Resources

Cassell, E. J. (1991). The nature of suffering. New York: Oxford University Press.

Coward, D. C. (1990). The lived experience of self‑transcendence in women with advanced breast cancer. Nursing Science Quarterly, 3, 162‑169.

Eifried, S. (1998). Helping patients find meaning: A caring response to suffering. International Journal for Human Caring, 2(1), 33-39.

Eifried, S. (2003). Bearing witness to suffering: The lived experience of nursing students.  Journal of Nursing Education, 42, 56-67

Eriksson, K. (1997). Caring, spirituality and suffering. In M. S. Roach (Ed.), Caring from the heart: The convergence of caring and spirituality (pp. 68-84). New York: Paulist Press.

Ferrell B. R. (1996). Suffering. Boston: Jones & Bartlett.

Frank, A. W. (1991). At the will of the body. New York: Houghton Mifflin.

Frankl, V. E. (1985). Man’s search for meaning. New York: Washington Square Press.

Frankl, V. E. (1986). The doctor and the soul (3rd ed.). New York: Vintage

Georges, J. M. (2002). Suffering: Toward a contextual praxis. Advances in Nursing Science, 25(1), 79-86.

Kahn, D. L., & Steeves, R. H. (1986). The experience of suffering: Conceptual clarification and theoretical definition. Journal of Advanced Nursing, 11, 623‑631.

Kahn, D. L. & Steeves, R. H. (1994). Witnesses to suffering. Nursing knowledge, voice, and vision. Nursing Outlook, 42, 260-264.

Kahn, D. L. & Steeves, R. H. (1995). The significance of suffering in cancer care.  Seminars in Oncology Nursing, 11(1), 9-16.

Lewis, F. M. (1982). Experienced personal control and quality of life in late‑state cancer pages. Nursing Research, 31, 113‑119.

Morse, J. M. (2000). Responding to the cues of suffering. Health Care for Women International, 21, 1-9.

Morse, J. M. (2001). Toward a praxis theory of suffering. Advances in Nursing Science, 24(1), 47-59.

Picard, C. (1991). Caring and the story: The compelling nature of what must be told and understood in the human dimension of suffering. In D. A. Gaut & M. M. Leininger (Eds.), Caring: The compassionate healer (pp. 89-98). New York: National League for Nursing Press.

Rawlinson, M. C. (1986). The sense of suffering. The Journal of Medicine and Philosophy, 11, 39-62.

Rodgers, B. L., & Cowles, K. V. (1997). A conceptual foundation for human suffering in nursing care and research. Journal of Advanced Nursing, 25, 1048-1053

Rowe, J. (2003). The suffering of the healer. Nursing Forum, 38(4), 16-20.

Starck, P. L., & McGovern, J. P. (1992).  The hidden dimension of illness: Human suffering. New York: National League for Nursing Press.

Steeves, R. H. (1992). Patients who have undergone bone marrow transplantation: Their quest for meaning. Oncology Nursing Forum, 19, 899‑905.

Steeves, R., Cohen, M. Z., & Wise, C. T. (1994). An analysis of critical incidents describing the essence of oncology nursing. Oncology Nursing Forum, 21(8, Supplement), 19-25.

Steeves, R. H., & Kahn, D. L. (1987). Experience of meaning in suffering. Image, 19, 114‑116.

Tapp, D. M. (2001). Conserving the vitality of suffering: Addressing family constraints to illness conversations. Nursing inquiry, 8(4), 254-263.

Taylor, E. J. (1993). Factors associated with meaning in life among people with recurrent cancer. Oncology Nursing Forum, 20, 1399‑1407.

Eifried, S. (2005)