AORN educdion

Meaning in suffering

During the course of our lives, each of us experiences adversity. Occasionally, we en- dure excruciating pain. Such encounters motivate us to examine our personal phi- losophy of life, palrticularly the component of suffering. Ideally, introspection will allow us to find meaning in misfortune.

I have already found in my lifetime that misfortune has furthered the actualization of my own being. It has also been a powerful determinant in shaping my philosophy of nursing care; for the ability to discover value in suffering has allowed me to assist patients to develop, maintain, or restore inner strength in the face of hardship. Such intervention has complemented the phy- sical care I render.

Initially, my nursing experience with dying children and adults challenged me to formulate a philosophy of care which enabled me to aid patients in the search for meaning during the remaining portion of their lives. Later, as a psychiatric clinical specialist, I observed the intensity of

emotional suffering. I again struggled with helping patients to answer the ultimate questions: When dignity and hope are dif- ficult to retain in the face of what appears to be insurmountable anguish, why try to find meaning in life? At present, my involve ment in the specialty of operating room nursing demands that I perceive not only the restorative dimensions of surgery, but also the mutilating or disfiguring aspects which can cause patients to know suffering. How can I as an OR nurse convey to surgical patients that there i s significance in the intense hurt that their body, mind and soul may need to bear?

Suffering is the state or experience of one that i s forced to endure discomfort, distress, or misery; to sustain loss or damage; or to be subject to disability or handicap.' It is felt keenly as agonizing paiin, whether the origin is physical or psychological. Despite the anguish associated with suffering it also holds opportunity. Viktor Frankl, professor of psychiatry and neurology at the Uni-

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verdty of Vienna, states: "Whenever one i s confronted with an inescapable, unavoid- able situation, eg, an incurable disease, such as inoperable cancer, just then is one given a last chance to actualize the highest value, to fulfill the deepest meaning, the meaning of Inherent in his viewpoint is the belief that there is potential for self- growth in suffering, and that man can find significance and, ultimately, a desire to live in virtually any circumstance.

Lawrence Le Shan, a psychologist, also acknowledges that patients can find mwn- ing if they realize that painful experiences can provide opportunities whereby in- creased self-insight i s possible. In fact, suf- fering may serve as the incentive to develop "the full rich self . . . one's own being in one's own special way, the freedom to be oneself fully without fear. . . .lf3

Le Shan believes that professional prac- titioners should help patients identify mean- ing in adversity. Margaret Carolan, a nurse consultant at University Hospitals in Min- neapolis, Minn, cautions nurses to differenti- ate between aiding patients to find their own meaning and trying to impose a meaning on them.4 The former requires us to allow patients to overtly disclose their suffering. Carolan comments, "TOO often, we tend to make a patient feel that it is wrong to show suffering. He is not allowed to see his suffering as enobling rather than degrading. . . . Recognizing the patient's courage in facing his suffering can support him in his search for me~ning."~

To encourage a patient to express his in- terpretation of suffering, we must be willing to examine our own definition of suffering. Sometimes this forces us to be ruthlessly honest with ourselves. How do we perceive suffering? As a hideous injustice with hor- rendous consequences? As beneficial in terms of arousing our own assessment of our inner strength? Or as a mixture of positive and negative effects? Do our own feelings of denial, anger, happiness, or de- pression negate our ability to empathize

with another person's suffering and cause us to forsake him? Is our abandonment really a retreat from our own unresolved conflicts regarding our feelings about suf- fering and our fear to become involved, therefore vulnerable? Hopefully, such self- analysis will allow us as nurses to in- corporate the essence of Frankl's philosophy into our own value systems. If we believe that it is possible to capitalize upon the learning intrinsic in suffering, we will be able to transmit our positive beliefs to patients, thus helping patients to live as fully as possible within limitations imposed by physical or psychological affliction.

For example, I have been able to convey to dying children and adults that advance awareness of death may be a unique gift whereby they can evaluate the quality of their current existence, and more vividly experience the "now" of life. I have seen patients take greater advantage of their existing potential by focusing upon strengths instead of frailities. Often, they set new priorities for themselves, especially in re- lation to the deep expression of love for others. Friendships can become more precious. Anger and conflict may dissipate as dying patients comprehend the intricate art of forgiveness. Suddenly the routine daily struggle for survival i s secondary to the need to grasp the beauty of a delicate snowflake, a golden sunset; to experience the sensation of a caress or kiss; to enjoy laughter; to observe the antics of a curious child; or to explore one's environment and faith. I do not deny dying patients their grief. But by not engaging in deception or false reassurance, I encourage them to grapple with the significance of advance knowledge of death and to profit in terms of self-growth.

Preoperative and postoperative visits have provided me with a special means whereby I , as an operating room nurse, can assist patients to search for meaning in suf- fering. I can help a woman discuss the

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feelings triggered by the possible removal of a breast, yet enable her to think beyond the pain associated with loss, thus stimu- lating her to consider how she will use her many remaining attributes.

Any surgical experience can allow patients the opportunity to critique the ef- fectiveness of their past style of living and to explore viable alternatives if appropriate, for the future. For example, how may a radical neck procedure change one's life for the better? In many instances, surgery contributes to a new beginning in the sense that a patient's body image and self-con- cept change to some extent. If we as OR nurses can help patients discuss both the positive and negative aspects of such a be- ginning, we may be able to restore hope and facilitate actualization.

Perhaps I'm naive because I prefer to see purpose in adversity; however, such a philosophy ensures that I thoroughly ap- preciate the richness of happiness, yet cope with the realities of periodic suffering. I am truly fortunate for the understanding that profound suffering is often preceded by deep caring. Both components give my life meaning, foster the expansion of my being, and enhance my nursing intervention. In turn, I try to convey to patients that their suffering may be an unrecognized asset in terms of reflecting their caring.

David Sobel, a psychiatrist at Bellevue Hospital in New York City says poignantly, ''Love, if it is complete, allows for hurt . . . allowing for hurts which have occurred and which may occur, a person is freer to as- sume the risks of a love relation, to explore, and to find another, to expose his heart to things of the outside world, to involve him- self in a work he may love."6

I am committed to humanistic nursing- this implies that I must help patients to dis- cover value in suffering as in well-being. 0

Carol Alexander, RN, MS Director of Education

FOOTNOTES

I. Webster's Seventh New Collegiate Dictionary (Mars: G & C Merriam Company Publishers, 1969)

2. VE Frantl, Man's Search for Meaning: An In- troduction to Logotherapy (New York: Washington Square Press, 1959), pp 121-123, 178-181.

3. L Le Shan, "Psychotherapy and the Dying Patient," in Death and Dying, ed, by L Pearson (Cleveland: Press of Case Western Reserve Uni- versity, 1969), p 33.

4. M Carolan, "The Search for Meaning," American Journal of Nursing, June 1973, p 1062.

5. /bid

6. D Sobel, "Love and Pain," American Journal

878.

of Nursing, June 1972 p 912.

NLN sfudies sfudenj selecfion The National League for Nursing's division of research is conducting a two-year study of how students are selected for nursing educational programs. To be completed in June 1975, the study will investigate and evaluate the student selection process in nursing schools throughout the United States. The work will focus on determining the specific factors which may act as barriers to admission or to the successful completion of the nursing program. An initial step in the project is a questionnaire mailing to all schools preparing students for beginning registered nurse practice. The questionnaire will gather information about administrative control of the school; criteria and procedures used to select students; conditions under which one or more requirements might be waived; and number of applicants by ethnic group, sex, and enrollment status; and other facts.

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