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Female Suffering After Blunt Trauma and the Need to be Cared for and Cared About

Filhour, Louis D. PhD, RN

doi: 10.1097/JTN.0000000000000463

Using a phenomenological design, the researcher repeated a previous study of males, this time exploring the question of what is the experience of suffering voiced by female patients 6–12 months after hospitalization for blunt trauma. Eleven female volunteers were interviewed and asked questions about how they suffered, what made their suffering more or less bearable, and how they were transformed through their suffering. Like the males, female participants experienced changes in patterns resulting in perceptions of suffering. Participants reported mostly experiencing physical, emotional, and social forms of suffering, whereas fewer participants experienced economic and spiritual suffering. Experiences of suffering resulted from the threat to their sense of wholeness because of their injuries. Intrinsic and extrinsic factors made participants' suffering more or less bearable as they regained or revised their shattered wholeness. Positive attitude and motivation were significant intrinsic factors, whereas quality supportive care was the most significant extrinsic factor. Feeling cared about emotionally was as important as feeling cared for physically in helping participants better bear their suffering. Poor quality care was a significant negative extrinsic factor resulting in suffering being made more unbearable. Through their experiences of suffering and finding meaning in that suffering, participants were transformed, amending their previous state and resulting in a new state of wholeness. Knowledge gained through this phenomenological study may help nurses understand suffering and guide their care and caring to alleviate it or make it more bearable.

Albany Medical Center, Albany, New York.

Correspondence: Louis D. Filhour, PhD, RN, Albany Medical Center, 43 New Scotland Ave, Albany, NY 12208 (

The author declares no conflicts of interest.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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We are integrated biopsychosocial-spiritual beings who are in dynamic interaction with our environment (Bender & Feldman, 2015; Fawcett & DeSanto-Madeya, 2013). While we are integrated beings, we are also unitary in that we are more than the sum of our parts (Parse, 2014). Our dynamic interaction with our environment may result in events that negatively impact our ability to maintain our sense of wholeness and health (Eriksson, 2007). An example of such a life-altering event is blunt trauma, which may result in the victim's perceived or real loss of wholeness, manifesting itself as suffering (Filhour, 2016).

Individuals can experience blunt trauma regardless of their socioeconomic status, occupations, or where they live (Fantus & Fildes, 2003a). Blunt trauma occurs more frequently than penetrating trauma and is a serious injury because it is more likely to impact multiple organ system (Fantus & Fildes, 2003b). In 2015, blunt trauma as the result of a fall or motor vehicle accident (MVA) accounted for 82% of all traumatic mechanisms of injury for females compared with 62% for males (American College of Surgeons, 2016).

Victims of blunt trauma suffer. Suffering is a unique and subjective human experience, as well as being complex, and occurs in response to a perceived or actual threat of one's wholeness (Cassell, 1991; Eriksson, 1997; Ferrell & Coyle, 2008; Malpas & Lickiss, 2012). Although medicine and nursing share a long-term goal of relieving suffering, suffering as a phenomenon is poorly understood and frequently not viewed in relation to one's wholeness (Arman, Rehnsfeldt, Lindholm, Harmin, & Eriksson, 2004; O'Mahoney, 2005). Advancements in technology are enabling more people to survive blunt trauma events, which also mean they experience suffering for longer periods (Paiva, Rossi, Costa, & Dantas, 2010). Although addressing suffering is central to health care and serves as a motive for nursing care, there is inadequate knowledge about suffering, resulting in a lack of effective nursing care interventions (Eriksson, 1997,2007; Milton, 2013). Finding meaning is one way patients can manage their suffering, and nurses can play a role in assisting them (Deal, 2011). Poorly understood suffering for victims of blunt trauma is a significant issue for nurses and the focus of this modified replication of a previous phenomenological study by this researcher.

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Acquisition, substantiation, and verification of nursing knowledge develop and enhance nursing philosophy (Holt, 2014; Scott, Matthews, & Kirwan, 2014). The human experience of suffering results in a need for nursing care and therefore is an important focus for nursing (Deal, 2011) and thus the phenomenon of suffering is important to nursing's philosophy. Filhour (2016, 2017) studied the lived experience of suffering by males following blunt trauma. The purpose of this replicate study was to gain a fundamental understanding of the lived experience of suffering, bearing suffering, and becoming through suffering as described by female patients with blunt trauma.

“The living experience of suffering is an important phenomenon of interest to be studied” (Milton, 2013, p. 227). There is little research that focuses on both a patient's suffering and nursing care to alleviate that suffering (Rehnsfeldt & Eriksson, 2004). Without appropriate research, nursing lacks knowledge to guide recognizing and addressing patient suffering (Rydahl-Hansen, 2005).

Nurses should assist their patient in finding meaning in their suffering, which can help them make it bearable or alleviate it. However, nurses and other caregivers can fail to identify their patients' existential suffering because they did not view them holistically, resulting in neglect and a lack of caring (Arman et al., 2004). Failure of nurses to recognize and address more than physical needs puts their patients at risk for increased suffering (O'Mahoney, 2005). Caring for and caring about their patients holistically enable nurses to address various forms of suffering including anxiety, stress, pain, fear, confusion, isolation, loss of control, and despair. Additional knowledge of suffering will help guide nurses in their efforts to alleviate suffering or make it bearable.

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The research question for this phenomenological study was as follows: What is the lived experience of suffering for females who survived 3–12 months after the life-impacting event of blunt trauma? Subquestions can help refine the central question as well as provide specificity to it (Cohen, Kahn, & Steeves, 2000). Subquestions for this study included the following: How or in what forms did participants suffer? What made their suffering more bearable or unbearable? How were they transformed by their suffering?

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This study focused on the lived experience of suffering. Phenomenological research's central concern is experiential meanings that provide a rich description of a lived experience of a specific phenomenon (Finlay, 2009). Phenomenological inquiry, using an empirical approach, is “interested in seeing how people interpret their worlds, and how we can interpret their interpretations” (Shank, 2006, p. 132). The basic assumption of phenomenology is people use language to construct and communicate meaning, thus enabling them to reveal meaning of an experience through conversation. Phenomenology trusts informants and embraces exploration of participants' lived experiences within their natural context (Polit & Beck, 2004).

Although culture influences how things are perceived differently by men and women, evidence also supports biology playing a role (Miller & Holden, 2005). Neuroscience research using brain imaging has identified differences between sexes. For example, stress responses are affected differently in men and women by their sex hormones. Because of estrogen, females experience a higher stress response to fear whereas males experience a reduced reaction to pain because of testosterone. Other research has implicated sex hormones influencing the male tendency to express unhappiness externally through drinking and violence in contrast to females who express it internally as depression (Miller & Holden, 2005). To control for these biological influences in the experience of suffering, the researcher limited this replicate study to female participants.

After receiving approval from the medical center's institutional review board, the researcher collected data from the trauma registry to identify females older than 18 years who had suffered a mechanism of injury resulting in blunt trauma in the previous 3–12 months and were discharged alive. Phenomenology requires effective communication by participants, so individuals not identifying English as their preferred language for communication or those who had a documented history of dementia were excluded by the researcher. Prisoners were also excluded.

The remaining list of women were mailed a packet containing a letter of introduction, a copy of the informed consent, a list of questions to be used in the interview process, and a form response letter with a self-addressed stamped envelope. Women indicated their interest in participating in the study by returning the form letter. Participation in the study was voluntary, and no compensation was provided. Participants were not excluded on the basis of race, ethnicity, or socioeconomic status.

As in the previous study of males, data gathering about the female participants' lived experiences of suffering consisted of a single interview in a natural setting. The researcher again used the same design of an open-ended, semistructured interview process with participants having the questions as part of their introductory packet. By receiving the questions prior to the interview, it helped participants organize their thoughts ahead of time, which may have helped reduced some of the stress in revisiting their experiences. Participants were encouraged to tell their stories in their words. This approach supported probing of the complex issues, clarification of answers, and obtaining sensitive information. Interviews lasted between 60 and 90 min and were digitally recorded with the participant's permission.

The digital audio recordings were transcribed verbatim by a professional stenographer. The researcher compared each transcript with the audio recording to ensure accuracy. Participants were mailed copies of their validated, verbatim transcripts for review and editing. Participants were instructed to ensure the document reflected their experiences and approve it for use in the study. The few requested changes were made to the documents by the researcher before coding. These steps helped ensure the credibility of the study.

Data saturation was achieved with a sample size of 11 women. Participants ranged in age from 21 to 71 years, and their traumatic events had occurred in the previous 6–12 months (Table 1). Five participants were actively employed prior to the accident and four were retired. All but one of the employed participants had returned to their previous work or retired at the time of the interview. One had not yet been physically able to return to work. Seven of the blunt trauma events were related to falls, three to MVAs, and one related to a bicycle accident. All 11 participants experienced one or more fractures as a result of their accidents. Nine of the participants were discharged home after hospitalization, and two were discharged to an inpatient rehabilitation facility before going home.



Data analysis followed the steps of data immersion, transformation, and reduction as suggested by Cohen et al. (2000). The NVivo 12 (QRS International, 2018) software program was used to help facilitate the processing of these qualitative data. Participants' words or phrases from their transcripts were copied and then clustered under nodes, using van Manen's (1990) highlighting or selective approach. NVivo 12 software was useful in tracking the text related to each node by specific participant.

Initial coding of the 11 transcripts resulted in 37 nodes reflecting relevant concepts as they emerged from the data. The reduction process of nodes reflecting participants' experiences of suffering resulted in five clusters: physical, emotional, social, economic, and spiritual. These clusters were reflective of nursing's concept of man possessing wholeness: unitary, integrated biopsychosocial-spiritual beings (Bender & Feldman, 2015; Fawcett & DeSanto-Madeya, 2013; Parse, 2014) and similar to the clustering in the previous study. Also, as in the previous study, factors intrinsic and extrinsic to participants were identified as making suffering more or less bearable.

Themes developed as a result of data analysis were shared with participants for their feedback and validation. This validation helped ensure the themes reflected the meaning participants gave to their lived experience of suffering (Ploeg, 1999). Ten of 11 participants returned their review, validating the themes as proposed by the researcher.

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Four themes emerged from the analysis of the 11 interviews of female patients following a hospital admission for blunt trauma. Key themes related to (a) perceived or real threat to their state of wholeness, (b) disruptions to normal patterns resulting in suffering, (c) regaining their state of wholeness by bearing their suffering, and (d) revising their sense of wholeness through finding meaning in and being transformed by their suffering. Analysis identified the threat to wholeness related to a threat to how the participants defined themselves: in relation to their level of activity or independence, families, or work. Disruptions to normal patterns resulted in experiences of physical, emotional, social, economic, and spiritual suffering. The process of regaining wholeness was helped or harmed by intrinsic and extrinsic factors that made suffering more or less bearable. Figure 1 demonstrates the relationship of the themes.

Figure 1

Figure 1

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Theme 1: Threat to Wholeness

Understanding suffering requires understanding the basis of it. Suffering results when ones sense of self is threatened and the meaning one gives to that event (Kahn & Steeves, 1986). How participants defined themselves was threatened by blunt trauma. Although not a question asked during the interview process, analysis of the transcripts did reveal how participants defined themselves, their sense of wholeness. Participants defined themselves or their meaning in relation to being active or independent, to family, or to work (Table 2).



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Theme 2: Pattern Disruption

Through mutual, simultaneous, and dynamic interactions with our environment, patterns evolve (Baumann, Wright, & Settecase-Wu, 2014) and blunt trauma disrupts these patterns. Suffering is experienced when a person perceives an impending or actual destruction to his or her wholeness or disruption to patterns (Filhour, 2016, 2017). Relief from suffering occurs when the perceived threat no longer exists or wholeness and patterns are restored (Cassell, 1991), which may be achieved through the acceptance of new patterns or a newly defined sense of wholeness.

Data analysis identified physical, emotional, social, economic, and spiritual pattern changes reflective of the threat to the participants' sense of wholeness. Participants verbalized these disruptions to their previous patterns as experiences of suffering. Although not all forms of suffering were experienced by all participants, forms of suffering were found to be interrelated rather than mutually exclusive. Physical and emotional suffering was experienced by all participants, whereas social, economic, and spiritual suffering, in that order of significance, was experienced by some.

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Physical Suffering

Physical suffering was experienced by all 11 participants in the study. Physical suffering clustered into five major types: decreased activity, pain, sleep disruption, constipation, and personal hygiene. Suffering related to a decrease in activity was experience by all 11 participants. This is significant because their previous pattern of activity was tied to their identity and thus their sense of wholeness was threatened. Pain was the second significant source of suffering for nine of the participants. Concerns about addiction motivated participants to minimize use of narcotics. Constipation was the result of narcotic medication to control pain and was significant for four participants. Prior knowledge or experience helped two participants avoid constipation by proactively self-managing their diet and fiber intake. Sleep disruption was the third most significant experience of suffering for seven of the participants. Personal hygiene concerns were significant for four participants. The lack of nursing care to assist with these hygiene concerns added emotional suffering to the physical experience of suffering. Physical suffering was also identified as contributing to emotional suffering in the form of depression and social suffering because of isolation.

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Emotional Suffering

Injuries prevented participants from physically being able to do their typical activities, which, in turn, impacted the emotional joy they would have normally experienced from doing those things. For seven participants, this manifested itself as depression. Blunt trauma was a new experience for all participants, and the associated unknowns about outcomes resulted in emotional suffering reported as worry, doubt, concern, or fear. All were exposed to new situations and interventions they did not understand, which contributed to a sense of loss of control and suffering. Seven participants experienced emotional suffering related to a change in their roles and the need to be dependent on others for care. Seven participants also reported experiences of anger.

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Social Suffering

Social suffering resulted from a threat to previous normal social interaction patterns for nine participants. These experiences of suffering resulted from changes in normal social interaction patterns with hospital staff, spouses, children, other family members, friends, or acquaintances. Analysis of the data demonstrated social suffering was associated with a change in role, relationships, or socialization. A perception of not being listened to by the hospital staff resulted in not only social suffering but also emotional, and at times physical, suffering. Blunt trauma resulted in injuries causing participants to experience a change from their normal role pattern of caretaker to a new role of one needing care. “Good friends” who failed to help when needed also resulted in social and emotional suffering. As one participant reported, “everything flipped-flopped.” The significant decrease in mobility negatively impacted previous levels of social interactions resulting in feelings of isolation or loneliness, which contributed to the emotional suffering of depression.

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Economic Suffering

Economic suffering related to threats to the previous state of economic normal and was reported by five participants. This form of suffering related to decreases in income secondary to the inability to work because of the physical injuries or expenses not covered by insurance. All participants had some form of insurance. Participants voiced suffering because of additional uncovered expenses related to needed equipment at home to help with the recovery or extra expenses for child care. Economic suffering contributed to emotional suffering in the form of doubt and worry. Only one participant who was previously working was still not able to return to her job at the time of the interview.

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Spiritual Suffering

Spiritual suffering related to a threat to the participant's normal pattern of spirituality and was the least experienced form of suffering. Only three participants reported an experience that reflected spiritual suffering. Suffering related to questioning why their God would allow this to happen to them; “Why me?” These few reports did not mean spirituality was not important to the participants in the study. Seven participants found spirituality played a role in helping them bear their suffering rather than contributing to it. The experiences of suffering by participant are displayed in Table 3.



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Theme 3: Regaining Wholeness

Participants experienced threats to their sense of wholeness. These threats resulted in changes in their normal patterns that were experienced as physical, emotional, social, economic, and spiritual forms of suffering. During their recovery process as bones mended, participants journeyed toward regaining their wholeness. Data analysis revealed this journey was made easier by things helping participants bear their suffering and was made harder by things making suffering more unbearable.

Factors intrinsic to participants, such as positive attitudes and strong motivations to get better, helped participants bear better their suffering. Participants' knowledge, either from previous experiences or newly acquired, made suffering more bearable as well as helped participants regain lost control, which also made their suffering more bearable. Previous personal illnesses or experiences in providing care to family members imparted useful knowledge in helping 10 participants deal with this traumatic event. Two of the participants were registered nurses, which also gave them previous knowledge useful in helping them to bear their suffering. Nine participants reported gaining new information through such things as having their x-ray images shared with them and the injuries explained. This new knowledge helped them gain understanding and therefore regain lost control.

Extrinsic factors helped participants through the long process of recovery and the regaining of their sense of wholeness. Critical support from others to address physical, emotional, and social needs was an example of positive factors extrinsic to the participants. All 11 participants reported critical support from spouses, siblings, children, or friends. All participants also identified supportive care from their physicians, nurses, radiology technicians, or physical therapists that made their suffering more bearable. Beneficial support from others reflected physical caring for and emotional caring about them.

Other extrinsic factors made suffering more unbearable, negatively impacting participants' recovery process. Poor care quality by health care providers was the most significant negative extrinsic factor. Examples included participants not being listened to by providers, providers not making eye contact, participants feeling ignored, scolded, or demoralized by staff, excessively painful procedures, and participants feeling staff members were “too busy to care.” Poor care was unbeneficial and did not reflect caring for or about the participant. Other negative extrinsic factors included “good friends” who did not offer support or family members who provided support but were also disruptive and “put your home into upheaval.” For participants with unstabilized pelvic and rib fractures, hospital beds with air chambers that changed pressure every 15 min made suffering more unbearable by increasing the experience of physical suffering in the form of pain and sleeplessness. This suffering was then made worse when participants would complain about this discomfort because of the bed and the staff failed to take action to address it.

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Theme 4: Revising Wholeness

The significant injuries from blunt trauma threatened participants' state of wholeness, resulting in the experience of suffering. Suffering was made bearable by intrinsic and extrinsic factors during the long recovery, which included the intrinsic factors of positive attitude and motivation and the extrinsic factors of supportive, quality care. Poor care quality resulted in suffering being made more unbearable.

While recovering, participants reflected on their experiences, which resulted in a transformation or revision of their sense of wholeness. All participants recognized their own vulnerability and the fragility of life, which served as a motivator for transformations, a change in meaning and values. Five participants reported they were now more careful about what they do and how they do it. Five other participants reported being more empathic with others who are injured. One participant stated, “I am spiritually stronger and more willing to rely on others. It resets your values.”

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A phenomenon's nature can be uncovered using phenomenology (van Manen, 1990). By asking questions rooted in philosophy, phenomenology can help a researcher in the discovery and description of an experience. Being both appropriate and useful, the phenomenological method helped the exploration of this experience of suffering and also aligned with nursing's humanistic, caring paradigm. This method reflected a “from-inside-approach” because it enabled coming to know suffering through the participants' own stories or narratives (Isovarra, Arman, & Rehnsfeldt, 2006).

Frankl's (2000) work on man's need to find meaning supports this humanistic approach to the exploration of suffering related to blunt trauma. Frankl identifies it is through finding meaning in suffering that it becomes a transcendent experience. Through the therapeutic use of self, nurses play an important role in helping their patients find meaning that helps them endure suffering (Deal, 2011). Thus, this research contributes to a greater understanding of suffering, enhancing the nurse's ability to provide needed care.

A person's experience of suffering can only be understood if his or her wholeness is understood. It is necessary for nurses and other caregivers to recognize their patients' personal meanings if they are to understand their suffering. The interview process used in this study enabled participants to share their personal meaning because they revealed what was important to them. It was through their sharing of what they gave to life, got from life, and their attitudes that their meanings could be identified (Barnes, 2000). This study revealed three main sources of meaning reflecting wholeness: activity/independence, family, and work.

When beliefs and values are put to doubt, resulting in a lack of trust in the past, suffering is experienced (Cassell, 1992). One's connectedness, beliefs, values, meaning, and sense of life's purpose are impaired by suffering, thus compromising one's sense of wholeness (Chio et al., 2008). It is during times of suffering that one's life purpose and meaning are tested (Frankl, 1959; Travelbee, 1971).

The researcher's analysis and findings, validated by participants, aligned with constituents suggested by Morrissey (2011). These included suffering being personal, subjective, and multidimensional in nature and involving physical, emotional, social, and spiritual aspects. As noted by Cassell (1992),Reed (2003), and Morrissey (2011), participants in this study also experienced suffering by their whole person and not just their bodies. The threat to wholeness and the resulting suffering caused participants to reflect on their existence, perspective, and meaning. These reflective insights informed participants' abilities to bear and be transformed by their suffering.

Unlike the progressive diseases of cancer, heart failure, or kidney failure, the sudden and unexpected event of blunt trauma finds its victims psychologically unprepared for the massive expectancy disconfirmation (Janoff-Bulman, 2004). Unknowns about the present and future, loss of self-integrity and dignity, and lifestyle changes resulted in emotional suffering. Decreased self-integrity and dignity resulted in feelings of embarrassment, demoralization, and vulnerability. Emotional losses are more significant than corresponding gains (Redeimeier, Rozin, & Kahneman, 1993).

As a result of perceived or impending threat of destruction, a person experiences suffering until either the threat passes or the person's integrity, through some other fashion, is restored (Cassell, 1991). With internal and external supports, the healing process reduced threats to wholeness over time and thus reduced experiences of suffering. The long recovery process enabled the regaining of wholeness. While intrinsic and extrinsic factors helped them bear their suffering during this healing process, there were also extrinsic factors that made suffering more unbearable. People can bear suffering, making it compatible with health or it can significantly compromise health if unbearable (Ruijs, Onwuteaka-Philipsen, van der Wal, & Kerkhof, 2009).

A positive attitude and motivation to recover were common intrinsic factors among the participants in this study. Attitude is important because it contributes to both understanding and predicting social behaviors (Ajzen, 2001). “One is either the master or the victim of one's attitudes” (Starck & McGovern, 1992, p. 29). By activating the will to meaning, people have freedom to change attitudes about what may seem to be a meaningless situation (Frankl, 1959).

Participants' old and new knowledge, or more importantly their understanding, also played a role in helping them bear their suffering of the unknown and regain lost control. Their experience as caregivers for their families informed their abilities as patients. Unlike knowledge, understanding is intrinsically valuable (Boylu, 2010).

Participants' intrinsic spirituality also helped in bearing suffering. Frankl (2000) recognized spirituality as a significant source of both strength and healing in addressing suffering. Frankl viewed the human spirit as what we are and the essence of one's humanness. Spirit is a human dimension that contains therapeutic resources of self-transcendence and self-distancing rather than being a religious concept.

Support provided by others was the most significant positive extrinsic factor in helping participants bear their suffering during the recovery process to regain wholeness. While inpatients, nurses played a key role in providing physical and emotional support, making participants' suffering easier to bear. After being discharged, family and friends were critical in providing the needed support.

Poor care by health care providers was the most significant negative extrinsic factor identified in this study. Poor care was reflected in poor physical, emotional, and social care. Poor care resulted in participants neither feeling cared for nor cared about and resulted in undue suffering. Participants were not listened to by care providers, resulting in physical and emotional suffering. Social suffering was also experienced by participants when they perceived their care provider was not interested in them as a person. Participants readily identified which of their care providers cared about them as well as for them and how those who did not care made suffering more unbearable. These findings can help inform nurses about the need to ensure their patient are not only cared for but also cared about.

Suffering may transform the sufferer as well as facilitate personal growth (Starck & McGovern, 1992). Blunt trauma is a serious disruption that threatens one's sense of who he or she was or once was (Serlin & Cannon, 2004). This study found the event of blunt trauma forced participants to confront life's fragility, shattering their previous sense of coherence and meaning. This traumatic event resulted in participants discovering meaning, achieving transcendence reflecting growth, and creating a new sense of wholeness. With time, sufferers develop new values and meanings that help bridge old reality to the newly created and realistic present.

Through self-discovery, participants found truth and meaning about their authentic self. Making choices to change situations that could be changed or making choices to change attitudes about situations that could not be changed also informed meaning. Exercising freedom to act responsibly helped participants find meaning. Finally, meaning was found through participants' human spirit and therapeutic resource of self-transcendence.

As reflected in Selder's (1989) theory of life transition, participants created new realities based on current expectations that also influenced meaning derived from their new experiences. Participants identified previously unrealized values of life and developed heightened senses of responsibility for loved ones. Finding meaning in surviving and suffering helped participants make a cognitive shift and focus on living in the moment (Wang, Wang, & Liu, 2012). Not only did participants experience a transformation of interpersonal attitude but they also experienced an increased sense of empathy and altruism. Their philosophy of life changed, reflecting their change in priorities. Participants believed they developed a better understanding of self, life, and human nature because of this traumatic event.

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Hyatt, Davis, and Barroso (2015) identified knowledge of challenges and suffering experienced by patients following a significant injury is important for nurses to promote care and caring in support of the patient's need to regain wholeness. This study contributes to knowledge that may inform nursing practitioners. It provides knowledge about the human experience of suffering within the philosophy of nursing science and informs nursing practice in support of relieving patient suffering.

It is critical for a patient's experience to be understood prior to that understanding being applied by nurses in a caregiving process, resulting in the development of new interventions and measures (Yu, 2014). By employing strengths-based nursing, nurses can provide an environment of moral support, facilitating the patient's generation of self-awareness (Gottlieb, 2014). Patients can be given a sense of being cared for and cared about through the practice of ethical nursing care, using affective awareness and empathy, supporting person-centered care.

Suffering is a phenomenon universally experienced by humans, making it a focus of nursing care (Deal, 2011). The practice of nursing in relation to the experience of suffering can be informed and guided by caring human science theory (Eriksson, 2002; Swanson, 1999; Watson, 1979) to protect, enhance, and preserve the patient's wholeness. Through the transpersonal caring relationship, nurses help their patients in searching for meaning to address suffering, achieve transformation, and restore or revise wholeness.

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Limitations of this study are found in the population sample of 11 females. While the design of this study limited the sample to adult females, the sample consisted of women who had recovered fairly well from their injuries within 12 months of their accidents. All participants volunteered to participate in the study hoping the results would identify new knowledge that could help other victims of blunt trauma. The positive attitudes and strong wills to recover exhibited by all participants and related to their motivation to participate are most likely not reflective of the total female blunt trauma population. Although requests for participation went to a variety of potential participants, those agreeing to participate in the study were all Caucasian. Therefore, race and ethnicity were other limitations to this study.

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Formal inquiry can generate knowledge useful in guiding nursing practice as well as informing health care policies (Milton, 2013). The aim of this study was the description of the lived experience of suffering for females who survived the life-impacting event of blunt trauma. A subsequent aim of this study was the creation of new knowledge useful in guiding nursing practice and research. Both aims were achieved by the findings of this study.

Surviving blunt trauma resulted in study participants confronting their fragility and vulnerability. Participants struggled with understanding their new world, making sense of it and finding meaning. With supportive help from others in their environment such as health care providers, spouses, family, and friends along with their own cognitive processing, participants rebuilt their assumptive worlds and shattered senses of wholeness. Study findings suggest ways nurses can care for and care about their patients, reducing suffering while supporting healing and transformation. Because of their new appreciation of life's fragility, participants were transformed through meaning-making that focused on significance and created new senses of wholeness.

This study contributed knowledge and understanding about suffering as experienced by this population in an effort to guide nursing practice and inform policies. Thus, the results of this study may also contribute to nursing philosophy. Findings of this study may provide understanding useful to nurses in helping them meet their patients' unique needs for care and caring when experiencing suffering (Kikuchi, 2014).

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  • Suffering is a personal experience rooted in the meaning the person gives to life, his or her state of wholeness. The loss of that meaning or wholeness results in the experience of physical, emotional, social, economic, and spiritual suffering.
  • Through the process of enduring suffering and being transformed by it, the sufferer finds new meaning and a new state of wholeness.
  • Nurses can relieve suffering and facilitate this transformational process by providing care that makes the sufferer feel cared for physically and cared about emotionally.
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