Concept analysis of suffering

Suffering is commonly encountered in nursing and is defined as an individual and subjective experience. It is a complex human response to which there are physical, psychological, social and spiritual aspects. Perception of suffering threatens self-integrity, and induces negative behaviors, such as personal changes in relation to value system, sense of reality, withdrawal, feelings of helplessness, and despair. A great deal of relevant literature explores the influence of suffering, but only a few articles analyze the concept of suffering. The purpose of this article, therefore, is to clarify the concept of suffering. In order to do this, we used the technique of concept analysis described by Chinn and Kramer (1995). It is hoped that the results of the study will enhance nurses' understanding of suffering and that its lessons may be adopted in clinical nursing.     

The experience of suffering: conceptual clarification and theoretical definition

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.     

Self-compassion: a concept analysis

This concept analysis uses a modification of the evolutionary method (Rodgers, 1989) to identify the antecedent, attributes, and consequences of self-compassion. The antecedent to self-compassion is suffering, experienced in six possible realms: an event, a situation, an emotional response, a psychological state, spiritual alienation, or a physical response to illness or pain. Suffering has three dimensions: intrapersonal, interpersonal, and contextual. Suffering manifests as a pattern of decreased self-care, decreased ability to relate to others, and diminished autonomy. The attributes of self-compassion are self-kindness, mindfulness, commonality, and wisdom. The consequences of self-compassion are the opposite of the antecedent: self-compassion manifests as a pattern of increased self-care capacity, compassion for others, and increased relatedness, autonomy, and sense of self. Ideal, borderline and contrary cases of self-compassion provide examples of the concept. The article concludes with a discussion of implications of the concept of self-compassion for nursing practice and research.     

The experience of suffering: stories told by hospitalized children

The objective of this study was to learn about the experience of suffering in hospitalized school-aged children. The methodological strategy used was narrative inquiry, and the Model of Suffering as the theoretical framework. Participants were 14 children. Data collection was performed using semi-structured interviews, guided by the following question: Tell me your story about getting sick and coming to the hospital. Results show that hospital events comprise the child's experience of suffering, represented by five categories: knowing the suffering caused by the disease; enduring to survive the experience of being ill, relaxing from enduring to free their emotions, living the suffering, and floating between enduring and suffering. The suffering or enduring of the child is determined by the context of the experience and by the support or interactions that surrounds them. In conclusion, nurses have the duty to offer children opportunities to express themselves and make the suffering bearable.     

The silence of suffering: breaking the sound barriers.

Suffering is an inevitable reality that student nurses may be unprepared to witness. The 14-week college course, Understanding Suffering, was developed to help students better understand the suffering experience. Content for the course was drawn from nursing, sociological, and theological perspectives. Students scored significantly higher on a post-course evaluation of empathy and stated they felt better prepared to intervene in difficult clinical situations involving suffering. Course development, assignments, and evaluation are described in the article.     

Complex adaptive phenomenology: A conceptual framework for healthcare research

Rationale

Healthcare research exploring the lived experiences of health care professionals from different disciplines, such as nursing, medicine, and allied health, has repeatedly highlighted many methodological challenges, especially in understanding the individual human experience within complex systems. In response, complexity theory and phenomenological approaches emerged and evolved in ways that potentially offered researchers frameworks to inform an understanding of the individual human experience. However, while these two theoretical approaches inform a method of inquiry, there is a gap in understanding the phenomenon of ‘being’ and how this is embodied within complex systems such as the healthcare system.

The Aims and Objectives

The aim of this paper is to present an integrated theoretical framework, namely complex adaptive phenomenology (CAP). CAP aims to address this inquiry gap by offering a structured conceptual framework wherein complexity theory and phenomenology are complementary but multi-dimensional. The key objective of CAP was to synthesize and integrate two methods of inquiry that examine the relational aspects of ‘being’, that is the gestalt of perception, action, and context, The authors argue that CAP is well-suited to complex research contexts such as healthcare. The framework focuses on the reciprocal, co-constructive relationships extant between perception, meaning, context, and action that shape experiences of ‘being’ within complex systems. Complexity theory's connectionist orientation explains the relationships that are formative of the experience of being, while phenomenology explores the manifestations of these formative relationships by attending to the notion of ‘being’ itself.

Conclusion

The authors propose that an integrated framework, of phenomenology and complexity theory, can provide a platform for deeper understandings of the experiences of health professionals and contribute to healthcare scholarship.     

Energy: a bridging concept for nursing science

A philosophical inquiry into the concept of energy revealed two ideas of energy across multiple disciplines. Analysis of the conceptual models of Nightingale, Levine, and Rogers supported the presence of two paradigmatic views of energy in nursing science that, while divergent, share a common theme. The outcome of this inquiry leads to the tentative belief that there is unity in diversity and may perhaps lead to refinement of existing nursing theory and a more congruent framework for scientific inquiry. This article specifically addresses the nursing theoretical implications related to ideas of energy arising from the inquiry.     

"Getting through"--a difficult nursing concept

This analysis of the research literature related to the nursing concept "enduring" was carried out on the background of the demand for evidence based nursing. The aim was to test with an exemplary concept to what extent this request is feasible and meaningful, if related to a concept describing patients' subjective experience. The state of the art of research literature on enduring contains a variety of problematic aspects: conceptual, theoretical, linguistic as well as problems originating in nursing's moral tradition. These have important implications for the application of the concept in nursing practice.     

The concept of suffering in children and adolescents with cancer.

Survival rates for childhood cancer have increased over the past 2 decades, due in large part to the increase in the intensity and complexity of the treatment modalities used. We can presume that this increase in intensity has produced increased distress or suffering (physical, psychological, social, and spiritual) in the child or adolescent undergoing these therapies for cancer. However, measurement of suffering is more than symptom occurrence, frequency, duration, and severity. An analysis of the concept of suffering is presented. Suffering needs to be defined and measured by self-report (as opposed to parent or staff report) to gain an accurate, complete holistic picture of the nature and scope of the child's and adolescent's suffering. Knowledge of how children and adolescents experience suffering would enable practitioners to design interventions to prevent or ameliorate this suffering.     

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

Suffering is a phenomenon with physical and emotional components. Although several studies have drawn attention to the needs of, and demands placed on families who provide care for patients with a diagnosis of cancer at home, few have discussed the suffering which many of these caregivers experience. This paper will illustrate the phenomenon of suffering as seen in the responses made by family caregivers of patients with cancer. Eighty-three family caregivers drawn from a probability sample of patients with a diagnosis of cancer were interviewed in their homes to determine needs they encountered in their caregiving roles. The caregivers consisted of 43 males and 40 females, with mean ages of 53 and 54 years respectively. Families not only identified their needs, they also indicated several areas which were for them sources of suffering. The findings revealed that family suffering often stemmed from fear of loneliness; uncertainty about the future (their own and that of the patients); lifestyle disruption; communication breakdown; lack of support; and their sense of helplessness. These findings suggest that health professionals, particularly nurses, who work with families in their homes, must be alert and sensitive to cues and circumstances which could indicate suffering, and in so doing, take the necessary steps to ameliorate their situation.     

The concept of grief: An analysis of classical and contemporary thought

Grief has been a topic of focused inquiry for a number of years. However, in spite of the attention given to this significant aspect of human existence, progress in gaining a clear understanding of grief has been relatively slow. This situation is at least partially due to the existence of a conceptual problem concerning the definition of grief making it difficult to identify a grief response and to differentiate among grief and a variety of related concepts. Persons interested in grief have had to rely on their individual interpretations of the concept and, as a result, have generated a plethora of confusing terms to address the experience. In this article, the results of a systematic inquiry to define grief as a concept are presented. The findings provide a synthesis of existing thought, suggestions for the reconceptualization of grief and grief outcomes, and guidelines for further study.     

Frontiers of nursing in the 21st century: development of models and theories on the concept of nursing

In the past nursing has used a medically oriented perspective; consciously or not, nursing practice, education and research have been guided by the same conceptual frame of reference as has medicine. For nursing to justify its claim to being an independent health profession offering a particular service to society, it must adopt its own conceptual base, one that indicates those phenomena that are of concern to nursing and those health problems that nursing must try to solve. Many nurses have already chosen to base their teaching, research and nursing care on one of the existing conceptual models for nursing. The challenge for the 21st century is that all nurses adopt an explicit conceptual base. Broader than a theory, a conceptual model specifies nursing's focus of inquiry and may thus lead to the development of theories which will prove useful not only to nurses but to other health professionals as well. Since nursing exists to provide a necessary service to mankind, its conceptual base must be evaluated by using specific social criteria.     

What is Pain-Related Suffering? Conceptual Critiques,Key Attributes,and Outstanding Questions

Suffering holds a central place within pain research, theory, and practice. However, the construct of pain-related suffering has yet to be operationalized by the International Association for the Study of Pain and is largely underdeveloped. Eric Cassell's seminal work on suffering serves as a conceptual anchor for the limited pain research that specifically addresses this construct. Yet, important critiques of Cassell's work have not been integrated within the pain literature. This Focus Article aims to take a preliminary step towards an updated operationalization of pain-related suffering by 1) presenting key attributes of pain-related suffering derived from a synthesis of the literature and 2) highlighting key challenges associated with Cassell's conceptualization of suffering. We present 4 key attributes: 1) pain and suffering are inter-related, but distinct experiences, 2) suffering is a subjective experience, 3) the experience of suffering is characterized by a negative affective valence, and 4) disruption to one's sense of self is an integral part of suffering. A key outstanding challenge is that suffering is commonly viewed as a self-reflective and future-oriented process, which fails to validate many forms of suffering and marginalizes certain populations. Future research addressing different modes of suffering – with and without self-reflection – are discussed.PerspectiveThis article offers a preliminary step toward operationalizing the construct of pain-related suffering and proposes priorities for future research. A robust operationalization of this construct is essential to developing clinical strategies that aim to better recognize and alleviate suffering among people living with pain.     

Context and methodological decontextualization in nursing research with examples from phenomenography

In both human science and nursing research the concept of context is important. However, context can be understood in different ways. The aim of this article is to elucidate, discuss and problematize context, decontextualization and recontextualization in some health care-related phenomenographical studies. A further aim is to problematize the concept of context in a wider perspective of human science, in order to gain a better understanding of phenomenographical research related to nursing care. Our analysis indicates that the complex phenomena which characterize nursing research demand a broad contextual understanding. Both the local or immediate context and the global or mediated context must be considered, as they are dialectically related. This includes the informants' experiences of the phenomenon of interest as well as the socio-cultural discourse. A balance between openness and pliability to the phenomenon is suggested. Reflection is considered an important tool in this process. Within phenomenography, the interest is directed towards conceptions of certain aspects of the world. Thus, context in a wider sense is given a subordinate role. Accordingly, phenomenography is considered to have limited applicability in nursing research when complex phenomena are to be studied.     

Nursing expertise: a course of ambiguity and evolution in a concept

In this article, we clarify and describe the nature of nursing expertise and provide a framework to guide its identification and further development. To have utility and rigour, concept‐driven research and theories of practice require underlying concepts that are robust, valid and reliable. Advancing understanding of a concept requires careful attention to explicating its knowledge, metaphors and conceptual meaning. Examining the concepts and metaphors of nursing expertise, and how they have been interpreted into the nursing discourse, we aimed to synthesise definitions and similarities between concepts and elicit the defining characteristics and properties of nursing expertise. In clarifying the concept, we sought to move beyond the ambiguity that currently surrounds expertise in nursing and unravel it to make explicit the characteristics of nursing expertise from published peer‐reviewed studies and structured literature synthesis. Findings indicate a lack of clarity surrounding the use of the term expertise. Traditional reliance upon intuition as a way of explaining expert performance is slowly evolving. Emerging from the analysis is a picture of expertise as the relationship between networks of contextual reasoning, understanding and practice. Striking absences in the discourse include limited explication of ethical reasoning and theorising a broader interpretation of expertise reflective of contemporary forms of nursing.     

Refinement of the concept of uncertainty

AIMS: To analyse the conceptual maturity of uncertainty; to develop an expanded theoretical definition of uncertainty; to advance the concept using methods of concept refinement; and to analyse congruency with the conceptualization of uncertainty presented in the theory of hope, enduring, and suffering. BACKGROUND: Uncertainty is of concern in nursing as people experience complex life events surrounding health. In an earlier nursing study that linked the concepts of hope, enduring, and suffering into a single theoretical scheme, a state best described as 'uncertainty' arose. This study was undertaken to explore how this conceptualization fit with the scientific literature on uncertainty and to refine the concept. DESIGN/METHODS: Initially, a concept analysis using advanced methods described by Morse, Hupcey, Mitcham and colleagues was completed. The concept was determined to be partially mature. A theoretical definition was derived and techniques of concept refinement using the literature as data were applied. FINDINGS: The refined concept was found to be congruent with the concept of uncertainty that had emerged in the model of hope, enduring and suffering. CONCLUSIONS: Further investigation is needed to explore the extent of probabilistic reasoning and the effects of confidence and control on feelings of uncertainty and certainty.     

Feeling of 'lacking' as the core of envy: a conceptual analysis of envy

The aim of this paper is to explore the subjective experience of envy through concept analysis. Further, the study on which it is based aimed to answer questions about the composition and manifestations of envy. From the viewpoint of nursing science, the analysis of envy is based on a desire to understand human beings from the perspective of subjective health and illness and thus from a health promotion perspective. Envy is conceived of as a dimension of a person's health and illness. The concept is therefore meaningful from the viewpoint of nursing; it describes a phenomenon which enables us to deepen our understanding in a way relevant to nursing science. In the study the hybrid model developed by Schwartz-Barcott et al. was used for conceptual elaboration. In the theoretical phase of the study the subjective experience of envy was explored from the viewpoints of philosophy, religion, Finnish folklore and psychoanalysis, as well as nursing science. As a synthesis of these, a conceptual analysis of envy adapted from Wilson was conducted and a working definition of envy was proposed. In the fieldwork phase, envy was examined by means of an empirical analysis using a phenomenological approach. As a result, a classification describing the experience of envy was presented. The core experience of envy has been defined as a 'lacking', and the object of envy as something good possessed by someone else. Envy manifests itself in both destructiveness and creativity. The trends of development of envy are inflexibility and emancipation, and the essence of envy is multidimensional. Finally, the working definition of the concept was elaborated on the basis of the empirical phase and a new definition reflecting the composition and manifestations of envy was proposed.     

Nursing leaders' and nurses' view of health

This study is part of a scientific project, 'Multidimensional Health', the main goal of which is to introduce a broad view on health into health care and nursing The purpose of this study is to examine the view of health among nursing leaders and members of caring staff and to compare it to that of patients (a previous study in the project) The study is based on K Eriksson's theory of caring and its view of the human being with a body, soul and spirit, and health as a dynamic process concerning all aspects of human life An inquiry form with open questions that brought to the fore various aspects and dimensions of health was filled in by 20 nursing leaders and was used in interviewing 49 nurses According to the results many aspects of life are contained in the concept 'health' Health is above all an experience of well-being Ways of promoting one's health are described in terms of various 'healthy' living habits and preventive measures A supporting and humane attitude is hoped for in others There is unanimity that feelings affect health Belief may have a positive influence on health The meaning of life is connected with health Even suffering is part of health In interpreting the answers we assume three dimensions of health 'Health as behaviour' connects health with living in a healthy way 'Health as being' would mean a state of health and is characterized by a search for some kind of balance in one's inner state 'Health as becoming', growing towards health, means that a person becomes whole on a higher level of integration     

An exploration and advancement of the concept of trust

BACKGROUND: Trust is a concept used both in everyday language and in the scientific realm. An exploration of the conceptualizations of trust within the disciplines of nursing, medicine, psychology and sociology, revealed that trust is an ambiguous scientific concept. AIMS: In order to increase the pragmatic utility of the concept of trust for scientific application, further clarification and development of the concept was undertaken. METHODS: First, a concept analysis was conducted with the aim of clarifying the state of the science of discipline-specific conceptualizations of trust. The criterion-based method of concept analysis as described by Morse and colleagues was used (Morse et al. 1996a, 1996b, Morse 2000). This analytic process enabled the assessment of the scientific maturity of the concept of trust. The interdisciplinary concept of trust was found to be immature. Based on this level of maturity it was determined that in order to advance the concept of trust toward greater maturity, techniques of concept development using the literature as data were applied. In this process, questions were "asked of the data" (in this case, the selected disciplinary literatures) to identify the conceptual components of trust. RESULTS: The inquiry into the concept of trust led to the development of an expanded interdisciplinary conceptual definition by merging the most coherent commonalties from each discipline. CONCLUSIONS: The newly developed interdisciplinary conceptualization advances the concept toward maturity, that is, a more refined, pragmatic and higher-order concept. The refined concept of trust transcends the contextual boundaries of each discipline in a truly interdisciplinary scientific fashion.     

Hospitalized patients experienced suffering in life with incurable cancer

The concept 'suffering' has been central within nursing since Florence Nightingale. But few researchers have made empirical studies about the lived phenomenon. Several researchers within nursing agree that more research concerning individual groups of patients has to be initiated. Within research about patients with incurable cancer focus has been on death, the terminal period and patients experience of being dying. This qualitative study was initiated to describe the characteristics of a group of Danish hospitalized patients' experienced suffering in life with incurable cancer. Twenty-five semi-structured interviews were arranged with 12 patients ones a week within a period of 4 weeks. In week 2 and 4, the interviews were supplemented by questions developed on the basis of the potential signs of suffering which appeared during the participant observations that took place the day before each interview. C. S. Peirce's semiotic and phenomenological grounded theory of signs was used in order to identify the potential signs. A phenomenological methodology developed by A. Giorgi was used to develop and describe the general structure of the phenomenon. The phenomenon is described as: 'The experience of living in an increasingly unpredictable existents at the mercy of the body, the consciousness, the illness, the death, the treatment, the professionals, one's articulateness, the past, the present and the future, influenced by increasing powerlessness, loneliness and isolation, and the experience of existing in an persistent, and with time, unconquerable struggle to maintain and regain control'.