COPING ATTITUDE & MENTAL ADJUSTMENT TO CANCER

Objective Purpose is to examine the relationship between older persons with cancer coping attitudes and patterns of mental adjustment during treatment. Methods : Coping attitudes and patterns of mental adjustment were measured using an original questionnaire and the Mental Adjustment Cancer Scale (MAC) in 193 patients with cancer aged 65 or over under treatment with surgical therapy, chemotherapy, or radiotherapy. Results : The mean scores for “Do my best to cope with cancer” ,“Make my own decisions on treatment” in coping attitudes showed a significant positive correlation with [fighting spirit] scores in MAC, and “Cancer is just a part of my life”, “At my age, no complaint about cancer development”, “Face cancer in an easy-going manner”, “Do my best to cope with cancer” “Be anxious about my future” were significantly correlated with [fatalism] scores. Conclusions : In conclusion, [fighting spirit] [fatalism] were shown to form the basis for elderly’s mental adjustment. [Fatalism] was shown to be a main component of mental adjustment for elderly to develop affirmative coping skills based on their life experiences. In addition, [fighting spirit] was also essential to fulfill their lives, and it may be necessary to support them to keep [fighting spirit] to the end of their lives

Resilience in cancer care : What should nurses do?

Cancer is a serious threat to human health worldwide. Attention to the quality of life (QoL) of cancer patients is increasingly recognized as an important component of and a fundamental task in cancer care. Recent studies illustrate that resilience is a key biological factor affecting cancer patients’ health status and QoL. However, few studies have focused on resilience during medical procedures of cancer patients from the perspective of nursing. In this study, we summarize recent literature exploring the clinical significance of resilience in oncology nursing, propose strategies for cancer care to improve the QoL of patients through interventions on resilience, and focus on emerging theories in oncology nursing. In summary, this will emphasize the importance of resilience in oncology nursing and benefit the clinical practices that improve patients’ QoL and reduce the social burden caused by cancer

テンイ ノ アル コウレイ ガン カンジャ ノ チリョウ ニ タイスル ナットク ノ ヨウソ

本研究の目的は，転移のある高齢がん患者の治療に対する納得の要素を明らかにすることである．本研究では，納得とは「高齢がん患者が治療に対して，能動的に認知的かつ感情的に受容した状態」と定義する．研究方法は質的記述的研究デザインで、がんに対して治療を選択した現在治療過程にある65 歳以上の転移のある高齢がん患者20名を対象に半構造化面接法を実施した．結果，転移のある高齢がん患者の治療に対する納得の要素として，【自分を救おうとする強い意志】【生きるための治療であるとの確信】【治療の可能性への期待】【信じて任せられる最善の治療であるとの判断】【周りへ報いたいとの希求】【治療を含めて生ききる人生の受け容れ】の6つのカテゴリーが抽出された．これらの転移のある高齢がん患者の治療に対する納得の要素の特徴として，1 つは患者自身の価値が治療状況に反映していることが示唆された．2つ目として，自己の利害にとらわれずに周りの人達の気持ちを察し，それを自分の気持ちや意志として汲み取る特徴が推察できた．3つ目として，治療だけでなく，自分の人生に対するあり方や生き方も含めた今の状況に対する受け容れでもある特徴が示唆された．それは，病期が進んだ状況でのライフサイクル最終段階にある高齢者のもつ特徴が表れていた．また，これらの要素は転移のある高齢がん患者が生きてきた中で培われたものでもあり，その人の生き様や今の状況に患者がコミットできるように支援することも納得に導いていく看護となることが示唆された．The objective of this study was to identify elements of how older patients with metastatic cancer become “nattoku” with treatment. In this study, nattoku was defined as “a state of cognitive and emotional acceptance of treatment” by older cancer patients. A qualitative descriptive study was employed, and semi-structured interviews were carried out with 20 metastatic cancer patients aged 65 years or older who were currently undergoing cancer treatment on their own volition. We extracted six elements that involve becoming nattoku with treatment: a strong intention to save oneself, certainty that the treatment was required in order to live, expectations of the potential of treatment, trusting that they chose the optimum treatment, the desire to give something back to those around them, and accepting to live life to the fullest, even while undergoing treatment. Our results suggested that the values of patients themselves were affected by their treatment status. Also, patients were not solely concerned with their own interests, but sensed the feelings of those around them and took them into consideration. A third characteristic suggested by our findings was their acceptance of treatment, and their attitude towards life and the way in which they have lived. This was characteristic of older patients with advanced illness who were in the final stage of life. These elements were fostered during the lives of older patients with metastatic cancer, and our study suggested that support that encourages patients to commit to a lifestyle and their current circumstances may help them become nattoku with treatment

Postoperative Discomfort and Its Influence on Daily Life in Patients with Lung Cancer : A Study Concerning the Period from Hospital Discharge to 6 Months After Surgery

本研究の目的は，肺がん手術後の身体的不快症状の実態とそれらが生活に及ぼす影響について，退院時から術後6 カ月までの経時的推移を明らかにすることである．術後肺がん患者41 名（平均年齢67.0 歳）を対象とし，自記記入式質問紙法と診療録からデータ収集を行った． 分析の結果，肺がん手術後6 カ月を経過しても約6 割の患者が2 つ以上の不快症状を抱えていた．創部に関連する不快症状は，退院時は創部表面の訴えが最も多く，術後1 カ月以降は創部内部の訴えへと変化した．創部以外の不快症状は，術後1 カ月以降では半数以上の患者に術後の息苦しさが出現しており，経時的変化はみられなかったが，術式や喫煙経験により日常生活への影響の程度に関連がみられた．また術後1 カ月が経過しても，術後術側急性肩部不快症状が約17％の患者に存在し，術後6 カ月が経過しても約半数の患者に咳嗽が出現していた． 以上より，患者へ術後出現する可能性のある不快症状の回復過程やその機序に関する情報提供を行い，患者自身に不快症状に対するセルフモニタリングの実施を促し，自らの症状に対する認識を深めることで，セルフケア支援へと繋げる必要がある．今後は，患者の不快症状体験を加味した周手術期肺がん看護プログラム開発の必要性が示唆された．The purpose of this study was to evaluate changes in discomfort over 6 postoperative months in patients with lung cancer and determine the influence of this discomfort on their daily life. Data was collected from 41 patients who underwent surgery for non-small cell lung cancer (mean age 67.0 years) through a self-administered questionnaire and medical records. The results indicated that approximately 60% of patients experienced two or more symptoms of discomfort, even at 6 months after surgery. The most common wound-related discomfort was at the wound surface at the time of hospital discharge and inside the wound 1 month after surgery. In addition, choking was a common complaint in > 50% of patients 1 month after surgery and its incidence did not change over time, although the influence on the patientsʼ daily life varied depending on the type of surgical procedure and smoking history. Furthermore, acute shoulder discomfort on the operated side remained in approximately 17% of patients 1 month after surgery, while coughing was experienced by approximately 50% patients at 6 months after surgery. These results suggest that surgeons should educate patients with lung cancer about the recovery process and possible postoperative discomfort and encourage self-monitoring to gain a better understanding of symptoms and promote self-care. Perioperative nursing programs should be established for these patients in the future

Developing a model influencing hope

Aim Postoperative patients with lung cancer have a high recurrence rate and poor prognosis; hence, we aimed to identify the factors affecting hope to help develop a care-oriented perspective focused on the levels of hope in postoperative patients with lung cancer. Methods In the study, we included postoperative patients with lung cancer and collected data for treatment-related symptoms, coping, and support-related factors as the primary variables. We used the Herth Hope Index, Quality of Life Questionnaire Lung Cancer Module (QLQ-LC13) of the European Organization for Research and Treatment of Cancer, Japanese version of the Coping Inventory for Stressful Situations (CISS), and Social Support Scale for Cancer Patients. Results For the 82 patients included in our study, 55% of the variance in the level of hope was explained using a model that included the following: (1) symptoms of dyspnea, sore mouth, and chest pain; (2) support, including satisfaction with postoperative symptom control by healthcare providers, satisfaction with the amount of information provided by healthcare providers, and the trust in nurses during treatment and recovery; and (3) task-oriented and social diversion coping behaviors. Conclusion As a result of this study, the support-related factors had no direct influence on hope, but they did have a significantly negative influence on treatment-related symptoms, with improved symptoms also having influencing hope

高齢者看護学実習における学生の高齢患者の理解の実態

The purpose of this study was to clarify how the students understand the older patients based on Orem’s nursing theory in Geriatric Nursing Training. The participants were１７nursing students in third grade. The interview was carried out using semi-structured interview with students for how they felt older patients. As a result, two categories were extracted ; ［ they need limited care for deficient parts］and［they have toughness cultivated through their long life］. The students understood the older patients as having self-caring abilities and thought that limited care should be provided only for deficient parts of patients. Also, they understood older patients as having strength cultivated through their long life. It is necessary for teachers to assess the Self-care agency more severely for students to get hold of mature elements characteristic of older patients

再発転移後の肺がん患者が持つ見通し

This study aimed at clarifying prospects that lung cancer patients undergoing treatment after recurrence and metastasis have. The study method is based on the qualitative descriptive study design. A semi-structured interview was performed for １３ lung cancer patients undergoing treatment after recurrence and metastasis. As a result, the following five categories were extracted［; Since it is recurrence and metastasis, the death is coming to me］［, I am undergoing treatment so I’m alright now but I’ll die someday］［, Let a matter take its own course］［, My life will be going as before］and［I will be living as long as I receive treatment］. Characteristics of the above are that all of the patients are ready to accept death and they had more than two prospects. They were characteristic of patients after recurrence and metastasis that symptoms that remind them of repeated treatment and death appear and there is uncertainty for their future. The above results have suggested the need to capture the state of each prospect while confirming the prospects of lung cancer patients under treatment after recurrence and metastasis

Students’ assessments of their patients’ self-care agency during gerontological nursing practicum

本研究では，高齢者看護学実習における学生のセルフケア・エージェンシーのアセスメントの実態を明らかにすることを目的に，A看護系大学３年生の実習記録用紙を分析した．その結果，８０％の学生は妥当なアセスメントであった．特に，［孤独と社会的相互作用］，［基本的条件付け要件］，［問題の明確化］のアセスメントの評価が高く，逆に［正常性］，［特定のセルフケア要件］は低かった．また，［セルフケア・エージェンシー］の分析の結果，評価的操作から【今の自分の状態の認識】【先の状態に対する理解】【特定のセルフケア要件実施において必要な知識】【特定のセルフケア要件に対する必要性の認識】【理解力や認識力】が抽出された．移行的操作から【今の自分の状況に対する判断予測】【特定のセルフケア要件実施への関心・意欲】【自己判断力に影響する要因】が抽出された． 本研究を通して，学生の［セルフケア・エージェンシー］のアセスメントの実態として，患者の内面的な状況に関するアセスメント不足が示された．これより，学生の課題として，関係性の形成や意図的な情報収集・アセスメントが考えられた．今回の課題としてあげられた意図的行為は，セルフケアや看護ケアを深める可能性がある．そのためにも，自分の得た情報やアセスメントがどのような意味を持つのか十分な推論を通して対象者理解につなげていけるような指導を検討する必要がある．The purpose of this study is to determine the students’ assessments of their self-care agency in a gerontological nursing practicum. There were ６５ third-year students enrolled at a nursing college in Shikoku Island, Japan. Analysis was done using the students’ entries in their nursing practicum recording forms as data. The results of the analysis revealed that８０％ of the students appropriately evaluated their patients’ self-care assessments. In particular, students’ assessments were found to be high for “the maintenance of a balance between solitude and social interaction”, “basic conditioning, and “the clarification of the problem”. However, assessments were low for “normalcy” and “individualized self-care requisites”. As a result of the analysis, the following five thematic categories were revealed : a）. Recognition of one’s personal situation ; b）Understanding one’s former state of mind（?）, c）Knowledge of particular self-care requisites, d）Recognition of the necessity of self-care requisites, and e）Understanding and cognition of self-care. Content analysis also revealed the following three thematic sub-categories : a）Judgment of one’s situation, b）Interest in particularized self-care requisites, and c）factor-influencing judgment. The students’ assessments of their patients’ self-care agency did not include an internal assessment of patient situations, suggesting the necessity to provide educational guidance to improve students’ ability to engage in full assessments of their patients’ self-care agency

The Lived Experience of Nurses Who Cared for Patients with Cancer during the Terminal Phase

本研究の目的は終末期肺がん患者・家族への看護に対する看護師のネガティブおよびポジティブな感情を含めた心情を明らかにし，肺がん患者・家族の終末期における看護を検討することである．終末期肺がん患者を担当した経験がある看護師２２名に半構造的面接を行い，内容を質的帰納的に分析した．結果，看護師の心情として【肺がん特有の苦悩を取り除けない心苦しさ】【終末期看護に対する自分の技量の不足への不甲斐なさ】【その人の人生最期を支える重圧感】【家族の看取りのプロセスとして心する】【人の最期に関わることへのやりがい】【患者の死を大切に理解したいという切実な思い】の６つのカテゴリーが抽出された．看護師は終末期肺がん患者のケアを行う中で多様な苦悩や治療に対する葛藤を抱えていることが分かった．また患者のみならず，家族をも看護の対象として捉え，その関わりへの困難を抱えていた．看護師は家族が患者の死を自然なものとして捉えることが出来るように関わり，患者が精神的に充実した最期を迎えることが出来るように介入していた．また患者の死の体験は死生観，看護観を深め，看護師の成長につながっていることが分かった．This study aimed to describe the lived experiences of nurses who cared for patients with cancer and their families during the terminal phase. A semi-structured interview was conducted with twenty-two nurses who cared for patients with cancer at their terminal stage. These interviews were transcribed and analyzed by identifying words, phrases and statements that describe the experiences of the nurses. As a result, the findings of the study discovered the following six thematic categories : Regret for failing to rid of distress peculiar to lung cancer ; Cowardliness for lack of competency in their nursing skills ; Disheartening feeling during the last moments of the patient’s life ; Expressing EOLC process for the family ; Worthiness to be involved during the last moments of the patient’s life ; and Earnest desire to understand the patient’s death. While nurses may have emotional distress and personal conflicts while taking care of patients, particularly those with lung cancer, this study revealed that The nurses’ experiences of caring for patients with lung cancer during the terminal stage is critical to understanding the humanness during the EOLC. As a recommendation from this study, it is important to include the patients’ families in their care. Family participation may lead them to have an easier acceptance of the patients’ death, by focusing on the situation as a natural occurrence, and for the patients to have a good death. Moreover, the experience of the nurses have deepened their views of life and death situations impacting their practice, and enhancing their growth as nurses during EOL

Perioperative QOL in lung cancer patients

Objective : Patients with lung cancer generally undergo minimally invasive surgery, such as video-assisted thoracoscopic surgery (VATS). This study examined the changes in health conditions and symptoms of patients with lung cancer using the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC QLQ) C-30 questionnaires after surgery. Methods : This was a longitudinal descriptive study. One hundred and three patients with lung cancer who underwent lung resection at Tokushima University Hospital between 2012 and 2021 were eligible. They completed EORTC QLQ-C30, QLQ-LC13, the Cancer Dyspnea scale (CDS), and pulmonary-ADL (P-ADL) before and 1, 3, and 6 months after surgery. Results : Regarding functional scale scores, impairments in physical and role functions persisted for 6 months after surgery. In symptom scale scores, fatigue, pain, dyspnea, and appetite loss continued for 6 months after surgery. In CDS, sense of effort, discomfort, and total dyspnea scale scores were elevated for 6 months after surgery. In P-ADL, most ADL were impaired 1 month after surgery, but recovered by 3 months. The dyspnea index of ADL was lower for 6 months after surgery. Conclusions : Impairments in health conditions and symptoms persisted for 6 months after surgery despite its minimally invasive nature