There is a need to define the concept of suffering more appropriate in the context of Korean culture. This research is an attempt to analyze and develop the concept of suffering by applying the Hybrid Model suggested by Schwartz -Barcott and Kim. The data were collected from March 20, 1995 to September 17,1995. The subjects of the study were eight persons including in-patients and out-patients of a general hospital who were diagnosed as having cancer and those resting in sanatoria for natural treatment of cancer. Qualitative research methods of in-depth interview and participant observation were used for data collection. The contents of the interviews were recorded on tape. Data-analysis progressed according to the 3 phases suggested by the Hybrid Model. For each case, in-depth interview data and participant observation data were included and the attributes of suffering revealed in these data were analyzed. Finally, by summarizing the results from each case, the attributes of suffering, its dimensions, definition, and processes observed in the field were suggested. According to the results of the study, the following new definition of suffering is suggested: Suffering is a fundamental and inevitable experience of all human beings. When each individual experiences loss, damage, and pain which threaten one's personal integrity, suffering is perceived differently among each individual depending on their personal inner factors, one's significant others, exterior circumstances and stimuli, and the ultimate meaning of life. Suffering brings severe and unendurable distress which accompany despair, powerlessness, anxiety, bitterness, fear, anguish, guilt, depression, withdrawal and anger. The results of this study suggest that the more responsibility and burden a cancer patient felt, the more suffering she/he experienced and it tended to be more relevant to one's significant others and exterior circumstances and stimuli; the less responsibility and burden a cancer patient had, the less suffering she/he experienced and it tended to be related to one's inner factors. These findings have implications for nursing profession. When caring for patients who experience suffering, nurses need to consider the influence of responsibility, burden, and each dimension of suffering. Moreover, appropriate nursing interventions aimed at relieving pain and satisfying the spiritual need of patients experiencing loss need to be developed and implemented more widely.

The main objectives of this study were to analyze the concept of hope, so to provide basic data to develop a valid instrument to measure hope, and to develop hope enhancing nursing intervention a program for cancer patients. The hybrid model approach was applied in three phases, the theoretical phase, the empirical phase, and the analytic phase. The study was developed on universal attributes explaining generalized hope and specific hope, which were revealed in a comprehensive review of the literature. In the empirical phase, eight cancer patients undergoing chemotherapy were interviewed to reveal causes, motivation, and their resource of hope according to The Hope Assessment Guide (Farren, Herth, & Popovich, 1995). In the analytical phase, the results of the two previous stages of the study were compared. The results were as follows: In the theoretical phase, six dimensions of hope emerged; affective, cognitive, behavioral, affiliative, temporal and contextual dimension. The antecedent of hope was loss, crisis, uncertainity, and stress. The consequences were renewal, development of new methods, safety, peace and transcendental competence. In the empirical phase, these six dimensions emerged as theoretical phases were verified and specified as these descriptive terms: feeling, intention, expectation, activity, relation, future- orientation, reality and goal-setting. The antecedent factor of hope was occurrence or recurrence of cancer. The consequence of hope was ability to cope with real condition, feeling of safety and comfort, peace, development of new strategy and recovery of disease. The major content of hope in this phase was related to specific hope, but it was also influenced on by general hope. In the analytic phase, general and specific hope was renamed as trait and state hope. All attributes emerged at the empirical phases, and also emerged at the theoretical phase. However, cognitive and contextual dimensions were revised and specified. In conclusion, the concept of hope is divided into trait hope and state hope, and state hope is an anticipatory expectation that occurs at the time of a stressful stimulus, such as being diagnosed with cancer. Hope is a multidimensional dynamic energized mental state which has the dimensions of affective, cognitive, behavioral, affiliative, temporal and contextual. There should be further studies to develope the state and trait hope scale according to definition and attributes of hope investigated in this study. In addition, considering results of the empirical phase, the family is very a important factor as a resource of hope, so it is necessary to consider family in implementing a nursing intervention program to enhance hope.

The Resilience is described as the personal capacity which brings psychosocial comeback. The role of nursing is to do its best to rehabilitate patients and to explore the individual in order to promote patients psychosocial change. However, as the current nursing is heavily physical nursing oriented, the identity of the nursing would be lost. Therefore this researcher reviewed if the concept of resilience can be applied to the nursing after examining the concept of resilience by Documents and Fieldwork. The methodology of this research is Hybrid Model developed by Schwartz-Bracott and Kim for the concept development and analysis. The process and procedure consist of The Theoretical Phase, The Fieldwork Phase and The Final Analytical Phase in accordance with the Hybrid Model. The followings the summary of the Research. 1. The Concept of Resilience Finally Analyzed by Documents and Fieldwork. (1) The Redefinition of Resilience. The resilience is the latent psychological capacity which minimize the negative emotion and promote the adaptation under adversity. Resilience appears as cognitive, emotional and behavioral response in the course of changing from negative response to positive response through the interaction of the individual and the environments in a given time. Resilience changes and decreases according to time and situation and it can be nurtured. Resilience is the higher concept including hardiness, sense of coherence and self-strength which maintain the health under stress. (2) The Attribute of Resilience. The attribute of resilience was divided into psychological and social dimension. In psychological attributes, there are admission of reality of situation, denial of negative emotion, desire to live, responsibility, confidence, courage, hope, pursuit of positive meaning, identification and pursuit of goal, self-esteem, reception, spontaneity, planning, positiveness, will power, flexibility and creativity. In social attributes, there are a sense of belonging, perception of social support and active social relations. (3) The Process of Resilience. There are 4 resilience phases which were the process minimizing the possibility of the negative chain reactions under adversity, the process minimizing the negative emotion, under adversity, the process gaining the desire to live and the process exposing the active social relations. 2. The Application Possibility of Resilience Concept to Nursing. The resilience concept is the psychosoical capacity with which an individual manages adversity. As many nursing scientists have developed nursing theory based on this capacity and the identification of nursing has been established in this field, resilience is not the new conception in nursing. However, since resilience appears in the attributes related with the resilience process concretely, it would help a lot when nurses execute psychosocial nursing.