| Summary: | Suffering has been part of the human condition since time began, and people have
long sought answers to the questions it raises from religion, philosophy, medicine, and the
arts. People living with progressive, life threatening illness can suffer greatly from
physical symptoms and a variety of personal issues. Palliative care offers these patients
quality of life through symptom management and a unique approach of competent,
compassionate care in which nurses play a major role. Many health professionals and
others in society believe that assisted suicide and voluntary euthanasia should be options
for people who are suffering despite the best efforts of palliative care.
Throughout the health literature on suffering, there is a wealth of philosophical
perspectives and research using both quantitative and qualitative methods. Although many
papers focus on suffering in palliative care, none were done from the perspective of
palliative care nurses. Using a qualitative method based on grounded theory, this study
explored the perceptions of eight palliative care nurses about the suffering of their
patients. Specifically, findings describe how the nurses recognize suffering, their strategies
for helping patients who are suffering, the conditions which help or hinder the alleviation
of suffering, and the personal impact on the nurses of caring for patients who suffer.
Findings suggested that patients suffer in three realms: bodily discomfort,
interpersonal discord, and personal distress. Strategies that patients and nurses used to
alleviate suffering were specific to each realm. Their goals were to achieve bodily
comfort, create interpersonal harmony, and find inner peace. The work pattern of patients
and nurses was unique; as suffering became progressively less tangible through the bodily,
interpersonal, and personal realms, the work of patients increased, and the work of nurses
decreased. Physical suffering was more amenable to direct nursing interventions;
suffering at the interpersonal and personal levels was essentially something only patients
could resolve, and the nursing role became more supportive.
Caring for patients who suffer affected the nurses positively and negatively. The
nurses derived great satisfaction from being able to help alleviate suffering. Unfortunately,
the nurses, too, suffered when they could not prevent or relieve suffering in their patients.
They coped with these difficulties by setting realistic expectations of themselves, being
able to learn from their experience, and feeling supported by their colleagues and by
management in specific ways. From the results of this study, nursing implications for
practice, education, administration, and research were identified.
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