Meaning in Suffering Caring Practices in the Health Professions pptx

Meaning in Suffering

Interpretive Studies in Healthcare and the Human Sciences

Volume VI

Series Editors

Nancy L. Diekelmann, PhD, RN, FAAN, Helen Denne Schulte Professor

Emerita, School of Nursing, University of Wisconsin–Madison

Pamela M. Ironside, PhD, RN, FAAN, Associate Professor, Indiana University

School of Nursing

Editorial Board

David Allen, PhD, RN, FAAN, Professor, Department of Psychosocial

Community Health, University of Washington School of Nursing

Michael E. Andrew, PhD, C.Stat., Mathematical Statistician, Centers for

Disease Control and Prevention, National Institute for Occupational

Safety and Health

Patricia Benner, PhD, RN, FAAN, Professor, Department of Physiological

Nursing, University of California–San Francisco School of Nursing

Karin Dahlberg, PhD, RN, Professor, Department of Health Sciences, Borås

University, Borås, Sweden; Professor, Department of Caring Sciences,

Mälardalens University, Eskiltuna, Sweden

Daniel W. Jones, MD, Associate Vice Chancellor, Herbert Langford Professor

of Medicine, University of Mississippi Medical Center

Kathryn H. Kavanagh, PhD, RN, Professor, Department of Sociology,

Anthropology, and Criminal Justice, Towson University

Fred Kersten, PhD, Frankenthal Professor Emeritus of Philosophy, University

of Wisconsin–Green Bay

Birgit Negussie, PhD in International Education, Docent in Education,

Professor Emerita in Education at the Stockholm Institute of Education

Thomas Sheehan, PhD, Professor, Department of Religious Studies, Stanford

University; Professor Emeritus, Department of Philosophy, Loyola

University, Chicago

Meaning

in Suffering

Caring Practices

in the Health Professions

Nancy E. Johnston

and

Alwilda Scholler-Jaquish

Volume editors

THE UNIVERSITY OF WISCONSIN PRESS

The University of Wisconsin Press

1930 Monroe Street, 3rd Floor

Madison, Wisconsin 53711-2059

www.wisc.edu/wisconsinpress/

3 Henrietta Street

London WC2E 8LU, England

Copyright © 2007

The Board of Regents of the University of Wisconsin System

All rights reserved

13542

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data

Meaning in suffering : caring practices

in the health professions / edited by

Nancy E. Johnston and Alwilda Scholler-Jaquish.

p. cm.—(Interpretive studies in healthcare and

the human sciences; v. 6)

Includes bibliographical references and index.

ISBN 0-299-22250-0 (cloth: alk. paper)

ISBN 0-299-22254-3 (pbk.: alk. paper)

1. Suffering 2. Medical care 3. Terminal care

I. Johnston, Nancy E. II. Scholler-Jaquish, Alwilda. III. Series.

[DNLM: 1. Pain—nursing. 2. Stress, Psychological—nursing.

3. Empathy. 4. Palliative Care—methods.

5. Terminal Care—methods. WY 160.5 M483 2007]

BF789.S8M43 2007

616´.029—dc22 2006031772

Dedicated to our fathers

james robert porter

(1919–2006)

and

donald lee scholler

(1913–2005)

who taught us how to find

meaning in suffering

Contents

Acknowledgments ix

Introduction 3

nancy e. johnston and

alwilda scholler-jaquish

1 Meaning in Suffering: A Patchwork Remembering 7

kathryn h. kavanagh

2 The Gift of Suffering 60

ingrid harris

3 Finding Meaning in Adversity 98

nancy e. johnston

4 Narrative Phenomenology: Exploring Stories

of Grief and Dying 144

craig m. klugman

5 Wish Fulfillment for Children with Life-Threatening

Illnesses 186

bonnie ewing

6 Moral Meanings of Caring for the Dying 232

shelley raffin bouchal

Contributors 277

Index 279

vii

Acknowledgments

No volume comes to fruition without the contributions of many people.

Although we cannot name all of the generous people who offered their

time, wisdom, and talent, we would like to particularly acknowledge the

following people:

Nancy Diekelemann and Pamela Ironside for their wise guidance

and encouragement.

Kathryn H. Kavanagh for her contribution to this volume, astute

counsel, and unfailing friendship.

Nadine Cross for her skillful accompaniment through challenging

times.

Christine Sorrell Dinkins for her ability to make excellent ideas

sparkle.

The authors for the knowledge and skill that went into producing

outstanding manuscripts.

The reviewers who responded generously to our call and offered

their insightful comments under tight time constraints.

Our families who assumed extra burdens and gave us gifts of time

so that we could work on this volume.

And each other for the journey we have shared. It has taken us to

places we never imagined, deepening our mutual trust, respect,

and friendship.

ix

Meaning in Suffering

Introduction

nancy e. johnston and

alwilda scholler-jaquish

Suffering does not happen to us; we happen to suffer. Suffering is what we

choose to do with pain.

Younger, 1995, 55

When we suffer personally, and when we encounter the suffering of

another person, we are confronted with many questions. A taken-for￾granted and apparently robust future now jeopardized leaves in its place

a hollow of uncertainty and fragility. Painfully unsettling, suffering seems

to call forth a natural human proclivity to distance oneself from the spec￾ter of vulnerability. Understandably there is a tendency for healthcare

professionals to protect ourselves from the ravages of suffering encoun￾tered in the lives of the persons we care for. We do this by relating from a

distance even though this is incongruent with our commitment to remain

engaged and to care compassionately. This volume calls us to strengthen

our capacity to remain fully present to individuals and their families dur￾ing times of profound loss and also reveals ways in which new possibilities

both arrive and are closed down during suffering.

In the opening chapter Kathryn H. Kavanagh uses narrative ethnog￾raphy to offer an intimate portrait of one woman’s journey with a chronic

illness. She deepens our understanding of the essential facts of suffering,

illuminates how meaning and purpose come to be challenged in a time of

suffering, and reveals how the self comes to be redefined. Laying the

foundation for her interpretive inquiry by developing the metaphor of

quilt, Kavanagh asks how we explore and understand such interrupted

3

4 introduction

lives. She explores this question by writing that we understand by listen￾ing, and further suggests that listening involves “attending to both the

dominant and the muted meanings . . . [and] searching for the pain and

stories that lie outside expectable discussion.”

Ingrid Harris then offers a compelling philosophical approach to suf￾fering. Suggesting that suffering can be a gift, Harris creates awareness

of the opportunities that come to sufferer and healer alike. Drawing on

the thought of Calvin Schrag, she writes that the way the gift becomes

present is through the interaction of the sufferer and the healer. Harris

reminds us that meaning is double edged since it is all too often that neg￾ative rather than positive meanings are taken up. These negative, de￾structive meanings close down our ways of being in the world, prevent

healing, and distort attempts to regain wholeness. Expanding further on

how health professionals can respond “fittingly” in ways that help with

the reconstruction of positive meanings, Harris encourages us to con￾sider the infinite number of possible ways our imagination allows us to

interpret any event.

Nancy Johnston takes the position that enabling healthcare profes￾sionals to come to grips with suffering in a way that helps them to over￾come the tendency to care “at a distance” requires a new discourse. This

discourse must not only enable us to understand the threats to meaning

and purpose that people experience during a time of adversity but it must

also generate knowledge about how meaning comes to be restored in

the face of great trial and hardship. She also shows how her interpretive

phenomenological study contributes such knowledge by illuminating

how people reconstruct meaning in situations of adversity and by shed￾ding light on human and healthcare practices that both help and hinder

the restoration of positive meanings.

Craig Klugman uses a narrative phenomenological study to reveal

how the practice of inviting bereaved people to tell stories of loved ones

who are deceased assists individuals to accomplish important grief work.

Noting that tellers are often searching for new hope, new interpreta￾tions, and new outcomes, Klugman affirms that it is during a “break￾down” that people have the opportunity to grasp new meaning about

their lives. Revealing the power of storytelling as a caring health practice,

Klugman shows how it enables catharsis, heals wounds, constructs new

meanings, restores connections to community, and fosters openness to

new experiences.