Abstract The objective of this study was to understand the bodily experiences of patients who have undergone surgery for lung cancer and provide suggestions for nursing support. We conducted qualitative research employing hermeneutic phenomenology methods. Data was obtained from in-depth interviews with 17 patients who had undergone surgery for lung cancer within eight weeks. The data was analyzed with reference to the hermeneutic phenomenological method proposed by Cohen et al ^1）. Four themes related to bodily experiences of patients who have undergone surgery for lung cancer emerged. They were “Awareness of bodily vulnerability which differed to their usual condition”; “Understanding bodily recovery through action-related sensations”; “Regaining bodily strength with remaining lungs”; “Recognition of bodily strength gain from others”. The patients, who realized that they were physically vulnerable when noticing differences from their usual selves, analyzed their bodies differently than usual by checking for signs of physical recovery in their own subjective ways. They seemed to obtain new values and confidence while making an effort to regain their bodily strength, which could cause stress on the remaining lung. And when recognizing their vulnerability, when striving towards physical recovery, and receiving support from others at the appropriate timing, the patients would regain the will to challenge their bodies to enhance their futures.

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Abstract In this study, we aimed to describe the concept of awareness of patients with secondary lymphedema developing after undergoing surgery for cancer. We analyzed a total of 20 materials: literature selected from the fields of nursing science, medicine, sociology, and psychology, as well as relevant publications, using methods suggested by Walker and Avant. The analyses revealed that the subjectsʼ self-awareness had covered “focusing on self”, “discomfort”, “differences from normal”, “interest”, and “fear”. Based on these findings, we defined the awareness of patients with secondary lymphedema developing after undergoing surgery for cancer as a “sense in which such individuals show reactions to symptoms/signs of lymphedema or perceive some changes; specifically, feeling discomfort or differences from normal, through objectively focusing on themselves as those who have a risk of lymphedema”. In addition, according to our definition, this cognitive process is influenced by patientsʼ knowledge and experience of lymphedema, the extent to which the disease hinders their lives, symptom severity, and the physical recognition after the cancer treatment. This concept is a part of the general ideas regarding symptom control, such as self-monitoring, and is necessary for recognizing and dealing with problematic symptoms. Thus, the concept is important for the early detection of symptoms, and will become a basis for providing thorough and effective support to prevent lymphedema.

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Abstract This study aimed to clarify emotional experiences of patients with advanced lung cancer suffering from cancer pain（N=12）．We conducted participant observation and semi-structured interviews. Furthermore, we analyzed results using the Qualitative Synthesis Method（KJ Method）．Emotional experiences of participants were integrated into six categories：a feeling of recovery of body and mind due to self-regulation of pessimistic thoughts and surrounding support；a sense of security and release from cancer brought by pain relief；accepting self-help efforts stemming from anxiety over opioid analgesics as an ultimate solution when pain increases；commitment to medical treatment to maintain current condition even though the cancer cannot be completely cured；commitment to medical treatment as a cornerstone for improved mind, religion, and a new way of life；and moderate fear of death based on the predictive response that assumes the progress of cancer leading to death. We found that emotional experiences of patients suffering from cancer pain relate to the struggle to live in society as autonomous existence inspired by their wills to recover, and their experiences will turn into preparation for their predicted death. We consider that it is necessary for nurses to enhance these patientsʼ expectations of physical and mental recovery, encourage their desire to recover, and support each of them in living in society as autonomous existence.

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Abstract This study investigated the relationship between the self-perceived severity of urinary incontinence, quality of life（QOL），and perception of emotional support in cancer patients after radical prostatectomy（RP）．An anonymous self-reporting questionnaire was conducted with 77 patients with postoperative urinary incontinence. The questionnaire covered demographics, self-perceived severity of urinary incontinence（International Consultation on Incontinence Questionnaire - Short Form），perception of emotional support from others（Emotional Support Network Scale），and QOL（King's Health Questionnaire）．Descriptive statistics and correlation coefficients were calculated, and hierarchical multiple regression analysis was performed using QOL as a dependent variable. Patients perceived their urinary incontinence as moderately severe, with no significant difference from their perceived general health. Perception of incontinence was significantly related to its impact on daily life and to seven factors describing its impact on daily living. The self-perceived severity of urinary incontinence and perception of emotional support（other people）had the direct main effect of limiting physical activity（β＝.618, p＜0.01 and β＝－.230, p ＜0.01, respectively），while the self-perceived severity of urinary incontinence and perception of emotional support （workplace）had the direct main effect on emotional problems（β＝.419, p＜0.01 and β＝－.236, p＜0.10, respectively）．There were no significant differences among the interaction terms. After RP, patients consider the impact of incontinence on daily life. The influence of urinary incontinence on daily living may be ameliorated by reducing limitations on physical activity through perceived emotional support outside the workplace, and by reducing emotional problems through perceived emotional support in the workplace. Nurses should adequately assess the self-perceived severity of urinary incontinence and the perception of emotional support by patients after RP, in order to provide targeted support for its physical and psychological （mental）impact on daily living.

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Abstract The purpose of this study was to clarify difficulties and learning needs of home care nurses when they are required to provide nursing care for advanced-recurrent treatment stage cancer patients and their families. Data was collected using semi-structured interviews and self-administered questionnaires given to eighteen home care nurses. Collected data was analyzed to extract responses concerning difficulties and learning needs relating to nursing care for advanced-recurrent treatment stage cancer patients and their families, and categorize them according to similarities in semantic content. The difficulties in nursing care for advanced-recurrent treatment stage cancer patients were classified into nine categories including：“Struggling with intervention regarding the continuation and cancellation of treatment”; “Troubled over how to deal with the patient’s anxiety regarding an uncertain future”; “A lack of knowledge about chemotherapy”. Learning needs in nursing care for advanced-recurrent treatment stage cancer patients were classified into seven categories including：“Wanting to learn the basics of chemotherapy”, “Wanting to learn the latest chemotherapy treatments”. The difficulties of home care nurses when they are required to provide nursing care for cancer patients and their families relate to ethics, knowledge and the technique to support on their own care, the provided system for the home care. We suggested that it is necessary to educate about nursing ethics, latest treatment, communication skill and psychological care so that home care nurses can reduce difficulties to provide cancer care and support the patients and their family in local area.

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Abstract The purpose of this study was to identify the meaning of strength and strategy in keeping up strength in advanced lung cancer patients receiving chemoradiotherapy（CRT），and to consider proper support for them to complete treatment. We conducted semi-structured interviews with 6 locally advanced lung cancer patients twice during treatment. A qualitative design was chosen for this study and date was interpreted using content analysis techniques. In this study, the meaning of strength was integrated into 5 major categories. The 5 major categories were： “facing the cancer”, “knowing and trusting your bodily strength”, “strength being affected by emotions”, “indicators for preventing homeostasis”, “permit activities according to purpose”. Details of individual strategies to maintain strength were integrated into 9 major categories. The 9 major categories were：“having a strong will to keep up strength”, “accepting strength reduction to a certain degree”, “management with anxiety and worry”, “confronting life and death, and reviewing oneʼs own life”, “receiving enough nutrition”, “adjusting the rhythm of living for a 24-hour day cycle” “controlling activities”, “adjusting to oriental medicine”, “placing value on human relationships and support”. Advanced lung cancer patients were forced to face poor prognosis. CRT was the only way to cure their advanced lung cancer, so they put forth all energy to complete their treatment and expressed their energy using the word “strength”. “Having a strong will to keep up strength” was most important for the patients, and they found their own ways to keep their strength. As has been discussed, strength did not only imply physical ability for patients receiving CRT. Strength is a complex, subjective concept. To support these patients, nurses must pay attention to their symptoms, physical condition and psychological response.

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Abstract The purposes of this study were to clarify the feelings, thoughts, and coping strategies of adult male patients with cancer chemotherapy drugs-induced alopecia upon their return to work, and review the necessary nursing practices. We conducted semi-structured interviews with six adult male patients who returned to work without a full recovery from alopecia, and analyzed the responses using Krippendorffʼs content analysis method. The results indicated that the responses could be categorized into five main themes: “feeling embarrassed at looking abnormal,” “the hair loss is unrelated to employment,” “the hair loss coping method depends on the relationship with oneself and others” “earnest desire to self-image recovery,” and “hair loss camouflage as consideration to others.” “Feeling embarrassed at looking abnormal” and “hair loss camouflage as consideration to others” were new findings from the current study that were different from those previously published. The results indicated that it may be necessary for nurses to support these patients by performing practical training so that a patient can prepare necessary materials and achieve a sense of control before his return to work, by stressing the health benefits of wearing a wig, and by providing objective comments highlighting the differences between the patientʼs current and pre-alopecia self-image.

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Abstract Aim: A qualitative study was performed to clarify the methods patients employed to manage uncertainty in the period between diagnosis of advanced lung cancer and initiation of treatment. Methods: Fifteen patients participated in semi-structured interviews to obtain information. Analysis of the interviews was done by employing a qualitative descriptive study. Results: The core category for managing uncertainty was identified as 《finding a way to live despite bewilderment at the prospect of dying.》 In the period between diagnosis and the initiation of treatment, patients experienced uncertainty due to their 〈inability to predict the future and fear that treatment for lung cancer may bring death closer〉 and 〈having the foundations of existence shaken.〉 They responded by engaging in survival-related activities through 〈gaining distance from death and accepting the challenge of living〉 and by 〈searching for the meaning of living while dealing with cancer.〉 Conclusions: In patients diagnosed with advanced lung cancer, managing uncertainty involved attempts to prolong survival and to find meaning in living. In the period between diagnosis and the start of treatment, these patients attempted to manage uncertainty through trying to live to the fullest extent possible by making use of the surrounding environment despite uncertainty about the risk of dying.

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Abstract The purpose of this study was to develop a Lymphedema Self-Management Program based on the social cognitive theory, and conduct a short-term evaluation in order to improve the program. A single-group post-test quasiexperimental study was conducted at a cooperating hospital（A-Hospital）. Subjects were 31 patients diagnosed with breast cancer, uterine cancer, and ovarian cancer, who underwent lymphadenectomy. All subjects participated in the Lymphedema Self-Management Program, and a short-term evaluation was conducted using a questionnaire survey regarding achievement of educational goals and appropriateness of the educational method, as well as the assessment of early signs of lymphedema. The intention of the questionnaire, which consisted of 52 items（41 items pertaining to recognition and 11 to behavior）, was to probe the achievement of educational goals and appropriateness of the educational method. The questionnaire survey confirmed the achievement of educational goals and appropriateness of the educational method. Moreover, examination of the percent change in limb volume from the baseline at two months post-intervention and comparison of the number of lymphedema symptoms revealed the development of early signs of lymphedema in two subjects（6.5％）；however, early detection prevented the worsening of these symptoms. Based on the results of individual analysis, we were able to improve the program by revising content related to measures for comfortably continuing work after discharge. We consider our Lymphedema Self-Management Program, which is based on social cognitive theory and aims to support the education of cancer survivors, to be useful for increasing the self-efficacy of patients and achieving the three aspects of lymphedema management.

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