| Summary: | 博士 === 國立臺北護理健康大學 === 護理研究所 === 100 === Rheumatoid arthritis (RA) is a disease which is chronic, and whose pathological change has been irreversible, and which may cause joint deformation, leading to physical disabilities. Although this disease is without any immediate life threat, to some patients it may cause a drastic change in life, influencing their body, mind, and spirit. Therefore, it is an important subject to help reconstruct the patients’ body, mind, and spirit to elevate their life quality.
The purposes of this study were as follows. 1. The qualitative research was used to initially explore the lived experiences of Taiwanese RA patients. 2. The qualitative meta-synthesis analysis was employed to understand the spiritual well-being of RA patients. 3. The quantitative research was used to analyze the spiritual well-being of Taiwanese RA patients, researching the related factors that influence spiritual well-being. The research design was divided into three parts. First, adopting the phenomenological approach, we use a purposive sampling to interview 21 patients belonging to a national aid group association of RA patients in order to explore the lived experience. Second, the qualitative meta-synthesis method was used to integrate the published studies that were related to the RA spiritual well-being. The third part adopted the quantitative method, based on the findings of the first two parts to propose and confirm the factors that related to spiritual well-being. The cross-section design was adopted for the convenience of sampling the patients in the national aid group of RA patients and two clinics of a northern medical center. The participants were invited to answer the questionnaires or to be interviewed. Participants were 223 patients of RA who completed the HAQ, the Multidimentional Health Locus of Control Scales, the Jalowiec Coping Scale, the ISEL, and the FACIT-Sp.
According to the result of this study, the first part of RA lived experiences manifested four themes: “suffering of body and mind”, “doubting about the cause of disease”, and “feeling frustration when seeking treatment” these three themes presented how the illness influenced the patient’s body, mind, and spirit. Additionally, the fourth theme “coping with the challenge of the illness”, presented the help, attitude, and strategy the patient has while adapting to the illness. In the second part, the meta-analysis of the qualitative research presented four characteristics of the spiritual well-being of RA patients. There were, they needed to have the awareness of “living with disease.” And by “reframing the situation,” and “bolstering courage,” they could “reclaim control.” In the third part, we tested seven concepts, the demographic characteristic, disease status, religious belief, health control faith, social support, coping strategy and the spiritual well-being. Result demonstrated that spiritual well-being was not significant difference with religious belief and gender. RA patients who had lower stress in economics, tendency to adopt problem-oriented strategies, with better social support, tendency internal control, doctor control, who with better spiritual well-being. The problem-oriented strategy acts the important intermediary role in all factors. In addition, patients who had worse function of daily activities and physical pain, had more difficult to feel “the internal control” and to use the problem-oriented strategies. Problem oriented strategies and social support could directly enhance the spiritual well-being. Via the problem-oriented strategies, the function of daily activities, pain, social support, doctors’ control, and internal control can improve and enhance the spiritual well-being. Pain directly influences the spiritual well-being, making patients more inclined to employ affective-oriented strategies, which could enhance spiritual well-being through religious faith and social support.
The result of this study can help medical and nursing staff to understand that the RA disease makes the whole condition of the patient changed. When the patient seeks to adapt to the illness, they should help with spiritual power including knowledge of caring for the illness, the skills of solving the problems confronted in everyday life, and evaluation of the interaction in a family. In this way, the advantageous surroundings can be created to help the patient. And evaluation of how the patient adapts to the illness should be included in the characteristics of the contents of the spiritual well-being.
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