The progression of suffering implies alleviated suffering

There is a lack of research focusing directly on both patients' suffering and alleviated suffering in relation to care. The aim of this paper was to investigate the progression of suffering in relation to the encounter between the suffering person and the caregiver from the perspective of an understanding of life. The progression of suffering is assumed to be an existential 'sign' of the development of understanding of life as an ontological or spiritual entity, which demands a meaning-creating encounter between the patient and caregiver. The concept 'existential caring encounter' was used to describe how the encounter between patient and caregiver can create meaning in communion and thereby alleviate suffering by making it bearable. The study was carried out using an interpretive, hermeneutic approach. The study as a whole comprises three parts, and these include letter-writing and interviews. The findings are described by the following main theses: (a) a darkness in life understanding is existentially experienced as unbearable suffering and requires an encounter involving attentive care and confrontation; (b) the turning point means that the struggle of suffering begins; and (c) the encounter involves being meaning-creating in a communion in the struggle of suffering. An understanding of the patterns of unbearable and bearable suffering can be of help to the caregiver in caring for the patient by serving as a basis for meaning-creation in communion. This may thereby be a way of alleviating the patient's suffering by making it bearable during the progression of suffering.     

Finding meaning in suffering

Nurses commonly encounter pain and suffering, and alleviation of pain and suffering is a focus of the nurse's job. Spirituality and religion may assist patients who are suffering, and understanding the relationship between spiritual influences and suffering can help nurses better care for patients. Finding meaning in suffering has been described as a transcendent experience. Nurses can help patients find meaning through interventions such as listening to and witnessing suffering, connecting suffering and spirituality, creating a healing environment, and inviting reflections on suffering. Patients are "wounded story tellers" who can use their stories to make sense of their illness. Little research however has looked at patients' stories and caregivers' response in relation to patients' suffering. This article describes how patients find meaning in suffering and how nursing interventions can assist suffering patients. The process of caring for a suffering person is painful for the nurse and requires exceptional effort on the nurse's part, but the very act that drains the nurse can also create the fuel for compassionate care.     

The meaning of preceptorship: nurses' lived experience of being a preceptor

AIM OF THE STUDY: This phenomenological study is aimed at illuminating nurses' lived experience of the process of preceptoring and the meaning of preceptorship in a Swedish context. METHODS: Seventeen nurses from the North of Sweden with varied previous experience of preceptorship volunteered to participate. Their narratives, describing their experience of being a personal preceptor for a student nurse during practical training on a hospital ward in the third year of a 3-year diploma programme within a university college of nursing in Sweden, were transcribed verbatim. A phenomenological-hermeneutic interpretation disclosed the themes 'sheltering the students when learning' and 'facilitating the students' learning', together with eight sub-themes, which created an understanding of the meaning of preceptorship. FINDINGS AND DISCUSSION: The meaning of preceptorship was understood as reducing the risk of the students learning helplessness and empowering the students when learning in practice. The meaning of preceptorship highlighted the need for further preceptor support and development of the role of the preceptor. On the basis of the findings, suggestions were made to increase the preceptors' awareness of values in nursing practice and use of pedagogical strategies in the process of preceptoring. Through such strategies a reciprocal development of the preceptors' and the faculty's knowledge may take place, to the best advantage of the students' learning and the development of the profession.     

Bearing witness to suffering: the lived experience of nursing students

This study explored the meanings of the lived experience of nursing students as they care for patients who are suffering. In this interpretive phenomenological study, 13 nursing students participated in conversational interviews and wrote narratives about their experiences of being with someone who was suffering. Embedded in the students' stories are the ways they came to understand suffering in the context of learning to practice nursing. The metatheme of bearing witness to suffering emerged from the analysis of the students' reflections. Bearing witness was exemplified with the subthemes of grappling with suffering, struggling with the ineffable, getting through, being with suffering patients, embodying the experience of suffering, and seeing possibilities in suffering. Bearing witness to suffering patients called students to an awareness of their own vulnerability. A concern for learning amid suffering was present throughout the students' texts. The call to care can be sustained through a pedagogy of suffering that acknowledges the need for support through a caring community.     

Being in the world of the suffering patient: a challenge to nursing ethics

Ethics in caring is what we actually make explicit through our approach and how we invite the suffering patient into a caring relationship. This phenomenological study investigates suffering and health and how this presupposes a deeper reflection on ethics in caring. The aim was to try to discover, describe and understand how patients experience their life situation three years after undergoing surgery. The theoretical approach is based on central aspects of Eriksson's caritative theory (i.e. the view of the person as body, soul and spirit). The informants were four women and four men aged between 55 and 77 years. The empirical material revealed suffering that was connected with both illness and life. Suffering involves experiences of grief, loneliness and struggling. Health implies a yearning for something beyond the current life situation, a yearning to experience some meaning in life. This leads to an awareness of unplumbed possibilities. Understanding the experiences of individual patients demands of us, as both researchers and nurses, to act, seeking after the scientific truth (i.e. a deeper reflection of the ontological, epistemological and methodological questions). The idea of responsibility helps us to interpret and meet the innermost desires of suffering patients in their true presence. Caritative caring ethics means 'being there', confirming patients' absolute dignity; it is a manifestation of the love that 'just exists'. Compassion requires an inner disposition to go with others to the places where they are weak, vulnerable, lonely and broken. An ontology of caring provides both a starting point and a context for reflection about ethics and the ethical life.     

The meaning of the family: lived experiences of Turkish women immigrants in Germany

The basic premise underpinning this research is that the family plays a key role in understanding and providing adequate nursing care for an ill member. To understand the family, the view on what members are as a family and what meanings are attributed to their various roles is of central importance for nurses. Since Turkish Muslim families who live as migrants in Germany differ considerably in their own understanding of themselves in their German environment, qualitative research, based on Spradley's developmental research sequence method, was conducted with nine Turkish women in order to learn about the meaning of family for them.     

Weaving a fabric of moral meaning: how nurses live with suffering and death

Nursing has a long and rich history of caring for those who are sick and suffering, as well as for those who are dying. The threat of death, and/or the reality of suffering till death, for patients, is a reality in the lives of nurses. The purpose of this study was to examine how nurses live with patients who are suffering and dying. Founded on notions of relationship and embodiment, naturalistic inquiry was used to generate and analyse qualitative data from nine nurses who, at the time of the study, were working with patients whom they described as suffering or dying. Findings reflected how the nurses used the dilemmas of their patients' lives to inform their own personal and professional lives through a process of 'weaving a fabric of moral meaning'. Findings are discussed in terms of practice, research and education.     

The problem drinker's lived experience of suffering: an exploration using hermeneutic phenomenology

Research in the area of problem drinking has traditionally relied on quantitative methodologies which view the problem from the researcher's perspective. The purpose of this hermeneutic-phenomenological study was to describe and understand the problem drinker's lived experience of suffering using a philosophy and research approach which preserves the uniqueness of the experience from the sufferer's point of view. The method involved conducting in-depth interviews with a sample of six problem drinkers. Interviews were analysed using an interpretive process, which aimed at generating a deeper understanding of the topic by facilitating a fusion of the world views of both participant and researcher. A reflexive journal recorded the involvement of the self of the researcher throughout the research process. Suffering was viewed as a spiralling vicious circle of physical, psychological, social and spiritual distress. Symptoms of physical dependence, shame and guilt emerged strongly as being both sequelae of heavy drinking and cues to further drinking bouts. Evoking memories of previous suffering through telling one's story was found to be an empowering and motivating force. The results have relevance to specialist and generic workers, who are urged to pay greater attention to the social, psychological and spiritual care of problem drinkers.     

Bearing witness to suffering in AIDS: constructing meaning from loss.

The phenomenon of AIDS volunteerism has been described as an act of bearing witness. It has been suggested that bearing witness assists individuals affected by the suffering in HIV/AIDS to heal. The purpose of this research was to explore AIDS volunteerism as a potentially healing phenomenon. Using grounded theory methodology, open-ended interviews were conducted with 17 participants over a 7-month period of time. The constant comparative method was used for data analysis. A substantive theory was generated that identified the basic sociological process as constructing meaning from loss and described the transformative psychosocial and spiritual healing process individuals undergo as they volunteer. Constructing meaning from loss is described within the following three major stages: (a) experiencing suffering, (b) containing suffering, and (c) transforming suffering. Characteristics within each stage are described. Suffering and complex loss are major issues in HIV/AIDS. Interventions are recommended for nurses who care for those affected by HIV disease.     

The meaning of the lived experience of hope in patients with cancer in palliative home care

The aim of this study was to illuminate the meaning of the lived experience of hope in patients with cancer in palliative home care. Narrative interviews with 11 patients were interpreted using a phenomenological-hermeneutic method, inspired by Ricoeur. The findings revealed a tension between hoping for something, that is a hope of getting cured, and living in hope, that is reconciliation and comfort with life and death. This tension is highlighted, according to the views of the French philosopher Gabriel Marcel, as a state of 'recollection'. The interviewees told of the hope of living as normally as possible and of the experience of confirmative relationships as dimensions of their lived experience of hope. These findings show that hope is a dynamic experience, important to both a meaningful life and a dignified death, for those patients suffering from incurable cancer.     

The meaning of good and bad care in the community care: older people's lived experiences

In spite of a considerable body of research in the past decades on what does or does not constitute good care for older people, there are still few studies addressing this question in which older people narrate their experiences of being dependent on community care. This study was therefore carried out aiming to explore older people's lived experiences of what good and bad care meant to them, when it was offered by community care services. Nineteen older persons in three Swedish communities participated in the study, which used a phenomenological–hermeneutic approach. Data were collected through unstructured interviews and Colaizzi's framework was utilized in the analysis of the data.
The key theme arising from the analysis was that of being encountered as a human being by caregivers who, through the provision of safe and secure care, provide opportunities for living life as usual. When any of these circumstances are lacking, bad care will be the consequence. As the general intention in society is to ensure good quality of care to older people as well as others, the findings in our study should have important implications for providers of community care for older people.     

Being in an alien world: Danish parents' lived experiences when a newborn or small child is critically ill

Parents of critically ill small children have received quite a lot of attention in nursing and allied health literature. However, no documented studies were found from Danish paediatric or neonatal contexts. The aim of the study therefore was to identify Danish parents’ lived experiences during a newborn or small child's critical illness. The study was undertaken in a human caring perspective assuming that caring is primary and relational, and that persons are concerned when things matter to them. Thirteen parents were interviewed twice, and data were analysed following Van Manen's phenomenological methodology. The findings revealed that being a parent when a newborn or small child is critically ill resembled being in another world, alien from what they knew and had earlier experienced. The parents wanted to be close to the child, they were seeking for an understanding of what happened, and they felt inexperienced and insecure but at the same time they were attentive and vigilant. The sub‐themes that were more prominent were ‘a need to be there’, ‘What is going on?’, ‘being vigilant’, ‘being a spectator to your own life’, and ‘oscillating between hope and hopelessness’. The study implies that the staff needs to help the parents perceive some kind of meaning of what is going on, to instill hope despite not knowing the outcome, and to accept and respect the parents’ style of coping with stress and concern for their sick child.     

Qualified nurses' lived experience of violence perpetrated by individuals suffering from enduring mental health problems: a hermeneutic study.

The incidence of violence within the National Health Service is rising and attention to the issue is increasing. Due to the ramifications in terms of physical, psychological and economic cost, the need to understand all the dynamics and variables involved in violence becomes evident. If nurses can provide care that reduces the frequency, intensity and negative consequences of violence, then clients, nurses and the organisation all benefit. This study attempted to discover the lived experience of nurses who experience violence perpetrated by individuals suffering from enduring mental health problems. It adopted a hermeneutic, phenomenological, method and produced an emerging theory comprised of the three key themes; Personal construct of violence, Feeling equipped and Feeling supported. Furthermore, the author suggests relationships between exposure to violent incidents and the nurse's ability to deal with the incidents therapeutically and how formal support systems for nurses influence this relationship. Strategic plans that are concerned with caring for violent individuals need to consider this reciprocity, as staff who feel well supported may well have a substantial impact on the quality of care offered to these people.     

The lived experiences of spiritual suffering and the healing process among Taiwanese patients with terminal cancer

Aims and objectives. The purposes of this study were to explore the lived experiences of spiritual suffering and the change mechanism in healing processes among Taiwanese patients with terminal cancer. Methods. The approach to this study was phenomenological‐hermeneutic. Twenty‐one patients with terminal cancer were invited to participate in a semi‐structured interview that dealt with their experiences of spiritual suffering and the healing process. This study was conducted in the inpatient unit of the oncology department in two general hospitals. The interviews were recorded, transcribed and later analysed using the approach of narrative analysis. Results. According to the results of case narration, the causes of spiritual suffering included cancer, known as a life‐threatening illness, physical pain, treatment complications, uncertain illness progression, disability problems and lack of support. Patients turned to internal resources (including regarding the suffering as a life challenge, volunteering to help other cancer patients and searching for life wisdoms) and external resources (including peer support groups and family support) as they endured spiritual suffering. Taiwanese patients turned to Eastern and Western philosophies of Taoism, Confucianism, Buddhism and Christianity as methods to interpret their spiritual suffering. Conclusion. Patients’ positive views of misfortune because of cancer and sufficient social supports were the key elements of the healing process to alleviate spiritual suffering. Relevance to clinical practice. Nurses who learn to participate in suffering assessment are better able to understand spiritual needs of cancer patients. Cancer patients’ views on the change mechanism in healing processes could provide essential information for nurses in developing an effective intervention programme. If nurses consider cultural factors that shape patients’ experiences of spiritual suffering and the healing process, they could learn how to meet the needs of patients better from different cultural backgrounds.