Background: Dementia, which affects an estimated 35 million individuals worldwide, is now recognised as a growing health and economic problem. With insufficient levels of health and welfare services in many nations, there exists a reliance on family caregivers to provide care for individuals with dementia (IWDs). However, the potential negative psychological and physical consequences of the caregiving role cannot be ignored. A growing literature base has improved the theoretical understanding of mental health difficulties (e.g. depression, burden) in caregivers. However, significant gaps in the research remain. These include understanding outcomes such as caregiver anxiety and examining the role of potentially crucial variables, such as levels of suffering and empathy. Objectives: An empirical study was conducted in order to add to the literature regarding depression and anxiety in spousal caregivers of IWDs. This research conducted exploratory analyses of the relationships between the suffering of IWDs, IWDs' depression and anxiety, caregivers' levels of empathy, caregiver satisfaction and caregiver anxiety and depression. Caregivers' anxiety and depression is considered in the context of research on co-morbidity. In addition, the levels of discrepancy between ratings of suffering, whereby caregivers frequently report IWDs to be suffering more than IWDs self-report, were also examined. A systematic review was conducted in order to evaluate the effectiveness of psychosocial interventions for anxiety in informal caregivers of IWDs. Method: For the empirical study, a cross-sectional survey methodology was employed where dyads of caregivers and IWDs completed questionnaires during face-to-face interviews. Primary variables examined were the suffering of IWDs, IWDs' levels of depression and anxiety, and caregivers' levels of empathy, satisfaction, depression and anxiety. The suffering of IWDs was rated both by the IWDs (self-reported suffering) and the caregivers (perceived suffering). Descriptive statistics and exploratory correlational analyses were used to address a number of exploratory research questions regarding the relationships between the investigated variables. For the systematic review, five scientific databases were searched for relevant randomised controlled trials (RCT). Study quality was assessed according to standardised, recommended criteria and a qualitative synthesis of the evidence, including effect sizes, is described. Results Results from the empirical study suggest high levels of clinical anxiety in the caregiver population. In the current sample, there was a high prevalence rate of anxiety (52.5%) and a lower rate of depression (15.0%). However, there were no statistically significant correlates for caregiver anxiety and depression found. Findings are discussed in the context of previous research, the demographics of the current sample and difficulties with recruitment. For the systematic review, twenty studies with substantially different methodological quality were included. Anxiety was rarely identified as the primary outcome measure. However, the evidence suggests that Cognitive Behavioural skills training and psycho-educational interventions can be effective in treating caregiver anxiety. Some preliminary evidence for interventions underpinned by Mindfulness-based strategies was also found. Conclusions: The empirical study found that a large proportion of Scottish spousal caregivers experience clinical levels of anxiety. This suggests that caregiver anxiety must be a key priority for both clinicians and researchers alike. In addition, further research examining these understudied variables and using dyadic methods remains crucial to increasing understanding into caregivers' outcomes. The systematic review demonstrated that research regarding interventions for anxiety in caregivers is growing and there is now a greater emphasis on the underlying theoretical models of delivered interventions. There is also growing evidence that interventions with clear theoretical basis may be more likely to be effective. However, both the empirical study and the systematic review highlight further questions that remain to be addressed in the literature. Further research continues to be necessary in this area to ensure that services are appropriately meeting the needs of both caregivers and IWDs.

This dissertation explores a number of interrelated metaphysical and epistemological issues regarding pleasure, suffering and their apparent value and disvalue, thematically tied together by the broad idea that pleasant and unpleasant experiences are, respectively, experienced as good and bad. More specifically, I try, firstly, to advance the debate regarding the nature of pleasure by arguing for what I shall call the "Self-Experiential View" - the view that pleasant experiences are pleasant in virtue of being experienced as good. Secondly, I assess the merits of the "Hedonic-Evaluative Acquaintance Thesis" - the natural conjecture, expressed by a number of authors, that our especially intimate experiential relationship ("acquaintance") with the evaluative features of our hedonic experiences grounds a particularly robust kind of epistemic status enjoyed by our hedonic-evaluative beliefs, which makes them less vulnerable to sceptical doubt. In chapter 1, I lay some groundwork for the ensuing discussion, by introducing a number of background claims which help to motivate these two theses. Moreover, I isolate two specific important ways of unpacking the Hedonic-Evaluative Acquaintance Thesis and clarify some central concepts which feature prominently in the subsequent chapters. In chapter 2, I defend the "Self-Experiential View." I proceed by addressing a number of objections which have been levelled against the view in the literature, and locate it in relation to the views which currently dominate the debate regarding the nature of pleasure. In chapter 3, I assess and ultimately reject the first important version of the Hedonic-Evaluative Acquaintance Thesis singled out in chapter 1, the "Naïve Realist Hedonic-Evaluative Acquaintance Thesis," which states that Naïve Realist acquaintance with pleasure's evaluative nature grounds a distinctive, especially robust kind of epistemic status enjoyed by our hedonic-evaluative beliefs. In chapter 4, I assess the "Introspective Hedonic-Evaluative Acquaintance Thesis", the attempt to vindicate the Hedonic-Evaluative Acquaintance Thesis by extending an acquaintance account of phenomenal introspective justification to the hedonic-evaluative case. By carefully unpacking a range of different candidate conceptions of introspective acquaintance, I home in on what I consider the most appealing acquaintance account of phenomenal introspection, and argue that it should not be extended to the hedonic-evaluative case, which means that this proposal also fails. A brief concluding chapter summarises the key conclusions of the dissertation and highlights some questions raised in the course of my discussion which would seem to warrant further investigation.

Hinton's theology of pain posits that an individual's suffering contributes to God's redemptive work in the world. This dissertation explores Hinton's theological appropriation of pain in four ways. First, we examine Hinton's life and writings to establish his personal interest about pain. Factors that contribute to Hinton's theological interest were the death of his brother, his sojourn in Whitechapel, his mental health, and his practice and skepticism of medicine. Second, we examine Hinton's redemptive nexus of suffering, beneficence, and deification in light of the Jewish and Christian traditions. While our exploration shows that the biblical tradition interweaves suffering, beneficence and deification, we also see that the biblical tradition adds elements that Hinton's treatment misses. The tradition shows that society also has an obligation to those who suffer. Suffering and wellbeing are ultimately social issues that require social, not simply personal, solutions. The serendipitous nature of suffering in the Hebrew bible fleshes out what in Hinton is simply an argument. In light of the serendipitous suffering in the Hebrew tradition, we examined participants in medical trials and the advancement of medicine as possible instances to bolster Hinton's theological nexus. The New Testament suggests that Hinton is too unidirectional in his understanding of the nexus of suffering, beneficence and deification. The New Testament places identification with Christ preeminently ahead of the suffering of the individual. Third, we explore the relevance of Hinton's thinking about pain in his contemporary setting in light of the philosophical, theological, and scientific developments in the nineteenth century. Hinton's metaphysical speculations bridge theology to Darwin's theory of evolution. Darwin was unable to connect Christianity to his thinking about natural selection because of his acceptance of ideas within natural theology. Hinton's metaphysical conceptualization allows him to reject natural theology while embracing the Darwinian revolution from a Christian perspective. Finally, we explore modern pain theories and the literature on the role of religious coping on pain and illness to see if Hinton's theology of pain remains intelligible. The modern medical and social science literature sustains Hinton's basic premise that theological outlook can influence one's tolerance of pain. / McAnulty College and Graduate School of Liberal Arts / Theology / PhD / Dissertation

<p>Respect for autonomy is the foundation of modern bioethics, even (or especially) where bioethics is attentive to the problem of suffering caused by the practice of medicine itself. It provides guidance in the midst of therapeutic and moral uncertainty, justification for morally problematic enterprises, and the promise of protection against self-serving or predatory medical personnel. Yet bioethical arguments that appeal to the injustice or the horror of suffering depend on an instinctual and uncomplicated association of suffering, especially imposed suffering, with evil. This uncomplicated association, this flattening of the complexities of the moral landscape, must lead to a diminished capacity to navigate the very difficulties that define the field of bioethics. This dissertation explores the relationship, particularly, of autonomy, suffering, and happiness in modern bioethics, as represented by three key theorists (James Childress, Tom Beauchamp, and H. Tristram Engelhardt). It then contrasts these findings with resources from the Christian tradition: Luke-Acts, the letters of Paul, and the theologians Thomas Aquinas, Catherine of Genoa, and Margaret Ebner. Their accounts of the meaning and experience of suffering within well-lived lives makes for a more robust account of the moral life, one in which suffering plays a formative part.</p> / Dissertation

Thesis (Th. M.)--Dallas Theological Seminary, 2003. / Includes bibliographical references (leaves 102-113).

The purpose of this study was to develop an inductive theory describing the process that hospice nurses use to identify and respond to their patients' suffering. Additionally, the study sought to describe the coping strategies that hospice nurses used when working with patients they considered to be suffering. By examining nurses' responses to suffering, this study is the first step in developing effective interventions to alleviate patient suffering and mitigate its consequences on the nurses caring for those patients. Additionally, by knowing the different strategies that nurses use to cope when working with suffering patients, nurse administrators could institute educational programs, build supportive environments, and develop policies to support nurses as they deal with these difficult clinical situations. This is especially important in a hospice environment where the registered nurse is the focal point for ensuring ongoing patient assessment and implementation of the interdisciplinary plan of care by the various team members. Charmaz (2006) description of grounded theory methodology guided the study design and analysis. Participants identified and responded to their patients' suffering within the context of the nurse-patient relationship. Phases of the relationship included: preparation, establishment, cultivation, maintenance, and letting go. The participants gained insight into the psychosocial and existential aspects of the patient's psyches by cultivating the nurse-patient relationship. Within this relational context, the participants used a four-phase process: observation, issue assessment, suffering, and intervention to respond to their patient's suffering. In addition to pain and other signs of physical suffering, the participants identified other aspects of suffering: role losses, the patient's fear of the impending death, the patient's aloneness, and the patient's feelings of guilt or regret. Interestingly, suffering also was considered a family affair and could involve the loss of self-identity. While the participants recognized the importance of self-care, often they had difficulty naming strategies used to respond and cope with their patients' suffering. Clinical supervision and emotional support through mentoring and practical guidance need to be further developed to help nurses cope with the complexity of feelings that arise when caring for dying people. / text

Background          Schizophrenia has been negatively observed in today’s society due to several major violent crimes and violent actions committed by persons with the diagnosis. The general populations’ lack of knowledge increases the risk of a faulty attitude when meeting individuals with schizophrenia. Schizophrenia is a psychosis which creates suffering for the effected. Common symptoms of schizophrenia are hallucinations, delusions, apathy and difficulties with emotional relations. Nearly half of all schizophrenics attempts suicide, at some point.   Aim                        The aim of this study was to describe how people with schizophrenia experience their life-world.               Method                  This study is based on six autobiographies and is analyzed with qualitative content analyses.   Results                   The study resulted in six categories which are perception of their illness, positive symptoms, negative symptoms, suffering, experiences of health care and medication and strategies towards a brighter future. During psychotic periods the individuals often experienced their surrounding as frightening because of hallucinations. Some of them live their lives alone because they are afraid of being perceived as crazy and want to conceal their diagnosis. The result shows strategies that the persons were using for reducing their suffering.                                  Conclusion            Prejudices about the disease can generate that persons with schizophrenia is not getting the care they need. If the patient is treated based on a life-world perspective, he or she will feel like being seen as a person rather than a diagnosis.

Lidande är en naturlig och oundviklig del av det mänskliga livet. En av de mest centrala uppgifterna inom vården innebär att lindra lidande. Därmed är det aktuellt att undersöka områdets kunskapsposition. Syftet var att beskriva lidande i omvårdnadStudien genomfördes som en litteraturstudie där 15 vetenskapliga artiklar utgjorde underlaget för resultatet. Resultatet i denna studie delades in i sex tema inom omvårdnad: ”Existentiellt lidande”, ”Livslidande”, ”Sjukdomslidande”, ”Vårdlidande”, ”Den vårdande personalens upplevelser av lidande” och ”Socioemotionellt lidande”. Studien visar att forskning i nutid på många sätt beskriver uttryck för patientens lidande i liknande former som det lidande som beskrivits i forskning tidigare. Utöver detta framkommer även beskrivningar av lindrande av lidande inom omvårdnad. Det framkommer att fokus i vården tenderar att ligga främst på att behandla fysiska symptom. En helhetssyn, där även existentiella, psykologiska, kulturella och sociala dimensioner uppmärksammas, är nödvändig för att förbättra patientens hälsa och minska patientens lidande.För att kunna möta patienten i lidandet krävs medvetenhet hos sjuksköterskan kring egna upplevelser av lidande. Fortsatt forskning samt belysning av området i sjuksköterskeprogrammet är betydelsefullt. / Suffering is a natural and inevitable part of human life. One of the central parts in health care is to alleviate suffering. Consequently, the present knowledge state is of importance to follow up. The aim of this study was to describe suffering in nursing. The study was conducted as a literature review were 15 scientific articles were the basis for the results. The result of this literaturereview was divided into six themes in nursing: "Existential suffering", "Suffering in life", “Suffering in illness", "Suffering in care", "Socioemotional suffering" and ”Perceptions of suffering in nursing staff." Expressions of suffering of the patient are found to be found similar in recent studies compared to the suffering described in research further back. Recent studies additionally indicate other expressions of suffering and approaches to alleviate suffering in nursing. It emerges that the focus in care tends to be primarily focused on treatment of physical symptoms. A holistic focus, with awareness of existential, psychological, cultural and social dimensions, is necessary to promote health and to alleviate suffering. To respond to the patient in its suffering, awareness of the nurse’s own experiences of suffering is required. Further research and illumination of the subject in the nursing program is of importance.

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