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1 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,
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Page 1: Research study by kennedy

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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.

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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

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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,

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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

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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

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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

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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

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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

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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

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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

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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).

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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.

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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.

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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

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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

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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

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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.

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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.

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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

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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.

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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.”

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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

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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

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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

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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)

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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

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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

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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

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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.

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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

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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.

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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.

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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

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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

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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

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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

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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.

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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

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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:

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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.

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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.

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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.

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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

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Decision Rule: Reject null hypothesis if t is > 2.16 or <-2.16 otherwise

accept null hypothesis.

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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.

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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

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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

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(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)

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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

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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).

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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

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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

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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)

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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.

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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)

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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

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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.

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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)

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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.

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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,

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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

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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

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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)

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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,

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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

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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)

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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.

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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

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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)

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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

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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).

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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

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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)

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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:

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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

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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

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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)

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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

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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

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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

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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)

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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

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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

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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)

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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

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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).

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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,

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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

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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)

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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:

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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,

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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.,

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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.

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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)

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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.

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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

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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

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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.

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)

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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

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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

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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

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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

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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)

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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.

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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).

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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

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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

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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).

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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

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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

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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).

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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).

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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

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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.

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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

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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

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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

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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).

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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:

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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?

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

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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.

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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

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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.

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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.

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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:

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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

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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.

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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.

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162

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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

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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                  

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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                    

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APPENDIX C

RESEARCH INSTRUMENTS

1. Caring Factor Survey

2. Ways of Coping

a. Original Format

b. Translated Format

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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)

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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

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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)

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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

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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

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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)

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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

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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)

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

Page 204: Research study by kennedy

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)

Page 205: Research study by kennedy

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

Page 206: Research study by kennedy

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

Page 207: Research study by kennedy

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

Page 208: Research study by kennedy

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

Page 209: Research study by kennedy

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

Page 210: Research study by kennedy

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

Page 211: Research study by kennedy

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

Page 212: Research study by kennedy

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

Page 213: Research study by kennedy

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

Page 214: Research study by kennedy

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

Page 215: Research study by kennedy

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

Page 216: Research study by kennedy

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

Page 217: Research study by kennedy

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

Page 218: Research study by kennedy

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

Page 219: Research study by kennedy

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

Page 220: Research study by kennedy

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

Page 221: Research study by kennedy

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

Page 222: Research study by kennedy

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

Page 223: Research study by kennedy

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

Page 224: Research study by kennedy

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

Page 225: Research study by kennedy

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

Page 226: Research study by kennedy

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

Page 227: Research study by kennedy

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)

Page 228: Research study by kennedy

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

Page 229: Research study by kennedy

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

Page 230: Research study by kennedy

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

Page 231: Research study by kennedy

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

Page 232: Research study by kennedy

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.

Page 233: Research study by kennedy

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)

Page 234: Research study by kennedy

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

Page 235: Research study by kennedy

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)

Page 236: Research study by kennedy

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)

Page 237: Research study by kennedy

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)

Page 238: Research study by kennedy

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

Page 239: Research study by kennedy

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)

Page 240: Research study by kennedy

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

Page 241: Research study by kennedy

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)

Page 242: Research study by kennedy

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)

Page 243: Research study by kennedy

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)

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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

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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

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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

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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)

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= ∑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

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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

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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

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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)

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= (∑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

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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

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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.

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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

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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

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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

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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.

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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

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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

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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

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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.

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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.

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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

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