Praxis theory of suffering

The praxis theory of suffering is a healthcare model used to guide nurses seeking to ease patient suffering. It is credited to the New Zealand-born anthropologist and nursing care researcher Janice Morse, who first published the theory in 2001 and expanded on it in 2010. The central aspects of the praxis theory of suffering posit that patients experience two main types of suffering, which Morse describes as “enduring” and “emotional” suffering. Morse also identifies tools caregivers can purposefully apply in interactive ways to diminish patient distress.

Morse’s view holds that enduring and emotional suffering are mutually exclusive, and that suffering patients alternate between them and experience them in separate ways. Thus, each type of suffering demands various targeted interventions in order to achieve a constructive outcome.

Background

The praxis theory of suffering emerged in 2001 from many years of qualitative research performed by Janice Morse and her collaborators. Morse was born in 1945 and grew up in New Zealand, where she became a registered nurse before relocating to the United States to attend Pennsylvania State University. There, Morse completed bachelor’s and master’s degrees in transcultural nursing. She then earned a master’s degree in anthropology at the University of Utah before adding doctorates in transcultural nursing and physical anthropology. Her career includes research and professorial stints at Pennsylvania State University, the University of Utah, and the University of Alberta in Edmonton, Canada. Morse founded the University of Alberta’s International Institute for Qualitative Methodology in 1997, advancing her work in the emerging field of qualitative health research, of which she is also recognized as the founder. In 1991, Morse established Qualitative Health Research as an interdisciplinary, peer-reviewed journal with an international scope. As of 2021, Morse continues to serve as the publication’s editor-in-chief while holding a Presidential Endowed Chair and professor emeritus position in the University of Utah’s College of Nursing.

Morse’s creation of the field of qualitative health research intended to bridge systemic care gaps created by healthcare’s historically exclusive focus on data driven by statistics, statistical analysis, trends, and event frequencies. Qualitative health research relies on inductive methodologies and makes extensive use of patient and caregiver interviews, direct and indirect observation, and other forms of nonnumeric information-gathering. It places a strong emphasis on the subjective experiences, impacts, and perspectives of research participants. The goal of qualitative health research is to develop theories, concepts, and operational methodologies that enhance the interactive social functions seen in institutional care settings and improve the physical, mental, and emotional outcomes of patients and their loved ones.

Prior to publishing her initial iteration of the praxis theory of suffering in 2001, Morse had spent decades compiling related qualitative research. She devised the framework as a means of developing new perspectives on nursing interventions based on intelligent exchanges between caregivers and their patients.

Overview

Together with fellow qualitative researcher Barbara Carter, Morse began to map out her praxis theory of suffering in 1996. She released a developed version of the framework in 2001, describing it in an article titled “Toward a Praxis Theory of Suffering,” published in the journal Advances in Nursing Science. Morse revisited her theory in 2010, when she contributed a chapter titled “The Praxis Theory of Suffering” to the textbook Philosophies and Theories in Advanced Nursing Practice.

“Toward a Praxis Theory of Suffering” offers an overview of Morse’s qualitative research findings into the behavioral and experiential aspects of patient suffering. In the work, Morse separates suffering into two prevalent and mutually exclusive forms: enduring and emotional suffering. Enduring suffering is defined by the patient’s efforts to suppress their emotional state and maintain control over the situation they are in. Morse identifies multiple definitive behaviors associated with the enduring form of suffering: individuals often display blank, neutral facial expressions and robotic movements, usually speaking in short phrases or sentences and limiting discussions to purely factual matters of immediate or situational relevance. She also notes that individuals dealing with enduring suffering frequently busy themselves with mundane or repetitive tasks, such as doing puzzles or performing chores. Occasionally, individuals experiencing enduring suffering require a temporary emotional release, which may come in any number of forms. Morse and other commentators specifically recognize fits of hysterical laughter, yelling or screaming, and violent outbursts as examples of such releases.

Morse characterizes emotional suffering as the opposite of enduring suffering. It is defined by the release of the emotions repressed by the suffering individual during the enduring phase. Emotionally suffering people frequently devolve into overt states of moderate to severe distress marked by fits of weeping and other verbalized or gestured expressions of anguish. In “The Praxis Theory of Suffering,” initially published in Philosophies and Theories in Advanced Nursing Practice in 2010, Morse specified that emotional suffering tends to indicate that the suffering individual is now prepared to face the true emotive impact of the sorrow, fear, and sense of loss they were repressing in the enduring phase.

In “Toward a Praxis Theory of Suffering,” Morse notes that individuals tend to vacillate back and forth between states, moving between them as dictated by their own physical, psychological, and emotional needs, or as a response to their acknowledgement or acceptance of a grim or troubling prognosis or diagnosis. Similar fluctuations also occur in different contexts, or as a reaction to the real or perceived needs or situational responses of other people. For instance, patients may revert to the enduring form of suffering in an effort to appear calm and brave in the face of adversity while loved ones are present, before breaking down into a state of emotional suffering once alone.

Morse’s praxis theory also develops multiple strategic approaches caregivers can use to address each of the two mutually exclusive forms of suffering. Broadly summarized, Morse believes that enduring suffering should generally be addressed by giving the patient or suffering individual space and avoiding direct discussion of the source of their suffering so as not to explicitly remind them of it. Conversely, Morse assigns value to comforting responses when an individual enters an emotional suffering state, encouraging caregivers to offer condolences and emotional or physical support.

Bibliography

Aranda, Kay. Critical Qualitative Health Research: Exploring Philosophies, Politics, and Practices. Routledge, 2020.

Green, Judith and Nicki Thorogood. Qualitative Methods for Health Research. SAGE Publishing, 2018.

Hansen, Emily C. Successful Qualitative Health Research: A Practical Introduction. Routledge, 2020.

Morse, Janice M. “The Praxis Theory of Suffering.” Philosophies and Theories in Advanced Nursing Practice, edited by J.B. Butts and K.L. Rich. Sudbury, Jones and Bartlett, 2010, pp. 569–602.

Morse, Janice M. “Theoretical Coalescence: A Method to Develop Qualitative Theory.” Nursing Research, vol. 67, no. 2, Mar. 2018, pp. 177–187.

Morse, Janice M. “Toward a Praxis Theory of Suffering.” Advances in Nursing Science, vol. 24, no. 1, Sept. 2001, pp. 47–59.

Pope, Catherine and Nicholas Mays. Qualitative Research in Health Care. John Wiley & Sons, 2020.

Swezey, Nancy Lynn. “A Nurse’s Perspective on Janice Morse’s Praxis Theory of Suffering.” City University of New York, 6 Dec. 2017, commons.gc.cuny.edu/papers/60044/. Accessed 10 Jun. 2021.