Conserving the vitality of suffering: addressing family constraints to illness conversations

Suffering is a particularly human experience that often brings with it loneliness or alienation from others. The theory described in this article explains the mechanisms through which suffering affects an individual's sense of community and connectedness with others. The intricate patterns are explained to provide a basis for prescriptive nursing to prevent or reverse this loss of connectedness. First, the article develops the concept of suffering and its influences on relationship with the self and with others and the relationship of others with the sufferer. Then, the concept of alienation is developed in this context, its philosophical roots explored, and a continuum described that encompasses alienation through connectedness. Related concepts of separation, shame, and stigma are briefly described as partial cases of alienation of the sufferer that also show the pervasiveness of the phenomenon. Next, the personal characteristics of an individual who might help are developed through the concept of wisdom. Last, an explanation is given as to why care is the contextual framework through which alienation is reversed and connectedness achieved. Although suffering, alienation, and care have gone by many names, the essences of these phenomena have been recurrent theme in descriptions of human response.

The purpose of this study was to explore any patterns that may be evident in the experiences of 20 patients and their partners 1 month after a first heart attack. An interpretive research approach was used to illuminate the illness experience of patients and its impact on their partners. Semi-structured interviews were conducted with the participants, and qualitative analysis of the data revealed six major categories. These were: expectations about advice and information; feelings about the future; reactions of the partner; playing down the significance of the heart attack; wanting to get back to normal; and the effect on the couple's relationship. These findings are discussed in relation to the theoretical literature and other empirical research. The results of this study may provide pointers to the implications for practice of nurses, particularly on ways to improve support for patients and their partners during early convalescence.