Hanik Endang Nihayati*) Faculty of Nursing, Airlangga University Background
Breast cancer positioned as the disease most feared by women, and is the greatest cause of death, women aged 18 to 54 years. In addition, women aged 45 years have a risk of breast cancer 25% higher than the older (Lee, 2008). As a result, women with breast cancer seem experienced the discomfort of life and suffering. Suffering itself was described as a state of loss which affects the physical, emotional, social and spiritual (O, Brien, 1999, in Mauk Smidt, 2004).
Cancer is one of the diseases that cause of mortality. Currently breast cancer has a rating of 5-10% of all types of cancer. The incidence of breast cancer reported increases 2 times higher during thirty years world widely. WHO (Word Health Organization) estimates that the incidence of this disease in 2009 were 11 million affected and by 2030 will grow to approximately 27 million people live with cancer from 7 million to 17 million. As a result there will be 75 million people living with cancer in 2030. In the coming year of medical problems, especially in developing countries where breast cancer, with an increased incidence of up to 70% and by 2002 globally recorded 10.9 million cases. This is equal with mortality rate of 6.7 million people (John, 2008). Ibrahim (2008) stated that in Indonesia breast cancer is a type of cancer that positioned after cervix cancer. Studies show that almost of 26 cases of breast cancer recorded per 100,000 populations each year. Data in dr. Soetomo General Hospital (DSGH), the number of new patients with breast cancer showed an increasing trend. Starting form 2010 to 2012, the medical records report the snowballing trend on breast cancer by 385 people, 526 and 544 patients respectively.
Accordingly, in 2013 the incidence of breast cancer decrease to 320 patients and in January 2014 until November 2014 declined slightly to 296 patients. Although in 2013 and 2014 the number women with breast cancer decreased, but during that year there are an increasing number of new patients diagnosed with breast cancer (Oncology Outpatients Service DSGH, 2014). The number of visits in to Oncology outpatient service (POSA) in DSGH showed that breast cancer was the highest cases of cancer next to cervical. This data is similar to the explanation of researchers from the University of Gadjah Mada Yogjakarta, dr. Samuel Johny Haryoni that breast cancer in Indonesia has predicted to increase by the year. Furthermore, breast cancer has been estimated to be the highest type of cancer in Indonesia.
DISTRESS BREAST CANCER PATIENTS
Suffering in breast cancer patients is described as a state of loss which affects the physical, emotional, social and spiritual (O, Brien, 1999, in Mauk Smidt, 2004). Suffering possibly changes their daily habits, relationships with others, eliminating expectations, cause of conflict and sorrow.
A person who was diagnosed with cancer, there will be several stages of emotional reactions; one that often occurs is distress. Distress particularly in patients with breast cancer occurs due to the emergence of a sense of loss, for example, breast cancer patients felt that she would lose her figure.
Distress may be also caused by a sense of separation from the world, such as the inability to work, economic difficulties, no longer able to perform his favorite activity. Accordingly, perceived suffering of breast cancer patients seems carrying out people into the spiritual domain and invites
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the big questions in life as a process of finding meaning in life. Questions that are frequently expressed are; why I have to suffer like this? How could my family solve this problem? Why my life would change quickly, why is this happening to me? (Wright, 2005).
The suffering experienced by individuals who suffer from breast cancer has three components; loss of autonomy, loss of self-esteem, and loss of hope that shows that is not the meaning of life for individuals with cancer (Morita, Tsunoda 1999). Besides, there are other things that can lead to distress in cancer patients include medications, therapy complications and others.
Handling of distress in patients with breast cancer are not always the same, we need a correct understanding and proper diagnosis so that the selection of adequate treatment improve the quality of life.
SPIRITUAL CARE OF BREAST CANCER PATIENTS, IS IT A PRIORITY?
Complexity of the problems experienced by individuals with cancer led to the emergence of spiritual needs. Spiritual needs described as an essential part of all human life (Taylor, 2005).
Spirituality is known and experienced in a relationship (Burkhardt & Jacobson, 2000 in Mauk &
Schmidt, 2004). The relationship is described as the horizontal dimension of spirituality which is in line with the vertical relationship with Allah (Maauk & Schmidt, 2004). Someone who face serious illness and is considered a terminal illness such as breast cancer would show a high awareness of the trust shown in everyday behavior (Johnson, 2005). Gathering the needs of breast cancer patients not only focuses on physical health but also psychological health, social and spiritual.
Spiritual needs may reduce the suffering and positive effect on the recovery of physical and mental health clients. Therapeutic communication skills, sensitivity, empathy and understanding of the value of the client values are the main skill needed by nurses in psycho-spiritual treatment of patients with breast cancer (Kozier, Erb, Berman, 2004).
Distress experienced by breast cancer patients required an intervention in delivering the sense of meaning and the life’s purpose by always grateful and improve the relationship with Allah, the environment and the people around. Randi (1984 in Hamid 2008) revealed that the main spiritual needs of women with cancer is to find the meaning of life, died of natural causes and needs to be accompanied at the time of death. Spiritual nursing care used to improve the adaptability and quality of life of breast cancer patients. Psycho-spiritual care approach offered a way to improve the relationship with the Creator, emotional control, as a result breast cancer patients able to face the pain with gratitude.
THE DIMENSION OF POSITIVE PERCEPTION IN PATIENTS WITH BREAST CANCER SEHAT CARE PSYCHO-SPIRITUAL “SEHAT” SYUKUR SELALU HATI DAN TUBUH
SEHAT Syukur Selalu Hati dan Tubuh is a spiritual healing attitude focuses on the researchers modified therapeutic communication, draw closer to Allah and to control emotions as it expected by patients with breast cancer. This approach is enabling them to adapt to the pain they experienced. This cause’s psycho-spiritual care ‘SEHAT’ Syukur Selalu Hati dan Tubuh has not been studied and carried out elsewhere. Psycho-spiritual care provision in patients with breast cancer-related beliefs relationship with Allah the Almighty and the Creator may increase coping patients with breast cancer. As a result, they able to reduce the intensity of stress themselves.
SEHAT psycho-spiritual healing attitude minimizes the intensity of distress resulting by applying coping mechanism and conditions of the quality of life of breast cancer patients. SEHAT is a series of worship by always grateful for the favors of Allah with the purpose of breast cancer patients would be able to improve their spiritual intelligence. Additionally SEHAT is a spiritual healing intervention that is modified by the researchers intended to people with chronic diseases; especially breast cancer can have emotional intelligence. As a result, the intention of the patient is able to
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make sense of his condition, and unaware of anything that happens in life is the grace of Allah the Almighty. SEHAT focuses on the rituals of Duha prayer, reading the Qur'an, dhikr and spiritual motivation to write the favor of Allah SWT is expected to change coping strategies, changing perceptions of distress into eustress stress that affects the body's response. The condition is in line with the psychological concept, which states that the cognitive changes can reduce the intensity of stress (Quinn, 2001).
SEHAT psycho-spiritual care provision (Syukur Selalu Hati dan Tubuh ) refers to the development of psychoneuroimmunology (PNI), which focuses on the perception of stress and the stress response. Psychological distress experienced by patients with breast cancer affects the quality of life and the way they manage stress through coping mechanisms. Additionally, SEHAT as a psycho-spiritual healing will be perceived in the limbic system, precisely in the hypothalamus.
These signals will propagate to neuralgia and neurons in the hypothalamus. Psycho-spiritual signals are perceived in the limbic system propagate to hypothalamic neurons lead to CRH (corticotrophin releasing hormone) decreases. Furthermore, the production of ACTH by the anterior pituitary neurons decreased, which responded with a decrease cortisol adrenal cortex. (Alexy 2005, Dror Avisar, 2008).
CONCLUSION
SEHAT Syukur Selalu Hati dan Tubuh is constructed based on the needs of breast cancer patients. In major, distress experienced by breast cancer patients may increase the negative perceptions and emotions that seems difficult to control. SEHAT Syukur Selalu Hati dan Tubuh as a psycho-spiritual method of healing helps breast cancer survivors to always close to the Allah and to help them improve their spiritual intelligence. By implementing SEHAT in daily life, it is clear that cancer is not a frightening disease but it will motivate people to always think positively, to draw closer to Allah and gain a deeper understanding of a good life. In the final analysis breast cancer patients whose emotional and spiritual intelligence are bearing out properly, this would be then the logic is perceived to be SEHAT.
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