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CHAPTER I
INTRODUCTION
BACKGROUND OF THE STUDY
Cancer or “The Big C” is identified as the third leading cause of
mortality in the Philippines accounting to 39, 298 cases as of January 11,
2007 (Department of Health). Lung cancer ranks among the leading
causes of mortality where it affects almost 120 patients for every 100,
000 population (Philippine Health Statistics, 1994). Hermoso (2007)
further identified that lung cancer kills 43 Filipinos everyday regardless
of sex and age.
This data proves that as health care providers, there is a need to act
to prevent, promote, cure and rehabilitate patients with lung cancer.
Nurses caring for lung cancer patients must ensure that these patients are
able to cope with their condition to facilitate better physical, emotional,
mental, social and spiritual healing.
There are many core elements of a nurse in caring for a lung
cancer patient. These elements include: communication, information,
coordinated care, nursing assessment, patient advocacy, accessibility and
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support (Darlison, 2006). Jean Watson's nursing theory as stated is to
"gain greater harmony within the mind, body and soul.” Focusing on the
patient in a holistic manner and utilizing a caring attitude can have
positive reflections throughout all spheres of the patient's well-being, as
positive energy is released. Watson's theory of caring is based on ten
carative factors and these are: formation of a humanistic-altruistic
system of values; instillation of faith-hope; cultivation of sensitivity to
self and others; development of a helping-trust relationship; promotion
and acceptance of the expression of positive and negative feelings;
systematic use of the scientific problem-solving method for decision
making; promotion of interpersonal teaching-learning; provision for
supportive, protective, and corrective mental, physical, sociocultural,
and spiritual environment; assistance with gratification of human needs
and; allowance for existential-phenomenological forces. According to
Watson, “nursing is concerned with promoting health, preventing
illness, caring for the sick and restoring health.” Holistic care is the
heart of the practice of caring in nursing. While breathlessness and
anxiety have been found to be significant reasons why lung cancer
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patients struggle to cope at home (Summers, 2007), the nurse and other
care providers must make sure that these patients do not experience a
longer stay in health care institutions than necessary. Aside from the
assistance in the provision of quality care to patients, Watson’s caring
factors make the nurse an active co-participant in the patients’ struggle
toward self-actualization.
Lazarus and Folkman’s concept of coping defines how a person
reacts to a stressful event. An individual’s way of coping to stressful
encounters can be assessed based on the cognitive-phenomenological
theory of stress and coping by Lazarus and Folkman. For instance,
young people uses proportionately more active, interpersonal problem-
focused forms of coping than do the older people, while the older people
uses proportionately more passive, intrapersonal emotion-focused forms
of coping than do the younger people (Folkman et.al, 1987) Coping,
when considered as a process, is characterized by the dynamics and
changes that are a function of continuous appraisals and reappraisals of
the shifting person-environment relationship (Folkman et.al, 1986).
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In relation to the coping of lung cancer patients, Lazarus and
Folkman’s Ways of Coping will describe the effort for each type of
coping – confrontive, distancing, self-controlling, seeking social support,
accepting responsibility, escape-avoidance, planful problem solving and
positive reappraisal.
The study aims to correlate the caring abilities of nurses as
perceived by lung cancer patients and the patients’ ability to cope in the
disease process in Hospital X.
STATEMENT OF THE PROBLEM
The purpose of the study is to determine the relationship between
the nurse’s caring factors and the extent of coping of lung cancer
patients at a selected special tertiary hospital in Quezon City.
Specifically, the study sought to answer the following questions:
1. What is the perception of the lung cancer patients in terms of the
caring factors they received when grouped according to the
following age groups:
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a. Young Adult (20 - 39)
b. Middle Adult (40 – 64)
2. What is the extent of coping of the young and middle adult
patients according to the following categories of coping:
a. Confrontive Coping
b. Distancing
c. Self-controlling
d. Seeking Social Support
e. Accepting Responsibility
f. Escape-Avoidance
g. Planful Problem Solving
h. Positive Reappraisal
3. Is there a significant difference between the perception of lung
cancer patients in terms of the caring factors they received when
grouped according to the following age groups:
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a. Young Adult (20 - 39)
b. Middle Adult (40 – 64)
4. Is there a significant difference among the coping of lung cancer
patients when grouped according to the following age groups:
a. Young Adult (20 - 39)
b. Middle Adult (40 – 64)
5. Is there a significant relationship between the caring factors and
the extent of coping of the lung cancer patients?
SIGNIFICANCE OF THE STUDY
The alarming mortality rate of 6, 395 (18%) of lung cancer in the
Philippines (Department of Health, 2000) implies that there is much to
be done for the condition and the implementation of all aspects of its
prevention. Nursing is bound to intervene in such situation - promoting
health, preventing illness, caring for the sick and restoring health.
Moreover, coping abilities of lung cancer patients needs to be assessed
to find out if the care they receive from nurses assist them towards
health promotion.
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Nursing Practice
Nurses in clinical practice, face an enduring challenge in providing
quality care to lung cancer patients (Lung Cancer Resource Center,
2007). The results of this study will contribute to the evidence-based
nursing practice in the provision of quality holistic care to patients,
specifically lung cancer patients. Furthermore, quality of care given by
nurses can be assessed using the Caring Factor Survey tool used in this
study. This will help improve the caring experience of patients, their
families and significant others while receiving care in a health care
facility. Specifically, lung cancer patients can identify the present kind
of care given by the nurses – whether or not the lung cancer patients
receive quality holistic care.
In addition, the results of this study will serve as an indicator of the
quality of care rendered by nurses in practice to lung cancer patients.
Furthermore, the results will identify the present type of coping of the
lung cancer patients. Thus, interventions geared towards maximum
coping can be identified for the benefit of the lung cancer patients.
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The study can also be a springboard for nurses who aim to provide
holistic nursing management on cancer patients based on evidence-based
practice.
Nursing Administration
The nursing administration of Hospital X can use the results of this
study to serve as supportive data to develop policies and guidelines
pertaining to the improvement of quality holistic care, specifically to
lung cancer patients.
Moreover, the nursing administration of the Department of Health
can utilize this study as evidence to provide quality and effective care to
patients. The results of this study can indicate the need to uplift the
potency of nursing care to patients.
Nursing Education
The study can signal nurse educators to include the Caring Factors
of Jean Watson in the curriculum of level III nursing students in Far
Eastern University. The study can help nursing educators in teaching
Nursing Care Management 103A, particularly in the concept of Cellular
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Aberration to provide supportive data in caring for lung cancer patients.
Furthermore, the study can also aid the nursing educators in identifying
the extent of coping of lung cancer patients. This may help students
become effective health care providers in the future when they are
giving care to cancer patients.
Furthermore, the teaching-learning environment can make use of
this study as an aid in discussion wherein the importance of providing
quality holistic care to patients is discussed and coping of patients is
addressed.
Nursing Research
The study can serve as a channel for other researchers who want to
conduct similar studies using different participants, different illness and
different research locale in addressing the holistic demand for caring.
Furthermore, the study can also direct other researchers who want to
determine the extent of coping of a different study participants.
SCOPE AND LIMITATIONS
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The study was conducted at a selected special tertiary hospital in
Quezon City. The researchers have chosen this hospital primarily
because it is a premiere institution for specific disease which caters to
the most number of in-patients of lung cancer cases in the Philippines.
The hospital also provides quality health care through excellent service,
training, research, and provides quality healthcare through advanced
medical facilities.
The study focused on clients diagnosed with lung cancer, grouped
according to age, receiving treatment from the selected tertiary hospital
in Quezon City. The study population included male and female lung
cancer patients, ages 20 to 64, who received treatment from Hospital X
in Quezon City, and who were not mentally and emotionally disabled
and who are not mute, deaf or blind. Patients who were not able to read
and write due to conditions like decreased level of consciousness,
terminally ill and those who were hooked to artificial resuscitative
devices were also excluded from the study. Patients’ family members or
guardians were not allowed to answer the survey. Furthermore, those
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who refused to answer due to personal reasons were not included in the
study. The participants’ religion, length of stay in the selected tertiary
hospital and extent of social support were variables that were beyond the
control of this study.
The total population of lung cancer patients during the data
collection was 67. Not all lung cancer patients agreed to participate in
the study. Furthermore, not all lung cancer patients were eligible to
participate in the study.
The sample size obtained during the data collection was 35, 18
from the young adult and 17 from the middle adult. The sample was
presently admitted and receiving treatment during the duration of data
collection.
The lung cancer patients who were eligible and presently admitted
at Hospital X during the data collection period were selected as study
participants.
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The study investigated the perception of the lung cancer patients
on the care they received from nurses working in Hospital X and the
extent of the lung cancer patients’ coping behavior according to their age
groups. This provided statistical evidences to describe the quality of care
provided by nurses in Hospital X and furthermore supply vital data
about the coping strategies of patients and correlate the coping behavior
of the patients to the caring environment they received.
The study revolved on the significant differences between the
patients’ perception of care according to their age groups and their
coping behavior. This will describe the age differences in coping and
age differences in the perception of care.
The study was conducted during the second semester of school
year 2008 – 2009. In particular, the planning and data gathering was
from December 22, 2008 to January 6, 2009 to give sufficient time for
the analysis and processing of data for the study.
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CHAPTER II
THE THEORETICAL FRAMEWORK
REVIEW OF RELATED LITERATURE
CARING ENVIRONMENT:
Based on Human Caring Theory, Jean Watson presented that “the
practice of caring is central to nursing; it is the unifying focus for
practice” (Kozier, 2004). Jean Watson defines caring as a science. She
states that “caring is a science that encompasses a humanitarian, human
science orientation, human caring processes, phenomena, and
experiences” (Watson 2001). She claims that “caring is an
intersubjective human process and is the moral ideal of nursing”.
Watson emphasized that caring can only be effectively established
interpersonally and that caring promotes health more compared with
curing (Kozier, 2004).
According to Watson (2001), the major elements of her theory are:
(a) the carative factors, (b) the transpersonal caring relationship, and (c)
the caring occasion/caring moment. Assisting the patient gain a higher
degree of harmony within the mind, body, and soul is the goal of nursing
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with Watson’s theory. It is achieved through caring transactions. Watson
termed the nursing interventions related to human caring as carative
factors, a guide which she considered as the “core of nursing” (Kozier,
2004). She uses the term carative to contrast with conventional
medicine’s curative factors. It also involves the transpersonal caring
relationship. Transpersonal means a concern for the inner life, wherein
the nurses are committed in protecting and enhancing human dignity as
well as the deeper or higher self. The patient is viewed as whole and
complete, regardless of any illness or disease. The transpersonal nurse
seeks to connect with, embrace the spirit or soul of the patient, through
the processes of caring and healing (Watson, 2001).
According to Watson (1999), a caring occasion is the moment
when the nurse and his patient come together in which an occasion for
human caring is built up. The caring moment does not only concentrate
with the one cared-for, but the caregiver, also needs to recognize his
presence of being in a caring moment with his patient. Relationship
developed both within the one cared-for and the one caring can thereby
become a part of their own life history. The caring occasion becomes
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“transpersonal” when “it allows for the presence of the spirit of both—
then the event of the moment expands the limits of openness and has the
ability to expand human capabilities” (Watson, 1999).
Watson’s caring theory aims every nurse to be an ideal nurse - one
who is deepened by his professional roots and values. Applying these
caring values in our daily practice helps transcend the nurse from a state
where nursing is perceived as “just a job,” to that of a gratifying
profession. Upholding Watson’s caring theory not only allows the nurse
to practice the art of caring and compassion to ease patients’ and
families’ suffering and to promote their healing and dignity but it can
also contribute to expand the nurse’s own actualization. Watson is
known to be one of the few nursing theorists who consider not only the
cared-for but also the caregiver. It was stressed that advocating these
caring values in our practice are not only essential to our own health, as
nurses, but its significance is also necessary that one may find meaning
in his work (Watson, 2001).
Jean Watson and her colleagues developed the Caring Factor
Survey; this is a survey that measures the client’s perception of care
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while in a health care institution. For the purpose of the study, the
nurse’s caring factors would be measured using the Caring Factor
Survey. The clients would be asked to respond to each of the 20
statements about how they feel regarding the care
they are currently receiving from the nursing staff. For each question,
they will be asked to indicate how much they agree or disagree with the
statement. They would be marking their response by filling in the circle
that best represent their opinion.
STUDY ON HUMAN CARING
Watson’s theory of Human Caring has received worldwide
recognition and is being used as a theoretical framework in most of the
studies.
One example of the practical application of Watson’s theory was
made by Neil and Schroeder (1992). They studied people 51 participants
with Human Immunodeficiency Virus (HIV) and Acquired
Immunodeficiency Syndrome (AIDS). The research examined the caring
perspectives of nurses who worked in an outpatient clinic and how they
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related to their clients. The results of this study indicated that through
authentic caring relationships formed between the clients and the nursing
staff, this result into cost saving due to decreased hospital stays and the
nurses also prevented many hospital admissions. The relationships
formed between the clients and the nurses led to a more ‘open’ form of
nursing care and to a better communication and therefore better nursing
care. This formation of the therapeutic relationship is the central
principle of caring as described by Watson and forms the basis of
delivering nursing care in all fields of nursing (Maeve & Vaughn, 2001).
CARE ON CANCER PATIENTS
Cancer Care for Whole Patients claims that cancer care today often
provides state-of-the-science biomedical treatment, but fails to address
the psychological and social problems brought about by the illness. This
failure can interfere with the effectiveness of health care, thus would
affect the health of cancer patients. Psychological and social problems
created or aggravated by cancer--including depression and other
emotional problems may result to additional suffering and threaten
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patients' recovery to health. They argue that today, to deliver high-
quality cancer care, different approaches, tools, and resources are needed
to address patients' psychosocial health needs. All patients with cancer
and their families have the right to expect and receive cancer care that
ensures the provision of appropriate psychosocial health services (Adler
and Page, 2008).
Cancer care is often incomplete. Many cancer patients have
reported that their psychosocial health care needs are not well addressed
in their care. They are not satisfied with the amount and type of
information they are given about their diagnosis, their prognosis,
available treatments, and ways to manage their illness and health. Health
care providers often fail to communicate this information effectively, in
ways that are understandable to patients (Epstein and Street, 2007).
Moreover, individuals diagnosed with cancer often report that their care
providers do not understand their psychosocial needs; do not consider
psychosocial support an integral part of their care; and fail to recognize
depression or stress experienced by patients due to the illness (IOM,
2007). Twenty-eight percent of respondents to the National Survey of
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U.S. households affected by Cancer reported that doctors do not pay
attention to factors beyond their direct medical care, such as sources of
support for dealing with the illness (USA Today et al., 2006). Studies
also have revealed that physicians largely underestimate oncology
patients’ psychosocial distress (Merckaert et al., 2005). Indeed,
oncologists themselves report failure to address their patients’
psychosocial needs. In a national survey of members of the American
Society of Clinical Oncology, a third of respondents stated that they do
not routinely screen their patients for distress. Of the 65 percent that
comply, methods used were often untested or unreliable. In a survey of
members of 20 of the world’s leading cancer centers, only 8
accomplished screening for distress in their patients, and only 3
routinely screened all of their patients for psychosocial health needs
(Jacobsen and Ransom, 2007).
As evidenced by the studies conducted, a number of factors can
interfere with clinicians’ addressing psychosocial health needs. Because
of this, improving the delivery of psychosocial health services needs to
be addressed as part of the caring moment. The above studies
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recommend that a standard of care be followed for the quality of cancer
care to improve. All cancer care should ensure the provision of
appropriate psychosocial health services by facilitating effective
communication between patients and care providers (Adler and Page,
2008).
Caring for patients with lung cancer requires continuity of care.
According to Summers (2007), lung cancer patients experiencing
breathlessness, when provided with individual interventions,
experienced an improvement in their condition. Moreover, the
interventions made by the nurses made the patients receive a proactive
type of care. Summers also stated that the health problems of the lung
cancer patients were acted upon even before they became
unmanageable. Summers’ study postulated that the interventions made a
decrease in the average length of hospital stay in days of patients. The
baseline was 12.5 days, and with the proactive interventions made by the
nurses, it fell to 7.1 days (Summers, 2007).
DIFFERENCES IN PERCEPTION OF CARE
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In a study by Johnson and Lin et.al (2000), it was stated that the
“perceptions of patients and proxies with respect to the goals of care
recommended to them by physicians may be the result of many forces.”
Thus, the perception of care among patients is a result of numerous
factors affecting them.
Furthermore, factors such as personal preferences, cultural
practices and beliefs, and the synthesis of input from several physicians,
friends and family members may all contribute to a patient’s perception
of care (Johnson and Lin).
Okumura (2008) proposed that there are some factors that directly
affect the quality and perception of care for young and middle adults
with chronic illnesses, and according to him, how these factors impact
patients outcomes must be studied for future use. Moreover the
researcher’s studies revealed that there are also some certain barriers that
affect the provision of quality care, such as lack of proper training of
health care practitioners, might limit their ability to provide high quality
primary care for patients with chronic illness. Another barrier in
receiving primary health care for patients with chronic conditions
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recognized by Okumura was that there might be not enough health care
services provided to patients to have productive lives. These barriers, in
the provision of primary health care to young and middle adult patients
with chronic illnesses, might in return affect patient’s perception of the
care provided.
COPING BEHAVIOR
As defined by Lazarus and Folkman, coping is the “cognitive and
behavioral efforts done to manage specific external or internal demands,
appraised as taxing or exceeding the resources of the individual”. As
what the definition implies, it states that coping is a: (1) process-
oriented; (2) management is essential rather than mastery; (3) prior
judgment should not be made about the quality of coping processes; and
(4) there is a stress-based difference between coping and automatic
adaptive behaviors (Lazarus and Folkman, 1988).
Coping refers what an individual actually thinks and does in a
particular encounter and the way these thoughts and actions change as
the encounter unfolds explains what coping is as a process-oriented
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approach. As a process, coping is described by dynamics and changes
that are a function of continuous assessment of the changing person-
environment relationship (Folkman et.al, 1986). Changes may occur
from whether coping efforts are intended for outward toward or inward
toward changing the implication of a situation. Every shift in the person-
environment relationship is significant. But it should be remembered
that shifts may also result from environmental changes alone without
interaction to individual. There are conceptualizations that equated
coping with mastery. If someone was able to cope with the demands of a
particular situation, then this implies that the person has mastered those
demands; and if someone did not cope well suggests that the person's
efforts were inadequate. Lazarus and Folkman also claim that the quality
of a coping strategy can only be judged in relation to adaptational
outcomes. Researchers should evaluate the effectiveness of a given
coping strategy contextually and on an empirical basis, thus saying that a
particular coping method may be adaptive in one circumstance and
maladaptive in other situations. They stressed that the word coping
would only mean coping if such adaptational activities involve effort; it
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does not pertain to all the things that we do in our interaction to the
environment (Lazarus and Folkman, 1988).
The Ways of Coping questionnaire developed by Folkman and
Lazarus as the research instrument would be utilized for the purpose of
the study. As a research tool, it would measure the coping abilities of the
lung cancer patients. Using the coping measure, it aims to “assess and
identify thoughts and actions that individuals the use to cope with the
stressful encounters of everyday living” (Lazarus and Folkman). It
provides a list of specific ways in which people might use to manage a
stressful event. Clients would be asked to rate the extent to which they
use each particular coping method in the situation. The 66-item
cognitive and behavioral strategies encompass the checklist. The items
are categorized under eight distinct coping strategies and these are:
Confrontive Coping, Seeking Social Support, Planful Problem-Solving,
Self-Control, Distancing, Positive Appraisal, Accepting Responsibility,
and Escape/Avoidance. The coping measure would help healthcare
providers to evaluate their client’s strengths and weaknesses, thus
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present other coping mechanisms so that clients would develop practical
coping skills (Lazarus and Folkman, 1988).
Brian Mishara (2002) pointed out that coping is a process of
seeking different ways of dealing so as to improve a certain situation.
According to Mishara, coping strategies vary depending upon the type of
situation and the individual’s strength. There are some who may deal in
a situation less well because they simply do not know how to use more
effective strategies whereas others simply choose an ineffective strategy
for a specific situation (Mishara, 2002).
According to an Institute of Medicine (IOM) report, a diagnosis of
cancer can result into many types of challenges to a person. The physical
effects of the disease and treatments are considered significant in the
attempt to cure the cancer. Yet, it is also important for the healthcare
team to deal with psychosocial effects, which are the emotional and
social issues that cancer patients often encounter and can greatly affect
patients' well-being (IOM, 2007).
IOM presented notes that psychosocial obstacles can interfere with
a person's healthcare, thus diminish his health and functioning.
26
However, such emotional and social issues experienced by clients can be
significantly reduced through effective communication between the
patient and the healthcare providers. Patients and caregivers can take an
active role in addressing these challenges by sharing insights about
coping with the diagnosis and offering support to cancer patients would
indeed provide an enormous benefit to the patient's overall care (IOM,
2007).
AGE DIFFERENCES IN COPING
A study was conducted by McCrae (1982) to examine the effect of
age differences in the community sample of men and women with the
way they make use of 28 coping mechanisms.
As a result, after controlling the type of stress (challenge, loss, or threat),
he concluded that younger and older subjects coped in similar ways. The
differences may be due to the different types of stress encountered by
the two age groups. From the study, it was known that older subjects do
not mostly use the hostile reaction and escapist fantasy. These findings
27
was also made clear from the earlier study made by Folkman and
Lazarus (1980), who assessed age differences among individuals aged
45 to 64 in the use of problem-focused coping and emotion-focused
coping. And as stated earlier, differences in sources of stress is a factor
on how different ages cope. For instance, they found out that subjects
used more emotion-focused coping in health encounters than in other
types of encounters, and more stressful encounters related to health are
being experienced by older clients than the younger subjects. It was also
found out that in encounters related to health, the older and younger
subjects did not differ on the way they make use of problem- and
emotion-focused coping. The fact that only a relatively small age range
and only two modes of coping were assessed is considered to be as the
limitations of that study included (Folkman and Lazarus, 1988).
Age differences in coping was also the focus of the study made by
Folkman et al. (1987) by comparing the community sample of married
couples (the wives aged 35 to 44) with a sample of community residing
men and women between the ages of 65 and 74. More active,
interpersonal problem-focused forms of coping (confrontive coping,
28
seeking social support, and planful problem solving) are mostly used by
younger group whereas the older group used proportionately more
passive, intrapersonal emotion-focused forms of coping (distancing,
acceptance of responsibility, and positive reappraisal). Also when the
two groups were compared on how they coped within specific types of
encounters, these age differences remained consistent (family
encounters, health encounters, and encounters that were appraised as
changeable, highly threatening to self-esteem, or highly threatening to a
loved one's well-being) (Folkman and Lazarus, 1988).
Most of the studies reported above are descriptive and presented
that coping is determined by the relationship between the person and the
environment. They recommend that researchers should focus on more
complex questions about coping effectiveness, as well as coping
outcomes. They wish that researchers would continue make studies that
will provide basic descriptive information about the determinants and
consequences of coping processes (Folkman and Lazarus, 1988).
SPIRITUALITY AND CANCER
29
According to Balboni et.al (2007), religiosity and spirituality
contribute significantly to the adjustment to a diagnosis of cancer and
cancer treatment. Balboni et.al stated that “individuals who rely on their
faith tend to have more active coping styles, addressing treatment
options in a more positive manner (Balboni, T. et al. Religiousness and
spiritual support among advanced cancer patients and association with
end-of-life treatment preferences and quality of life. Journal of Clinical
Oncology. 2007. 25(2):467-8.).”
Balboni et.al furthermore stated that “patients, who are given
spiritual support by religious communities, have a significantly better
quality of life (Balboni, T. et al. Religiousness and spiritual support
among advanced cancer patients and association with end-of-life
treatment preferences and quality of life. Journal of Clinical Oncology.
2007. 25(2):467-8.).”
SPIRITUALITY FOR CANCER PATIENTS AND THEIR
CAREGIVERS
30
According to Andrew J. Weaver, MTH, PHD and Kevin J.
Flannelly, PHD, in their research titled "The Role of
Religion/Spirituality for Cancer Patients and Their Caregivers", which
was published in the December 2004 Southern Medical Association
Journal, they found out that religiosity and spirituality significantly
contribute to psychosocial adjustment to cancer and its treatments.
Religion offers hope to those suffering from cancer, and it has been
found to have a positive effect on the quality of life of cancer patients.
Numerous studies have found that religion and spirituality also provide
effective coping mechanisms for patients as well as family caregivers.
COMING TO TERMS WITH LUNG CANCER
According to the Caring Ambassadors Lung Cancer Program or
CAP Lung Cancer, there are 5 stages of coming to terms with a
significant loss or life threatening illness and these are: Denial, anger,
bargaining, depression and acceptance. Furthermore, each person has a
unique way of experiencing these stages. Most people, according to
CAP Lung Cancer, discover that they have similar feelings related to
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each stage and that it is not uncommon to come and go from one stage to
another (http://www.lungcancercap.org/index.php?
option=com_content&view=article&id=112&Itemid=178).
COPING WITH IT ALL
According to the Oral Cancer Foundation, there are several factors
that will help a cancer patient cope and these are: being optimistic;
committing a goal (fighting spirit); having enough information about the
treatment, its goals, and possible side effects; having a caring medical
team; having a caring nurse who can interpret the doctor’s
communications; having support from families and friends; seeking
counseling (http://oralcancerfoundation.org/emotional/coping.htm).
On the other hand, there are also some factors that can hinder a
cancer patient to cope and these are: being pessimistic; feeling
inadequately informed about the nature of the treatment, the need for it
and its goals and side effects; having a medical team that communicates
poorly and does not convey a sense of caring; feeling isolated, without a
person whom to share the stress; and having no personal philosophy or
32
belief system that gives a perspective on adverse events
(http://oralcancerfoundation.org/emotional/coping.htm).
STUDY ON COPING BEHAVIOR
Hanoch Livneh regarded cancer as the most widely researched
disabling condition. Cancer demands a broad range of coping options to
deal with shifting functional abilities, medical implications, treatment
modalities, and psychosocial reactions (Livneh, 2000).
Many studies were accomplished that have stressed on the role
played by coping efforts in adapting to this life-threatening disease. For
instance, Gordon and coworkers (1980) conducted a study to show the
worth of a comprehensive program for improving the level of
psychosocial functioning among cancer survivors. The researchers
provided information so that clients would understand what cancer is
and its treatment, informed them of relaxation techniques that would
help them and educated them about significance of recognition of
emotional reactions to the disease. The researchers acted as counselors
that would assist patients to share their feelings with others, thus
33
recognizing their feelings. Researchers also made a move that let the
patients act on their environment (i.e., problem solve daily issues) in
which medical them would aid them. A more rapid decline in negative
affect (i.e., anxiety, depression, hostility), a more realistic outlook on
life, and engagement in more active use of time and work were
demonstrated by the treatment group of cancer patients who were under
the program, thus the results indicated that comprehensive coping skill
training program is really beneficial because it provides social and
emotional support to cancer patients, helps them in problem
identification and solving, and in general, assists them to be optimistic
despite their disease towards a goal-directed rehabilitation atmosphere
(Livneh, 2000).
Furthermore, a coping-based study that introduced psychosocial
intervention model was made by Meyerowitz, Heinrich, and Schag
(1983). In their model, they outlined a three-phase competency-based
approach for cancer survivors. The phases include: (a) problem-
specification, in which daily stressors, which the client encounters are
recognized; (b) response enumeration, in which how the client responses
34
and makes use of coping strategies to each problem area are determined
and (c) response evaluation, where the client would identify the value of
each response for alleviating the problem. As a result, the psychosocial
intervention model is advantageous on instilling in cancer survivors
those cognitive-behavioral coping skills essential for confronting,
solving, and finally lessening the problems associated with the
limitations caused by cancer and its treatment (Livneh, 2000).
Lately, comprehensive problem-solving approach to coping with
cancer was depicted by Nezu, Friedman, Faddis, and Houts (1998). They
claimed that this therapeutic model aims at "helping individuals to
understand the nature of problems in living and directs their attempts at
changing the nature of the problematic situation itself, their reactions to
them, or both" (Livneh, 2000). Circumstances that increase distress
would be identified by the researchers, and then they aim to reduce the
extent of distressing emotions thru coping efforts. They wanted to
increase the effectiveness of problem-solving coping efforts to manage
problematic situations, and teaching skills that will enable the cancer
survivor to deal successfully with the identified problems. To address
35
their goals, the researchers planned an intervention program to be carried
out for ten weeks, with the following phases: (a) problem orientation, (b)
problem definition and formulation, (c) generation of alternatives, (d)
decision making, (e) solution implementation and verification, and (f)
practice and termination. This coping-oriented cognitive-behavioral
approach then focuses on the use of engagement-type coping skills to
help clients solve problems and reduce their stressful emotional
responses. As a result of the study, this model showed that the
psychosocial mechanisms important for the effectiveness of these
interventions revolve around enhanced self-efficacy, personal control,
problem-solving ability, and realistic appraisals of current and future
situations (Andersen, 1992).
The findings from the literature on coping strategies propose that
making use of so-called adaptive coping (and the refraining from the use
of maladaptive coping) strategies are, indeed, associated with decreased
psychosocial distress and increased personal well-being of cancer
patients. The above studies recommend that upon conducting a research,
researchers should consider age of respondents, because coping
36
strategies are partially age-determined. It was concluded that coping
with life stresses, as well as those generated by cancer is partly
influenced by age of respondents (Strack and Feifel, 1996). Thus, coping
should be assessed in reference to one’s age group. Furthermore, the
information from the effects of age to an individual should be correlated
with the type, context and effectiveness of coping (Livneh, 2000).
DENIAL IN LUNG CANCER PATIENTS
According to a study by Martina Vos, Hein Putter, Hans val
Houwelingen and Hanneke de Haes (2007), 86.6% of lung cancer
patients displayed a low or moderate level of denial at baseline. On the
other hand, 3% showed a high denial. Vos et.al also stated that male
lung cancer patients exhibited more denial than female lung cancer
patients and that elderly patients showed more denial than the younger
patients (John Wiley and Sons, Ltd., 2008).
37
Vos et.al concluded that denial is considered to be a normal
phenomenon in lung cancer patients and is also a part of the illness
process that they undergo (John Wiley and Sons, Ltd., 2008).
THE SCIENCE OF CARING: A MODEL BY JEAN WATSON
A case study that was conducted by Ms. Glenser R. Soliman aimed
to apply specific nursing care using the Ten Carative Factors of Jean
Watson for the care of specific clients particularly the cancer patients. It
is also aimed to increase awareness of the nurses to go back to the basics
of caring in spite of the occurrence of highly modernized equipments
and machines.
According to Ms. Soliman, cancer patients were chosen to be the
subject of the study because they meet some problems due to their
condition both in physiological and psychological aspects. In addition,
Jean Watson’s model has been selected because it has a good point of
view and it is relevant in providing nursing care to cancer patients and in
the nursing practice as well.
38
As a result, Ms. Soliman came up and presented several nursing
diagnoses with corresponding nursing interventions. The care plan was
focus on the Ten Carative factors of Jean Watson. The plan was
implemented to a 57 year old, cancer patient admitted in an institution in
the Philippines.
Ms. Soliman concluded that the application of Jean Watson’s
Carative Factors were advantageous to the care of cancer patients. “By
using her (Watson’s) theory, we could give a broader definition of our
profession as we go on with our everyday challenges in patient care,”
added by Ms. Soliman.
SURVIVAL OF LUNG CANCER PATIENTS SEEN AT LUNG
CENTER OF THE PHILIPPINES FROM JANUARY, 1991 TO JUNE,
1997
Dr. Bai Naida V. Sinsuat and Dr. Sullian Sy-Naval of F.P.C.C.P.
conducted a research which aims to study the outcome of staging and
treatment on the survival of patients with lung cancer observed at the
Lung Center of the Philippines.
39
4, 036 patients, ages 19-89 and who were registered from January,
1991, up to June, 1997 were included in this study. Management all
through entrance or session was supportive or diagnostic only, external
radiation, brachytheraphy, surgery, chemotherapy and combination
therapy. It is also noted the admission date, last follow-up date, as well
as the date of death. In contrasting the survival experience of patients
group, Wilcoxon-Gehan statistics was utilized.
According to Lung Cancer Study Group Trials, with regards to the
five year post operative survival by stage, there were 83% for stage IA
Squamous cell 69% for adenocarcinoma, weigh against 49% five year
survival for stage IB Squamous cell and 0.09 % five year survival IB
Adenocarcinoma. 52%with Adenocarcinoma, 52 % with Squamous Cell
carcinoma, and &71% with Non-specific NSCLC in the other operable
stages IA to IIIA decide to obtain basic supportive care and only 20%,
7.2%, and 6.1% decide for surgical resection.
The overall comprehension of the biologic mechanisms of Lung
Cancer has increased even though there was no advances in treatment of
Lung Cancer have aroused before. Doctors should have an indicator in
40
diagnosing Lung Cancer so as not to waste time for possible surgical
treatment. Techniques and procedures to patient with Lung Cancer
should be developed for the benefits of the surgical management.
Several studies are needed in order to distinguish the factors that may
result in lower survival of surgical treated patient. Positive outcomes of
such medical management such as chemotherapy, and radiotherapy or
any combination of the two over basic supportive care needs further
studies for patients having untreatable stages of lung cancer.
A STUDY ON THE QUALITY OF LIFE OF LUNG CANCER
PATIENTS
A study, spearheaded by Dr. Ma. Corazon Gallas-Martir and Dr.
Eillen G. Aniceto, on the quality of life of lung cancer patients were
done on the year 1997. The study aimed to see the effect of the cancer
support program proposed by the Lung Center of the Philippines on the
quality of life of lung cancer patients of the same institution. In the
study, the researchers chose 40 participants to attend on the Cancer
Support Program’s education and counseling sessions for four
41
consecutive weeks. Before and after the study, the participants were
asked to fill up and answer a patient information sheet and a quality of
life questionnaire (FACT-L). The patient information sheet includes
demographic data where as the Functional Assessment Cancer Therapy
– Lung (FACT-L) is a standardized instrument that was used on quality
of life. The questionnaire included six spheres of the quality of life:
physical well-being (PWB), social well-being (SWB), relationship with
the doctor (REL), emotional well-being (EWB), functional well-being
(FWB), and lung cancer subscale (LCS).
The researchers used two statistical treatments to analyze the data
gathered in the study. T-test was utilized to observe the change on the
quality of life of the lung cancer patients before and after the Cancer
Support Program’s education and counseling sessions. On the other
hand, chi square was used to determine the effect of the demographic
data to the quality of life questionnaire.
The findings on the study demonstrated an important change of the
emotional well-being and functional well-being of the lung cancer
patients that attended the four-week Cancer Support Program’s
42
educational and counseling sessions. It was also noted that the
improvement of the participants in the study was attributed to higher
level of education.
In conclusion, the results of the study proved that the LCP Cancer
Support Program has a helpful result of the total quality of life of lung
cancer patients. The progress in the quality of life of the participants was
not associated to sex, age, type of lung cancer, treatment and level
education. But it was seen that there were trends of improvement on
patients with higher level of education and who have received
treatments.
The researchers on the study recommended that all lung cancer
patients be signed up in the Cancer Support Program. They also
recommended for the continued reassessment of the quality of life of the
patients. According to the researchers, the education and counseling
sessions were useful in helping cancer patients handle their illness,
reduce their anxiety and their depression, and therefore improve the
quality of life.
43
CONCLUSION
Jean Watson’s carative factors present a holistic approach to
patient care thru nursing. It embodies a wide range of principles
necessary in promoting a client’s well-being. Watson’s theory will be
used as a basis in assessing the perception of care by the patients in the
study. The Caring Factor Survey, which makes use of Watson’s ten
carative factors, will be the standard tool in assessing the quality of care
given by nurses to the study participants.
Moreover, Adler and Page’s (2008), provides an idea that to
deliver high-quality cancer care, different approaches, tools, and
resources are needed to address patients' psychosocial health needs. This
idea is in line with Watson’s holistic theory of the ten carative factors.
Adler and Page’s assertion will be used as a co-reference to Watson’s
assumption of holistic patient care.
Ms. Soliman’s conclusion that the application of Jean Watson’s
Carative Factors was advantageous to the care of cancer patients will
strengthen the need for providing holistic care to the study participants.
44
Lazarus and Folkman’s principles on coping also present standards
in the coping efforts of an individual. Lazarus and Folkman’s Ways of
Coping questionnaire will further assess the extent of coping of the study
participants. Thru the coping principles of Lazarus and Folkman, the
researchers will be able to categorize coping efforts of a lung cancer
patient according to the following: confrontive, distancing, self-
controlling, seeking social support, accepting responsibility, escape-
avoidance, planful problem solving and positive reappraisal. Thru the
Ways of Coping questionnaire, the researchers will be able to describe
which coping mechanisms are utilized by lung cancer patients.
Furthermore, Lazarus and Folkman’s study on the age differences
in coping made baseline knowledge for the researchers that in
encounters related to health, the older and younger subjects did not
differ on the way they make use of problem- and emotion-focused
coping. This finding will help to ascertain that there is no significant
difference between age and coping. Livneh’s principle that coping
should be assessed in reference to one’s age group will also augment the
45
assumption that there is no significant difference between age and
coping.
Dr. Gallas-Martin and Dr. Aniceto’s findings on their study
demonstrated an important change in the well-being of lung cancer
patients who were attendees at the four-week Cancer Support Program’s
educational and counseling sessions. Their verdict will strengthen the
idea that specialized programs are highly beneficial to in-need patients.
In the study, the needs of the clients are of most important – whether or
not the nurse or other health care providers help to satisfy their needs.
46
RESEARCH PARADIGM
Watson’s Ten Carative Factors are based on a dynamic
phenomenological approach related to the nurse-client relationship.
The first factor – formation of humanistic and altruistic values – is
learned young in life (Neil, 2002). But this can also be influenced by
nurse-educators (Neil, 2002).
The second factor - instillation of faith and hope - integrates
humanistic and altruistic values, aid the promotion of holistic nursing
care and positive health within the patient population (Neil, 2002). This
factor also states that by helping clients adopt health-seeking actions, the
nurse can help develop an effective nurse-client interrelationship (Neil,
2002).
The third factor - cultivation of sensitivity to self and others –
means self-acceptance and acknowledgment of feelings for both the
nurse and the client (Neil, 2002). According to Neil (2002), “as nurses
acknowledge their sensitivity and feelings, they become more genuine,
authentic and sensitive to others.”
47
The fourth factor - development of a helping-trust relationship – is
very important for transpersonal caring. A helping-trust relationship
encourages the expression of both positive and negative feelings. It also
involves congruence, empathy, non-possessive warmth and effective
communication (Neil, 2002).
The fifth factor - promotion and acceptance of the expression of
positive and negative feelings - is a risk-taking experience for both nurse
and patient (Neil, 2002). Nurses should be ready for a positive or a
negative expression of feelings is carried out by the client. The nurse
must also realize that intellectual and emotional understandings of a
situation differ (Neil, 2002).
The sixth factor - systematic use of the scientific problem-solving
method for decision making - is the utilization of the nursing process in
the provision of care to patients. Thus, this factor eliminates the belief
that nurses are handmaids of doctors (Neil, 2002).
The seventh factor - promotion of interpersonal teaching and
learning – separates nursing from curing. This factor allows the patient
to have a sense of responsibility over his own health. The nurse helps the
48
patient in acquiring this responsibility through teaching-learning
techniques. These techniques are geared at enabling patients to provide
self-care, determine personal needs, and provide opportunities for their
personal growth (Neil, 2002).
The eighth factor - provision for supportive, protective, and
corrective mental, physical, sociocultural and spiritual environment -
implies that nurses must recognize the influence internal and external
environments have on the health and illness of individuals (Neil, 2002).
The ninth factor – assistance with the gratification of human needs
– involves the nurse’s recognition of the biophysical, psychophysical
and psychosocial and intrapersonal needs of patients. Following
Maslow’s hierarchy of needs, patients must answer lower needs first
before moving up to satisfy higher needs (Neil, 2002).
The tenth and last factor – allowance for existential-
phenomenological forces - describes the relevant information needed by
an individual to understand the present situation. This factor aims to a
better understanding of self and others (Neil, 2002). Watson believes
that nurses have the responsibility to go beyond the 10 carative factors
49
and to facilitate patient’s development in the area of health promotion
through preventive health actions (Neil, 2002). This goal is
accomplished by teaching patients personal changes to promote health,
providing situational support, teaching problem-solving methods and
recognizing coping skills and adaptation loss (Neil, 2002).
The Caring Factor Survey will be used to assess the perception of
care that patients receive from the health care team.
A process-oriented approach is directed toward what an individual
actually thinks and does within the context of a specific encounter and
how these thoughts and actions change as the encounter unfolds
(Lazarus and Folkman, 1988).
Coping, when considered as a process, is characterized by
dynamics and changes that are a function of continuous appraisals and
reappraisals of the shifting person-environment relationship (Folkman
et.al, 1986). Shifts may result from coping efforts that are directed
outward toward changing the environment, or efforts that are directed
inward toward changing the meaning of the event. Shifts may also result
from environmental changes independent of the individual. Any shift in
50
the person-environment relationship leads to a reappraisal of what is
happening, its significance, and what can be done. This reappraisal then
influences subsequent efforts (Lazarus and Folkman, 1988).
Lazarus and Folkman’s Ways of Coping Questionnaire is rooted
on an explanation of coping as the cognitive and behavioral efforts to
manage specific external and/or internal demands appraised as taxing
or exceeding the resources of an individual (Lazarus and Folkman,
1988).
The patients’ perception of Watson’s caring factors is assessed
using the Caring Factor Survey and it will describe the interrelationship
to the Ways of Coping Questionnaire by Lazarus. The Caring Factor
Survey will determine whether or not the nurses are providing the
carative factors to the patients as based on the patients’ perception per
se. The utilization of the carative factors on patient-care will be
correlated with the extent of the patient’s extent of coping in a
healthcare environment.
THEORETICAL FRAMEWORK
JEAN WATSON’S CARATIVE FACTORS
FORMATION OF A HUMANISTIC ALTRUISTIC SYSTEMINSTILLATION OF FAITH AND HOPECULTIVATION OF SENSITIVITY TO SELF AND OTHERSDEVELOPMENT OF A HELPING-TRUST RELATIONSHIPPROMOTION AND ACCEPTANCE OF THE EXPRESSION
OF POSITIVE AND NEGATIVE FEELINGSSYSTEMATIC USE OF THE SCIENTIFIC PROBLEM-
SOLVING METHOD FOR DECISION M AKINGPROMOTION OF INTERPERSONAL TEACHING AND
LEARNING
PROVISION FOR SUPPORTIVE, PROTECTIVE AND CORRECTIVE MENTAL, PHYSICAL, SOCIOCULTURAL
AND SPIRITUAL DEVELOPMENTASSISTANCE WITH THE GRATIFICATION OF HUMAN
NEEDSALLOWANCE FOR EXISTENTIAL-PHENOMENOLOGICAL
FORCES
LAZARUS CONCEPT OF COPING
CONFRONTIVE COPINGDISTANCINGSELF-CONTROLLINGSEEKING SOCIAL SUPPORTACCEPTING RESPONSIBILITYESCAPE-AVOIDANCEPLANFUL PROBLEM-SOLVING
POSITIVE REAPPRAISAL
AGE GROUPS:YOUNG ADULT (20-39)
MIDDLE ADULT (40 – 64)
51
RESEARCH HYPOTHESES
There is no difference between the perception of young adult
lung cancer patients and the middle adult lung cancer patients towards
the care they received.
There is no difference between the extent of coping of young
adult lung cancer patients and the middle adult lung cancer patients.
There is no relationship between the nurse’s caring factors and
the coping behavior of lung cancer patients.
THE MAIN VARIABLES OF THE STUDY
The major variables under investigation are the nurse’s caring
factors and the extent of coping of lung cancer patients. The
independent variable is the nurse’s caring factors whereas the dependent
is the extent of coping of lung cancer patients. The researchers identified
the nurse’s caring factors as the independent variable because based
from Neil and Schroeder (1992), the application of Jean Watson’s caring
factor theory resulted to decrease number of hospital days to patients.
Thus, the nurse’s caring factors was the presumed cause. On the other
52
hand, the extent of coping of the lung cancer patients was identified as
the effect because according to Lazarus and Folkman (1988), coping
refers what an individual actually thinks and does in a particular
encounter. The encounter stated was further defined by Lazarus and
Folkman as a stressful situation experienced by an individual. Thus,
coping strategies result from the experiences of an individual.
The nurse’s caring factors would be measured using the Caring
Factor Survey which is a standardized tool developed by Jean Watson
and her colleagues. This is a survey that measures the client’s perception
of care while in the institution. The clients would be asked to respond to
each of the 20 statements about how they feel regarding the care they are
currently receiving from the nursing staff. For each question, they will
be asked to indicate how much they agree or disagree with the statement.
They would be marking their response by filling in the circle that best
represents their opinion.
The extent of coping would be measured using the Ways of Coping
Questionnaire. This questionnaire is designed to identify the thoughts
and actions an individual has used to cope with a specific stressful
53
encounter. The 66-item cognitive and behavioral strategies comprise the
Checklist. The items are categorized under the eight coping scales, but
not all 66 items are scaled. The clients would have to read each
statement then respond to a 4-point Likert scale by circling 0, 1, 2, or 3,
to what extent they used it in the situation.
DEFINITION OF TERMS
1. Extent of coping
The cognitive and behavioral efforts to manage specific external or
internal demands appraised as taxing or exceeding the resources of the
individual (Lazarus and Folkman, 1988).
Refers to the client’s response on the coping strategies they utilize
when given a stressful situation. The extent of coping is measured in this
study by using a standardized questionnaire developed by Lazarus. For
each question, they will be asked to indicate, by circling 0 for “does not
apply or not used”, 1 for “used somewhat”, 2 for “used quite a bit” , or 3
for “used a great deal”, to what extent they used it in the situation.
2. Lung Cancer
54
Cancer that forms in tissues of the lung, usually in the cells lining
air passages (National Cancer Institute, 2008).
Refers to all patients of the selected tertiary hospital diagnosed
with malignant or benign cancer including pulmonary adenocarcinoma,
bronchogenic carcinoma, and pulmonary mass.
3. Nurse’s caring factors
The act of providing nursing care that attempts to honor the human
dimensions of nursing’s work and the inner life world and subjective
experiences of the people we serve (Cara, 2000)
Refers to the client’s response about how they feel regarding the
care they are currently receiving from the nursing staff. The nurse’s
caring factors are measured in this study by using a standardized
questionnaire developed by Jean Watson and her colleagues. For each
question, they will be asked to indicate how much they agree or disagree
with the statement. They would be marking their response by filling in
the circle, 7 for “strongly agree”, 6 for “agree”, 5 for “slightly agree”, 4
for “neutral”, 3 for “slightly disagree”, 2 for “disagree” and 1 for
“strongly disagree”, that best represents their opinion.
55
4. Selected Special Tertiary Hospital
An institution that provides specialized care and treatment for the
sick or the injured. (The American Heritage Dictionary of the English
Language, Fourth Edition 2006).
Refers to a health institution in Quezon City chosen by the
researchers primarily because it is a premiere institution for specific
disease which caters to the most number of in-patients of lung cancer
cases in the Philippines. Moreover, the tertiary hospitals are established
to provide specialized care for the Filipino people.
CHAPTER III
RESEARCH METHODOLOGY
RESEARCH DESIGN
56
The study utilized descriptive correlational design – a non-
experimental descriptive research approach, by describing the
relationship between the nurse’s caring factors and the extent of coping
of lung cancer patients.
POPULATION AND SAMPLE
The study focused on clients diagnosed with lung cancer, grouped
according to age, receiving treatment from the selected special tertiary
hospital in Quezon City. The study population included male and female
lung cancer patients, ages 20 to 64, who received treatment from
Hospital X in Quezon City, and who were not mentally and emotionally
disabled and who were not mute, deaf or blind. Patients who were not
able to read and write due to conditions like decreased level of
consciousness, terminally ill and those who were hooked to artificial
resuscitative devices were also excluded from the study. Patients’ family
members or guardians were not allowed to answer the survey.
Furthermore, those who refused to answer due to personal reasons were
not included in the study.
57
The total population of lung cancer patients during the data
collection was 67. Not all lung cancer patients agreed to participate in
the study. Furthermore, not all lung cancer patients were eligible to
participate in the study.
The sample size obtained during the data collection was 35, 18
from the young adult and 17 from the middle adult. The sample was
presently admitted and receiving treatment during the duration of data
collection.
The lung cancer patients who were eligible and presently admitted
at Hospital X during the data collection period were selected as study
participants.
RESEARCH LOCALE
The study was conducted at a selected special tertiary hospital in
Quezon City. The researchers have chosen this hospital primarily
because it is a premiere institution for specific disease which caters to
the most number of in-patients of lung cancer cases in the Philippines.
58
The hospital also provides quality health care through excellent service,
training, research, and provides quality healthcare through advanced
medical facilities.
RESEARCH INSTRUMENTS
The researchers utilized a standardized instrument on Caring
Factor Survey by Jean Watson in collecting data regarding the
perception of care the patients received from the institution. This tool
was a seven-point Likert Scale which enabled the respondents to specify
their level of agreement to a statement. Each statement was graded as 7
for strongly agree, 6 for agree, 5 for slightly agree, 4 for neutral, 3 for
slightly disagree, 2 for disagree and 1 for strongly disagree. The Caring
Factor Survey, which has 20 items, measured the patient’s perception of
care while in the facility. Participants were asked to indicate how much
they agreed or disagreed with each of the statements implied in the
survey tool. The survey tool was not modified nor translated to Filipino.
The developers of the Caring Factor Survey did not have any guidelines
indicating the modification of the survey tool. However, the Caring
59
Factor Survey was explained to the study participants during the data
collection.
This Caring Factor Survey tool has been tested for validity and
reliability by Jean Watson and her colleagues using test-retest.
In addition, the researchers also used the Ways of Coping
Questionnaire developed by Richard Lazarus and Susan Folkman to
assess for the subjects’ extent of coping behavior. This was translated to
Filipino version since the Ways of Coping Questionnaire can be
modified and improved as recommended by Lazarus and Folkman.
Furthermore, the Filipino version provided for better understanding of
its content to the study participants. The main idea of each question was
preserved on translation.
The Ways of Coping Questionnaire has 66 questions which
determined the extent of coping strategies that the participants utilized
given a stressful situation. Not all 66 items were scaled according to the
categories of coping in the Ways of Coping Manual by Lazarus and
Folkman. There were only 50 questions included in the study. The
excluded items from the Ways of Coping Questionnaire do not fall on
60
Lazarus and Folkman’s ways of coping categories. Thus, these items
that were not included in the statistical treatment of data are: 2, 3, 4, 5,
19, 24, 27, 32, 37, 53, 55, 57, 61, 64, 65 and 66.
The researchers used these tools for gathering the data needed in
assessing for the relationship between the nurse’s caring factors and
extent of coping of lung cancer patients. The Caring Factor Survey
helped the researchers understand the experience of care of the
participants more clearly. This also aided in improving the caring
experience of the patients and their guardians while in the facility.
The Ways of Coping Questionnaire described the coping effort for
each category of coping namely confrontive, distancing, self-controlling,
seeking social support, accepting responsibility, escape-avoidance,
planful problem solving and positive reappraisal. There were four
possible responses to the Ways of Coping Questionnaire and these are:
0, 1, 2 and 3.
The study participants responded to each item on a four-point
Likert scale, indicating the extent with which each coping strategy was
used. 0 indicates “does not apply or not used” or “hindi ginagamit”, 1
61
indicates “used somewhat” or “madalang gamitin”, 2 indicates “used
quite a bit or “ginagamit paminsan-minsan” and 3 indicates “used a
great deal” or “ginagamit palagi”.
In the statistical treatment of data, the participants’ responses were
interpreted as: scores ranging from 0-0.49 were interpreted as “does not
apply or not used” or “DNA”; scores ranging from 0.50-1.49 were
interpreted as “used somewhat” or “US”; scores ranging from 1.50-2.49
were interpreted as “used quite a bit” or “UQAB” and scores ranging
from 2.50-3.00 were interpreted as “used a great deal” or “UAGD”.
High scores indicated that the patient often used the behaviors described
by the scale in coping with the stressful event.
The researchers utilized the standardized tool created by Lazarus
and Folkman. The creators of the tool tested the reliability and validity
of the Ways of Coping Questionnaire using Cronbach’s coefficient
alpha.
DATA COLLECTION PROCEDURE
The researchers obtained data from the eligible lung cancer
patients only. The researchers decided to collect quantitative data from
62
the subjects using a formal measurement tool that was analyzed by
statistical operations. The gathering was performed last December 22,
2008 to January 6, 2009 at the selected tertiary hospital in Quezon City.
The tools that the researchers used were standardized. Ethical
considerations were applied through confidentiality.
Consent letters were given to the participants in accordance with
the ethical considerations of the study.
The researchers gathered quantitative data from the lung cancer
patients using the two standardized instruments. The quantitative data
were the coping ways of the lung cancer patient and their perception
regarding the care they received from the nurses.
The coping ways of the patients were based on the eight categories
of coping of Lazarus and Folkman. On the other hand, the lung cancer
patients’ perception of care provided by the nurses in the hospital, were
based from ten carative factors of Jean Watson.
The researchers also gathered personal information from the
subjects for classification which includes the name, age, gender, and
civil status.
63
In the collection of data, the researchers used two instruments. The
first one was the Ways of Coping Questionnaire from Lazarus and
Folkman. This instrument assessed thoughts and actions that an
individual uses to cope with the stressful encounters of everyday living.
It is derived from a cognitive-phenomenological theory of stress and
coping that was articulated in Stress, Appraisal, and Coping (Lazarus
and Folkman, 1984). The subjects answered the questionnaire.
The second instrument was the Caring Factor Survey. This
instrument was formulated by Jean Watson and her colleagues. This tool
measured the perception of the patient regarding the care they received
from the nurses based on the ten caring factors of Watson.
The researchers obtained permission from the institution through
the department head to nursing department of the Hospital X and from
the Dean of Far Eastern University Institute of Nursing prior to data
collection.
The researchers made a letter of approval addressed to the Dean of
Far Eastern University Institute of Nursing to conduct a research outside
64
the school. A request letter was also addressed to the head of the
Nursing Departments of Hospital X.
The two survey tools were obtained from the respective authors
following legal actions. The Caring Factor Survey was sent in by Jean
Watson while Ways of Coping Questionnaire was purchased online
under the permission of Mind Garden Incorporated.
STATISTICAL TREATMENT OF DATA
For this study, the researchers used the weighted arithmetic mean,
analysis of variance, t-test of significance, Pearson product-moment
correlation coefficient and Testing the Significance of r.
In answering question numbers 1 and 2, which deals with the
perception of the lung cancer patients in terms of the caring factors they
received and the extent of the coping abilities of the young and middle
adult patients respectively, the weighted arithmetic mean was used such
that:
65
Where: X = weighted arithmetic mean
Σwx = sum of all the products of w and x where w is the
frequency of each option and x is the weight of each option.
Σw = sum of all subjects
In answering question numbers 3 and 4, Analysis of Variance or
ANOVA and t-test of significance was utilized. ANOVA was used to
find out if the frequency of 2 or more variables in the study differ
significantly (Calmorin, 1995).
ANOVA was a method for dividing the variation observed into
two different parts, each part assignable to a known source, cause or
factor. It was developed by R.A. Fisher and was used when testing the
significance of the differences between two or more means obtained
from independent samples.
Understanding Analysis of Variance (ANOVA)
Raw Score Method
Step 1: Enter the data in a worksheet table.
66
Step 2: Find the square of each raw score.
Step 3: Compute the sum of N for each group, the total N, the sums of
the raw scores and the sums of the squared scores.
X1 X12 X2 X2
2
SUMS ∑ xt
=MEANS ∑
xt2=
N Nt =
Where:
x = Raw Score
x2 = Square of the raw score
SUMS = Sums of the raw scores in each group
MEANS = Sums of the raw scores in each group / number of
scores in each group
N = number of scores in each group
∑xt2 = Sums of the squared scores
∑xt = Sums of the raw scores
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Nt = Total number of scores in all groups combined
k = number of groups
Step 4: Compute Sums of Squares
Sums of Squares are the sum of the squared raw scores. (∑xt2 )
a. SSt (SS for total variability) – sum of the squared deviations of
every raw score from the mean of the total distribution
= ∑xt2 - ( ∑xt) 2
Nt
b. SSb (SS for between group variability) - sum of the squared
deviations of individual group mean from the mean of the total
distribution
= (∑x1) 2 + (∑x 2) 2 - (∑x t) 2
N1 N2 Nt
c. SSw = (SS for within group variability)- sum of the squared
deviations of individual scores from their group mean
= SSt - SSb
Step 5: Find the Degrees of Freedom
a. Between groups: dfb = k – 1
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b. Within groups: dfw = Nt – k
Step 6: Find the Mean Squares (MS) - a measure of variation obtained
by dividing between-groups sum of squares or within-groups sum of
squares by the appropriate degrees of freedom
a. MSb = SSb
dfb
b. MSw = SSw
dfw
Step 7: Find the T-ratio – a statistical technique which indicates the size
of the mean square between-groups relative to the size of the mean
square within-groups
T = MSb
MSw
Step 8: Determine the significance of T. Refer to the table of T-Ratio.
If the computed T-ratio is equal to or greater than its
tabular value at 0.05 level of significance, it is significant. The opposite
is true when the T-ratio is less than the region of acceptance or the
tabular value at 0.05 level of significance.
69
Step 9: Summarize the three sources of variations and the computed t-
ratio in a table for the One-way ANOVA.
Source of Variation
SS DF MS T-ratio Significance
Between Groups
Within GroupsTotal
Step 10: Interpret the computed statistics.
In answering question number 5, Pearson product-moment
correlation coefficient and Testing the Significance of r was used. The
Pearson product-moment correlation coefficient or PMCC is a common
measure of the correlation between two variables. In this study, the
relationship between the two variables, represented as X – Nurse’s
caring factors and Y – Coping of lung cancer patients, will be measured.
The possible value of Pearson r is +1, 0 to -1, of the value of r is +1 or -
1, then there is a perfect correlation between x and y. It can be said that
x influences y. If the r value is equal to 0, then x and y are independent
of each other.
70
The formula for finding the Pearson r is given as:
n Σ xy – Σ x Σ y
r =
√ [ n Σx2 – (Σx)2 ] [nΣy 2 - (Σy) 2 ]
Where:
r = the Pearson Product Moment Coefficient of Correlation
n = Sample Size
Σ xy = the sum of the product of x and y
Σ x Σ y = the product of the sum of Σ x and the sum of Σ y
Σx2 = sum of squares of x
Σy2 = sum of squares of y
Testing the Significance of r
Although the researchers have computed the r value still it is not
sure if the figure is statistically significant of r. Therefore, a test for the
significance of r is needed.
Test statistic:
t= r √n-2
√l-r2
71
Decision Rule: Reject null hypothesis if t is > 2.16 or <-2.16 otherwise
accept null hypothesis.
72
73
74
75
CHAPTER IV
RESULTS AND DISCUSSION
This chapter will present the results of the statistical treatment and
data interpretation.
PRESENTATION OF THE FINDINGS
In order to answer the research questions stated in Chapter I, the
researchers utilized statistical treatments which are: weighted arithmetic
mean, Analysis of Variance, t-test of significance, Pearson product-
moment correlation coefficient and Testing the Significance of r was
applied.
In question numbers 1 and 2, the researchers used weighted
arithmetic mean. For questions number 3 and 4, Analysis of Variance
and T-test of significance was utilized and for question number 5,
Pearson product-moment correlation coefficient and Testing the
Significance of r was applied.
76
Table 1
Perception of the Young Adult towards the Caring Factors Received
CARING FACTOR
VERBAL INTERPRETATION
Responded to client as a whole person (16) 5.67 ACreation of an environment for physical and spiritual healing(10) 5.56 AEmbracing of client’s feelings(19) 5.5 AEstablishment of helping-trust relationship(13) 5.44 SAValues relationship (15) 5.44 SASolved unexpected problems (2) 5.39 SACreative problem solving (4) 5.39 SAEncouraged verbalization of feelings (17) 5.39 SASupport client’s beliefs (18) 5.39 SAHonored client’s faith, instilled hope, and respected client’s belief system (5) 5.33 SA
77
Respectful of spiritual beliefs and practices(9) 5.33 SAAcceptance and support to client’s belief to a higher power (20) 5.33 SAOver-all care was provided with loving-kindness(1) 5.28 SATeaching client on the level the client can understand (6) 5.22 SAHelped support client’s hope and faith (7) 5.22 SAHelped meet client’s physical, emotional and physical needs (14) 5.17 SAResponsive to client’s readiness to learn(8) 5.11 SAEncouraged practice own spiritual beliefs (11) 5.11 SACreation of an environment that recognizes the client’s connection between mind, body and spirit (12) 5 SACare is provided with loving kindness
4.72 SA
78
(3)Total computed weighted average towards caring factor received 5.30 SA
Interpretation:
Table 1 shows the perception of young adult towards the caring
factor received. Researchers found out that young adult cancer patient
had a total weighted average score of 5.30 in the Caring Factor Survey.
This data presents that young adult cancer patients slightly agree about
receiving holistic care. Caring Factor #3, which is about if the cancer
patient received a care provided with loving kindness, got the lowest
computed weighted average, for having an average of 4.72. And, Caring
Factor #16, which is about if the caregivers have responded to the
patients as a whole person, helping to take care of all their needs and
Legend:0.5 – 1.49 Strongly Disagree (StD) 4.50 – 5.49 Slightly Agree (SA)1.50 – 2.49 Disagree (D) 5.50 – 6.49 Agree (A)2.50 – 3.49 Slightly Disagree (SD) 6.50 – 7.49 Strongly Agree (StA)3.50 – 4.49 Neutral (N)
79
concerns, got the highest computed weighted average, for having an
average of 5.67.
Analysis:
It is said that the practice of holistic nursing requires nurses to
integrate self-care, self-responsibility, spirituality, and reflection in their
lives (http://www.ahna.org/AboutUs/Whatis
HolisticNursing/tabid/1165/Default.aspx). This may lead the nurse to
greater awareness of the interconnectedness with self, others, nature, and
spirit. This awareness may further enhance the nurses understanding of
all individuals and their relationships to the human and global
community, and permits nurses to use this awareness to facilitate the
healing process.
According to Watson (2001), the major elements of her theory are:
(a) the carative factors, (b) the transpersonal caring relationship, and (c)
the caring occasion/caring moment. Assisting the patient gain a higher
degree of harmony within the mind, body, and soul is the goal of nursing
with Watson’s theory. It is achieved through caring transactions. Watson
termed the nursing interventions related to human caring as carative
80
factors, a guide which she considered as the “core of nursing” (Kozier,
2004). She uses the term carative to contrast with conventional
medicine’s curative factors. It also involves the transpersonal caring
relationship. Transpersonal means a concern for the inner life, wherein
the nurses are committed in protecting and enhancing human dignity as
well as the deeper or higher self. The patient is viewed as whole and
complete, regardless of any illness or disease. The transpersonal nurse
seeks to connect with, embrace the spirit or soul of the patient, through
the processes of caring and healing (Watson, 2001).
81
Table 2
Perception of the Middle Adult towards the Caring Factors Received
CARING FACTOR
VERBAL INTERPRETATION
Creation of an environment for physical and spiritual healing (10) 5.76 ARespectful of spiritual beliefs and practices (9) 5.65 AResponded to client as a whole person (16) 5.65 AEmbracing of client’s feelings (19) 5.65 AResponsive to client’s readiness to learn (8) 5.59 AEstablishment of helping-trust relationship (13) 5.59 AOver-all care was provided with loving-kindness (1) 5.53 AHelped support client’s hope and faith (7) 5.53 AEncouraged practice own spiritual beliefs (11) 5.53 A
82
Encouraged verbalization of feelings (17) 5.47 SASupport client’s beliefs (18) 5.47 SASolved unexpected problems (2) 5.35 SACare is provided with loving kindness (3) 5.35 SAValues relationship (15) 5.35 SAAcceptance and support to client’s belief to a higher power (20) 5.35 SATeaching client on the level the client can understand (6) 5.3 SACreation of an environment that recognizes the client’s connection between mind, body and spirit (12) 5.18 SAHelped meet client’s physical, emotional and physical needs (14) 5.18 SACreative problem solving (4) 5.12 SAHonored client’s faith, instilled hope, and respected
4.82 SA
83
client’s belief system (5)Total computed weighted average towards caring factor received 5.42 SA
Interpretation:
Table 2 shows the perception of middle adult towards the caring
factor received. Researchers found out that the middle adults, on the
other hand, had an average score of 5.42. This data presents that middle
adult cancer patients slightly agree about receiving holistic care. Caring
factor # 5, which is about if the care providers honored the patients own
faith, helped instill hope, and respected their belief system as part of
their care, got the lowest computed weighted average, for having an
average of 4.82. Caring factor # 10, which is about if the facility or
hospital and its care providers have created an environment which helps
Legend:0.5 – 1.49 Strongly Disagree (StD) 4.50 – 5.49 Slightly Agree (SA)1.50 – 2.49 Disagree (D) 5.50 – 6.49 Agree (A)2.50 – 3.49 Slightly Disagree (SD) 6.50 – 7.49 Strongly Agree (StA)3.50 – 4.49 Neutral (N)
84
patients to heal physically and spiritually, got the highest computed
weighted average, for having an average of 5.76.
Analysis:
Leininger (1980) stated that it is critical that health care providers
recognize individual differences and do not participate in "cultural
stereotyping", persons of the same ethnicity can have very different
beliefs and practices, it is important to understand the particular
circumstances of the patient or family by obtaining information on:
place of origin; social and economic background; degree of
acculturation; and personal expectations concerning health and medical
care. And according to Leininger’s transcultural nursing theory,
culturally competent care can only occur when culture care values are
known and serve as the foundation for meaningful care.
Rossi and Lent (2006) said that every buildings and devices used
to treat patients and the people, residents that provide care could
contribute to the healing process of a disease or illness that the nurses
are trying to cure. Physical environments can stimulate patient’s
healing.
85
Nightingale (1969) stated that nurses should utilize the
environment of the patient to assist for recovery and that it involves the
nurse's initiative to configure environmental settings appropriate for the
gradual restoration of the patient's health, and that external factors
associated with the patient's surroundings affect life or biologic and
physiologic processes, and development.
Table 3
Comparison of the Perception of the Young and Middle Adult
Towards the Caring Factors Received
VERBAL INTERPRETATION
Young Adult 5.30 SAMiddle Adult 5.42 SA
Interpretation:
Table 3 shows the comparison of the perception of the young
Legend:0.5 – 1.49 Strongly Disagree (StD) 4.50 – 5.49 Slightly Agree (SA)1.50 – 2.49 Disagree (D) 5.50 – 6.49 Agree (A)2.50 – 3.49 Slightly Disagree (SD) 6.50 – 7.49 Strongly Agree (StA)3.50 – 4.49 Neutral (N)
86
and middle adult towards the caring factors received, researchers found
out that the young adults had an average score of 5.30 in the Caring
Factor Survey. This data presents that the young adult cancer patients
slightly agree about receiving holistic care. The middle adults, on the
other hand, had an average score of 5.42. This data presents that middle
adult cancer patients slightly agree about receiving holistic care.
Analysis:
Okumura (2008) proposed that there are some factors that directly
affect the quality and perception of care for young and middle adults
with chronic illnesses, and according to him, how these factors impact
patients outcomes must be studied for future use. Moreover the
researcher’s studies revealed that there are also some certain barriers that
affect the provision of quality care, such as lack of proper training of
health care practitioners, might limit their ability to provide high quality
primary care for patients with chronic illness. Another barrier in
receiving primary health care for patients with chronic conditions
recognized by Okumura was that there might be not enough health care
services provided to patients to have productive lives. These barriers, in
87
the provision of primary health care to young and middle adult patients
with chronic illnesses, might in return affect patient’s perception of the
care provided.
88
Table 4
The Confrontive Coping of the Young and Middle Adult Lung Cancer
Patients
Confrontive Coping
Young Adult
Verbal Interpretation
Young Adult
Verbal Interpretation
Total Mean
Verbal Interpretation
Letting feeling’s out somehow
2.11 UQAB 2.06 UQAB 2.09 UQAB
Fighting for what I want
1.78 UQAB 1.82 UQAB 1.8 UQAB
Get person’s responsibility to change his mind
1.77 UQAB 1.71 UQAB 1.74 UQAB
Doing something that I didn’t think would work
1.72 UQAB 1.65 UQAB 1.69 UQAB
Expressing anger to the person who caused the problem
1.56 UQAB 1.41 US 1.49 US
Taking a big chance to solve the problem
1.39 US 1.41 US 1.4 US
Average 1.72 UQAB 1.68 UQAB 1.70 UQAB
Legend:0-0.49: Does not apply or not used (DNA)0.50-1.49: Used somewhat (US)1.50-2.49: Used quite a bit (UQAB)2.50-3.00: Used a great deal (UAGD)
89
Interpretation:
Table 4 shows the Confrontive Coping of Young and Middle Adult
lung cancer patients. Based on the obtained results, both the young and
middle adult used confrontive coping quite a bit, with an average score
of 1.72 for the young adult and 1.68 for the middle adult.
The confrontive coping most used by the young adult is letting the
feelings out which scored 2.11, and the least confrontive coping used is
taking a big chance to solve the problem, having an average of 1.39.
Letting the feelings out is also the confrontive coping that the
middle adult used most which scored 2.06, and expressing anger to the
person who caused the problem and taking a big chance to solve the
problem with a same score of 1.41 are the least confrontive coping used
by middle adult.
90
The table shows that among the confrontive coping of the lung
cancer patients, letting feeling’s out somehow when dealing with
problem ranked first. The young and middle adult used this coping quite
a bit. Fighting for what i want ranked second. Both the young and
middle adult used this coping quite a bit. Getting person’s responsibility
to change his mind ranked third. Both the young and middle adult used
this coping quite a bit. Doing something that I didn’t think would work
ranked fourth. Both the young and middle adult used this coping quite a
bit. Expressing anger to the person who caused the problem ranked fifth.
Between the young and middle adult, the young adult used this coping
quite a bit while the middle adult used this coping somewhat. Taking a
big chance to solve the problem ranked sixth. Both the young and
middle adult used this coping quite somewhat.
Analysis:
Fighting spirit, typically measured by the Mental Adjustment to
Cancer (MAC) Scale (Watson et al., 1988), is described as accepting the
diagnosis of cancer while optimistically challenging, tackling,
91
confronting, and recovering from cancer (Greer, 1991; Nelson et al.,
1989; Watson et al., 1988). It has been implicated as a factor
contributing to longer survival among people, usually older, diagnosed
with cancer (Greer, 1991; Greer, Morris, Pettingale, & Haybittle, 1990;
Morris, Pettingale, & Haybittle, 1992; Pettingale, 1984) and, in some
studies, inversely related to scores on anxiety and depression (Burgess,
Morris, & Pettingale, 1988; Schnoll, Harlow, Stolbach, & Brandt, 1998;
Schwartz, Daltroy, Brandt, Friedman, & Stolbach, 1992; Watson et al.,
1991; Watson et al., 1994), emotional or psychological distress (Classen,
Koopman, Angell, & Spiegel, 1996; Ferrero, Barreto, & Toledo, 1994;
Friedman et al., 1988, 1990; Nelson et al., 1989; Nelson, Friedman,
Baer, Lane, & Smith, 1994; Schnoll, Mackinnon, Stolbach, & Lorman,
1995), and positively related to active-cognitive coping and optimism
(Nelson et al., 1989). Other measures of confrontation (e.g., the
Confrontive Coping Scale of the WOC Questionnaire; Folkman,
Lazarus, Dunkel-Schetter, DeLongis, & Gruen 1986) failed to replicate
these findings and even suggested a positive relationship between
confrontive coping and both reported physical symptoms and
92
psychological distress including negative affect (Hannum, Giese-Davis,
Harding, & Hatfield, 1991; Manne et al., 1994; Pettingale, Burgess, &
Greer, 1988).
Table 5
The Distancing Coping of the Young and Middle Adult Lung Cancer
Patients
Distancing
Young Adult
Verbal Interpretation
Middle Adult
Verbal Interpretation
Total Mean
Verbal Interpretation
Refusing to think
too much
2.06 UQAB 1.94 UQAB 2 UQAB
Refusing 2 UQAB 1.94 UQAB 1.94 UQAB
93
to get too serious
Looking for silver
lining
2.11 UQAB 1.59 UQAB 1.85 UQAB
Forgetting the whole
thing
1.89 UQAB 1.53 UQAB 1.71 UQAB
As if nothing
happened
1.78 UQAB 1.35 US 1.57 UQAB
Fate and bad luck
1.33 US 1.35 US 1.34 US
Average 1.86 UQAB 1.62 UQAB 1.74 UQAB
Interpretation:
Table 5 shows the Distancing Coping of the young and middle
adult lung cancer patients. Based on the obtained result by the
researcher, both the young and the middle adult used distancing quite a
bit with an average score of 1.86 for the young adult and an average
score 1.62 for the middle adult.
Legend:0-0.49: Does not apply or not used (DNA)0.50-1.49: Used somewhat (US)1.50-2.49: Used quite a bit (UQAB)2.50-3.00: Used a great deal (UAGD)
94
Looking for silver lining or on the bright side of things is the
distancing coping used by the young adult mostly, and the least likely
distancing coping used by the young adult is going along with fate and
having bad luck having an average score of 1.33.
Refusing to think too much with an average score of 2.06 and
refusing to get too serious having the same average score of 1.94 is the
most distancing coping used by the middle adult. However, Going along
with fate and having bad luck, going on as if nothing had happened are
the least distancing coping used by the middle adult with the same
average score of 1.35.
The table shows that among the distancing coping of the lung
cancer patients, Refusing to think too much ranked first. The young and
middle adult used this coping quite a bit. Refusing to get too serious
ranked second. Both the young and middle adult used this coping quite a
bit. Looking for silver lining ranked third. Both the young and middle
adult used this coping quite a bit. Forgetting the whole thing ranked
fourth. Both the young and middle adult used this coping quite a bit. As
if nothing happened ranked fifth. Between the young and middle adult,
95
the young adult used this coping quite a bit while the middle adult used
this coping somewhat. Fate and bad luck ranked sixth. Both the young
and middle adult used this coping somewhat.
Analysis:
Denial is the extensively researched coping (or defensive) modality
that implicates cognitions and behaviors that seek toward off anxiety,
minimize threat, and alleviate related distressing emotions. It has been
found to be prevalent among adult survivors of cancer (Cooper &
Faragher, 1992, 1993; Nelson et al., 1989; Wool & Goldberg, 1986). It
has also been linked to: (a) higher levels of psychosocial distress (Carver
et al., 1993; Quinn, et al., 1986); and (b) poorer adjustment to health
care especially to that of the old ones (Friedman et al., 1988). On the
other hand, it has also been linked to increased feelings of well-being
and psychological adjustment (Ferrero et al., 1994; Filipp et al., 1990;
Heim et al., 1997). Relatedly, denial, often in the form of detachment of
the seriousness of cancer diagnosis, was also related to lower mood
disturbance and emotional distress (Mishel & Sorenson, 1991; Watson,
Greer, Blake, & Shrapnell, 1984). It was not related to social adaptation
96
in a study by Heim et al. (1997). Denial was even found to be associated
with shorter term survival in one study (Derogatis, Abeloff, &
Melisaratos, 1979). A series of longitudinal studies however, reversed
these findings as deniers had longer survivability (Greer et al., 1990;
Morris et al., 1992; Pettingale, 1984).
As a specific form of the behavioral disengagement coping mode,
social withdrawal has been seldom studied; it was, however, found to be
linked to increased psychiatric symptomatology (i.e., higher GHQ
scores) in a single study (Chen et al., 1996).
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Table 6
The Self-Controlling Coping of the Young and Middle Adult Lung Cancer Patients
Self Controlling
Young Adult
Verbal Interpretation
Middle Adult
Verbal Interpretation
Total Mean
Verbal Interpretation
Going over my mind what to do
2.22 UQAB 2 UQAB 2.11 UQAB
Leaving things open
1.89 UQAB 1.88 UQAB 1.89 UQAB
Not acting too hastily
1.83 UQAB 1.94 UQAB 1.89 UQAB
Thinking about the person I admire as a model
1.94 UQAB 1.77 UQAB 1.86 UQAB
Keeping my feeling from interfering the
1.89 UQAB 1.77 UQAB 1.83 UQAB
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problemKeeping bad things from others
1.83 UQAB 1.71 UQAB 1.77 UQAB
Keeping feelings to myself
1.83 UQAB 1.47 US 1.65 UQAB
Average 1.92 UQAB 1.79 UQAB 1.86 UQAB
Interpretation:
Table 6 shows self controlling as a coping mechanism of young
and middle adult lung cancer patients. Both the young and middle adult
used self-controlling quite a bit based on the results obtained by the
researchers with an average of 1.92 for young adult, and 1.79 for the
middle adult.
Going over in their mind is the one used mostly by the young adult
in self-controlling as their coping mechanism which scored 1.92, and the
Legend:0-0.49: Does not apply or not used (DNA)0.50-1.49: Used somewhat (US)1.50-2.49: Used quite a bit (UQAB)2.50-3.00: Used a great deal (UAGD)
99
least self-controlling as coping mechanism used by the young adult is
trying to keep their feelings.
Trying not to act too hastily is the most self-controlling coping
mechanism used by the middle adult having an average score of 1.94.
And the least self controlling they used is trying to keep their feelings.
The table shows that among the self-controlling coping ability of
the lung cancer patients, going over my mind on what to do ranked first.
The young and middle adult used this coping quite a bit. Leaving things
open and not acting too hastily ranked second. Both the young and
middle adult used this coping quite a bit. Thinking about the person I
admire as a model ranked third. Both the young and middle adult used
this coping quite a bit. Keeping my feeling from interfering the problem
ranked fourth. Both the young and middle adult used this coping quite a
bit. Keeping bad things from others ranked fifth. Both the young and
middle adult used this coping quite a bit, keeping feelings to myself
ranked sixth. Between the young and middle adult, the young adult used
this coping quite a bit while the middle adult used this coping somewhat.
100
Analysis:
Personal control or the ability to use self-restraint is another
strategy adopted by survivors of cancer to cope with the stresses evoked
by the disease. It was found to be a predictor of positive psychosocial
adaptation (Ell et al., 1992; Heim, Valach, & Schaffner, 1997; Manne et
al., 1994) and lower distress (Morris, 1986) usually demonstrated by the
middle adults. Others, however (e.g., Wagner, Armstrong, & Laughlin,
1995), reported that a related coping strategy, that of suppression of
competing activities, was associated with poorer reported quality-of-life
among survivors of cancer.
Table 7
The Seeking Special Support of the Young and Middle Adult Lung Cancer Patients
Seeking Social
Support
Young Adult
Verbal Interpretation
Middle Adult
Verbal Interpretation
Total Mean
Verbal Interpretation
Asking advice from a relative
2.39 UQAB 2 UQAB 2.2 UQAB
Talking to 2.39 UQAB 1.94 UQAB 2.17 UQAB
101
someone about the situationAccepting sympathy from someone
2 UQAB 2 UQAB 2 UQAB
Talking something about my feeling
2 UQAB 2 UQAB 2 UQAB
Talking to someone about doing something concrete about the problem
2.06 UQAB 1.65 UQAB 1.86 UQAB
Getting professional help
1.44 US 1.82 UQAB 1.63 UQAB
Average 2.05 UQAB 1.90 UQAB 1.98 UQAB
Interpretation:
Legend:0-0.49: Does not apply or not used (DNA)0.50-1.49: Used somewhat (US)1.50-2.49: Used quite a bit (UQAB)2.50-3.00: Used a great deal (UAGD)
102
Table 7 shows the Seeking Self Support of the young and middle
adult lung cancer patients. Based on the results, both the young and
middle adults seek self support quite a bit
having an average score of 2.05 for young adult, and an average score of
1.90 for the middle adult.
In this category, talking more about the situation and taking to
someone about their feeling are the used mostly by the young adult with
the same average of 2.39. Getting professional help having an average
score of 1.44 is least likely used by the young adult.
Middle adult mostly accept sympathy, asks advice from a relative,
and talks to someone about their feelings. All those 3 has an average
score of 2. And the slightest thing used by the middle adult in this
category is doing something concrete about the problem having an
average of 1.65.
The table shows that among the seeking-social support coping
ability of the lung cancer patients, Asking advice from a relative ranked
first. The young and middle adult used this coping quite a bit. Talking to
someone about the situation ranked second. Both the young and middle
103
adult used this coping quite a bit. Accepting sympathy from someone
and talking something about my feeling ranked third. Both the young
and middle adult used this coping quite a bit. Talking to someone about
doing something concrete about the problem, ranked fourth. Both the
young and middle adult used this coping quite a bit. Getting professional
help ranked fifth. Between the young and middle adult, the young adult
used this coping somewhat while the middle adult used this quite a bit.
Analysis:
Another coping strategy directed at defusing stress among adult
people with cancer is seeking support from others. Results have
generally demonstrated a positive association between seeking or
reporting satisfaction with social support and decreased
emotional/psychological distress (Dunkel-Schetter et al., 1992; Jamison,
Wellisch, & Pasnau, 1978; Mishel & Braden, 1987; Rodrigue, Behen, &
Tumlin, 1994; Stanton & Snider, 1993), better psychosocial adaptation
(Heim et al., 1997), and higher subjective perceptions of well-being,
albeit only in a transient manner (Filipp et al., 1990).
104
A frequently researched coping strategy, in both the general
population and among survivors of cancer, is expressing or venting
emotions. Its use has been linked to higher levels of depression (Keyes
et al., 1987), greater psychosocial distress (Quinn, Fontana, &
Reznikoff, 1986), sickness-related dysfunction (Keyes et al., 1987), and
lower perceived quality-of-life (Wagner et al., 1995). However, in two
studies, this strategy was also related to decreased psychiatric morbidity
as measured by the General Health Questionnaire (Chen et al., 1996) and
lower mood disturbance (emotional control, alternatively, was associated
with mood disturbance; Classen et al., 1996).
Table 8
Accepting Responsibility of the Young and Middle Adult Lung
Cancer Patients
105
Accepting Responsibility
Young Adult
Verbal Interpretation
Middle Adult
Verbal Interpretation
Total Mean
Verbal Interpretation
Apologizing or making up
2 UQAB 1.94 UQAB 1.97 UQAB
Promising to make things different next time
2.11 UQAB 1.77 UQAB 1.94 UQAB
Criticizing myself
2.33 UQAB 1.18 US 1.76 UQAB
Realizing the problem on myself
1.61 UQAB 1.47 US 1.54 UQAB
Average 2.01 UQAB 1.59 UQAB 1.8 UQAB
Interpretation:
Table 8 shows the Accepting Responsibility of young and middle
adult lung cancer patients. Based on the following results, both the
young and middle adult accepts responsibility quite a bit, having an
average score of 2.01 for the young adult and 1.59 for the middle adult.
Criticizing themselves is the most common accepting
responsibility used by the young adult having an average score of 2.33.
Legend:0-0.49: Does not apply or not used (DNA)0.50-1.49: Used somewhat (US)1.50-2.49: Used quite a bit (UQAB)2.50-3.00: Used a great deal (UAGD)
106
And the least accepting responsibility that they are using is realizing the
problem brought about by them, which has an average of 1.6.
Apologizing or do something to make up is the most accepting
responsibility used by the middle adult with an average score of 1.94,
and the least accepting responsibility used is criticizing themselves with
an average score of 1.18.
The table shows that among the accepting responsibility coping
ability of the lung cancer patients, apologizing or making up ranked first.
The young and middle adult used this coping quite a bit. Promising to
make things different next time ranked second. Both the young and
middle adult used this coping quite a bit. Criticizing myself ranked third.
Between the young and middle adult, the young adult used this coping
quite a bit while the middle adult used this somewhat. Realizing the
problem on myself ranked fourth. Between the young and middle adult,
the young adult used this coping quite a bit while the middle adult used
this somewhat
Analysis:
107
Accepting responsibility is not always easy. Even though few
people enjoy listening to them, the human supply of excuses is
seemingly endless.
(http://www.ideasandtraining.com/WTTleadership_courage_01.pdf)
Attribution blame as a coping strategy has been only sporadically
studied. Results suggest, however, that it may be associated with: (a)
greater emotional distress (Berckman & Austin, 1993; Faller, Schilling,
& Lang, 1995; Quinn et al., 1986), (b) increased level of depression
(Faller et al., 1995), and (c) decreased general psychosocial adjustment
(Heim et al., 1997).
Acceptance of one's condition, including the reality of its
implications, learning to live with it, and at times, its irreversible course,
has been found to be a common coping strategy among people with
cancer, usually adults (Berckman & Austin, 1993; Carver et al., 1993). It
has been linked to lower psychosocial distress in one study (Carver et
al., 1993). More frequently, though, it has been linked to higher short-
term mood disturbance and state anxiety (Watson et al., 1984), increased
depression and anxiety (Parle et al., 1996), increased psychosocial
108
distress (Miller et al., 1996), and decreased feelings of well-being
(Miller et al., 1996).
Table 9
The Escape-Avoidance Coping Strategy of the Young and Middle Adult Lung Cancer Patients
Escape- Avoidance
Young Adult
Verbal Interpretation
Middle Adult
Verbal Interpretation
Total Mean
Verbal Interpretation
Having fantasies
2.11 UQAB 1.88 UQAB 2 UQAB
Sleeping more than the usual
1.83 UQAB 1.59 UQAB 1.71 UQAB
Refusing to believe what happened
1.61 UQAB 1.77 UQAB 1.68 UQAB
Wishing situation would go away
1.61 UQAB 1.65 UQAB 1.63 UQAB
Generally avoiding people
1.5 UQAB 1.59 UQAB 1.55 UQAB
Taking it out on other people
1.5 UQAB 1.59 UQAB 1.55 UQAB
109
Hoping for a miracle
1.33 US 1.41 US 1.37 US
Trying to make myself feel better
1.44 US 1.18 US 1.31 US
Average 1.62 UQAB 1.58 UQAB 1.60 UQAB
Interpretation:
Table 9 shows the Escape Avoidance Coping Mechanism of the
young and middle adult lung cancer patients. Both the young and the
middle adult used Escape Avoidance quite a bit based on the obtained
results by the researcher. There is an average score of 1.62 for the young
adult, and an average score of 1.58 for the middle adult.
In this category, having fantasies is used mostly by the young adult
with an average score of 2.11, and the one that is used least is hoping for
a miracle with an average score of 1.33.u
Legend:0-0.49: Does not apply or not used (DNA)0.50-1.49: Used somewhat (US)1.50-2.49: Used quite a bit (UQAB)2.50-3.00: Used a great deal (UAGD)
110
Having fantasies is also the one used mostly by the middle adult in
this category, having an average of 1.88, and trying to make them feel
better is the least escape avoidance they used with an average of 1.18.
The table shows that among the escape-avoidance coping ability of
the lung cancer patients, having fantasies ranked first. The young and
middle adult used this coping quite a bit, Sleeping more than the usual
ranked second. Both the young and middle adult used this coping quite a
bit. Refusing to believe what happened ranked third. Both the young and
middle adult used this coping quite a bit. Wishing situation would go
away ranked fourth. Both the young and middle adult used this coping
quite a bit. Generally avoiding people and taking it out on other people
ranked fifth. Both the young and middle adult used this coping quite a
bit. Hoping for a miracle, both the young and middle adult used this
coping somewhat. Trying to make myself feel better ranked seventh.
Both the young and middle adult used this coping somewhat
Analysis:
The existence of this cognitive-behavioral strategy was
demonstrated in several factorial analytic studies of adult people with
111
cancer (e.g., Dunkel-Schetter et al., 1992; Jarrett, et al., 1992). This
strategy resembles wishful thinking and miracle seeking strategies. It
also includes praying for restoration of health; preparing for the worst;
avoiding other people; resorting to eating, drinking, smoking; and
engaging in risky behaviors. This strategy appears to be associated
mainly with: (a) increased emotional distress (Dunkel-Schetter et al.,
1992; Nelson et al., 1994; Rodrigue et al, 1994; Stanton & Snider,
1993); (b) poor general psychosocial adjustment including the
vocational, domestic, familial, and social domains (Friedman et al.,
1988, 1990; Heim et al., 1997); (c) increased levels of anxiety
(Rodrigue, Boggs, Weiner, & Behen, 1993; Watsen et al., 1994); and (d)
lower degree of vigor (Stanton & Snider, 1993). A study by Schwartz et
al. (1992), however, failed to detect any relationship between avoidance
and measures of depression and anxiety. This strategy was also
characteristic of those who demonstrated low commitment, low sense of
control, and high perception of uncertainty (Hilton, 1989).
This coping strategy, conceptually related to denial, seeks to
diminish negative feelings by resorting to fantasy, diversion, and
112
distraction of thoughts (all are forms of mental disengagement) from the
problem at hand. This strategy has been linked to: (a) greater
psychosocial distress (Quinn et al., 1986; Stanton & Snider, 1993); (b)
lower feelings of vigor (Mishel & Sorenson, 1993; Stanton & Snider,
1993); (c) lower perceived quality-of-life (Wagner et al., 1995); and (d)
affective distress, including increased depression and anxiety (Mishel &
Sorenson, 1991, Mishel, et al., 1991; Parle, Jones, & Maguire, 1996). It
was also marginally related to higher (increased symptomatology) scores
on the GHQ (Chen et al., 1996).
Table 10
The Planful Problem Solving Coping Strategy of the Young and Middle Adult Lung Cancer Patients
Planful Problem Solving
Young Adult
Verbal Interpretation
Middle Adult
Verbal Interpretation
Total Mean
Verbal Interpretation
Concentrating on the next step
2.39 UQAB 2.24 UQAB 2.32 UQAB
Coming up with different solution to problem
2.11 UQAB 2.12 UQAB 2.12 UQAB
Making a 2.33 UQAB 1.88 UQAB 2.11 UQAB
113
plan of action and following itChanging something to do right
2.11 UQAB 2.06 UQAB 2.09 UQAB
Knowing what had to be done and doubling my efforts to make things work
2.06 UQAB 1.82 UQAB 1.94 UQAB
Drawing on my past experiences
1.67 UQAB 1.88 UQAB 1.78 UQAB
Average 2.11 UQAB 2 UQAB 2.06 UQAB
Interpretation:
Table 10 shows the Planful Problem Solving of young and middle
adult lung cancer patients. Based on the obtained result, both the young
Legend:0-0.49: Does not apply or not used (DNA)0.50-1.49: Used somewhat (US)1.50-2.49: Used quite a bit (UQAB)2.50-3.00: Used a great deal (UAGD)
114
and the middle adult used Planful Problem Solving quite a bit, having an
average of 2.11 for young adult and 2 for middle adult.
The Planful Problem Solving technique that is mostly used by the
young adult is concentration on the next step, which has an average of
2.39, while drawing on their past experiences is the one that they used
least in this category with an average of 1.67.
Same with young adult, the Planful Problem Solving technique that
is mostly used by the middle adult is concentration on the next step,
having an average of 2.24, but the one that they used least in this
category is “Knowing what had to be done” with an average of 1.82.
The table shows that among planful problem solving ability of the
lung cancer patients, concentrating on the next step ranked first. The
young and middle adult used this coping quite a bit. Coming up with
different solution to problem ranked second. Both the young and middle
adult used this coping quite a bit. Making a plan of action and following
it ranked third. Both the young and middle adult used this coping quite a
bit. Changing something to do right ranked fourth. Both the young and
middle adult used this coping quite a bit. Knowing what had to be done
115
and doubling my efforts to make things work ranked fifth. The young
and middle adult used this coping quite a bit. Drawing on my past
experiences ranked sixth. Both the young and middle adult used this
coping somewhat.
Analysis:
This category refers to coping efforts directed at problem (e.g.,
stressful situations) resolution via focused planning and direct action
taking. The available literature suggests that this strategy is frequently
used by adult patients with cancers, like breast and cervical (Gotay,
1984; Heim et al., 1987; Hilton, 1989). It was generally found to have
salutary effects on global mental health (Chen et al., 1996), lower levels
of depression and anxiety (Mishel & Sorenson, 1993; Morris, 1986),
increased vigor (Mishel & Sorenson, 1993), but also was unexpectedly
associated with poorer social adjustment (Merluzzi & Martinez-Sanchez,
1997).
Table 11
116
The Positive Reappraisal Coping Strategy of the Young and Middle Adult Lung Cancer Patients
Positive Reappraisal
Young Adult
Verbal Interpretation
Middle Adult
Verbal Interpretation
Total Mean
Verbal Interpretation
Changing as a person
2.06 UQAB 2.65 UQAB 2.36 UQAB
Praying 2.22 UQAB 2.35 UQAB 2.29 UQABChanging something about myself
2.22 UQAB 1.94 UQAB 2.08 UQAB
Rediscovering life
2.11 UQAB 1.94 UQAB 2.03 UQAB
Inspired to do something creative about the problem
2.06 UQAB 1.82 UQAB 1.94 UQAB
Experiencing better than what I went through
1.94 UQAB 1.71 UQAB 1.83 UQAB
Finding new faith
1.78 UQAB 1.47 US 1.63 UQAB
Average 2.06 UQAB 1.98 UQAB 2.02 UQAB
Interpretation:
Legend:0-0.49: Does not apply or not used (DNA)0.50-1.49: Used somewhat (US)1.50-2.49: Used quite a bit (UQAB)2.50-3.00: Used a great deal (UAGD)
117
Table 11 shows the Positive reappraisal of young and middle adult
lung cancer patients. Based on the results obtained by the researcher,
both the young and the middle adult lung cancer patients used Positive
Reappraisal quite a bit, having an average of 2.06 for the young adult
and an average of 1.98 for the middle adult.
Changing something about themselves and praying are the Positive
Reappraisals used mostly by the young adult, having the same average
of 2.22. And the least like used Positive Reappraisal is finding new faith
with an average of 1.78.
Middle adult used changing as a person mostly in this category,
having an average of 2.65, and the one that is used least is finding new
faith with an average of 1.47.
The table shows that among the positive reappraisal coping ability
of the lung cancer patients, changing as a person ranked first. The young
and middle adult used this coping quite a bit. Praying ranked second.
Both the young and middle adult used this coping quite a bit. Changing
something about myself ranked third. Both the young and middle adult
used this coping quite a bit. Rediscovering life ranked fourth. Both the
118
young and middle adult used this coping quite a bit. Inspired to do
something creative about the problem, ranked fifth. Both the young and
middle adult used this coping quite a bit. Experiencing better than what I
went through ranked sixth. Both the young and middle adult used this
coping quite a bit. Finding new faith ranked seventh. Between the young
and middle adult, the young adult used this coping quite a bit while the
middle adult used this coping somewhat.
Analysis:
Seeking comfort in, or actively relying on, religion and praying for
reversal of the disease course has been reported to be more common
among late stage cancer groups of adult population (Gotay, 1984). It has
been found to be related to: (a) higher scores on mental health and
psychological well-being (Ell et al., 1989) and (b) better adjustment to
the medical aspects of cancer (Merluzzi, & Martinez-Sanchez, 1997).
119
However, it has also been related to poorer perceived quality-of-life
(Wagner et al., 1995). Searching for meaning in religion was also found
to be independent of levels of well being (as an indicator of an affective
state) in a sample of German survivors of cancer (Filipp et al., 1990).
Finally, other researchers (e.g., Berckman & Austin, 1993) failed to find
any relationship between measures of psychosocial adjustment and
measures of cognitive control including those of prayer and accepting
God's will.
This group of coping strategies has surfaced under a number of
different and, at times, slightly variant names such as:, cognitive
(re)appraisal, positive growth, focus on the positive, positive thinking,
and This coping, among survivors of cancer, has been studied
extensively and is reported to be used frequently (Berckman & Austin,
1993; Jarrett, Ramirez, Richards, & Weinman, 1992). It has been linked
to higher scores on measures of mental health and psychological well-
being (Ell, Mantell, Hamovitch, & Nishimoto, 1989), positive affect
(Manne et al., 1994), lower psychological or emotional distress (Carver
et al., 1993; Dunkel-Schetter et al., 1992; Ell et al., 1989; Mishel,
120
Padilla, Grant, & Sorenson, 1991; Mishel & Sorenson, 1991; Schnoll et
al., 1995), lower psychiatric symptomatology (Chen, et al., 1996), and
increased vigor (Schnoll et al., 1995; Stanton & Snider, 1993). This
strategy, along with seeking social support, problem solving, and self-
controlling, were also adopted more by those with high threat of cancer
reoccurrence and high sense of control common in older population
(Hilton, 1989).
Table 12
Summary of the Total Mean of Each Category
Categories Young Adult
Verbal Interpretation
Middle Adult
Verbal Interpretation
Total Mean
Verbal Interpretation
Planful Problem Solving
2.11 UQAB 2 UQAB 2.06 UQAB
Positive Reappraisal
2.06 UQAB 1.98 UQAB 2.02 UQAB
Seeking Social Support
2.05 UQAB 1.90 UQAB 1.98 UQAB
Self- Controlling
1.92 UQAB 1.79 UQAB 1.86 UQAB
Accepting Responsibility
2.01 UQAB 1.59 UQAB 1.8 UQAB
Distancing 1.86 UQAB 1.62 UQAB 1.74 UQAB
121
Confrontive Coping
1.72 UQAB 1.68 UQAB 1.7 UQAB
Escape Avoidance
1.62 UQAB 1.58 UQAB 1.6 UQAB
Average 1.92 UQAB 1.77 UQAB 1.85 UQAB
Interpretation:
Table 12 shows the summary of the average score of the different
ways of coping in each category. Based on the obtained results, both the
young and middle adult used the following ways of coping quite a bit,
with an average of 1.92 for the young adult, and an average of 1.77 for
the middle adult.
Young adult used the Planful Problem Solving mostly, having an
average of 2.11 while Confrontive coping is the one that they used least
among the different ways of coping, having an average of 1.72.
Legend:0-0.49: Does not apply or not used (DNA)0.50-1.49: Used somewhat (US)1.50-2.49: Used quite a bit (UQAB)2.50-3.00: Used a great deal (UAGD)
122
Middle adult used Planful Problem Solving mostly, having an
average of 2, while escape avoidance is the one that they used least as a
way of coping with an average of 1.58.
The table shows that among the coping abilities of the lung cancer
patients, planful problem solving ranked first. The young and middle
adult used this coping quite a bit. Positive Reappraisal ranked second.
Both the young and middle adult used this coping quite a bit. Seeking
Social Support about me ranked third. Both the young and middle adult
used this coping quite a bit. Self- Controlling ranked fourth. Both the
young and middle adult used this coping quite a bit. Accepting
Responsibility ranked fifth. Both the young and middle adult used this
coping quite a bit. Distancing, ranked sixth. Both the young and middle
adult used this coping quite a bit. Confrontive Coping ranked seventh.
The young and middle adult used this coping quite a bit. Escape
Avoidance ranked eighth. The young and middle adult used this coping
quite a bit.
Analysis:
123
Younger and older subjects coped in similar ways, based on the
study conducted by McCrae (1992), which was made clear from the
young study made by Folkman and Lazarus (1980) which states that
younger and older did not differ on the way they make use of problem-
and emotion-focused of coping.
Pargament (1997) proposed a theoretical explanation for why
gender and race may influence the use of religion in coping. He
postulated that older people have less societal access to resources and
power. Therefore, religion becomes an accessible resource that is easily
called upon for coping in times of crisis. Women and African Americans
reported higher levels of personal religiousness and more religious
involvement and, thus, may gain more from the use of religious coping.
Findings from a searched study support prior research results that
suggests that older people report using a repertoire of pharmacologic and
non-pharmacologic strategies to manage different infirmity like that of
having chronic pain. Of the nonreligious coping strategies, older people
reported taking pain medications, reporting pain to doctors and nurses,
124
diversion, and exercise most often. These findings suggest that (a) older
people were focused on solving their pain problem so that they could
perform everyday activities with less difficulty; (b) older people
appraised their chronic pain as treatable; (c) older people sought
professional help from health care providers to help manage their pain;
and (d) combinations of pain medications and cognitive coping
strategies were used most often to manage pain. Prior research has
suggested that older adults used more passive coping strategies and
fewer information-seeking efforts as compared to that of the younger
adults. However, this study found that respondents used more active,
problem-focused strategies than passive strategies. Thus, older
people appear to be open to diverse pain management options in an
effort to feel better. Therefore, clinicians who care for geriatric patients
need to maintain current knowledge of treatment strategies for pain
management in later life.
Having effective coping mechanisms may be one of the most
important predictors of well being across the life span. Baca, D. P.,
125
George, S. M., & Albertson Owens, S. A. (1999, November) conducted
a study on the Coping and life satisfaction in younger and older adults.
They examined the relation between four types of coping strategies
and life satisfaction in 224 younger adults (18-35 years) and 223 older
adults (60-95 years). All participants were healthy community dwelling
volunteers who were interviewed about their coping competency, and
their use of optimism, humor and spirituality to cope with difficult life
events. Participants were queried about health and life satisfaction; and
answered questions from the Life Orientation Test, Coping Humor Scale
and the Spiritual Well Being Scale. The researchers found no age
differences on reports of health, life satisfaction, and the use of
optimism, humor and spirituality. Collapsing across age, the researchers
also found a positive and statistically significant relation between each
of the four coping strategies and life satisfaction. Descriptions of these
coping strategies are included. These results may be interesting to
individuals who are caregivers or who are providing supportive services
to older adults.
126
Table 13
Comparison of the Perception of the Young and Middle Adult
Towards the Caring Factors Received
VERBAL INTERPRETATION
Young Adult 5.30 SAMiddle Adult 5.42 SA
Interpretation:
Table 13 shows the comparison of the perception of the young
and middle adult towards the caring factors received, researchers found
out that the young adults had an average score of 5.30 in the Caring
Factor Survey. This data presents that the young adult cancer patients
slightly agree about receiving holistic care. The middle adults, on the
other hand, had an average score of 5.42. This data presents that middle
adult cancer patients slightly agree about receiving holistic care.
Legend:0.5 – 1.49 Strongly Disagree (StD) 4.50 – 5.49 Slightly Agree (SA)1.50 – 2.49 Disagree (D) 5.50 – 6.49 Agree (A)2.50 – 3.49 Slightly Disagree (SD) 6.50 – 7.49 Strongly Agree (StA)3.50 – 4.49 Neutral (N)
127
Analysis:
Okumura (2008) proposed that there are some factors that directly
affect the quality and perception of care for young and middle adults
with chronic illnesses, and according to him, how these factors impact
patients outcomes must be studied for future use. Moreover the
researcher’s studies revealed that there are also some certain barriers that
affect the provision of quality care, such as lack of proper training of
health care practitioners, might limit their ability to provide high quality
primary care for patients with chronic illness. Another barrier in
receiving primary health care for patients with chronic conditions
recognized by Okumura was that there might be not enough health care
services provided to patients to have productive lives. These barriers, in
the provision of primary health care to young and middle adult patients
with chronic illnesses, might in return affect patient’s perception of the
care provided.
128
Table 14
The Significant Difference between the Perception of Young and Middle
Adult Patients Towards the Care Received
Source of variation
SS DF MS T-ratio Significance
Between Groups
0.15 1 0.153
No significanceWithin Groups 1.78 38 0.05
Total 1.93 Interpretation:
Table 14 shows the significant difference between the perception
of young and middle adult patients towards the care received. The
critical value of T for df = 1/38 at the 0.05 level of significance is 4.08.
Since the computed T-ratio of 3 is lesser than 4.08 at the 0.05 level of
significance, the researchers found out that there is no significant
129
difference between the perception of young adult and middle adult lung
cancer patients towards the care received.
Analysis:
In a study by Johnson and Lin et.al (2000), it was stated that the
“perceptions of patients and proxies with respect to the goals of care
recommended to them by physicians may be the result of many force,”
affirming that the perception of care among patients is a result of
numerous factors affecting them.
Okumura (2008) proposed that there are some factors that directly
affect the quality and perception of care for young and middle adults
with chronic illnesses, and according to him, how these factors impact
patients outcomes must be studied for future use. Moreover the
researcher’s studies revealed that there are also some certain barriers that
affect the provision of quality care, such as lack of proper training of
health care practitioners, might limit their ability to provide high quality
primary care for patients with chronic illness. Another barrier in
receiving primary health care for patients with chronic conditions
130
recognized by Okumura was that there might be not enough health care
services provided to patients to have productive lives. These barriers, in
the provision of primary health care to young and middle adult patients
with chronic illnesses, might in return affect patient’s perception of the
care provided.
Table 15
Comparison of the Extent of Coping of Young and Middle Adult Lung Cancer
Patients
Verbal Interpretation
Young Adult 1.92 UQABMiddle Adult 1.77 UQAB
Interpretation:
Legend:0-0.49: Does not apply or not used (DNA)0.50-1.49: Used somewhat (US)1.50-2.49: Used quite a bit (UQAB)2.50-3.00: Used a great deal (UAGD)
131
Table 15 shows the comparison between the extent of coping of
young and middle adult lung cancer patients. Based on the obtained
results, both the young and middle adults used the following ways of
coping quite a bit, with an average of 1.92 for the young adult, and an
average of 1.77 for the middle adult.
Analysis:
In the study conducted by McCrae (1982) to examine the effect of
age differences in the community sample of men and women with the
way they make use of 28 coping mechanisms, after controlling the type
of stress (challenge, loss, or threat), he concluded that younger and older
subjects coped in similar ways. From the study, it was known that older
subjects do not mostly use the hostile reaction and escapist fantasy.
These findings was also made clear from the earlier study made by
Folkman and Lazarus (1980), who assessed age differences among
individuals aged 45 to 64 in the use of problem-focused coping and
emotion-focused coping. For instance, they found out that subjects used
more emotion-focused coping in health encounters than in other types of
encounters, and more stressful encounters related to health are being
132
experienced by older clients than the younger subjects. It was also found
out that in encounters related to health, the older and younger subjects
did not differ on the way they make use of problem- and emotion-
focused coping.
Table 16
The Significant Difference between the Extent of Coping of Young and Middle Adult
Lung Cancer Patients
Source of Variation
SS DF MS T-ratio Significance
Between Groups
0.09 1 0.093
NoSignificaneWithin Groups 0.42 14 0.03
Total 0.51 Interpretation:
Table 16 shows the significant difference between the extent of
coping of young and middle adult lung cancer patients. The critical
value of T for df = 1/14 at the 0.05 level of signigicance is 4.60. Since
the computed T-ratio of 3 is lesser than the value of 4.60 at the 0.05
133
level of significance, the researchers found out that there is no
significant difference between the extent of coping of young and middle
adult lung cancer patients.
Analysis:
In the study conducted by McCrae (1982) to examine the effect of
age differences in the community sample of men and women with the
way they make use of 28 coping mechanisms, after controlling the type
of stress (challenge, loss, or threat), he concluded that younger and older
subjects coped in similar ways. From the study, it was known that older
subjects do not mostly use the hostile reaction and escapist fantasy.
These findings was also made clear from the earlier study made by
Folkman and Lazarus (1980), who assessed age differences among
individuals aged 45 to 64 in the use of problem-focused coping and
emotion-focused coping. For instance, they found out that subjects used
more emotion-focused coping in health encounters than in other types of
encounters, and more stressful encounters related to health are being
experienced by older clients than the younger subjects. It was also found
134
out that in encounters related to health, the older and younger subjects
did not differ on the way they make use of problem- and emotion-
focused coping.
Table 17
Comparison of Coping and Caring between Young Adults and
Middle Adults
CARING COPINGAverage Verbal
InterpretationAverage Verbal
InterpretationYoung Adults
5.30 SA 1.92 UQAB
135
Middle Adults
5.42 SA 1.77 UQAB
Interpretation:
Table 17 shows the comparison of coping and caring between
young adult and middle adult lung cancer patients. Based from the value
obtained, the researchers have found out that both young and middle
adults slightly agree that they receive a caring environment from the
nurses based on the carative factors of Jean Watson. When it comes to
coping ways of lung cancer patients, the researchers have found out that
both young and middle adults used quite a bit the coping ways provided
by Lazarus and Folkman.
Analysis:
Legend:0.5 – 1.49 Strongly Disagree (StD) 4.50 – 5.49 Slightly Agree (SA)1.50 – 2.49 Disagree (D) 5.50 – 6.49 Agree (A)2.50 – 3.49 Slightly Disagree (SD) 6.50 – 7.49 Strongly Agree (StA)3.50 – 4.49 Neutral (N)
Legend:0 – 0.49 Does not apply or not used (DNA)0.50 - 1.49 Used somewhat (US)1.50-2.49 Used quite a bit (UQAB)2.50-3.00 Used a great deal (UAGD)
136
Okumura (2008) proposed that there are some factors that directly
affect the quality and perception of care for young and middle adults
with chronic illnesses, and according to him, how these factors impact
patients outcomes must be studied for future use. Another barrier in
receiving primary health care for patients with chronic conditions
recognized by Okumura was that there might be not enough health care
services provided to patients for them to have productive lives. These
barriers, in the provision of primary health care to young and middle
adult patients with chronic illnesses, might in return affect patient’s
perception of the provision of care given to them. According to Johnson
and Lin, the perception of care among patients is a result of numerous
factors affecting them. Some factors such as personal preferences,
cultural practices and beliefs, and the synthesis of input from several
physicians, friends and family members may all contribute to a patient’s
perception of care (Johnson and Lin).
Younger and older subjects coped in similar ways, based on the
study conducted by McCrae (1992). From the study, it was known that
older subjects do not mostly use the hostile reaction and escapist fantasy.
137
These findings was also made clear from the earlier study made by
Folkman and Lazarus (1980), who assessed age differences among
individuals aged 45 to 64 in the use of problem-focused coping and
emotion-focused coping. And as stated earlier, differences in sources of
stress is a factor on how different ages cope. For instance, they found out
that subjects used more emotion-focused coping in health encounters
than in other types of encounters, and more stressful encounters related
to health are being experienced by older clients than the younger
subjects. It was also found out that in encounters related to health, the
older and younger subjects did not differ on the way they make use of
problem- and emotion-focused coping. Lazarus and Folkman also claim
that the quality of a coping strategy can only be judged in relation to
adaptational outcomes. According to Mishara, coping strategies vary
depending upon the type of situation and the individual’s strength. There
are some who may deal in a situation less well because they simply do
not know how to use more effective strategies whereas others simply
choose an ineffective strategy for a specific situation (Mishara, 2002).
138
Table 18
The Significant Relationship Between the Caring Factors Received
and the Extent of Coping of Young and Middle Adult Lung Cancer Patients
Degree of Relationshi
p
Level of Significance
Computed r-Value
Computed t statistics
value
Interpretation Decision
33 0.05 -0.03 -0.17 Not significantly
related
Accept Null
Hypothesis
Interpretation:
Table 18 shows the significant relationship between the caring
factors received and the extent of coping of young and middle adult lung
cancer patients. According to the data shown, there is no significant
relationship between the provision of a caring environment by the nurses
and the coping of the lung cancer patients for the reason that the
computed r-value which is -0.03 is lesser than the tabular value which is
0.33. Thus, the null hypothesis is accepted.
The provision of a caring environment by the nurses to the lung
cancer patients will not influence their ways of coping to the disease.
Hence, coping of lung cancer patients and the provision of a caring
139
environment are independent from each other; they do not go hand in
hand.
In testing the significance of r, the computed t-statistics which is -
0.17, is greater than the reference value which is -2.16. Therefore, we
will accept the null hypothesis.
Analysis:
Based from the results of the study, the very small negative
correlation between the extent of coping of lung cancer patients and the
provision of a caring environment can be due to the fact that coping of
lung cancer patients can be affected by several factors. Other factors that
can affect coping are:
First, having different personality, each person has own specific
coping strategies, there is no right way to perfectly cope with a disease
of lung cancer. Rather a right coping strategy is one that favors your
personality or attitude that it contributes to your well being. People cope
better when they face a problem or crisis head-on, rather than try to
avoid the inevitable or count on its going away. There is evidence that a
positive attitude improves a person's quality of life. However, trying to
140
be positive should not become a burden. Very few people are optimistic
all the time and it is natural and understandable to feel down sometimes.
Successful copers tend to feel challenged rather than thrown or defeated
by a problem, and they believe they can master it. They also demonstrate
a “fighting spirit,” committing themselves to a goal, hanging in, and
following through
(http://oralcancerfoundation.org/emotional/coping.htm).
Second, having a caring medical team that is supportive and
reassuring and having a caring nurse who can interpret the doctor’s
communications. A caring healthcare provider is vital factor for better
coping of the patient with Lung cancer. Through the support of the
healthcare team, the patient may be able to enhance his coping and take
things into a positive side. Upholding Watson’s caring theory not only
allows the nurse to practice the art of caring and compassion to ease
patients’ and families’ suffering and to promote their healing and dignity
but it can also contribute to expand the nurse’s own actualization
(Watson, 2001).
141
Third, having support from others (family, friends). Patients need
extra support from friends, family, your oncology team, or a counselor.
Communicating with a cancer survivor who has gone through the same
treatment can be helpful; someone who is living proof that you can make
it becomes a beacon of hope. Practical advice from survivors has a
credibility that other people’s advice lacks, because you know they have
been there (http://oralcancerfoundation.org/emotional/coping.htm).
Fourth, seeking counseling to change behaviors or ways of coping
that is counter-productive. Based o the study on the quality of life of
lung cancer patients done in 1997. The study aimed to see the effect of
the cancer support program proposed by the Lung Center of the
Philippines on the quality of life of lung cancer patients of the same
institution. Participants will join the education and counseling program.
The findings on the study demonstrated an important change of the
emotional well-being and functional well-being of the lung cancer
patients that attended the four-week Cancer Support Program’s
educational and counseling sessions. It was also noted that the
142
improvement of the participants in the study was attributed to higher
level of education (Sinsuat and Naval, 1997).
Fifth, inadequate spiritual support provided by the medical system.
Research has shown that religiosity and spirituality significantly
contribute to psychosocial adjustment to cancer and its treatments.
Religion offers hope to those suffering from cancer, and it has been
found to have a positive effect on the quality of life of cancer patients.
Numerous studies have found that religion and spirituality also provide
effective coping mechanisms for patients as well as family caregivers.
(Weaver and Flannelly December 2004). In short, faith plays a
significant role in helping one to have hope and in turn hope plays a
significant role in providing an effective coping mechanism. Individuals
who rely on their faith tend to have more active coping styles,
addressing treatment options in a more positive manner. These benefits
extend beyond those living with cancer, and caregivers who consider
spirituality important in their lives, are also able to cope better as they
care for their loved ones with cancer. Studies also tell us that patients
143
who are given spiritual support by religious communities, have a
significantly better quality of life. Whether this is due to an individual’s
faith or the services that such a community can provide is uncertain.
Regardless, many religious communities can provide support for those
living with cancer ranging from social interaction, to assistance with
chores and transportation, to financial assistance in some cases (Balboni,
T. et al, 2007).
Sixth, personality of the individual person, studies shows that
individual having type c personality that is poor ability to cope with
stress, individuals who show inability to express and resolve deep
emotional problems and a history of lack of closeness. Ongoing
suppression and internalization of emotion weakens the body. Those
people having the type c personality are more likely to engage in
smoking and other vices. The correlation suggests that managing
personality traits is necessary for recovery (Cowan, Thomas S. The
Fourfold Path to Healing. 2004).
144
Seventh, present stage in the Grief cycle of Kubler Ross, according
to a study in denial of lung cancer patients, most patients display low to
moderate level of denial. More male patients exhibited more denial than
female ones, while younger patients showed less denial than the elderly.
Patient with a lower level of education denied stronger than educated
ones. As a conclusion a certain level of denial has to be considered a
normal phenomenon. Whether the level of denial is used in adaptive or
maladaptive coping, it still to be investigated (Vos et. al December
2007).
Eight, feeling inadequately informed about the nature of the
treatment: the need for it and its goals and side effects. Lung cancer are
not satisfied with the amount and type of information they are given
about their diagnosis, their prognosis, available treatments, and ways to
manage their illness and health. Health care providers often fail to
communicate this information effectively, in ways that are
understandable to patients (Epstein and Street, 2007).
145
Ninth, having a medical team that communicates poorly and
doesn’t convey a sense of caring. Studies also have revealed that
physicians largely underestimate oncology patients’ psychosocial
distress (Merckaert et al., 2005). In a national survey of members of the
American Society of Clinical Oncology, a third of respondents stated
that they do not routinely screen their patients for distress (Jacobsen and
Ransom, 2007).
DISCUSSION OF THE FINDINGS
In question number one, the researchers found out that the young
adult age group slightly agreed that they received the nurse’s caring
factors from the institutions. The middle adult age group also responded
similarly.
In the study conducted by Ms. Glenser R. Soliman, the application
of Jean Watson’s carative factors is advantageous to the care of cancer
patients. Similarly, the study participants benefit from the care they
receive from the institutions. This would support why the study
146
participants slightly agree that they received holistic care.
Furthermore, prior evidence from Dr. Ma. Corazon Gallas-Martir
and Dr. Eillen G. Aniceto proved that provision of support programs to
lung cancer patients will brought about significant changes in their well-
being and functional well-being. The provision of support programs of
Martir and Aniceto’s study can be used as an application of Jean
Watson’s promotion of interpersonal teaching and learning wherein the
nurse helps the patient in acquiring this responsibility through teaching-
learning techniques.
In question number two, the researchers found out that both age
groups - young adulthood and middle adulthood - used coping strategies
quite a bit.
This finding is in accordance with McCrae’s (1982) study wherein
he concluded that young and older subjects coped in similar ways.
147
In question number three, the researchers found out that there is
no significant difference between the perception of young adult and
middle adult lung cancer patients towards the care they received.
According to Johnson and Lin et.al (2000), factors such as personal
preferences, cultural practices and beliefs, and the synthesis of input
from several physicians, friends and family members may all contribute
to a patient’s perception of care. Thus, the perception of care among
patients is a result of numerous factors affecting them.
In question number four, the researchers found out that there is no
significant difference between coping of young adult and middle adult
lung cancer patients.
Moreover, Folkman and Lazarus (1980) made it clear that
differences in sources of stress are a factor on how different ages cope.
In this study, the two age groups which are: young adult and middle
adult are diagnosed with lung cancer. Their diagnosis is a significant
stressor. Taking into consideration the conclusion of Folkman and
Lazarus, the study participants’ source of stress is similar between them
148
which warrant the conclusion that they also have similar coping
strategies.
In question number five, the researchers have found out that there
is no significant relationship between the nurse’s caring factors and the
coping behavior of lung cancer patients. Hence, coping of lung cancer
patients and the provision of care are independent from each other.
Therefore, the research hypothesis is accepted based from the result of
statistical test.
In determining if the research hypothesis is accepted or rejected,
the researchers used the Pearson Product-Moment Correlation
Coefficient or PMCC. PMCC is a common measure of the correlation
between two variables. PMCC measured the strength of the linear
dependence of the Caring Factors (X) and the Coping of the Subjects
(Y).
Since the result is 0.006 which is less than 1 level of significance,
this means that the two variables are independent from each other.
The caring factors of the nurses do not have any relationship with
149
the coping of lung cancer patients. According to Adler and Page (2008),
all patients with cancer and their families have the right to expect and
receive cancer care that ensures the provision of appropriate
psychosocial health services. Still, according to Epstein and Street
(2007), cancer care is often incomplete. Many cancer patients have
reported that their psychosocial needs are not well addressed in their
care. They are not satisfied with the amount and type of information they
are given about their diagnosis, their prognosis, available treatments, and
ways to manage their illness and health.
Moreover, Lazarus and Folkman also claim that the quality of a
coping strategy can only be judged in relation to adaptational outcomes.
Researchers should evaluate the effectiveness of a given coping strategy
contextually and on an empirical basis, thus saying that a particular
coping method may be adaptive in one circumstance and maladaptive in
other situations. They stressed that the word coping would only mean
coping if such adaptational activities involve effort; it does not pertain to
all the things that we do in our interaction to the environment (Lazarus
150
and Folkman, 1988). This means that coping, in itself, is independent
from the environment.
Thus, if a lung cancer patient is provided with a caring
environment, it does not mean that his coping strategies are directly
resulting from his environment. Moreover, adaptational activities should
have an effort principle (Lazarus and Folkman, 1988) to consider it as an
independent coping mechanism.
The very small negative correlation between the coping ways of
lung cancer patient and the provision of a caring environment can be due
to having different personality (http://oralcancerfoundation.org). Each
person has own specific coping strategies, there is no right way to
perfectly cope with a disease of lung cancer
(http://oralcancerfoundation.org). Rather a right coping strategy is one
that favors your personality or attitude that it contributes to your well
being (http://oralcancerfoundation.org).
151
CHAPTER V
SUMMARY OF FINDINGS,
CONCLUSIONS AND RECOMMENDATIONS
The study determined the relationship between the nurse’s caring
factors and the extent of coping of lung cancer patients. The study aims
to correlate the caring abilities of nurses as perceived by lung cancer
patients and the patients’ ability to cope in the disease process in
Hospital X.
The purpose of the study is to determine the relationship between
the nurse’s caring factors and the extent of coping of lung cancer
patients at a selected special tertiary hospital in Quezon City.
Specifically, the study sought to answer the following questions:
1. What is the perception of the lung cancer patients in terms of the
caring factors they received when grouped according to the
following age groups:
152
a. Young Adult (20 - 39)
b. Middle Adult (40 – 64)
2. What is the extent of coping of the young and middle adult patients
according to the following categories of coping:
a. Confrontive Coping
b. Distancing
c. Self-controlling
d. Seeking Social Support
e. Accepting Responsibility
f. Escape-Avoidance
g. Planful Problem Solving
h. Positive Reappraisal
3. Is there a significant difference between the perception of lung
cancer patients in terms of the caring factors they received when
grouped according to the following age groups:
153
a. Young Adult (20 - 39)
b. Middle Adult (40 – 64)
4. Is there a significant difference among the coping of lung cancer
patients when grouped according to the following age groups:
a. Young Adult (20 - 39)
b. Middle Adult (40 – 64)
5. Is there a significant relationship between the caring factors and
the extent of coping of the lung cancer patients?
The study utilized descriptive correlational design – a non-
experimental descriptive research approach, by describing the
relationship between the nurse’s caring factors and the extent of coping
of lung cancer patients.
The study focused on clients diagnosed with lung cancer, grouped
according to age, receiving treatment from the selected special tertiary
hospital in Quezon City. The study population included male and female
lung cancer patients, ages 20 to 64, who received treatment from
Hospital X in Quezon City, and who were not mentally and emotionally
154
disabled and who are not mute, deaf or blind. Patients who were not able
to read and write due to conditions like decreased level of
consciousness, terminally ill and those who were hooked to artificial
resuscitative devices were also excluded from the study. Patients’ family
members or guardians were not allowed to answer the survey.
Furthermore, those who refused to answer due to personal reasons were
not included in the study.
The total population of lung cancer patients during the data
collection was 67. Not all lung cancer patients agreed to participate in
the study. Furthermore, not all lung cancer patients were eligible to
participate in the study.
The sample size obtained during the data collection was 35, 18
from the young adult and 17 from the middle adult. The sample was
presently admitted and receiving treatment during the duration of data
collection.
155
The lung cancer patients who were eligible and presently admitted
at Hospital X during the data collection period were selected as study
participants.
The researchers utilized a standardized instrument on Caring
Factor Survey by Jean Watson in collecting data regarding the
perception of care the patients received from the institution. This tool is
a seven-point Likert Scale which enables the respondents to specify their
level of agreement to a statement. Each statements were graded as 7 for
strongly agree, 6 for agree, 5 for slightly agree, 4 for neutral, 3 for
slightly disagree, 2 for disagree and 1 for strongly disagree. The Caring
Factor Survey, which has 20 items, measured the patient’s perception of
care while in the facility. Participants were asked to indicate how much
they agree or disagree with each of the statements implied in the survey
tool.
In addition, the researchers also used the Ways of Coping
Questionnaire developed by Richard Lazarus and Susan Folkman to
assess for the subjects’ extent of coping behavior. This was translated to
Filipino version since the Ways of Coping Questionnaire can be
156
modified and improved as recommended by Lazarus and Folkman.
Furthermore, the Filipino version provided for better understanding of
its content to the study participants. The main idea of each question was
preserved on translation.
SUMMARY OF FINDINGS
After the data gathering and statistical treatment, the following are
the results of the study:
1. The young adult lung cancer patients slightly agreed
that they receive the nurse’s caring factors.
2. The middle adult lung cancer patients slightly agreed
that they receive the nurse’s caring factors.
3. The young and middle adult lung cancer patients used
confrontive coping quite a bit.
4. The young and middle adult lung cancer patients used
distancing quite a bit.
5. The young and middle adult lung cancer patients used self-
controlling quite a bit.
157
6. The young and middle adult lung cancer patients used seeking
self support quite a bit.
7. The young and middle adult lung cancer patients used accepting
responsibility quite a bit.
8. The young and middle adult lung cancer patients used escape-
avoidance quite a bit.
9. The young and middle adult lung cancer patients used planful
problem solving quite a bit.
10. The young and middle adult lung cancer patients
used positive reappraisal quite a bit.
11. The young adult lung cancer patients used planful
problem solving the most among the eight coping mechanisms.
12. The young adult lung cancer patients used
confrontive coping the least among the eight coping mechanisms.
13. The middle adult lung cancer patients used planful
problem solving the most among the eight coping mechanisms.
14. The middle adult lung cancer patients used escape-
avoidance the least among the eight coping mechanisms.
158
15. There is no significant difference between the
perception of young adult lung cancer patients and the middle adult
lung cancer patients towards the care they received.
16. There is no significant difference between the extent
of coping of young adult lung cancer patients and the middle adult
lung cancer patients.
17. There is no significant relationship between the
nurse’s caring factors and the coping behavior of lung cancer
patients.
CONCLUSION
With the necessary information gathered, reviewed and studied
upon, the researchers have drawn the following conclusions:
159
Based on the Caring Factor Survey, young adult and middle adult
lung cancer patients slightly agreed that they receive the nurse’s caring
factors.
Based on the Ways of Coping Questionnaire, young adult and
middle adult lung cancer patients utilized coping strategies quite a bit.
Based on the research findings on the perception of lung cancer
patients in terms of the nurse’s caring factors they received when
grouped according to age, there is no significant difference between the
perception of young adult lung cancer patients and the middle adult lung
cancer patients towards the care they received.
Based on the research findings on the coping of lung cancer
patients when grouped according to age, there is no significant
difference between the extent of coping of young adult lung cancer
patients and the middle adult lung cancer patients.
Based on the research findings between the perception of lung
cancer patients in terms of the caring factors they received and their
coping behavior, there is no significant relationship between the nurse’s
160
caring factors and the coping behavior of lung cancer patients.
As such, the researchers concluded that the problem has been
answered in a way that it was falsified and the researchers’ hypothesis of
the problem being null has been qualified.
Equal or more than 30 is the ideal number of samples. The sample
population is adequate to answer the research problems.
RECOMMENDATIONS
On the light of the findings, the following recommendations are
offered.
In the nursing practice, the researchers advocate that nurses render
holistic care to every patient, regardless of the patient’s race, sex,
religion and social status. Providing holistic care to patients improves
their care experiences towards health and well-being.
Moreover, the results of the study advise that nurses in the clinical
practice work efficiently and effectively to improve the perception of
care of the patients.
161
In the nursing administration, the researchers suggest for the
formulation of policies and guidelines pertaining to the improvement of
quality holistic care, specifically to lung cancer patients.
In the nursing education, the researchers suggest to strengthen Jean
Watson’s Carative Factors in the curriculum of level III nursing students
in Far Eastern University. The results of the study can furthermore
indicate the need to teach the provision of holistic care to patients.
In the nursing research, the investigators advise the other
researchers to conduct similar studies using different participants,
different illness and different research locale in addressing the holistic
demand for caring.
162
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170
APPENDIX A
1. Letter to Dr. Annabelle R. Borromeo RN, CNS, PhD
2. Letter to Dr. Glenda L. Picardal RN, MAN, MM, MPA, PhD
3. Letter to Ms. Belinda B. Villasencio RN, MAN
171
APPENDIX B
GANTT CHART
Activities 1-6 Dec
7-14 Dec
21-30
Dec2-
9Jan10-
17Jan18-
25Jan26 Jan -
2 Feb3-8 Feb
9-Feb
1. Revision of Chapters I and II 2. Revision of Chapter III 3. Entry to Research Locale for Data Collection 4. Data Collection 5. Statistical Treatment of Data
172
6. Encoding Chapters IV and V 7. Revision of Chapters IV and V 8. Revision of the Final Output and Mock Defense 9. Oral Defense
109
APPENDIX C
RESEARCH INSTRUMENTS
1. Caring Factor Survey
2. Ways of Coping
a. Original Format
b. Translated Format
110
APPENDIX D
TABLES AND STATISTICAL TREATMENT OF DATA
Problem No. 1 Perception of Care
Age 20-39 yrs. Old
CARING FACTOR
VERBAL INTERPRETATION
Responded to client as a whole person (16) 5.67 ACreation of an environment for physical and spiritual healing(10) 5.56 AEmbracing of client’s feelings(19) 5.5 AEstablishment of helping-trust relationship(13) 5.44 SAValues relationship (15) 5.44 SASolved unexpected problems (2) 5.39 SACreative problem solving (4) 5.39 SAEncouraged verbalization of feelings (17) 5.39 SASupport client’s beliefs (18) 5.39 SAHonored client’s faith, instilled hope,
5.33 SA
111
and respected client’s belief system (5)Respectful of spiritual beliefs and practices(9) 5.33 SAAcceptance and support to client’s belief to a higher power (20) 5.33 SAOver-all care was provided with loving-kindness(1) 5.28 SATeaching client on the level the client can understand (6) 5.22 SAHelped support client’s hope and faith (7) 5.22 SAHelped meet client’s physical, emotional and physical needs (14) 5.17 SAResponsive to client’s readiness to learn(8) 5.11 SAEncouraged practice own spiritual beliefs (11) 5.11 SACreation of an environment that recognizes the client’s connection between mind, body
5 SA
112
and spirit (12)Care is provided with loving kindness (3) 4.72 SATotal computed weighted average towards caring factor received 5.30 SA
Question no. 1
Average: 3(7) + 4(6) + 6(5) + 5(4) + 0(3) + 0(2) + 0(1)
18
21 + 24 + 30 + 20 + 0 + 0 + 0 = 5. 28
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 2
Average: 2(7) + 6(6) + 8(5) + 1(4) + 1(3) + 0(2) + 0(1)
18
14 + 36 + 40 + 4 + 3 + 0 + 0 = 5.39
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 3
113
Average: 1(7) + 3(6) + 7(5) + 4(4) + 3(3) + 0(2) + 0(1)
18
7 + 18 + 35 + 16 + 9 + 0 + 0 = 4.72
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 4
Average: 2(7) + 6(6) + 8(5) + 1(4) + 1(3) + 0(2) + 0(1)
18
14 + 36 + 40 + 4 + 3 + 0 + 0 = 5.39
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 5
Average: 3(7) + 4(6) + 7(5) + 4(4) + 0(3) + 0(2) + 0(1)
18
21 + 24 + 35 + 16 + 0 + 0 + 0 = 5.33
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 6
114
Average: 1(7) + 6(6) + 8(5) + 2(4) + 1(3) + 0(2) + 0(1)
18
7 + 36 + 40 + 8 + 3 + 0 + 0 = 5.22
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 7
Average: 1(7) + 4(6) + 11(5) + 2(4) + 0(3) + 0(2) + 0(1)
18
7 + 24 + 55 + 8 + 0 + 0 + 0 = 5.22
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 8
Average: 0(7) + 7(6) + 6(5) + 5(4) + 0(3) + 0(2) + 0(1)
18
115
0 + 42 + 30 + 20 + 0 + 0 + 0 = 5.11
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 9
Average: 3(7) + 6(6) + 5(5) + 3(4) + 0(3) + 1(2) + 0(1)
18
21 + 36 + 25 + 12 + 0 + 2 + 0 = 5.33
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 10
Average: 3(7) + 6(6) + 7(5) + 2(4) + 0(3) + 0(2) + 0(1)
18
21 + 36 + 35 + 8 + 0 + 0 + 0 = 5.56
18
Interpretation: 21-39 y/o Agree
Question no. 11
Average: 1(7) + 3(6) + 11(5) + 3(4) + 0(3) + 0(2) + 0(1)
18
116
7 + 18 + 55 + 12 + 0 + 0 + 0 = 5.11
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 12
Average: 0(7) + 5(6) + 9(5) + 3(4) + 1(3) + 0(2) + 0(1)
18
0 + 30 + 45 + 12 + 3 + 0 + 0 = 5
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 13
Average: 1(7) + 8(6) + 7(5) + 2(4) + 0(3) + 0(2) + 0(1)
18
7 + 48 + 35 + 8 + 0 + 0 + 0 = 5.44
18
Interpretation: 21-39 y/o Slightly Agree
117
Question no. 14
Average: 1(7) + 7(6) + 4(5) + 6(4) + 0(3) + 0(2) + 0(1)
18
1 + 42 + 20 + 24 + 0 + 0 + 0 = 5.17
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 15
Average: 1(7) + 7(6) + 9(5) + 1(4) + 0(3) + 0(2) + 0(1)
18
7 + 42 + 45 + 4 + 0 + 0 + 0 = 5.44
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 16
Average: 3(7) + 8(6) + 5(5) + 2(4) + 0(3) + 0(2) + 0(1)
18
21 + 48 + 25 + 8 + 0 + 0 + 0 = 5.67
18
118
Interpretation: 21-39 y/o Agree
Question no. 17
Average: 2(7) + 5(6) + 9(5) + 2(4) + 0(3) + 0(2) + 0(1)
18
14 + 30 + 45 + 8 + 0 + 0 + 0 = 5.39
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 18
Average: 1(7) + 7(6) + 8(5) + 2(4) + 0(3) + 0(2) + 0(1)
18
7 + 42 + 40 + 8 + 0 + 0 + 0 = 5.39
18
Interpretation: 21-39 y/o Slightly Agree
Question no. 19
Average: 2(7) + 7(6) + 7(5) + 2(4) + 0(3) + 0(2) + 0(1)
18
14 + 42 + 35 + 8 + 0 + 0 + 0 = 5.5
18
119
Interpretation: 21-39 y/o Agree
Question no. 20
Average: 2(7) + 5(6) + 8(5) + 3(4) + 0(3) + 0(2) + 0(1)
18
14 + 30 + 40 + 12 + 0 + 0 + 0 = 5.33
18
Interpretation: 21-39 y/o Slightly Agree
120
Age 40-64 yrs. Old
Question no.
7=Strongly Agree 6=Agree
5=Slightly Agree 4=Neutral
3=Slightly Disagree 2=Disagree
1=Strongly Disagree Average
1 1 10 3 3 0 0 02 1 5 10 1 0 0 03 2 6 6 2 1 0 04 0 6 8 2 1 0 05 0 5 7 2 3 0 06 1 7 6 2 1 0 07 1 8 7 1 0 0 08 1 8 8 0 0 0 09 3 5 9 0 0 0 010 2 9 6 0 0 0 011 1 9 5 2 0 0 012 0 6 9 1 1 0 013 1 10 4 2 0 0 014 1 2 13 1 0 0 015 0 7 9 1 0 0 016 1 11 4 0 1 0 017 1 9 4 3 0 0 018 1 9 4 0 0 0 019 2 8 6 1 0 0 020 0 8 7 2 0 0 0
Question no. 1
Average: 1(7) + 10(6) + 3(5) + 3(4) + 0(3) + 0(2) + 0(1)
17
7 + 60 + 15 + 12 + 0 + 0 + 0 = 5.53
17
121
Interpretation: Age 40-64= 5.53 (AGREE)
Question no. 2
Average: 1(7) + 5(6)+10(5)+1(4)+0(3)+0(2)+0(1)
17
7 + 30 +50 + 4 + 0 + 0 + 0 = 5.35
17
Interpretation: Age 40-64= 5.35 (SLIGHTLY AGREE)
Question no. 3
Average: 2(7)+6(6)+6(5)+2(4)+1(3)+0(2)+0(1)
17
14+36+30+8+3+0+0 = 5.35
17
Interpretation: Age 40-64= 5.35 (SLIGHTLY AGREE)
122
Question no.4
Average: 0(7)+6(6)+8(5)+2(4)+1(3)+0(2)+0(1)
17
0+36+40+8+3+0+0 = 5.12
17
Interpretation: Age 40-64= 5.12 (SLIGHTLY AGREE)
Question no.5
Average: 0(7)+5(6)+7(5)+2(4)+3(3)+0(2)+0(1)
17
0+30+35+8+9+0+0 = 4.82
17
Interpretation: Age 40-64= 5.53 (AGREE)
Question no.6
Average: 1(7)+7(6)+6(5)+2(4)+1(3)+0(2)+0(1)
123
17
7+42+30+8+3+0+0 = 5.29
17
Interpretation: Age 40-64= 5.29 (SLIGHTLY AGREE)
Question no.7
Average: 1(7)+8(6)+7(5)+1(4)+0(3)+0(2)+0(1)
17
7+48+35+4+0+0+0 = 5.53
17
Interpretation: Age 40-64= 5.53 (AGREE)
Question no.8
Average: 1(7)+8(6)+8(5)+0(4)+0(3)+0(2)+0(1)
17
7+48+40+0+0+0+0 = 5.59
124
17
Interpretation: Age 40-64= 5.59 (AGREE)
Question no.9
Average: 3(7)+5(6)+9(5)+0(4)+0(3)+0(2)+0(1)
17
21+30+45+0+0+0+0 = 5.65
17
Interpretation: Age 40-64= 5.65 (AGREE)
Question no.10
Average: 2(7)+9(6)+6(5)+0(4)+0(3)+0(2)+0(1)
17
14+54+30+0+0+0+0 = 5.76
17
Interpretation: Age 40-64= 5.76 (AGREE)
125
Question no.11
Average: 1(7)+9(6)+5(5)+2(4)+0(3)+0(2)+0(1)
17
7+54+25+8+0+0+0 = 5.53
17
Interpretation: Age 40-64= 5.53 (AGREE)
Question no.12
Average: 0(7)+6(6)+9(5)+1(4)+1(3)+0(2)+0(1)
17
0+36+45+4+3+0+0 = 5.18
17
Interpretation: Age 40-64= 5.18 (SLIGHTLY AGREE)
Question no.13
Average: 1(7)+10(6)+4(5)+2(4)+0(3)+0(2)+0(1)
17
126
7+60+20+8+0+0+0 = 5.59
17
Interpretation: Age 40-64= 5.59 (AGREE)
Question no.14
Average: 1(7)+2(6)+13(5)+1(4)+0(3)+0(2)+0(1)
17
7+12+65+4+0+0+0 = 5.18
17
Interpretation: Age 40-64= 5.18 (SLIGHTLY AGREE)
Question no.15
Average: 0(7)+7(6)+9(5)+1(4)+0(3)+0(2)+0(1)
17
0+42+45+4+0+0+0 = 5.35
17
127
Interpretation: Age 40-64= 5.35 (SLIGHTLY AGREE)
Question no.16
Average: 1(7)+11(6)+4(5)+0(4)+1(3)+0(2)+0(1)
17
7+66+20+0+3+0+0 = 5.65
17
Interpretation: Age 40-64= 5.65 (AGREE)
Question no.17
Average: 1(7)+9(6)+4(5)+3(4)+0(3)+0(2)+0(1)
17
7+54+20+12+0+0+0 = 5.47
17
Interpretation: Age 40-64= 5.47 (SLIGHTLY AGREE)
128
Question no.18
Average: 1(7)+9(6)+4(5)+3(4)+0(3)+0(2)+0(1)
17
7+54+20+12+0+0+0 = 5.47
17
Interpretation: Age 40-64= 5.47 (SLIGHTLY AGREE)
Question no.19
Average: 2(7)+8(6)+6(5)+1(4)+0(3)+0(2)+0(1)
17
14+48+30+4+0+0+0 = 5.65
17
Interpretation: Age 40-64= 5.65 (AGREE)
Question no.20
129
Average: 0(7)+8(6)+7(5)+2(4)+0(3)+0(2)+0(1)
17
0+48+35+8+0+0+0 = 5.35
17
Interpretation: Age 40-64= 5.35 (SLIGHTLY AGREE)
130
Problem No. 2 Coping Behavior
Age 21-39 yrs. OldCategory 1: Confrontive Coping
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q6: Doing something 1 11 6 0 1.72
Used quite a bit
Q7: Person’s responsibility 0 14 4 0 1.77
Used quite a bit
Q17: Anger to problem 1 10 5 2 1.56
Used quite a bit
Q28: Letting feeling’s out 2 16 0 0 2.11
Used quite a bit
Q34: Taking a big chance to solve the problem 0 12 1 5 1.39
Used somewhat
Q46: Fighting for what I want 1 13 3 1 1.78
Used quite a bit
Question no. 6
Average: 1(3) + 11(2) + 6(1) + 0(0)
18
3+ 22 + 6+ 0 = 1.72
18
131
Interpretation: 21-39 y/o Used quite a bit
Question no. 7
Average: 0(3) + 14(2) + 4(1) + 0(0)
18
0 + 28 + 4 + 0 = 1.77
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 17
Average: 1(3) + 10(2) + 5(1) + 2(0)
18
3 + 20 + 5 + 0 = 1.56
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 28
Average: 2(3) + 16(2) + 0(1) + 0(0) = 2.11
18
6 + 32 + 0 + 0 = 2.11
132
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 34
Average: 0(3) + 12(2) + 1(1) + 5(0)
18
0 + 24 + 1 + 0 = 1.39
18
Interpretation: 21-39 y/o Used somewhat
Question no. 46
Average: 1(3) + 13(2) + 3(1) + 1(0)
18
3 + 26 + 3 + 0 = 1.78
18
Interpretation: 21-39 y/o Used quite a bit
133
Category 2: Distancing
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q12: Fate and bad luck 0 9 6 3 1.33
Used somewhat
Q13: As if nothing happened 1 13 3 1 1.78
Used quite a bit
Q15: Looking for silver lining 4 12 2 0 2.11
Used quite a bit
Q21: Forgetting the whole thing 1 14 3 0 1.89
Used quite a bit
Q41: Refusing to think too much 3 13 2 0 2.06
Used quite a bit
Q44: Refusing to get too serious 3 13 1 1 2
Used quite a bit
Question no. 12
Average: 0(3) + 9(2) + 6(1) + 3(0)
18
134
0+ 18 + 6 + 0 = 1.33
18
Interpretation: 21-39 y/o Used somewhat
Question no. 13
Average: 1(3) + 13(2) + 3(1) + 1(0)
18
3 + 26 + 3 + 0 = 1.78
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 15
Average: 4(3) + 12(2) + 2(1) + 0(0)
18
12+ 24 + 2 + 0 = 2.11
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 21
Average: 1(3) + 14(2) + 3(1) + 0(0)
18
135
3 + 28 + 2 + 0 = 1.89
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 41
Average: 3(3) + 13(2) + 2(1) + 0(0)
18
9 + 26 + 2 + 0 = 2.06
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 44
Average: 3(3) + 13(2) + 1(1) + 1(0)
18
9 + 26 + 1 + 0 = 2
18
Interpretation: 21-39 y/o Used quite a bit
136
Category 3: Self controlling
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q10: leaving things open 4 9 4 1 1.89
Used quite a bit
Q14: Keeping feelings to myself 4 8 5 1 1.83
Used quite a bit
Q35: Not acting too hastily 0 15 3 0 1.83
Used quite a bit
Q43: Keeping bad things from others 3 10 4 1 1.83
Used quite a bit
Q54: Keeping my feeling from interfering 2 12 4 0 1.89
Used quite a bit
Q62: Going over my mind 5 12 1 0 2.22
Used quite a bit
Q63: Thinking about the
3 11 4 0 1.94 Used quite a bit
137
person I admire as a model
Question no. 10
Average: 4(3) + 9(2) + 4(1) + 1(0)
18
24+ 16 + 2+ 0 = 1.89
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 14
Average: 4(3) + 8(2) + 5(1) + 1(0)
18
12+ 16 + 5 + 0 = 1.83
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 35
138
Average: 0(3) + 15(2) + 3(1) + 0(0)
18
0 + 30 + 3 + 0 = 1.83
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 43
Average: 3(3) + 10(2) + 4(1) + 1(0)
18
9 + 22 + 4 + 0 = 1.83
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 54
Average: 2(3) + 12(2) + 4(1) + 0(0)
18
6 + 24 + 4 + 0 = 1.89
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 62
139
Average: 5(3) + 12(2) + 1(1) + 0(0)
18
15 + 24 + 1 + 0 = 2.22
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 63
Average: 3(3) + 11(2) + 4(1) + 0(0)
18
9 + 22 + 4 + 0 = 1.94
18
Interpretation: 21-39 y/o Used quite a bit
Category 4: Seeking Social Support
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q8: Talking more about the situation 8 9 1 0 2.39
Used quite a bit
Q18: Accepting sympathy 4 11 2 1 2
Used quite a bit
140
Q22: Getting professional help 2 9 2 5 1.44
Used somewhat
Q31: Doing something concrete about the problem 5 10 2 1 2.06
Used quite a bit
Q42:Asking advice from a relative 7 11 0 0 2.39
Used quite a bit
Q45: Talking something about feeling 3 13 1 1 2
Used quite a bit
Question no. 8
Average: 8(3) + 9(2) + 1(1) + 0(0)
18
24+ 18 + 1+ 0 = 2.39
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 18
Average: 4(3) + 11(2) + 2(1) + 1(0)
141
18
12 + 22 + 2 + 0 = 2
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 22
Average: 2(3) + 9(2) + 2(1) + 5(0)
18
6 + 18 + 2 + 0 = 1.44
18
Interpretation: 21-39 y/o Used somewhat
Question no. 31
Average: 5(3) + 10(2) + 2(1) + 1(0)
18
15 + 20 + 2 + 0 = 2.06
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 42
142
Average: 7(3) + 11(2) + 0(1) + 0(0)
18
21 + 22 + 0 + 0 = 2.39
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 45
Average: 3(3) + 13(2) + 1(1) + 1(0)
18
9 + 26 + 1 + 0 = 2
18
Interpretation: 21-39 y/o Used quite a bit
Category 5: Accepting Responsibility
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q9: Criticizing myself 8 8 2 0 2.33
Used quite a bit
Q25: Apologizing or making
2 15 0 1 2 Used quite a bit
143
upQ29: Realizing the problem on myself 1 9 8 0 1.61
Used quite a bit
Q51: Promising to make things different 4 12 2 0 2.11
Used quite a bit
Question no. 9
Average: 8(3) + 8(2) + 2(1) + 0(0)
18
24+ 16 + 2+ 0 = 2.33
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 25
Average: 2(3) + 15(2) + 0(1) + 1(0) = 2
18
6 + 30 + 0 + 0 = 2
18
Interpretation: 21-39 y/o Used quite a bit
144
Question no. 29
Average: 1(3) + 9(2) + 8(1) + 0(0)
18
3 + 18 + 8 + 0 = 1.61
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 51
Average: 4(3) + 12(2) + 2(1) + 0(0)
18
12 + 24 + 2 + 0 = 2.11
18
Interpretation: 21-39 y/o Used quite a bit
Category 6: Escape- Avoidance
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q11: Hoping for a miracle 0 8 8 2 1.33
Used somewhat
145
Q16: Sleeping more than the usual 2 12 3 1 1.83
Used quite a bit
Q33: Trying to make myself feel better 1 11 1 5 1.44
Used somewhat
Q40: Generally avoiding people 2 10 1 5 1.5
Used quite a bit
Q47: Taking it out on other people 0 12 3 3 1.5
Used quite a bit
Q50: Refusing to believe what happened 2 9 5 2 1.61
Used quite a bit
Q58: Wishing situation would go away 3 5 10 0 1.61
Used quite a bit
Q59: Having fantasies 4 12 2 0 2.11
Used quite a bit
146
Question no. 11
Average: 0(3) + 8(2) + 8(1) + 2(0)
18
0+ 16 + 8 + 0 = 1.33
18
Interpretation: 21-39 y/o Used somewhat
Question no. 16
Average: 2(3) + 12(2) + 3(1) + 1(0)
18
6 + 24 + 3 + 0 = 1.83
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 33
Average: 1(3) + 11(2) + 1(1) + 5(0)
18
3 + 22 + 1 + 0 = 1.44
18
147
Interpretation: 21-39 y/o Used somewhat
Question no. 40
Average: 2(3) + 10(2) + 1(1) + 5(0)
18
6 + 20 + 1 + 0 = 1.5
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 47
Average: 0(3) + 12(2) + 3(1) + 3(0)
18
0 + 24 + 3 + 0 = 1.5
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 50
Average: 2(3) + 9(2) + 5(1) + 2(0)
18
6 + 18 + 5 + 0 = 1.61
18
148
Interpretation: 21-39 y/o Used quite a bit
Question no. 58
Average: 3(3) + 5(2) + 10(1) + 0(0)
18
12 + 4 + 13 + 0 = 1.61
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 59
Average: 4(3) + 12(2) + 2(1) + 0(0)
18
12 + 24 + 2 + 0 = 2.11
18
Interpretation: 21-39 y/o Used quite a bit
Category 7: Planful Problem Solving
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q1: Concentratin
7 11 0 0 2.39 Used quite a bit
149
g on the next stepQ26: Making a plan of action 6 12 0 0 2.33
Used quite a bit
Q39: Changing something to do right 5 11 2 0 2.11
Used quite a bit
Q48: Drawing on my past experiences 1 13 1 3 1.67
Used quite a bit
Q49: Knowing what had to be done 4 13 1 0 2.06
Used quite a bit
Q52: Coming up with different solution 4 12 2 0 2.11
Used quite a bit
Question no. 1
Average: 7(3) + 11(2) + 0(1) + 0(0)
18
21 + 22 + 0 + 0 = 2.39
18
Interpretation: 21-39 y/o Used quite a bit
150
Question no. 26
Average: 6(3) + 12(2) + 0(1) + 0(0)
18
18 + 24 + 0 + 0 = 2.33
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 39
Average: 5(3) + 11(2) + 2(1) + 0(0)
18
15 + 22 + 2 + 0 = 2.11
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 48
Average: 1(3) + 13(2) + 1(1) + 3(0)
18
3 + 26 + 1 + 0 = 1.67
18
Interpretation: 21-39 y/o Used quite a bit
151
Question no. 49
Average: 4(3) + 13(2) + 1(1) + 0(0)
18
12 + 24 + 1 + 0 = 2.06
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 52
Average: 4(3) + 12(2) + 2(1) + 0(0)
18
12 + 24 + 2 + 0 = 2.11
18
Interpretation: 21-39 y/o Used quite a bit
Category 8: Positive Reappraisal
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q20: Inspired to do something creative 3 13 2 0 2.06
Used quite a bit
152
Q23: Changing as a person 5 10 2 1 2.06
Used quite a bit
Q30: Experiencing better than what I went through 3 11 4 0 1.94
Used quite a bit
Q36: Finding new faith 3 10 3 2 1.78
Used quite a bit
Q38: Rediscovering life 3 14 1 0 2.11
Used quite a bit
Q56: Changing something about myself 4 14 0 0 2.22
Used quite a bit
Q60: Praying7 8 3 0 2.22
Used quite a bit
Question no. 20
Average: 3(3) + 13(2) + 2(1) + 0(0)
18
9 + 26 + 2 + 0 = 2.06
18
Interpretation: 21-39 y/o Used quite a bit
153
Question no. 23
Average: 5(3) + 10(2) + 2(1) + 1(0)
18
15 + 30 + 2 + 0 = 2.06
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 30
Average: 3(3) + 11(2) + 4(1) + 0(0)
18
9 + 22 + 4 + 0 = 1.94
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 36
Average: 3(3) + 10(2) + 3(1) +2(0)
18
9 + 20 + 3 + 0 = 1.78
18
Interpretation: 21-39 y/o Used quite a bit
154
Question no. 38
Average: 3(3) + 14(2) + 1(1) + 0(0)
18
9 + 28 + 1 + 0 = 2.11
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 56
Average: 4(3) + 14(2) + 0(1) + 0(0)
18
12 + 28 + 0 + 0 = 2.22
18
Interpretation: 21-39 y/o Used quite a bit
Question no. 60
Average: 7(3) + 8(2) + 3(1) + 0(0)
18
15 + 22 + 3 + 0 = 2.22
18
Interpretation: 21-39 y/o Used quite a bit
155
Age 40-64 yrs. Old
Category 1: Confrontive Coping
Question no.
3 = Used
a great
deal
2 =
Used
quite a
bit
1 = Used
somewhat
0 = Does not
apply or not
used Average
Verbal
Interpretation
Q6: Doing
something 2 8 6 1 1.65
Used quite a
bit
Q7: Person’s
responsibility 1 11 4 1 1.71
Used quite a
bit
Q17: Anger
to problem 0 8 8 1 1.41
Used
somewhat
Q28: Letting
feeling’s out 1 16 0 0 2.06
Used quite a
bit
Q34: Taking
a big chance
to solve the
0 11 2 4 1.41 Used
somewhat
156
problem
Q46:
Fighting for
what I want 2 10 5 0 1.82
Used quite a
bit
Question no. 6
Average: 2(3) + 8(2) + 6(1) + 1(0)
17
6 + 16 + 6 + 0 = 1.65
17
Interpretation: 40-64 years old used quite a bit.
Question no. 7
Average: 1(3) + 11(2) + 4(1) + 1(0)
17
3 + 22 + 4 + 0 = 1.71
17
Interpretation: 40-64 years old used quite a bit.
Question no. 17
157
Average: 0(3) + 8(2) + 8(1) + 1(0)
17
0 + 16 + 8 + 0 = 1.41
17
Interpretation: 40-64 years old used somewhat.
Question no. 28
Average: 1(3) + 16(2) + 0(1) + 0(0)
17
3 + 32 + 0 + 0 = 2.06
17
Interpretation: 40-64 years old used quite a bit.
Question no. 34
Average: 0(3) + 11(2) + 2(1) + 4(0)
17
0 + 22 + 2 + 0 = 1.41
17
Interpretation: 40-64 years old used somewhat.
Question no. 46
158
Average: 2(3) + 10(2) + 5(1) + 0(0)
17
6 + 20 + 5 + 0 = 1.82
17
Interpretation: 40-64 years old used quite a bit
Category 2: Distancing
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q12: Fate and bad luck 1 6 8 2 1.35
Used somewhat
Q13: As if nothing happened 0 9 5 3 1.35
Used somewhat
Q15: Looking for silver lining 3 10 4 0 1.59
Used quite a bit
Q21: Forgetting the whole thing 0 10 6 1 1.53
Used quite a bit
Q41: Refusing to think too much 4 8 5 0 1.94
Used quite a bit
159
Q44: Refusing to get too serious 2 12 3 0 1.94
Used quite a bit
Question no. 12
Average: 1(3) + 6(2) + 8(1) + 2(0)
17
3 + 12 + 8 + 0 = 1.35
17
Interpretation: 40-64 years old used somewhat.
Question no. 13
Average: 0(3) + 9(2) + 5(1) + 3(0)
17
0 + 18 + 5 + 0 = 1.35
17
Interpretation: 40-64 years old used somewhat.
Question no. 15
160
Average: 3(3) + 10(2) + 4(1) + 0(0)
17
9 + 20 + 4 + 0 = 1.59
17
Interpretation: 40-64 years old used quite a bit.
Question no. 21
Average: 0(3) + 10(2) + 6(1) + 1(0)
17
0 + 20 + 6 + 0 = 1.53
17
Interpretation: 40-64 years old used somewhat.
Question no. 41
Average: 4(3) + 8(2) + 5(1) + 0(0)
17
12 + 16 + 5 + 0 = 1.94
17
Interpretation: 40-64 years old used quite a bit.
Question no. 44
161
Average: 2(3) + 12(2) + 3(1) + 1(0)
17
6 + 24 + 3 + 0 = 1.94
17
Interpretation: 40-64 years old used quite a bit.
Category 3: Self controlling
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q10: leaving things open 1 12 5 9 1.88
Used quite a bit
Q14: Keeping feelings to myself 1 7 8 1 1.47
Used somewhat
Q35: Not acting too hastily 3 10 4 0 1.94
Used quite a bit
Q43: Keeping bad things from others 1 11 4 1 1.71
Used quite a bit
Q54: 1 11 5 0 1.77 Used quite a
162
Keeping my feeling from interfering bitQ62: Going over my mind 2 13 2 0 2
Used quite a bit
Q63: Thinking about the person I admire as a model 0 11 4 1 1.77
Used quite a bit
Question no. 10
Average: 1(3) + 12(2) + 5(1) + 9(0)
17
3 + 24 + 5 + 0 = 1.88
17
Interpretation: 40-64 years old used quite a bit.
Question no. 14
Average: 1(3) + 7(2) + 8(1) + 1(0)
17
3 + 14 + 8 + 0 = 1.47
163
17
Interpretation: 40-64 years old used somewhat.
Question no. 35
Average: 3(3) + 10(2) + 4(1) + 0(0)
17
9 + 20 + 4 + 0 = 1.94
17
Interpretation: 40-64 years old used quite a bit.
Question no. 43
Average: 1(3) + 11(2) + 4(1) + 1(0)
17
3 + 22 + 4 + 0 = 1.71
17
Interpretation: 40-64 years old used quite a bit.
Question no. 54
Average: 1(3) + 11(2) + 5(1) + 0(0)
164
17
3 + 22 + 5 + 0 = 1.77
17
Interpretation: 40-64 years old used quite a bit.
Question no. 62
Average: 2(3) + 13(2) + 2(1) + 0(0)
17
6 + 26 + 2 + 0 = 2
17
Interpretation: 40-64 years old used quite a bit.
Question no. 63
Average: 0(3) + 11(2) + 4(1) + 1(0)
17
0 + 22 + 4 + 0 = 1.77
17
Interpretation: 40-64 years old used quite a bit.
Category 4: Seeking Social Support
Question 3 = Used 2 = 1 = Used 0 = Does not Average Verbal
165
no.a great
deal
Used quite a
bit somewhatapply or not
used
Interpretation
Q8: Talking more about the situation 1 14 2 8 1.94
Used quite a bit
Q18: Accepting sympathy 2 13 2 0 2
Used quite a bit
Q22: Getting professional help 2 10 5 0 1.82
Used quite a bit
Q31: Doing something concrete about the problem 0 11 6 0 1.65
Used quite a bit
Q42:Asking advice from a relative 4 9 4 0 2
Used quite a bit
Q45: Talking something about feeling 2 13 2 0 2
Used quite a bit
Question no. 8
166
Average: 1(3) + 14(2) + 2(1) + 8(0)
17
3 + 28 + 2 + 0 = 1.94
17
Interpretation: 40-64 years old used quite a bit.
Question no. 18
Average: 2(3) + 13(2) + 2(1) + 0(0)
17
6 + 26 + 2 + 0 = 2
17
Interpretation: 40-64 years old used quite a bit.
Question no. 22
Average: 2(3) + 10(2) + 5(1) + 0(0)
17
6 + 20 + 5 + 0 = 1.82
17
Interpretation: 40-64 years old used quite a bit.
Question no. 31
167
Average: 0(3) + 11(2) + 6(1) + 0(0)
17
0 + 22 + 6 + 0 = 1.65
17
Interpretation: 40-64 years old used quite a bit.
Question no. 42
Average: 4(3) + 9(2) + 4(1) + 0(0)
17
12 + 18 + 4 + 0 = 2
17
Interpretation: 40-64 years old used quite a bit.
Question no. 45
Average: 2(3) + 13(2) + 2(1) + 0(0)
17
6 + 26 + 2 + 0 = 2
17
Interpretation: 40-64 years old used quite a bit
168
Category 5: Accepting Responsibility
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q9: Criticizing myself 2 11 3 0 1.18
Used quite a bit
Q25: Apologizing or making up 3 10 4 0 1.94
Used quite a bit
Q29: Realizing the problem on myself 0 10 5 2 1.47
Used quite a bit
Q51: Promising to make things different 1 11 5 0 1.77
Used quite a bit
Question no. 9
Average: 2(3) + 11(2) + 3(1) + 0(0)
17
6 + 22 + 3 + 0 = 1.18
17
Interpretation: 40-64 years old used somewhat.
169
Question no. 25
Average: 3(3) + 10(2) + 4(1) + 0(0)
17
9 + 20 + 4 + 0 = 1.94
17
Interpretation: 40-64 years old used quite a bit.
Question no. 29
Average: 0(3) + 10(2) + 5(1) + 2(0)
17
0 + 20 + 5 + 0 = 1.47
17
Interpretation: 40-64 years old used somewhat.
Question no. 51
Average: 1(3) + 11(2) + 5(1) + 0(0)
170
17
3 + 22 + 5 + 0 = 1.77
17
Interpretation: 40-64 years old used quite a bit.
Category 6: Escape- Avoidance
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q11: Hoping for a miracle 1 9 3 1 1.41
Used somewhat
Q16: Sleeping more than the usual 1 9 6 1 1.59
Used quite a bit
Q33: Trying to make myself feel better 1 7 3 6 1.18
Used somewhat
Q40: Generally avoiding people 2 9 3 3 1.59
Used quite a bit
171
Q47: Taking it out on other people 1 9 6 1 1.59
Used quite a bit
Q50: Refusing to believe what happened 0 14 2 1 1.77
Used quite a bit
Q58: Wishing situation would go away 0 11 6 0 1.65
Used quite a bit
Q59: Having fantasies 1 13 3 0 1.88
Used quite a bit
Question no. 11
Average: 1(3) + 9(2) + 3(1) + 1(0)
17
3 + 18 + 3 + 0 = 1.41
17
Interpretation: 40-64 years old used somewhat.
Question no. 16
Average: 1(3) + 9(2) + 6(1) + 1(0)
172
17
3 + 18 + 6 + 0 = 1.59
17
Interpretation: 40-64 years old used quite a bit.
Question no. 33
Average: 1(3) + 7(2) + 3(1) + 6(0)
17
3 + 14 + 3 + 0 = 1.18
17
Interpretation: 40-64 years old used somewhat.
Question no. 40
Average: 2(3) + 9(2) + 3(1) + 3(0)
17
6 + 18 + 3 + 0 = 1.59
17
Interpretation: 40-64 years old used quite a bit.
Question no. 47
Average: 1(3) + 9(2) + 6(1) + 1(0)
173
17
3 + 18 + 6 + 0 = 1.59
17
Interpretation: 40-64 years old used quite a bit.
Question no. 50
Average: 0(3) + 14(2) + 2(1) + 1(0)
17
0 + 28 + 2 + 0 = 1.77
17
Interpretation: 40-64 years old used quite a bit.
Question no. 58
Average: 0(3) + 11(2) + 6(1) + 0(0)
17
0 + 22 + 6 + 0 = 1.65
17
Interpretation: 40-64 years old used quite a bit.
Question no. 59
Average: 1(3) + 13(2) + 3(1) + 0(0)
174
17
3 + 26 + 3 + 0 = 1.88
17
Interpretation: 40-64 years old used quite a bit.
Category 7: Planful Problem Solving
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q1: Concentrating on the next step 3 14 1 0 2.24
Used quite a bit
Q26: Making a plan of action 2 11 4 0 1.88
Used quite a bit
Q39: Changing something to do right 4 10 3 0 2.06
Used quite a bit
Q48: Drawing on my past experiences 2 12 2 1 1.88
Used quite a bit
Q49: Knowing what had to be done 2 10 5 0 1.82
Used quite a bit
Q52: Coming up with
4 11 2 0 2.12 Used quite a bit
175
different solution
Question no. 1
Average: 3(3) + 14(2) + 1(1) + 0(0)
17
9 + 28 + 1 + 0 = 2.24
17
Interpretation: 40-64 years old used quite a bit.
Question no. 26
Average: 2(3) + 11(2) + 4(1) + 0(0)
17
6 + 22 + 4 + 0 = 1.88
17
Interpretation: 40-64 years old used quite a bit.
Question no. 48
Average: 2(3) + 12(2) + 2(1) + 1(0)
176
17
6 + 24 + 2 + 0 = 1.88
17
Interpretation: 40-64 years old used quite a bit.
Question no. 49
Average: 2(3) + 10(2) + 5(1) + 0(0)
17
6 + 20 + 5 + 0 = 1.82
17
Interpretation: 40-64 years old used quite a bit.
Question no. 52
Average: 4(3) + 11(2) + 2(1) + 0(0)
17
12 + 22 + 2 + 0 = 2.12
17
Interpretation: 40-64 years old used quite a bit.
Category 8: Positive Reappraisal
177
Question no.
3 = Used a great
deal
2 = Used
quite a bit
1 = Used somewhat
0 = Does not apply or not
used Average
Verbal Interpretation
Q20: Inspired to do something creative 1 12 4 0 1.82
Used quite a bit
Q23: Changing as a person 5 10 2 0 2.65
Used quite a bit
Q30: Experiencing better than what I went through 2 8 7 0 1.71
Used quite a bit
Q36: Finding new faith 2 9 4 2 1.47
Used somewhat
Q38: Rediscovering life 1 14 2 0 1.94
Used quite a bit
Q56: Changing something about myself 2 12 3 0 1.94
Used quite a bit
Q60: Praying7 9 1 0 2.35
Used quite a bit
Question no. 20
Average: 1(3) + 12(2) + 4(1) + 0(0)
178
17
3 + 24 + 4 + 0 = 1.82
17
Interpretation: 40-64 years old used quite a bit.
Question no. 23
Average: 5(3) + 10(2) + 2(1) + 0(0)
17
15 + 20 + 2 + 0 = 2.65
17
Interpretation: 40-64 years old used a great deal.
Question no. 30
Average: 2(3) + 8(2) + 7(1) + 0(0)
17
6 + 16 + 7 + 0 = 1.71
17
Interpretation: 40-64 years old used quite a bit.
Question no. 36
Average: 2(3) + 9(2) + 4(1) + 2(0)
179
17
6 + 18 + 4 + 0 = 1.47
17
Interpretation: 40-64 years old used somewhat.
Question no. 38
Average: 1(3) + 14(2) + 2(1) + 0(0)
17
3 + 28 + 2 + 0 = 1.94
17
Interpretation: 40-64 years old used quite a bit.
Question no. 56
Average: 2(3) + 12(2) + 3(1) + 0(0)
17
6 + 24 + 3 + 0 = 1.94
17
Interpretation: 40-64 years old used quite a bit.
Question no. 60
Average: 7(3) + 9(2) + 1(1) + 0(0)
180
17
21 + 18 + 1 + 0 = 2.35
17
Interpretation: 40-64 years old used quite a bit.
Summary Score of Each Category
Categories Young Adult
Verbal Interpretation
Middle Adult
Verbal Interpretation
1. Confrontive Coping
1.72 Used quite a bit
1.68 Used quite a bit
2. Distancing 1.86 Used quite a bit
1.62 Used quite a bit
3. Self- Controlling
1.92 Used quite a bit
1.79 Used quite a bit
4. Seeking Social Support
2.05 Used quite a bit
1.90 Used quite a bit
5. Accepting Responsibility
2.01 Used quite a bit
1.59 Used quite a bit
6. Escape Avoidance
1.62 Used quite a bit
1.58 Used quite a bit
181
7. Planful Problem Solving
2.11 Used quite a bit
2 Used quite a bit
8. Positive Reappraisal
2.06 Used quite a bit
1.98 Used quite a bit
Average 1.92 Used quite a bit
1.77 Used quite a bit
Young Adult
1.72 + 1.86 + 1.92 + 2.05 + 2.01 + 1.62 + 2.11 + 2.06 = 1.92
8
Interpretation: 21-39 y/o Used all the coping strategies quite a bit
Middle Adult
1.68 + 1.62 + 1.79 + 1.90 + 1.59 + 1.58 + 2 + 1.98 = 1.92
8
Interpretation: 21-39 y/o Used all the coping strategies quite a bit
182
Problem No. 3 Difference in the Perception of Care
CARING FACTOR YOUNG ADULT
MIDDLE ADULT
X1 X12 X2 X2
2
Responded to client as a whole person (16) 5.67 32.15 5.65 31.92Creation of an environment for physical and spiritual healing(10) 5.56 30.91 5.76
33.29
Embracing of client’s feelings(19) 5.5 30.25 5.65
31.92
Establishment of helping-trust relationship(13) 5.44 29.59 5.59
31.25
Values relationship (15) 5.44 29.59 5.35 28.62Solved unexpected problems (2) 5.39 29.05 5.35
28.62
Creative problem solving (4) 5.39 29.05 5.12
26.21
Encouraged verbalization of feelings (17) 5.39 29.05 5.47
29.92
Support client’s beliefs (18) 5.39 29.05 5.47
29.92
Honored client’s faith, instilled hope, and respected client’s belief system (5) 5.33 28.41 4.82
23.23
Respectful of spiritual beliefs and practices(9) 5.33 28.41 5.65
31.92
Acceptance and support to client’s belief to a
5.33 28.41 5.35 28.62
183
higher power (20)Over-all care was provided with loving-kindness(1) 5.28 27.88 5.53
30.58
Teaching client on the level the client can understand (6) 5.22 27.25 5.3
28.09
Helped support client’s hope and faith (7) 5.22 27.25 5.53
30.58
Helped meet client’s physical, emotional and physical needs (14) 5.17 26.73 5.18
26.83
Responsive to client’s readiness to learn(8) 5.11 26.11 5.59
31.25
Encouraged practice own spiritual beliefs (11) 5.11 26.11 5.53
30.58
Creation of an environment that recognizes the client’s connection between mind, body and spirit (12) 5 25 5.18
26.83
Care is provided with loving kindness (3) 4.72 22.28 5.35
28.62
SUMS 105.99 562.53 108.43 588.8 ∑xt= 214.42
MEANS 5.30 5.42 ∑xt2=11
51.33 N 20 20 Nt = 40
Sums of Squares
d. SSt (SS for total variability)
184
= ∑xt2 - ( ∑xt) 2
N= 1151.33 – (214.42) 2
40= 1151.33 – 45975.9364
40= 1151.33 – 1149.39841
SSt = 1.93
e. SSb (SS for between group variability)
= (∑x1) 2 + (∑x 2) 2 - (∑x t) 2 N1 N2 Nt
= ( 105.99 ) 2 + ( 108.43 ) 2 - (214.42) 2 20 20 40
= 11233.8801 + 11757.0649 – 45975.9364 20 20 40
= 561.694005 + 587.853245 – 1149.39841 SSb = 0.15
f. SSw = (SS for within group variability)
= SSt - SSb
= 1.93 – 0.15
SSw= 1.78
Degrees of Freedom
185
c. Between groups: dfb = k – 1 dfb = 2 – 1
dfb= 1
d. Within groups: dfw = Nt – k dfw = 40 – 2
dfw = 38Mean Squares
c. MSb = SSb = 0.15 = 0.15 dfb 1
d. MSw = SSw = 1.78 = 0.05 dfw 38
T-ratio
T = MSb = 0.15 = 3 MSw 0.05
The critical value of T for df = 1/38 at the 0.05 level of
significance is 4.08 Therefore, the obtained T-ratio is not significant at
the 0.05 level of significance.
The Significant Difference between the Perception of Young and
Middle Adult Patients towards the Care Received
186
Source of variation
SS DF MS T-ratio Significance
Between Groups
0.15 1 0.15
3No
significanceWithin Groups
1.78 38 0.05
Total 1.93 Interpretation
Since the computed T-ratio of 3 is lesser than 4.08 at the 0.05 level
of significance, the researchers found out that there is no significant
difference between the perception of young adult and middle adult lung
cancer patients towards the care received.
Problem No. 4 Difference in the Extent of Coping
CATEGORIES YOUNG ADULT MIDDLE ADULTX1 X1
2 X2 X22
Planful Problem Solving
2.11 4.45 2 4
Positive Reappraisal
2.06 4.24 1.98 3.92
187
Seeking Social Support
2.05 4.2 1.9 3.61
Self- Controlling 1.92 3.69 1.79 3.2Accepting Responsibility
2.01 4.04 1.59 2.53
Distancing 1.86 3.46 1.62 2.62Confrontive Coping
1.72 2.96 1.68 2.82
Escape Avoidance 1.72 2.96 1.68 2.82SUMS 15.35 29.66 14.14 25.2 ∑ xt =
29.49MEANS 1.92 1.77 ∑ xt
2= 54.86
N 8 8 Nt = 16
Sums of Squares
a. SSt (SS for total variability)
= ∑xt2 - ( ∑xt) 2
N
= 54.86 – (29.49) 2 16
=54.86 – 869.6601 16
=54.86 – 54.35375625
SSt = 0.51
b. SSb (SS for between group variability)
188
= (∑x1) 2 + (∑x 2) 2 - (∑x t) 2 N1 N2 Nt
= (15.35) 2 + (14.14) 2 + (29.49) 2 8 8 16
=235.6225 + 199.9396 – 869.6601 8 8 16
= 29.4528125 + 24.99245 - 54.35375625
= 54.4452625 – 54.35375625 SSb = 0.09
c. SSw = (SS for within group variability)
= SSt - SSb
= 0.51 - 0.09
SSw = 0.42
Degrees of Freedom
a. Between groups: dfb = k – 1 dfb = 2 – 1
dfb= 1
b. Within groups: dfw = Nt – k dfw = 16– 2
dfw =14
Mean Squares
189
a. MSb = SSb = 0.09 = 0.09 dfb 1
b. MSw = SSw = 0.42= 0.03 dfw 14
T-ratio
T = MSb = 0.09 = 3 MSw 0.03
The critical value of T for df = 1/14 at the 0.05 level of
significance is 4.60 Therefore, the obtained T-ratio is not significant at
the 0.05 level of significance.
The Significant Difference between the Extent of Coping of Young
and Middle Adult Lung Cancer Patients
Source of Variation
SS DF MS T-ratio Significance
Between Groups
0.09 1 0.09
3No
SignificanceWithin Groups
0.42 14 0.03
Total 0.51
190
Interpretation
Since the computed T-ratio of 3 is lesser than the value of 4.60 at
the 0.05 level of significance, the researchers found out that there is no
significant difference between the extent of coping of young and middle
adult lung cancer patients.
191
Problem No. 5 Relationship Between Nurse’s Caring Factors and the Extent of Coping of Lung Cancer Patients
Coping of Lung Cancer Patients
Code Age 0 1 2 3 Computation WeightedAverage
001 28 5 9 7 29 110/50 2.2002 27 0 3 43 4 101/50 2.02003 29 0 0 41 9 109/50 2.18006 37 0 0 38 12 112/50 2.24007 24 0 5 43 2 97/50 1.94008 36 10 10 21 9 79/50 1.58009 28 0 4 43 3 99/50 1.98010 39 0 4 43 3 99/50 1.98011 27 6 7 28 9 90/50 1.8013 24 0 2 46 2 100/50 2015 22 4 10 26 10 92/50 1.84016 21 1 10 26 13 101/50 2.02017 32 4 12 22 12 92/50 1.84019 35 8 13 25 4 75/50 1.5022 23 0 0 50 0 100/50 2029 28 0 20 28 2 82/50 1.64032 36 0 10 37 3 93/50 1.86034 31 6 9 8 27 106/50 2.12004 42 2 15 26 7 88/50 1.76005 41 17 9 16 8 65/50 1.3012 53 0 0 50 0 100/50 2014 53 0 9 27 14 105/50 2.1018 57 4 12 22 12 92/50 1.84020 50 2 23 22 3 76/50 1.52021 47 4 13 22 9 84/50 1.68023 52 0 0 50 0 100/50 2024 63 0 0 50 0 100/50 2025 50 0 1 38 11 110/50 2.2
192
026 48 0 7 40 3 96/50 1.92027 62 4 26 18 2 68/50 1.36028 47 1 24 24 1 75/50 1.5030 59 1 26 22 1 73/50 1.46031 44 1 28 19 2 72/50 1.44033 43 1 5 37 7 100/50 2035 45 0 4 46 0 96/50 1.92
Summation: 64.74
Average: 64.74/35=1.85 or 2
Interpretation:
Based from the computed value of 1.85 or 2 using the averaging
method of computation, the majority of the 35 surveyed lung cancer
patients agreed that they used quite a bit the ways of coping provided in
the questionnaires based from the 8 categories of coping namely the
confrontive, distancing, self-controlling, seeking social support,
accepting responsibility, escape-avoidance, planful problem solving and
positive reappraisal provided by Lazarus.
Caring Environment
Code Age 3 4 5 6 7 Computation WeightedAverage
001 28 1 4 9 5 1 101/20 5.05
193
002 27 1 3 8 8 0 103/20 5.15003 29 0 4 4 8 4 112/20 5.6006 37 4 8 7 1 0 85/20 4.25007 24 0 6 8 6 0 100/20 5008 36 0 0 9 3 8 119/20 5.95009 28 0 0 20 0 0 100/20 5010 39 0 6 9 5 0 99/20 4.95011 27 0 5 3 12 0 107/20 5.35013 24 0 0 6 14 0 114/20 5.7015 22 0 4 12 4 0 100/20 5016 21 0 0 4 12 4 120/20 6017 32 0 3 10 7 0 104/20 5.2019 35 0 0 11 8 1 110/20 5.5022 23 0 1 7 6 6 117/20 5.85029 28 1 5 11 3 0 96/20 4.8032 36 0 1 7 4 8 119/20 5.95034 31 1 5 6 7 1 102/20 5.1004 42 4 0 9 7 0 99/20 4.95005 41 0 0 7 13 0 113/20 5.65012 53 0 3 7 8 2 109/20 5.45014 53 0 1 7 4 8 119/20 5.95018 57 0 0 7 11 2 115/20 5.75020 50 0 1 10 8 1 109/20 5.45021 47 0 4 10 6 0 102/20 5.1023 52 0 1 7 10 2 113/20 5.65024 63 0 0 7 13 0 113/20 5.65025 50 0 2 8 6 4 112/20 5.6026 48 0 0 9 11 0 111/20 5.55027 62 0 0 12 8 0 108/20 5.4028 47 1 4 9 6 0 100/20 5030 59 0 0 4 12 4 120/20 6031 44 4 5 8 3 0 90/20 4.5033 43 1 1 11 7 0 104/20 5.2035 45 0 0 6 14 0 114/20 5.7
194
Summation: 187.95
Average: 187.95/35= 5.37 or 5
Interpretation:
Based from the computed value of 5.37 or 5 using the averaging
method, the majority of the 35 lung cancer patients slightly agreed that
they receive a caring environment from the nurses whenever they are
confined in the hospital or having a follow-up care.
195
Table presentation to find the Pearson R
Young Adulthood
Code AgeCaring (x) Coping (y)
xyx x2 y y2
001 28 5.05 25.50 2.2 4.84 11.11002 27 5.15 26.52 2.02 4.08 10.40003 29 5.6 31.36 2.18 4.75 12.21006 37 4.25 18.06 2.24 5.02 9.52007 24 5 25 1.94 3.76 9.7008 36 5.95 35.40 1.58 2.50 9.40009 28 5 25 1.98 3.92 9.9010 39 4.95 24.50 1.98 3.92 9.80011 27 5.35 28.62 1.8 3.24 9.63013 24 5.7 32.49 2 4 11.4015 22 5 25 1.84 3.39 9.2016 21 6 36 2.02 4.08 12.12017 32 5.2 27.04 1.84 3.39 9.57019 35 5.5 30.25 1.5 2.25 8.25022 23 5.85 34.22 2 4 11.7029 28 4.8 23.04 1.64 2.69 7.87032 36 5.95 35.40 1.86 3.46 11.07034 31 5.1 26.01 2.12 4.49 10.81
Middle Adulthood004 42 4.95 24.50 1.76 3.10 8.71005 41 5.65 31.92 1.3 1.69 7.35012 53 5.45 29.70 2 4 10.9014 53 5.95 35.40 2.1 4.41 12.50018 57 5.75 33.06 1.84 3.39 10.58020 50 5.45 29.70 1.52 2.31 8.28021 47 5.1 26.01 1.68 2.82 8.57023 52 5.65 31.92 2 4 11.3024 63 5.65 31.92 2 4 11.3025 50 5.6 31.36 2.2 4.84 12.32
196
026 48 5.55 30.80 1.92 3.69 10.66027 62 5.4 29.16 1.36 1.85 7.34028 47 5 25 1.5 2.25 7.5030 59 6 36 1.46 2.13 8.76031 44 4.5 20.25 1.44 2.07 6.48033 43 5.2 27.04 2 4 10.4035 45 5.7 32.49 1.92 3.69 10.94
n=35 Σx=187.95 Σx2=1015.64Σy=
64.74Σy2=122.02
Σxy =347.55
The formula for finding the Pearson r is given as:
n Σ xy – Σ x Σ y
r =
√ [ n Σx2 – (Σx)2 ] [nΣy 2 - (Σy) 2 ]
Where:
r = the Pearson Product Moment Coefficient of Correlation
n = Sample Size
Σ xy = the sum of the product of x and y
Σ x Σ y = the product of the sum of Σ x and the sum of Σ y
Σx2 = sum of squares of x
Σy2 = sum of squares of y
197
Solution
n Σ xy – Σ x Σ y
r =
√ [ n Σx2 – (Σx)2 ] [nΣy 2 - (Σy) 2 ]
= 35 (347.55) – (187.95)(64.74)
√ [ 35(1015.64)– (187.95)2 ] [35(122.02) - (64.74) 2 ]
= 12,164.25 – 12,167.88
√ (35,547.4 – 35,325.20) (4,270.7 – 4,191.27)
= -3.63
√ (222.20) (79.43)
= -3.63
√ 17,649.35
= -3.63
132.85
= -0.027
198
Level of Significance
α= 0.05
df= n-2
=35-2
=33
r.05= 0.33
Interpretation:
This numerical value, -0.027 indicates a very small negative
correlation between the provisions of caring environment and the lung
cancer patients. In other words, the provision of a caring environment by
the nurses to the lung cancer patients will not influence their ways of
coping to their lung cancer. Hence, coping of lung cancer patient and the
provision of a caring environment are independent from each other, they
does not go hand in hand.
199
Testing the Significance of r
Test Statistic
t= r√ n-2
√l-r2
Level of significance
ɑ= 0.05
df= n-2 = 33
t= -0.33 √35-2
√1- (-0-33)2
= -0.03 √ 33
√0.991
= -0.03 √33.30
= -0.03 (5.77)
t= -0.17
Since t is -0.17 is > -2.16 which is the reference value, therefore accept
the null hypothesis.
200
201
Scatter Diagram showing the Very Small Negative Correlation
0
0.5
1
1.5
2
2.5
0 1 2 3 4 5 6 7
COPI
NG
CARING ENVIRONMENT
202
203