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.

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• Suffering Experience of Primary Caregivers of People with Mental Disabilities in Community Dwellings
  Eun Joung Choi, Hyun Mee Cho, Eun Ju Cho, Minkyung Lee
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• The Lived Experience of Suffering of Family with Cancer Patients: Parse’s Human Becoming Research Method
  Ye-Sook Choi
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  Kae Hwa Jo, Ae Ran Park, Jin Ju Lee, Su Jung Choi
  The Korean Journal of Hospice and Palliative Care.2015; 18(4): 276.     CrossRef
• Reliability and Validity of the Suffering Scale of Family of Patients with Terminal Cancer
  Kyung Ah Kang
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• Death Recognition, Meaning in Life and Death Attitude of People Who Participated in the Death Education Program
  Kyung Ah Kang, Kyung Soon Lee, Gang Won Park, Yong Ho Kim, Mi Ja Jang, Eun Lee
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PURPOSE: The purpose of this study was to develop Nurse's Suffering Experience Scale and to test the reliability and validity of the instrument. METHOD: The subjects used to verify the scale's reliability and validity were 220 nurses who were taking care of the end stage cancer patients, while working at university and general hospitals in Daegu and Kyungbuk province from April 20. to July 10, 2001. The data was analyzed by the SPSS/WIN 8.0 program. RESULTS: A factor analysis was conducted, and items that had a factor loading more than .40, and an eigen value more than 1.0. were selected. The factor analysis classified a total of seven factors statistically, and it's communality was 44%. The explanation of factors based on the conceptual framework and item content are as follows: The first factor was expanding self consciousness, the second factor was forming empathy with family, the third factor was professional challenge, the fourth factor was change of values, the fifth factor was spiritual sublimation, the sixth factor was helplessness, and finally the seventh factor was rejection to death. Cronbach's coefficient to test reliability of the scale was .8665 for total of 44 items. The Scale for Nurse's Suffering Experience developed in the study was identified as a tool with a high degree of reliability and validity. Therefore this scale can be effectively utilized for the evaluation of the degree of nurse's suffering experience in clinical settings.

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• Caregivers' psychological suffering and posttraumatic growth after patient death
  Eunmi Lee, Yujeong Kim
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  Jong Gun Kim, Su Min Oh, Eui Young Cheon, Jang Hak Yoo
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• The Effect of Suffering Experience, Empathy Ability, Caring Behaviors on Terminal Care Performance of Clinical Nurses
  Kae Hwa Jo, Ae Ran Park, Jin Ju Lee, Su Jung Choi
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  Seung Ae Yang
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• Effect of an End-of-Life Care Education Program Among Korean Nurses
  Kae-Hwa Jo, Ardith Z. Doorenbos, Gyeong Ju An
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PURPOSE: The Purpose of this study is to understand the meaning and the essence of suffering as viewpoint and to find the meaning and structure of the experience from encounters with patients in their terminal stages of illness.
METHOD
A descriptive design based on the phenomenological approach model developed by Collaizzi was used. The period of data collection was from August to November of 2000. Data collection was conducted by open-ended and audio-taped interviews. The participants were nine female nurses who were willing to take part in this study.
RESULTS
Results of this study were classified into five main categories. The main category clusters were "difficulty in experiencing suffering," "professional challenges to expert nurses," "formation of empathic relationships," "expanding consciousness through suffering," and "alleviation of the patient's suffering."
CONCLUSION
In conclusion, the implications for providing nursing care to end-stage patients in the throes of suffering is both rewarding and stressful. However, sharing these research results may help other nurses discover and experience deeper meanings in their own practice and careers.

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• The Effect of Suffering Experience, Empathy Ability, Caring Behaviors on Terminal Care Performance of Clinical Nurses
  Kae Hwa Jo, Ae Ran Park, Jin Ju Lee, Su Jung Choi
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• Nursing Students’ First Clinical Experiences of Death
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• Effect of an End-of-Life Care Education Program Among Korean Nurses
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PURPOSE: This study was conducted to detect the correlations and the main factors influencing depression, life satisfaction, burden, defenition of suffering, meaning of life, and suffering. METHOD: The samples were composed of 160 cancer patients who were or outpatients of four hospitals in Seoul. The reliability of the 6 instruments was tested with Cronbach's alpha which ranged from .62 to .90. The data was analyzed using a SAS program for descriptive statistics, Pearson correlation coefficients, and stepwise multiple regression. Results: The results were as follows: 1. The scores on the suffering scale ranged from 132 to 40 with a mean of 87.3 (SD 17.5). 2. There were significant correlations between all the predictive variables and even the amounts of suffering (r=.27-.84, p <.05). 3. Stepwise multiple regression analysis showed that depression was the main predictor of suffering, and accounted for 71.6% of the variance. In addition burden accounted for 4.6% of the variance in suffering. The two variables combined to account for 76.2% of the variance in suffering. CONCLUSION: In conclusion and depression, burden were identified as important variables in explaining the suffering of patients with cancer.

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• Stories of Suffering with Leprosy and Cancer in Korea
  Steven L. Baumann, Ok Ja Lee, Sook-Bin Im
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• Meaning of Life in Wives of Alcoholics: Autobiographical Method
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When people have experienced a personally life-threatening event, individuals try to find the meaning of suffering. In order to provide nurses with information about how meaning is individually experienced, nurses should assess the degree of suffering and the patient's perceptions of the meaning of suffering. The purpose of this study is to assess the reliability and validity of the Korean version of the MIST (the Meaning of Suffering Test) instrument originally developed by Starck (1983). The MIST consists of PART I and II. In this study, the validity and reliability of MIST I is tested except MIST II consisting of 17 open questions. The translation involved four steps: translation into Korean, checking agreement, translation into English, and arriving at a consensus. Then the Korean version of the MIST, PART I was tested with a sample of 160 patients with cancer who have experienced suffering. The Cronbach's alpha coefficient for internal consistency was .92 for the total 20 items and .91, .89, and .88 for the three dimensions in that order. As a result of the factor analysis using principal component analysis and varimax rotation, three factors with eigenvalue of more than 1.0 were extracted and these factors explained 93.6 percent of the total variance. The items clustered together in this study were almost identical with initial scale and subscales reported by Starck. The instrument for accessing patients' perceptions of the meaning of suffering was identified as a tool with a high degree of reliability and validity. In this sense, this tool can be effectively utilized for assessment in caring for patients with cancer.

Since cancer is not easily curable, patients who suffer from cancer may have physical, psychological and spiritual problems for the rest of their lives. Especially when cancer patients do not have much to live for and are placing a burden on their family they will experience more suffering emotionally as much as physically. This study was conducted to provide a basis of data for nursing intervention strategies to minimize a cancer patient`s suffering and to understand the relationship between suffering, burden and the meaning of life in cancer patients. The samples were composed of 160 cancer patients who were inpatients or outpatients of two university hospitals and two general hospitals in Seoul. Data collection were carried out from January, 25, 1999 to February, 26, 1999. The data were analyzed using a SAS program for descriptive statistics, pearson correlations, ANOVA, and Duncan tests. The results were as follows; 1. The scores on the two suffering scale ranged from 132 to 40 with a mean of 87.3(SD 17.5). The mean scores on the burden scale is 28.9(SD 6.9) and the score of the meaning of life ranged from 35 to 51 with a mean of 95.6(SD 18.4). 2. There were significant correlations between the amount of suffering and the magnitude of burden (r=.74, p=.00), the suffering and the meaning of life (r=-.59, p=.00) and the burden and meaning of life (r=-.61, p=.00). 3. In the degree of the suffering, the burden and the meaning of life were two very strong factors, the level of the suffering in cancer patients by age (F=2.64, p=.03) and education level (F=4.16, p=.00). The level of the burden in cancer patients differed by education level (F=4.70, p=.00) and type of cancer (F=2.97, p= .03). Also the level of the meaning of life in cancer patients was different by education level (F=3.55, p=.02). In conclusion, the burden and the meaning of life was identified as important variable that is contributed to reduce the suffering of cancer patients.

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• The Influences of Family Support on the Meaning of Life in Cancer Patients
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This study is a methodological research study to develop an instrument to measure in patients with cancer and to test the validity and reliability of the instrument. The research procedure was as follows: 1) The first step was to develop conceptual framework based on a comprehensive review of the literature and in-depth interviews with patients with cancer. This conceptual framework was organized in to three dimensions (the intrapersonal dimension, the significant-other and context related dimension, the transcendental dimension). Initially 59 items were adopted. 2) These items were analyzed through the index of content validity(CVI) and 53 items were selected which met more than 80% on the CVI. 3) The pretest was carried out with 87 patients with cancer. After the pretest results were analyzed by item analysis, 44 items were selected. A second test of content validity was conducted and 6 items were eliminated considering the 80% CVI. 4) To test for reliability and validity, data collection was done during the period from January 25, 1999, to February 26, 1999. The subjects for the test were 160 patients with cancer and 185 healthy persons. This study utilized Cronbach's alpha in analyzing the reliability of the collected data and applied factor analysis, item analysis and multitrait-multimethod method to analyze validity. The findings are as follows: 1) The Cronbach's alpha coefficient for internal consistency was .92 for the total 38 items and .79, .82, .85, for the three dimensions in that order. 2) The item analysis was based on the corrected item to total correlation coefficient( .30 or more) and information about the alpha estimate if this item was dropped from the scale. 3) As a result of the initial factor analysis using principal component analysis and varimax rotation, one item was deleted because of factor complexity (indiscriminate factor loadings). In the secondary factor analysis, 7 factors with eigenvalue of more than 1.0 were extracted and these factors explained 56 percents of the total variance. The seven factors were labeled as 'family relationship', 'emotional condition', 'physical discomfort', 'meaning and goal of life', 'contextual stimuli', 'change of body image', 'guilt feelings'. 4) The convergence effect between this instrument and the life satisfaction scale was identified and there was significant positive correlation(r= .52, p= .00). The discriminant validity between this instrument and the depression scale(CES-D) was tested and there was significant negative correlation(r= -.50, p= .00). The instrument for accessing the suffering of patients with cancer developed in this study was identified as a tool with a high degree of reliability and validity. In this sense, this tool can be effectively utilized for assessment in caring for patients with cancer.

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