Abstract

Various self‒care activities are continuously performed by many cancer patients who undergo cancer therapy. To perform self‒care activities, it is important that the patients acquire and utilize self‒care abilities, which form the basis of the activities. This study aimed to elucidate the self‒care abilities essential for cancer patients undergoing cancer therapy. An interview survey was performed for 20 cancer patients undergoing cancer therapy, after obtaining their informed consent. To raise the reliability, content analysis ‒ the epistemology and logic of which were clarified by K. Krippendorff ‒ was performed on the results obtained in the interview survey. Cancer patients were found to acquire self‒care abilities from their own experiences or through nurses and other medical professionals. The following 5 major abilities were found to be important：“to detect changes in physical condition”, “to independently judge and select health‒related behaviors”, “to focus toward positive thinking without adhering to the existence of cancer”, “to maintain relationships with others and to adjust his/her social life”, and “to review his/her lifestyle and to pursue self‒development activities”. There were 11 minor abilities. These self‒care abilities were found to be important for stimulating self‒care activities.

Abstract

The purpose of this study was twofold：identify the process laryngectomized patients used in reestablishing their communication style from the perioperative period to one year after discharge, and obtain insights into nursing practice in support of this process. The study included 12 patients with head and neck cancer who were scheduled to undergo total laryngectomy. Data were collected using participant observation and semi-structured interviews from the preoperative period up to one year after discharge, and analyzed through a qualitative inductive approach.

The process used by laryngectomized patients in reestablishing communication style represented that of “a departure from increased frustration because they could not make themselves understood.” This process began with “building an image of loss of voice” secondary to advance notice of loss of voice and “reoptimization of communication, reestablishment of a smooth form of communication and promotion of the efficiency of communication in the absence of laryngeal phonatory function,” and being prepared for “loss of voice in exchange for life.” In the postoperative period, “a desire was aroused” in patients over a course of four cycles, which worked together and were repeated, thereby further driving a “slight expansion of minimized communication.” Three cycles originating from “looking at someone with whom to communicate, coordinating with the person and concentrating on communication”（1）a cycle of further “reoptimization of communication：reestablishment of a smooth form of communication and promotion of the efficiency of communication in the absence of laryngeal phonatory function,”（2）a cycle of inducing “increased frustration not being able to make themselves understood and not speaking/not being able to speak” and（3）a cycle of “enjoying communicating with others” and “slight expansion of minimized communication”）and（4）one cycle of recalling the preparedness for “loss of voice in exchange for life” originating from the cycle of inducing “increased frustration at patients not being able to make themselves understood and not speaking/not being able to speak.” As this process was iterative and cyclical, it led to the recurrence of these four cycles. The study suggested the need for nursing practice in waiting until “a desire is aroused” spontaneously in patients, not missing the arrival of that time, and in relieving the suffering of patients and people around them until “a desire is aroused.”

Abstract

The aims of the present study were to clarify post-operative lifestyle restructuring by patients receiving adjuvant therapy during the post-esophagectomy recovery process and to obtain practical nursing suggestions. Subjects comprised 22 outpatients who had completed post-operative adjuvant therapy and who had been discharged from hospital for at least 6 months following esophagectomy for esophageal cancer. Semi-structured interviews were conducted during outpatient visits and data were analyzed using the modified grounded theory approach.

Results revealed that the process of post-operative lifestyle restructuring by patients receiving adjuvant therapy during post-esophagectomy recovery could be explained by the core categories of ‘narrowing of sphere of daily life’ and ‘accepting narrowing of sphere of daily life and acquiring a personalized way of life in exchange for being alive’. This process began with the subcategory “realization of unlikelihood of returning to original state” caused by “considerably greater pain than expected and damaged eating and swallowing behavior”. Although some patients perceived this realization as “loss of eating ability is only to be expected”, others had mixed feelings of “self-questioning regarding the meaning of undergoing esophageal surgery” and “inability to decide whether this was something that could happen to anyone” but were satisfied by “comparing food-related symptoms with other patients”. Both of these patients groups talked at this stage about “exchange for being alive” and while facing “difficulty living life as before” they continually attempted “to increase their food intake through trial and error” with the feeling of “pressure to recover from surrounding expectations”.

However, these attempts were protracted compared to post-operative adjuvant therapy and this caused “anxiety regarding economic hardship caused by loss of employment” and “narrowing of functional range”. However, through recalling their talk of “exchange for being alive” and objectively viewing their physical status, patients developed “realization of recovery over time” and “expectations of recovery accompanying increase in food intake capacity”. They acquired a new set of values comprising “changing lifestyle to date” and “living a health-based lifestyle”, and by “searching for a personalized way of life while trying to adapt”, they ultimately achieved lifestyle restructuring. Post-operative “fear of metastasis, relapse and cancer onset at a different location” constantly constituted a core part of the patient’s mental state.

Abstract

The purpose of this study was to evaluate the experiences of volunteers in a “cancer salon” where cancer patients and their families can talk to each other; these volunteers were cancer patients or their families. Data were collected using semi-structured interviews with 8 volunteers and were qualitatively analyzed.

The results showed that the experiences of the volunteers could be divided into 6 main categories: “desire to alleviate the mental pain of people with cancer,” “realization of the importance of the salon,” “increased self-respect,” “difficulties in attending to visitors,” “reliance on other volunteer members,” and “spiritual healing.”

Because the volunteers cherished the desire to alleviate the mental pain of people with cancer, they wanted to help those visiting the salon by making use of their experiences with cancer. Thus, the volunteers realized the importance of the salon in providing emotional support for the cancer patients and their families as these visitors could talk to each other and strike a chord with one another. Furthermore, the volunteers wanted to help as much as possible and realized that they could actually help the visitors; therefore, the salon was the place where they achieved increased self-respect.

Nevertheless, they experienced difficulties in attending to visitors, because they could not give the visitors useful advice or they experienced compassion for the visitors. However, these difficulties were solved by reliance on other volunteer members.

The experiences that the volunteers obtained at the cancer salon aided them in learning about other people’s way of life, becoming emotionally stable, and making practical use of their experiences. This led to spiritual healing, i.e., they could acquire a new sense of control as cancer survivors.

At such salons, it is important to provide nursing service that involves nurses who understand the conflicts and needs of volunteers and help them in supporting the patients and their families.

Abstract

The purpose of this research was to understand the value judgments of nurses with practical experience of nursing patients with terminal cancer, regarding support provided for decision making by these patients. Semi-structured interviews were carried out with 16 nurses having at least 4 years’ practical experience of nursing adult patients with terminal cancer, and qualitative functional analysis of the interview content was performed. Analysis of the research results identified seven value judgments held by these nurses：‘a patient should make his own decisions until the end,’ ‘a patient should be able to approach and appeal to the medical team so that his decision is realized at all costs,’ ‘a patient should be given support to enable him to spend the remainder of his life at home if he wishes,’ ‘the family should respect the decisions of the patient and should be supported so that they can make treatment and other related decisions on the patient’s behalf more easily during the final stages,’ ‘when a patient changes his decision, the information should be shared and supported so that he may change his decision as many times as required,’ ‘considering the amount of time the patient has left, care should be taken to respect the patient’s decision,’ and ‘care should be taken to minimize the burden on the patient in realizing the content of his decision.’ The suggestions given regarding the support provided for decision-making included emphasizing the ability of patients to make their own decisions until the end based on correct recognition of their condition and respecting their decisions in a variety of ways, including approaching and appealing to the substitute decision maker and/or medical team；providing sufficient information regarding social resources and medical staff support systems to the patients’ families to allow for home care if the patients wish to receive treatment at home；taking into account the burden on the patients in realizing the content of their decision；and supporting the realization of their decision while providing care to ensure their safety.

Abstract

Purpose：To present the findings of a survey that examined oral care in nursing practice for people with hematological malignancies during chemotherapy in Japan.

METHODS：A cross-sectional designed survey was undertaken. The questionnaires were sent to chief and staff nurses working in hematological units of 497 hospitals certified by The Japanese Society of Hematology. The data collected were from 172 chief nurses and 1,735 staff nurses in the hematological units.

RESULTS：Of the responding staff nurses （n＝1,735）, 78.6％ reported using povidone iodine to prevent oral mucositis yet, the Cochrane report says gargling with povidone iodine is not effective. On the other hand, only 13.0％ reported using cryotherapy, which is recommended by the Cochrane reports to prevent oral mucositis. The numbers of the nurses using povidone iodine in the hospitals that have Certified Oncology Nurse Specialists were significantly lower （p＜0.05） than the nurses in the hospitals that did not have Certified Oncology Nurse Specialists/Certified Nurses. Initiating oral observation after the onset （as opposed to prevention） were 7.6％ of the nurses in the hospitals that have Certified Oncology Nurse Specialists, compared with a significant number 16.4％（p＜0.05） of nurses in the hospitals that did not have Certified Oncology Nurse Specialists/Certified Nurses.

CONCLUSIONS：According to the results of this research, the latest information on oral care for people with hematological malignancies during chemotherapy is needed in Japan. In addition, this research shows that Certified Oncology Nurse Specialists take on an important role in improving oral care for people.