Abstract

The purpose of this study was to identify concerns about morphine and medication behavior and its related factors in cancer outpatients with pain. Subjects were 30 cancer outpatients who agreed to participate in this study. We interviewed the outpatients using Barriers Questionnaire (BQ), the Japanese version of Brief Pain Inventory (BPI), and Medication Behavior Questionnaire we developed for this study. The following results were obtained :

1. BQ was translated into Japanese and reliability of the Japanese version of BQ was confirmed.

2. There were high scores in BQ subscales of progression, tolerance and addiction.

3. There was a significant negative correlation in fatalism, addiction and total BQ with age.

4. Cancer patients who experienced side effects were high scores in BQ subscales of side effects. There was a significant difference between side effects and BQ subscales of side effects.

5. Factor analysis yielded there factors of regular medication behavior, medication consultation or adjustment, and additional adjustment of medication. There was a tendency that outpatients did not responded to regular medication behavior if concerns about morphine were high. It showed a significant negative correlation between total BQ and regular medication behavior.

6. BQ subscales of fatalism, addiction, side effects, tolerance, distraction and total BQ showed a significant positive correlation with least pain of BPI.

These findings suggested that nurses should provide information on morphine effects and side effects to outpatients. Also, nurses should continue to help outpatients to participate in pain management.

Abstract

The purpose of this study was to identify changes in cognitive appraisal of significance disease made by cancer patients following telling about the diagnosis, and to collect information which would help reduced the psychological distress of patients when the diagnosis is told.

The subjects were 13 patients with cancer whose the diagnosis was told for the first time and who gave informed consent to be involved in the study. Data were collected using a semi-structured interview.

As a result, perceiving they had cancer resulted in their mental-representation of “shocked at the threat of having cancer” and “confronted with my pre-ordained cancer”. Patients who described “shocked at the threat of having cancer” experienced the crisis and reported their mental state with such phrases as, “I am overwhelmed by cancer”, “I am unbelievably having cancer”, “I can't face with having cancer”, “I am trapped by cancer”, “I am uncertainty my own existence”. Some of these patients later changed their report of mental state to “I can confirm my own existence” after hearing of the good experiences of other individuals who had had cancer, and obtaining favorable information from their physician. Patients who described “confronted with my pre-ordained cancer” used statements such as, “I can't escape from my fate” and “Cancer is my fate”, “Cancer is a breakdown of my body”. To help patients with cancer, it is essential for nurses to talk with the patients and assess the psycho-social condition of each patient so that the nurses can provide adequate information to the patients and help them think realistically about their disease.

Abstract

The purpose of this study was to identify the philosophy of nursing, care behavior, and their developmental process and affecting factors of clinical nurses who participate in care of dying as generalists in order to consider the direction of continuous education to promote qualitative improvement of terminal care. Subjects included 22 clinical nurses who agreed to participate in this study. The qualitative data were collected through semi-structured interviews based on a questionnaire developed by the researchers and analyzed through exploratory content analysis from which a number of relevant categories were induced.

The categories of the philosophy of nursing in terminal care were “attitude on care”, “view on human”, “improvement of the quality of life”, and “value of terminal care” ; those of care behavior were “to find out needs”, “to palliate physical pain”, “to support family”, “to provide inner peace”, “to discuss about disease and death”, “to support personal sense of identity of patients”, “to establish a base of a trustful relationship”, “to manage environment”, and “to vitalize” ; and those of affecting factors were “personal factors” and “organizational factors”. The developmental process was classified into I to IV stages according to the depth of the philosophy of nursing and care behavior. The subjects belonging to the advanced stage group were those who were older, had longer experience, had worked for terminal care for 5 years or a longer period, and were in a managerial position. The following structure was found : nurse practitioners search for the meaning of the personal experience, reconsidering the philosophy of nursing and care behavior ; these are fed back to affect subsequent experience ; and affecting factors influence searching for the meaning of the personal experience and thus are involved in the development of the philosophy of nursing and care behavior.

A comparison with a previous study indicates that it is necessary for nurses to improve their sense of ethics, perceptions of life and death, and spiritual care and for organizational factors to be further improved for promoting qualitative improvement of terminal care.

Abstract

The purpose of this study was to prove a characteristic of the anticipatory grief expressed by spouses of patients in the hospice, in terms of couple relationships. Grounded Theory Approach was chosen for this research design and analysis for the purpose of the qualitative and inductive analysis. Partners of ten patients who had been suffering from the terminal cancer in hospice were the subjects for this study. This study was performed using semi-structured interviews.

As the result, interview yielded three categories ; Ⅰ. Reflecting their lives they shared with, Ⅱ. Trying their best in everything they can do only then, Ⅲ. Considering their own lives after their partner's death. Three categories were expressed not as the process but simultaneously in each case, however, emphasis differed in each case. The core category of “facing their partner's death” was extracted from three categories. Thus, it was suggested that four points are important in nursing for partners of patients in the hospice ; 1. Partners can express a strong emotion like love and hatred, 2. They have a feeling of achievement that they had done everything they can, 3. They don't have a sense of guilt of considering their own lives after their partner's death, 4. Their performances of problems are done at a stretch, but main problems differ with each case, therefore, they must be cared in accordance with their case.

Abstract

This study was based on Martha Rogers' science of unitary human beings. The qualitative and longitudinal approach was used as a hermeneutic and dialectic process to explore and describe the changes in experiences of adult participants in the nursing care with the integrated use of dialogue and massage. The whole process was taken as the interaction of energy fields between a participant and a researcher. Ten participants were adults with advanced lung cancer. They received chemotherapy a few days after the diagnosis. A partnership has been established between a client as participant and a nurse as researcher.

The search for evidence of changes in clients' in the face of difficult life situations was done with the ongoing partnership. The data analysis was focused on identifying patterns of the changes.

The four phases have been identified. Their experiences started with Phase Ⅰ, the establishment of the relationship after the encounter in the confusion. The clients started the interaction with the nurse as environment. Phase Ⅱ was the evolutionary emergence where the clients had expressed their real feelings better. Phase Ⅲ was the unification where the clients integrated their experiences to determine how to live in a new reality here and now. Phase Ⅳ was the transformation where the clients obtained future perspectives beyond their present relationship, attitude, perception, feelings, knowledge, values, choices, communication in the interaction between the client and the nurse.

The major turning point was observed during the Phases Ⅱ and Ⅲ. After expressing their feeling enough, the clients realized and understood the reality, and at the same time their new values and choices evolved. They regained energy and new rhythms in life.

The above phenomena have been observed in the framework of homeodynamic wave patterns defined in Rogers' nursing model. The integrated use of dialog and massage in oncology nursing care has created diverse changes in clients' experiences of the illness and the treatment processes. The knowledge on the patterns of the changes would be useful for oncology nurses.