| Summary: | 碩士 === 國立臺灣大學 === 護理學研究所 === 92 === Cancer has been the leading cause of death in Taiwan since 1982. Currently, lung cancer is the first cause of death for female and the second one for male cancer patients. However, many advanced lung cancer patients complained that their spiritual distress was not considered important or well dealt with. Moreover, most nursing staff didn’t know much about spiritual needs of such patients. Therefore, the main purpose of this exploratory qualitative study was to explore spiritual distress and spiritual needs of the patients with advanced lung cancer during their therapeutic transition and their development stage of unfulfilled and fulfilled spiritual needs. Purpose sampling was adopted to invite 19 advanced lung cancer patients from the oncology floor of a medical center in the north of Taiwan. Participant observation and in-depth face-to-face interview were employed to collect data. The total number of interview times was thirty-eight, averagely two times for each participant. The interview data were analyzed with descriptive analysis and qualitative content analysis.
The participants were aged between 38 and 81 and all but one male were married. Most of them (47%) had no education beyond elementary school. About 84% of the participants had a religious belief and most participants (32%) were Buddhists. Furthermore, 39% of the participants were informed of lung cancer within half a year. Most participants (63%) had fixed primary care givers in the hospital.
The results showed that the spiritual needs of the participants with advanced lung cancer during therapeutic transition were: (a) helping them accept their doctors’ diagnoses and increase their survival hope, (b) helping them establish concrete outlooks on life, value, and belief, (c) helping them feel fulfilled with love, (d) helping them build good relationships with God, and (e) helping them face death peacefully.
The results also indicated that the spiritual distress of the advanced lung cancer patients during therapeutic transition were derived from (a) a disturbance in the outlooks on life, value, and belief, (b) a disturbance in human love, (c) a disturbance in the relationship with God, and (d) fear of facing death. Only one participant didn’t have spiritual distress.
The fulfillment of the advanced lung cancer patients’ spiritual needs was involved with two-staged or three staged shock and adaptation. The three-staged fulfillment of spiritual needs included: (Stage 1) shock and initial adaptation, (Stage 2) spiritual distress, and (Stage 3) re-adaptation and spiritual satisfaction. The two-staged one included: (Stage 1) shock and initial adaptation and (Stage 2) re-adaptation & spiritual satisfaction. However, the fulfilled spiritual needs may become unfulfilled again due to patient wavering life belief and physical distress.
The unfulfillment of the advanced lung cancer patients’ spiritual needs was involved with three developmental stages: (Stage 1) shock and initial adaptation, (Stage 2) spiritual distress, and (Stage 3) re-adaptation & spiritual disturbance. Some other factors of the unfulfillment of spiritual needs related to patients or their family members contained (a) family fear of patients unable facing death, (b) family unwillingness to accept the truth or doctor’s diagnosis, (c) family restriction on visiting for protective isolation, (d) family unwillingness to accept the truth or doctor’s diagnosis, (e) patient’s unwillingness to talk, (f) patient’s verbal impairment due to medical treatment or the handicapped, or (g) patient’s atheism or patients losing faith on God. Furthermore, some other factors which unfulfilled the patients’ spiritual needs were related to the medical professionals. They were: (a) worry about intruding patient privacy, (b) worry about the religious conflict with patients, (c) lack of spiritual care knowledge, (d) lack of time or (e) inadequate self-preparation.
The findings of this study can help health care professionals (a) to detect the patients with spiritual distress as early as possible, (b) to accurately or precisely assess their spiritual distress and needs, and (c) to provide the patients and their family members with holistic nursing practice by actively unifying the help or support from the patients’ relatives and friends, the health care professionals, and religion or/and religious groups. Furthermore, they can help schools emphasize life and death, spiritual nursing, and palliative nursing education, which in turn facilitates health care professionals’ understanding the knowledge and skills in spiritual nursing. In addition, these findings could be a tool for quantitative questionnaire development and be a guide to the spiritual care model for domestic cancer patients.
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