suffering

Question 1

Suffering vs pain

Answer 1

• suffering is not synonymous with pain, but closely related to it
• when pain persists without meaning it becomes suffering
• occurs when an individual feels voiceless

Question 2

Key elements of total pain

Answer 2

• physical pain
• mental anguish
• spiritual suffering (makes physical pain worse)
• emotional distress

Question 3

what contributes to total pain

Answer 3

• uncontrolled pain and other distressing physical symptoms
• major depression
• loss of hope and meaning
• loss of important roles in life
• terror related to approaching death
• severe existential distress
• unresolved guilt
• inability to trust other
• financial distress
• family conflicts
• deep wounds from childhood abuse, neglect or abandonment

Question 4

define suffering

Answer 4

• a state of severe distress associated with events that threaten the intactness of personhood or the interconnected physical, social, spiritual, and psychological aspects of self.

Question 5

predictors of suffering

Answer 5

• regret for pass events
• current marital problems
• little social support
• a pessimistic attitude

Question 6

describe suffering

Answer 6

• unbearable state experienced as
• -> a split between the self and the now malfunctioning body
• -> loss of self-identity
• -> sense of isolation from the human community
• -> fear about continued or recurring physical or psychological pain
• -> sense of separation from transcendent truth
• INTENSELY PERSONAL

Question 7

When does suffering occur

Answer 7

• when a threat to the integrity of the person is perceived
• the experience of suffering persists until the threat has passed or until integrity of the person can be reestablished in some manner (or the patient dies)

Question 8

suffering as loss of control

Answer 8

• loss of control creates insecurity
• individual feels trapped and unable to escape ones circumstances
• sometimes the suffering is greater in the care giver than in the patient; caregiver feels out of control and unable to do something to protect loved ones

Question 9

suffering as loss of relationship

Answer 9

• loss of relationsip to others (social isolation)
• loss of previous relationship to ones body
• loss that the person diminished and a sense of brokenness (betrayal, abandonment)

Question 10

Bodies and persons

Answer 10

• a body experiences pain; a body does not suffer
• person experiences pain and suffers
• to acknowledge that there is suffering, one must acknowledge that a person is involved.

Question 11

suffering and meaning

Answer 11

• meaning is central to the human experience of suffering
• pain and privation are insufficient to explain suffering
• human suffering requires the felt loss of meaning and purpose in life
• pain and privation can be endured if it is for a purpose

Question 12

can you solve sufferin

Answer 12

YOu can’t sole suffering

Question 13

common goals of care serious illness

Answer 13

• control pain and other distressing symptoms
• alleviate psychosocial problems
• communicate effectively
• provide empathetic presence
• foster realistic hope

Question 14

psychosocial assessment

Answer 14

• suspect psychological and spiritual pain
• establish conducive atmosphere
• express an interest. ask a question
• then be quiet and let the patient ponder the question
• listen for broader meanings

Question 15

communicate effectively

Answer 15

• honest, compassionate, ongoing communication
• contributes to symptom control
• increase patients and family sense of control and self-worth
• creates a bond
• symptoms interfere with ability to hear and retain information. repeat as often as necessary

Question 16

alleviate psychosocial problems

Answer 16

• utilize the entire interdisciplinary team
• loneliness, financial concerns etc contribute to suffering
• solving these issues alleviate the patients sense of isolation.

Question 17

Foster hope

Answer 17

• essential to quality of life
• hope changes
• i hope for a cure; or i hope people will be honest with me, or i hope for more time
• i hope my life has meaning

Question 18

hope strategies

Answer 18

• effectively control pain
• develop caring relationship
• set attainable goals involving patient in decisions
• support spirituality
• affirm patients worth
• light-hearted humor when appropriate
• reminisce

Question 19

Presence

Answer 19

• to dare to walk with those who suffer is to become vulnerable to ones own death, ones own losses, ones own inability to answer the profound questions, and to be reminded of the relative finite nature of ones defined purpose of life
• WILLING to enter into the suffering of another –> deep relationship
• is a journey with the one who suffers, not a journey for the one who suffers

Question 20

provide empathic presence

Answer 20

• atmosphere that encourages questions
• reduces stress
• body language
• listen. being heard can be the most effective treatment. DON’T JUST DO SOMETHING, sit there
• presence and gentle reassuring touch (some don’t like it)

Question 21

Spiritual

Answer 21

• spiritual activity is largely relational with self, other and the other

Question 22

health care professionals assessment of spirituality

Answer 22

• humanity supersedes medical expertise
• -> listening is primary
• -> enabling conversation is essential
• -> personal views and convictions impede appropriate quality care.
• assessments are formal and informal

Question 23

FICA model of spiritual assessment

Answer 23

• F = faith and belief
• I = Importance
• C = community
• A = address/actions in care

Question 24

HOPE model

Answer 24

• H = sources of HOPE, meaning, comfort, strength, peace, loce and connection
• O = organized religion or community
• P = personal spirituality and practices
• E = effects on medical care and end of life issues

Question 25

Care Gates

Answer 25

• are doorways opened by patient
• -> opened care gates can indicate strengths to rely on
• -> opened care gates can reveal areas that need attention or development for wholeness
• -> opened gates are touchstones for spiritual care focus and attention initiated by the patient

Question 26

using the learning from assessments

Answer 26

• iformation shared by the patinet is a gift to you
• this gifts must be respected as personal and precious
• listening and recognizing the importance of what is shared is paramount
• a good assessment indicuastes who can assist and in what area
• referrals are appropriate, often necessary
• referrals allow patient to keep caregivers role clear and manageable

Question 27

Teamwork is essential to quality care

Answer 27

• spiritual care will be done when the patient is ready
• patients regularly choose the person they can/will work with
• the chosen person can be a doctor, nurse, social worker, nursing assistant, other health care provider or volunteer
• regular sharing across disciplines is necessary
• training in spiritual assessment is valuable to each team member
• mutual support opportunities are investments in quality care, not time consumers

Question 28

Summary

Answer 28

• pain and suffering are related but different
• suffering is intensely personal and does not need to be fixed
• tools for effective assessment and alleviation of psychosocial and spiritual pain are a necessary part of quality care of patients with serious illness
• team approach: no one of us is as smart as all of us
• self assessment, self reflection, and self care are important aspects of the health care professionals approach to pain and suffering