Exploration of Spiritual Distress and Spiritual Needs for the Hospitalized Patients with Advanced Cancer and Their Primary Family Caregivers

Autor: Szu-Mei Hsiao, 蕭思美
Rok vydání: 2010
Druh dokumentu: 學位論文 ; thesis
Popis: 98
Background: The World Health Organization stressed that health professionals should give holistic care to patients with terminal illness. This includes bio-psycho-social and spiritual nursing. Cancer has been the leading cause of death in Taiwan; furthermore, the rise in cancer related deaths is still apparent. Research shows that the unmet spiritual needs of primary family caregivers (PFC) also influenced patients with advanced cancer (PAC) and how their beliefs and needs were met. However, many nurse clinicians have concerns about the difficulties of providing spiritual care for ethnic-Chinese cancer patients within their cultural context, and this is a result of lack of knowledge and training. There has been little research completed on the potential impact of different living regions; Chinese cultural values; various religious influences; and the spiritual needs and spiritual distress of PAC and PFC in the community-based teaching hospital in south Taiwan. Purpose: The purpose of this qualitative study was to explore spiritual needs and spiritual distress of PAC and PFC during hospitalization. Moreover, an examination of the unmet spiritual needs will be discussed. Method: A qualitative exploratory study was used. A purposive sampling of PAC and PFC during medical hospitalization was obtained from a community-based army teaching hospital in south Taiwan. Data was collected by participant observation and in-depth face-to-face interviews. The interview data was analyzed with descriptive, qualitative content analysis. Results: A total of 43 informants including 21 PAC and 22 PFC participated in this project. In the PAC group, 11 of them were female, aging from 33 to 78 years old (M + SD = 55.6 + 10.2). Most of them were married (n = 14); had graduated from elementary school (n = 6); and were practicing Buddhists (n = 10). In the PFC group, 14 of them were female, aging from 34 to 80 years old. Most of them were married (n = 18); graduated from elementary school (n = 6); and were Buddhists (n = 10). The relationships of the PFC group were reported to have spouses (n = 11); had adult sons and daughters (n = 9); and had siblings (n = 2). This research was conducted with 9 dyadic samples of PAC and PFC, and the others were independent samples. During hospitalization, the PAC and PFC identified spiritual needs both the palliative phase and the dying phase: (a) the need to foster faith/confidence and hope for medicine and/or God, such as seeking help from complementary and alternative medicine (CAM) and God(s); and performing resuscitation upon death; (b) to understand the meaning and values of life; such as having the courage to face the challenges of life; getting married; having jobs; fulfilling one’s duties; helping others; knowing the value of suffering in the life; and having faith/beliefs; (c) to experience more reciprocal human love and forgiveness, such as accepting and searching for other’s love and support; showing care and gratitude for others; forgiving others; praising God/Heaven; and (d) to assist in facing death peacefully; such as obeying God’s/Heaven will; expressing one’s living will/hope; dying without physical and psychological pain; understanding the timing of death; and finally reaching a destination in the afterlife. Furthermore, the differences of spiritual needs between PAC and PFC are as follows: (a) PFC emphasized the need to inform relatives and say goodbye in order to die peacefully; (b) PAC emphasized the need to maintain a certain physical appearance in order to preserve their dignity; nurture one’s willpower; learn about the experiences of cancer survivors; and identify one’s own life experience for understanding the meaning and values of life. Moreover, the dissimilarity of spiritual needs between PAC and PFC is that, the PAC pointed out the need to understand God(s)’ will during the palliative treatment phase. However, the PFC identified the need to forgive each other, inform relatives and say goodbye to PAC in the dying phase. The discrepancies of spiritual needs are gender related. The female caregivers mentioned symptoms of relief, and caring and gratitude for others. Through the investigations, the PAC and PFC experienced the following spiritual distress in both palliative and dying phases: (a) a disturbance in human love and forgiveness; the inability to forgive others; and lack of family’s love and support; (b) hopelessness from advanced cancer, such as disappointment in CAM; expressed doubt on survival opportunity; loss of or no confidence in health professionals; (c) a disturbance in facing death peacefully, such as fear in facing the unknown world; fear of physical and psychological pain before death; and (d) doubt in the meaning and values of life, such as the value of human existence. The differences of spiritual distress between PAC and PFC suggest that: (a) PAC expressed notion of guilt from being a burden on significant others. While on the other hand, PFC drew attention to lack of consistent love and caring related to the PAC belief in a disturbance in human love and forgiveness; (b) PAC expressed anxiety/concern about unfulfilled duties. However, PFC elaborated on a feeling of guilt in facing family member’s death, and the inability to help PAC to face death peacefully. They expressed a feeling of fear of facing the future alone. (c) PAC claimed that they troubled others’ judgments due to their disturbed body image; lack of willpower to fight cancer; and the inability to fulfill one’s duties related to doubting the meaning and values of life. The differences of spiritual distress of PAC and PFC in relation to different phases include: (a) During dying phase, PAC described distress and lack of willpower to fight cancer, but PFC reported a sense of guilt in facing family member’s death, and expressed fear of facing the future alone. The discrepancy of spiritual distress had a strong relationship to gender. Female caregivers worried about PAC physical and psychological pain before death. On the other hand, PFC thought about not forgiving others when PAC was confined to bed for more than 50% of waking hours. Conclusion: The PAC and PFC needed love, faith, hope, and peace to bring meaning and value to their lives, to help them come to terms with death. The acceptance of death also came from the help of health professionals, family, significant others, and Heaven and God when it was imminent. When the values of life are not supported, the need for spiritual fulfillment occurred. Moreover, the investigation found that the unmet spiritual needs resulted in spiritual distress. The findings of this study can empower health professionals to unify support systems to meet the needs of PAC and PFC for higher quality oncology care.
Databáze: Networked Digital Library of Theses & Dissertations
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