Death acceptance from a Thai Buddhist perspective: A qualitative study.

PURPOSE: To have more in-depth understanding of death acceptance among patients with terminal cancer in Thailand. METHODS: A qualitative descriptive research approach was used to capture the perspectives of patients with terminal cancer about death acceptance. Purposive sampling was used to recruit the participants. A semi-structured interview guide was used during data collection to obtain in-depth interviews with 12 patients diagnosed with terminal cancer. An interpretive descriptive method was used for analyzing data. Analysis of the data for this study was conducted by the analytic team beginning at initial data collection. RESULTS: The findings of this study revealed six major themes relating to death acceptance: 1) perceiving death as a natural part of life; 2) perceiving that death cannot be controlled; 3) thinking that death can come at any time; 4) letting everything go before dying: finding a calmness; 5) additional Buddhist practices: clean living and making merit; and 6) additional means for attaining a peaceful death and peaceful life before death. CONCLUSION: Understanding death acceptance is important for nurses providing care for patients with terminal cancer in order to find strategies and support for patients to accept death and live peacefully with their family in the time they have left.

Spiritual dimension in palliative care from the perspective of Thai palliative caregivers.

BACKGROUND: In Thailand, most terminally ill patients die in hospital and are looked after by health professionals. Terminally ill patients tend to receive physical care only, while in the main, spiritual care is neglected. This study aimed to explore spirituality in palliative care health professionals and spiritual leaders in the Thai Buddhist context. METHOD: In this qualitative case study, seven experienced palliative caregivers took part in in-depth interviews. Thematic analysis and a trustworthiness process were used to analyse the data. FINDINGS: Three themes emerged: (1) the ability for self-awareness and faith; (2) acceptance and compassion for others; and (3) spiritual behaviour while nursing. CONCLUSION: The results revealed the meaning of spirituality and the necessary characteristics for spirituality in palliative care for the participants, which could serve as a basis for further development.

Bem-estar psicológico e meditação: um estudo associativo / Psychological well-being and buddhist meditation: an associative study / Bienestar psicológico y meditación budista: un estudio de asociación

A meditação budista é amplamente estudada devido aos benefícios percebidos pelos meditadores. Todavia, quando o tema é bem-estar psicológico em relação à prática de meditação budista a literatura ainda é escassa. Essa pesquisa verificou a associação entre o bem-estar psicológico e indicadores de envolvimento com a meditação (tempo, frequência de prática e sentidos da prática para a vida do meditador) em dois centros de meditação budista Vajrayana. Foram avaliados 50 meditadores, maiores de 18 anos (M = 41,2 anos, DP=13,7) e que praticavam há pelo menos um mês completo. Os dados foram coletados por meio de três instrumentos de autorrelato e submetidos a análises descritivas e inferenciais. Percebeu-se a relação positiva entre o tempo de meditação e o domínio autoaceitação da escala de bem-estar utilizada, indicando que os anos de prática meditativa parecem estar relacionados a um maior autoconhecimento e uma maior atitude positiva em relação a si mesmo (AU).

Buddhist meditation is widely studied mainly because of the benefits perceived by meditators. Although, when the subject is psychological well-being compared to the practice of Buddhist meditation literature is still little. The study verified the association between psychological well-being and indicators of involvement with meditation (time, frequency and meanings of practice for the life of the meditator) in two Vajrayana Buddhist meditation centers. 50 meditators (A= 41,2 years, SD =13,7), over 18 years of age and practicing for at least one full month, were evaluated. Data was collected through three self-report instruments, and subjected to descriptive analyzes. A positive relationship between the time of meditation and the selfacceptance domain of the well-being instrument was perceived, indicating that the years of meditative practice seem to be related to a greater self-knowledge and a greater positive attitude toward oneself (AU).

La meditación budista es ampliamente estudiada debido a los beneficios percibidos por los meditadores. En relación con el tema del bienestar psicológico en relación a la práctica meditativa budista la literatura es todavía escasa. Se verificó la asociación entre el bienestar psicológico e indicadores de participación con la meditación (tiempo, frecuencia y sentidos de la práctica para la vida del meditador) en dos centros de meditación budista Vajrayana. Fueron evaluados 50 meditadores, mayores de 18 años (M = 41,2 años, DE=13,7) y que practicaban por lo menos desde hace un mes completo. Los datos fueron recolectados mediante tres instrumentos de auto relato, y sometidos a análisis descriptivos. Se percibió la relación positiva entre el tiempo de meditación y el dominio auto acepción del instrumento de bienestar psicológico, indicando que los años de práctica meditativa parecen estar relacionados con mayores índices de autoconocimiento y actitud positiva hacia uno mismo (AU).

Effect of an intervention based on basic Buddhist principles on the spiritual well-being of patients with terminal cancer.

PURPOSE: To evaluate the effect of an intervention based on basic Buddhist principles on the spiritual well-being of patients with terminal cancer. METHODS: This quasi-experimental research study had pre- and post-test control groups. The experimental group received conventional care and an intervention based on basic Buddhist principles for three consecutive days, including seven activities based on precept activities, concentration activities and wisdom activities. The control group received conventional care alone. RESULTS: Forty-eight patients participated in this study: 23 in the experimental group and 25 in the control group. Their mean age was 53 (standard deviation 10) years. The spiritual well-being of participants in the experimental group was significantly higher than that of participants in the control group at the second post-test (P < 0.05). CONCLUSIONS: An intervention based on basic Buddhist principles improved the spiritual well-being of patients with terminal cancer. This result supports the beneficial effects of implementing this type of intervention for patients with terminal cancer.

Cancer-Induced Bone Pain Management Through Buddhist Beliefs.

Dealing with physical pain represents a huge public health expenditure, especially for cancer-induced bone pain, one of the most difficult health issues, which impairs appetite, sleep, and mobility, negatively impacting quality of life and evoking mental problems. Although some literature has reported positive correlation between religion and pain management, there is a dearth of research examining the effectiveness of Buddhism on this topic. This study investigates the usefulness of Buddhist beliefs in managing cancer-induced bone pain through a case example. It illustrates how an advanced cancer patient, with the assistance of a counsellor, perceived pain and coped with it and pain-induced mental problems via Buddhist teachings and practices, including the four noble truths, the law of dependent origination, and karma. It offers alternative perspectives for helping professionals (such as physicians, nurses, counsellors, social workers, hospice and palliative service providers, and pain management practitioners) who are keen to equip themselves with a wider worldview and life view to better serve their clients.

Bienestar Psicológico y Budismo: experiencias y significados en practicantes de Budismo en el Perú / Psychological wellbeing and Buddhism: practitioner's experiences and meanings of Buddhism in Peru

El objetivo de esta investigación fue explorar las experiencias y significados del bienestar psicológico en practicantes de la división joven del Budismo de Nichiren Daishonin en el Perú. Se contó con la participación de 10 jóvenes, 5 mujeres y 5 hombres entre 20 y 32 años de edad, practicantes del Budismo de Nichiren Daishonin residentes de Lima Metropolitana. Empleando un diseño cualitativo, la información recabada tomó como referencia los sistemas conversacionales propuestos por González Rey (2006). El presente estudio muestra que todas las experiencias y significados de los jóvenes participantes cuentan con la presencia de los seis factores propuestos por Ryff y Keyes (1995) para alcanzar el bienestar. Señala al budismo como un medio o camino por el cual los participantes han llegado a alcanzar el bienestar psicológico o la Revolución Humana. Este concepto presente en las conversaciones conducidas es percibido como la mejora de la calidad de vida y desarrollo personal de los budistas. Finalmente, se identificó la importancia del componente comunitario en los practicantes de budismo ya que es considerado como un factor esencial para alcanzar el bienestar psicológico.

The purpose of this research is to explore the experiences and meanings of psychological well being among practitioners of the young division of Nichiren Daishonin Buddhism in Peru. The sample consisted in 10 people (5 women and 5 men) ranging from 20 to 32 years old, who were Nichiren Daishonin Buddhism followers and lived in Lima City. The study was conducted through a qualitative approach, and the conversational system proposal created by González Rey (2006) was used as a tool to gather information. The results show that all six factors proposed by Ryff and Keyes (1995) to achieve wellness are found in the participants' experiences and meanings. Therefore, Buddhism is displayed as a means by which participants have sought to achieve psychological wellbeing or the Human Revolution. This concept came up in the conducted conversations, and it is thought to improve Buddhists' quality of life and personal development. Finally, this research highlights the importance of the community component, since it is considered essential in order to achieve psychological well-being.

Beliefs about tobacco, health, and addiction among adults in Cambodia: findings from a national survey.

There remains a very high rate of smoked and smokeless tobacco use in the Western Pacific Region. The most recent findings from national adult tobacco surveys indicate that very few daily users of tobacco intend to quit tobacco use. In Cambodia, a nation that is predominantly Buddhist, faith-based tobacco control programs have been implemented where, under the fifth precept of Buddhism that proscribes addictive behaviors, monks were encouraged to quit tobacco and temples have been declared smoke-free. In the present study, we included items on a large national tobacco survey to examine the relation between beliefs (faith-based, other) about tobacco, health, and addiction among adults (18 years and older). In a stratified, multistage cluster sample (n=13,988) of all provinces of Cambodia, we found that (1) 88-93% believe that Buddhist monks should not use tobacco, buy tobacco, or be offered tobacco during a religious ceremony; (2) 86-93% believe that the Wat (temple) should be a smoke-free area; (3) 93-95% believe that tobacco is addictive in the same way as habits (opium, gambling, alcohol) listed under the fifth precept of Buddhism; and (4) those who do not use tobacco are significantly more likely to cite a Buddhist principle as part of their anti-tobacco beliefs. These data indicate that anti-tobacco sentiments are highly prevalent in the Buddhist belief system of Cambodian adults and are especially evident among non-users of tobacco. Our findings indicate that faith-based initiatives could be an effective part of anti-tobacco campaigns in Cambodia.

Secular versus religious norms against smoking: which is more important as a driver of quitting behaviour among Muslim Malaysian and Buddhist Thai smokers?

BACKGROUND: This paper prospectively examined two kinds of social normative beliefs about smoking, secular versus religious norms. PURPOSE: The purpose of this paper is to determine the relative importance of these beliefs in influencing quitting behaviour among Muslim Malaysian and Buddhist Thai smokers. METHODS: Data come from 2,166 Muslim Malaysian and 2,463 Buddhist Thai adult smokers who participated in the first three waves of the International Tobacco Control Southeast Asia project. Respondents were followed up about 18 months later with replenishment. Respondents were asked at baseline about whether their society disapproved of smoking and whether their religion discouraged smoking, and those recontacted at follow-up were asked about their quitting activity. RESULTS: Majority of both religious groups perceived that their religion discouraged smoking (78% Muslim Malaysians and 86% Buddhist Thais) but considerably more Buddhist Thais than Muslim Malaysians perceived that their society disapproved of smoking (80% versus 25%). Among Muslim Malaysians, religious, but not societal, norms had an independent effect on quit attempts. By contrast, among the Buddhist Thais, while both normative beliefs had an independent positive effect on quit attempts, the effect was greater for societal norms. The two kinds of normative beliefs, however, were unrelated to quit success among those who tried. CONCLUSIONS: The findings suggest that religious norms about smoking may play a greater role than secular norms in driving behaviour change in an environment, like Malaysia where tobacco control has been relatively weak until more recently, but, in the context of a strong tobacco control environment like Thailand, secular norms about smoking become the dominant force.

The health behavior of Sri Lankan Buddhist nuns with type 2 diabetes: duty, devotion, and detachment.

Sri Lanka has experienced an increase in the rate of type 2 diabetes. Selfmanagement of diabetes among Sri Lanka's Buddhist nuns, who depend on food donations and limit physical activity in accord with the monastic code of conduct, presents unique challenges and has not been previously studied. The purpose of this focused ethnographic study of 10 Buddhist nuns was to understand how they managed their illness within the restrictions on diet and physical activity. Three themes-duty, devotion, and detachment-explained and described their health behavior regarding type 2 diabetes within the context of their daily routines and obligations.

Integrating job, Jesus' passion, and Buddhist Metta to bring meaning to the suffering and recovery from breast cancer.

Coming face-to-face with death was a spiritual crisis. My family and I suffered individually and collectively during my treatment and recovery for locally advanced breast cancer. Like Job, I learned that it takes tremendous energy to ruminate about the causes of suffering and to protest innocence with little gains in wisdom. Wisdom came as I deeply experienced a passion narrative based on the life of Jesus with reference to the psychological benefits as extolled by Wilkes. The grueling experience of treatment for locally advanced breast cancer broke my body and forced me to experience Easter Saturday as I retreated to heal in the tomb. My physical and emotional healing of Easter Saturday included the Buddhist meditation of Metta and guided imagery that involved spiritual healing focussed on God, Jesus and the Holy Spirit. My reflection on the story of Job, passion journaling and Buddhist meditation enabled me to physically, emotionally, and spiritually heal, even in the midst of chaos.

Craving to quit: psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions.

Humans suffer heavily from substance use disorders and other addictions. Despite much effort that has been put into understanding the mechanisms of the addictive process, treatment strategies have remained suboptimal over the past several decades. Mindfulness training, which is based on ancient Buddhist models of human suffering, has recently shown preliminary efficacy in treating addictions. These early models show remarkable similarity to current models of the addictive process, especially in their overlap with operant conditioning (positive and negative reinforcement). Further, they may provide explanatory power for the mechanisms of mindfulness training, including its effects on core addictive elements, such as craving, and the underlying neurobiological processes that may be active therein. In this review, using smoking as an example, we will highlight similarities between ancient and modern views of the addictive process, review studies of mindfulness training for addictions and their effects on craving and other components of this process, and discuss recent neuroimaging findings that may inform our understanding of the neural mechanisms of mindfulness training.

Life is uncertain. death is certain. Buddhism and palliative care.

It is part of a palliative care assessment to identify patients' spiritual needs. According to Buddhism, suffering is inherent to all human beings. Advice on how suffering can be reduced in the course of serious illness might be helpful to patients with incurable and progressive diseases. Palliative care could benefit from Buddhist insights in the form of compassionate care and relating death to life. Buddhist teachings may lead to a more profound understanding of incurable diseases and offer patients the means by which to focus their minds while dealing with physical symptoms and ailments. This might not only be beneficial to followers of Buddhism but to all patients.

Thai Buddhist families' perspective of a peaceful death in ICUs.

AIM: To describe the concept of a peaceful death in intensive care units (ICUs) from the perspective of Thai Buddhist family members. METHODS: This descriptive qualitative study was based on data generated from individual in-depth interviews of nine Thai Buddhist family members from the southern region of Thailand whose loved ones died in adult ICUs. Colaizzi's phenomenological approach was used to analyse the data. Rigour for the study was established by Lincoln and Guga's guidelines for qualitative research studies. FINDINGS: Five core qualities emerged that made-up the concept of a peaceful death as described by Thai Buddhist family members who cared for their loved ones while they were dying in ICUs. These core qualities were 'knowing death was impending, preparing for a peaceful state of mind, not suffering, being with family members and not alone, and family members were not mourning'. CONCLUSION: Thai Buddhist family members described what they meant by a peaceful death. 'This was: preparing for a peaceful state of mind in knowing that one's impending death is not a situation of suffering or being alone, but rather a time of being with family members who are not yet mourning one's death.' The findings support that family members should participate in promoting a peaceful death for their loved ones dying in ICUs. IMPLICATIONS FOR PRACTICE: The five core qualities of a peaceful death reported in this study could be used as a framework for nurses to create nursing practice interventions for quality end-of-life care for Thai Buddhists.

Smoking prevalence among monks in Thailand.

Previous studies among Buddhist monks in Thailand have reported smoking rates to be as high as 55%. Because 95% of Thais are Buddhist, monks are highly influential in establishing normative behavioral patterns. As the first population-based study on smoking among Buddhist monks in Thailand, this study aims to determine the smoking prevalence in six regions of the country, and to examine smoking knowledge, risk perceptions, behaviors, and associated demographics among full-fledged and novice monks (n = 6,213). Results demonstrated that the overall prevalence for current smoking monks is 24.4% (95% confidence interval [24.453, 24.464]), with regional differences ranging from 14.6% (North) to 40.5% (East). Findings suggest that integrating prevention and cessation programming into religious courses may be one avenue for reaching many incoming monks. Further, involving monks in tobacco control education and setting a nonsmoking standard among them is vital to the success of reducing smoking rates among the general population in Thailand.

Adult smokers' perception of the role of religion and religious leadership on smoking and association with quitting: a comparison between Thai Buddhists and Malaysian Muslims.

In recent years, attempts have been made to incorporate religion into tobacco control efforts, especially in countries like Malaysia and Thailand where religion is central to the lives of people. This paper is a prospective examination of the perceived relevance and role of religion and religious authorities in influencing smoking behaviour among Muslims in Malaysia and Buddhists in Thailand. Data were collected from 1482 Muslim Malaysian and 1971 Buddhist Thai adult smokers who completed wave 1 (early 2005) of the International Tobacco Control Southeast Asia Survey (ITC-SEA). Respondents were asked about the role of religion and religious leadership on smoking at Wave 1 and among those recontacted, quitting activity at Wave 2. Results revealed that over 90% of both religious groups reported that their religion guides their day-to-day behaviour at least sometimes, but Malaysian Muslims were more likely to report that this was always the case. The majority (79% Muslims and 88% Buddhists) of both groups believed that their religion discourages smoking. About 61% of the Muslims and 58% of the Buddhists reported that their religious leaders had encouraged them to quit before and a minority (30% and 26%, respectively) said they would be an influential source to motivate them to quit. Logistic regression models suggest that these religious factors had a clear independent association with making quitting attempts in both countries and this translated to success for Malaysian Muslims but not for the Thai Buddhists. Taken together, results from this study indicate that religion and religious authorities are both relevant and important drivers of quitting, but whether this is always enough to guarantee success is less clear. Religion can be a culturally relevant vehicle to complement other tobacco control efforts.

The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea.

This study examined the effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. A nonequivalent, control group, pre-posttest design was used. A convenience sample of 41 nursing students were randomly assigned to experimental (n=21) and control groups (n=20). Stress was measured with the PWI-SF (5-point) developed by Chang. Anxiety was measured with Spieberger's state anxiety inventory. Depression was measured with the Beck depression inventory. The experimental group attended 90-min sessions for eight weeks. No intervention was administered to the control group. Nine participants were excluded from the analysis because they did not complete the study due to personal circumstances, resulting in 16 participants in each group for the final analysis. Results for the two groups showed (1) a significant difference in stress scores (F=6.145, p=0.020), (2) a significant difference in anxiety scores (F=6.985, p=0.013), and (3) no significant difference in depression scores (t=1.986, p=0.056). A stress coping program based on mindfulness meditation was an effective intervention for nursing students to decrease their stress and anxiety, and could be used to manage stress in student nurses. In the future, long-term studies should be pursued to standardize and detail the program, with particular emphasis on studies to confirm the effects of the program in patients with diseases, such as cancer.

Increasing diversity of Americans' faiths alongside Baby Boomers' aging: implications for chaplain intervention in health settings.

Chaplains serving in the health care context provide a ministry to dying patients of inestimable worth as they comfort patients in the last chapter of the journey by being present, listening, and caring. Chaplains also play another important role, helping patients clarify ways in which their beliefs and values might influence health care decisions. This paper reviewed the current trends of spiritual diversity alongside the aging of a large Baby Boomer cohort. Chaplains may be challenged as they participate in the decision-making process, or as they support familes who make decisions about the care of loved ones nearing the end of life. Many of those who seek health care and comfort as the end of life approaches will bring a startling diversity of nonbelief, beliefs, and diverse religious and spiritual practices. This pattern of diversity will profoundly affect patients' decision-making around end-of-life issues. Case studies are used to illustrate possibilities for the chaplain's role at the bedside in the face of such diversity. The dimensional information of a new scale is presented for chaplains to assess diverse afterlife beliefs. As chaplains renew their studies of the worlds living religions, they will be better equipped to serve the needs of this large and spiritually diverse population.

The last 48 hours of life: a case study of symptom control for a patient taking a Buddhist approach to dying.

Caring for a patient dying of cancer can, at times, be extremely difficult. Sarah was 39 years old when she died, survived by her husband and two children aged 6 and 4 years. During the weeks leading up to her death, Sarah held extensive discussions with family and the multidisciplinary team. Her goal was to live the remainder of her last few hours as comfortable as possible and to die a "peaceful death". Terminal care is an important phase of life, one in which individuals have the right to expect quality of care to ensure that their death occurs with dignity. Sarah practised Buddhism on a daily basis. Issues of spirituality, serenity and peacefulness in dying were very important to her to ensure a good rebirth.

Religion, death of a loved one, and hypertension among older adults in Japan.

OBJECTIVE: To see whether three dimensions of religion (private religious practices, religious coping, and belief in the afterlife) buffer the effect of the death of a significant other on change in self-reported hypertension over time. METHODS: Interviews were conducted with a nationally representative sample of people aged 60 and older in Japan at two points in time, 1996 and 1999. Complete data were available on 1,723 older Japanese. Respondents were asked a series of questions about their religious beliefs and practices, whether a family member or close friend had died in the past year, and whether they had hypertension. RESULTS: The data suggest that older adults in Japan who experienced the death of a loved one but who believed in a good afterlife were less likely to report they had hypertension at the follow-up interview than elderly people in Japan who lost a close other but did not believe in a good afterlife. DISCUSSION: The results suggest how one overlooked dimension of religion (i.e., religious beliefs) may bolster the health of older people in the face of adversity.