Abstract

The purposes of this study were to clarify the details of decision-making among terminally ill cancer patients with life expectancies of approximately three weeks in the palliative care unit on how they would spend their remaining days, and to consider the role of nursing in ensuring that the decisions made by the patients were supported to maintain their quality of daily life.

Participant observation （participant-as-observer） and semi-structured interviews were conducted with 18 terminally ill cancer patients admitted to the palliative care unit with life expectancies of approximately three weeks. Data were obtained with careful consideration of each participant’s health status. The data were analyzed using Krippendorff’s content analysis method. The institutional ethics committee approved this study and each patient provided an informed consent.

We found that patients wanted to spend their remaining days by doing the following : live each day with each moment in time as a separate compartment ; live each day as it is without planning ahead of time ; live life by conserving physical strength ; create or leave something that can be left behind as a memento ; spend time doing something enjoyable ; talk about the frustrations and pain with people other than family and live in tranquility ; live in such a way that bonds with special people will last even after death ; do something for others with what’s left of their life ; and maintain dignity as a human being.

Through the results, it became clear that for nurses to support patients’ decisions, alleviating pain is of course a crucial issue, but most importantly, nurses should provide the best support for their patients to help them spend their precious days so that each day is the best day of their life. Nurses should actively listen to the patient ; respect the patient’s decision even if the patient has no plans set for the day ; respect the desire of patients who want opportunities to maintain hope by holding craft workshops and/or seasonal events and by setting achievable goals with other patients ; be someone they can talk to, and lastly, create an environment enabling patients to become as independent as possible by taking care of themselves, and allowing the opportunity for the patients themselves to help other patients.

Abstract

This study describes menopausal symptoms in breast cancer patients receiving hormonal therapy and discusses aspects regarding treatment and care for these symptoms. Self‒administered anonymous questionnaires were mailed to 133 patients. Demographic information and data regarding menopausal symptoms and health states were collected. Menopausal symptoms were assessed using the Simplified Menopausal Index （SMI）, a 10‒item scale that assesses symptom severity. Total SMI scores range from 0 （best） to 100 （worst） and a score of ≥51 indicates that treatment and care are necessary. In addition, health states were assessed using a 9‒item scale, with each item being rated from scores of 0 （best） to 10 （worst）. After using descriptive statistics, menopausal symptoms were compared by the type of hormone preparations and duration of hormonal therapy. Health states were compared by the total SMI scores. SPSS ver. 18 was used for data analysis.

A total of 83 patients responded to the questionnaire （response rate 62.4 ％）. Their mean age was 52.5 years （SD＝8.4 years） and the mean duration of hormonal therapy was 24.7 months （SD＝17.2 months）. More than half the patients experienced all menopausal symptoms. With regard to SMI, 63 patients （75.9 ％） scored ＜50 and 20 （24.1 ％） scored ≧51；health states among patients scoring ≧51, tended to be worse than health states of those scoring ＜50. Total SMI score showed no significant difference with regard to the duration of hormonal therapy. Our study results showed that menopausal symptoms continued through the duration of hormonal therapy.

Among breast cancer patients receiving hormonal therapy, 1 in 4 required treatment and care for menopausal symptoms, and the health states in those patients were worse. However, in reality they received neither treatment nor care. Once hormonal therapy begins, breast cancer patients have to take medications for a long period. If menopausal symptoms are managed according to the severity during this time, patients’ quality of life will improve.

Abstract

The objective of this study was to develop a nursing intervention for women with breast cancer while undergoing chemotherapy to help them deal with the uncertainties associated with this disease.

We designed a theoretical framework based on the theory of Uncertainty in Illness, the Problem-Solving Model of Worrying, and the theory of Mastery. We did an assessment based on the theoretical framework and nursing care, with women having breast cancer who were experiencing worry and anxiety while undergoing chemotherapy. Data were collected from a purposive sample of four participants. Eleven experiences of uncertainty were divided into four categories：‘permanent uncertainty’, ‘temporary uncertainty’, ‘uncertainties related to change of self’, and ‘uncertainties about adapting to a new daily life’. Different nursing interventions were developed for each category.

The theoretical framework was built that provides a new method of assessment to support women with breast cancer experiencing psychological distress. These findings indicate that nursing interventions adapted to the category of uncertainty are effective for supporting women with breast cancer.

Abstract

The present study aimed to clarify the state of nursesʼ experience with cancer complementary and alternative medicine （CAM） based on their extent of experience and CAM-related difficulties. A self-administered questionnaire survey was conducted on 375 nurses involved in cancer nursing at four university hospitals in the Kanto Region and surrounding areas. Responses were received from 230 （61％） nurses ; analysis was conducted on the remaining 214 responses after excluding 16 incomplete questionnaires. Analysis was comprised of descriptive statistics and Kruskal-Wallis test for the extent of experience. Qualitative analysis was used for difficulties content. Results revealed an overall low extent of CAM experience ; however, the extent of experience tended to increase with increased length of cancer nursing experience for the following 10 alternative therapies : acupuncture and moxibustion, homeopathy, shark cartilage, Agaricus subrufescens, Phellinus linteus, propolis, massage, chiropractic medicine, herbs, and the Maruyama vaccine. Five categories of difficulties were identified, ʻself-judgment by patients and familiesʼ, ʻeffect on patientʼs body and treatmentʼ, ʻdifficulties in finding approaches to patients care among nursesʼ, ʻadverse effects on nursing servicesʼ and ʻdifferences in opinion between patient and doctorʼ. These were further divided into 11 subcategories.

The present findings indicate the need for nurses to willingly accept patients undergoing CAM and their families while simultaneously creating an atmosphere in which they can always ask for CAM-related advice. Nurses must also acquire CAM-related knowledge and information.

Abstract

The purposes of this study were to clarify the characteristics of the family functioning with terminally ill cancer patients and to examine the factors that affect the family functioning.

The questionnaire survey was conducted with 46 families with terminally ill cancer patients, and 49 families without patients as a comparison group. The survey was comprised of the Family Systems Health Measurement（FSHM）. Each family was also asked to complete a form of their demographic profiles and social support networks they used. Mann-Whitney U-test and multi-regression analysis were used to identify the characteristics of the family functioning.

The following results were indicated：1）families with terminally ill cancer patients had higher scores on ‘sharing time and space’ and ‘family ties based on trust’ items, 2）family communication affected family functioning. According to the subscales, a factor that affect ‘family ties based on trust’, ‘sharing time and space’ and ‘role achievement’ items was instrumental network, while the number of family members who provided care was also an effect factor for ‘role achievement’. Sex of family member affected ‘the adaptation of environment’. If male members of the family were responsible for the patient care, they were less ‘adaptable to the environment’ than female members.

In order to improve the family functioning, it is necessary to facilitate communication among family members.

Abstract

The purpose of this study was to clarify the relationship between dyspnea management in palliative care units and nurses’ knowledge, skills, and attitudes. A questionnaire survey was conducted with 276 nurses working in palliative care units in the Tokai and Hokuriku regions of Japan. The questionnaire included items on nurses’ backgrounds and their basic knowledge, skills, attitudes, and implementation of care in dyspnea management. The response rate to the questionnaire was 89.1 ％. Basic knowledge of dyspnea was high on questions related to the nature of dyspnea and the effects of morphine, with a correct response rate of more than 90 ％, but low with regard to the effect of additional medical narcotics on dyspnea, with a correct response rate of around 50 ％. It is conjectured that nurses with knowledge of assessment scales in dyspnea management conduct assessments based on that knowledge, and that this may be linked to better patient care. The correct response rate for questions on dyspnea care related to adjusting body position and relieving anxiety was high at more than 90 ％. Sixty percent of respondents understood the squeezing technique and 40 ％ could perform it. The results of multiple regression analysis suggest that training for knowledge and skills where understanding is insufficient promoted the practice of physical care, since basic knowledge, physical care skills, and attitude toward dyspnea affects the implementation of physical care. The implementation of psychological-emotional care is affected by psychological-emotional care skills, attitude toward dyspnea, and attitude toward communication, suggesting that in addition to cultivating a proper attitude toward dyspnea, acquiring communication skills is necessary.