Shih, Gau, Lin, Pong, and Lin (2006

Shih, Gau, Lin, Pong, and Lin (2006) indicated that quality care during the dying process can turn an expected loss into a positive for patients, the patients’ families, and healthcare providers. In contrast, an unsatisfactory level of care may prevent patients from achieving a peaceful passage because of physical discomforts and an unsuccessful completion to life. Some patients may even believe that their afterlife is negatively affected during the dying process. Based on patient, family member, and healthcare provider suggestions, the elements of good death care include bodily peace (e.g., effective pain and symptom management, cleanliness, integrity of the body), peace of mind (e.g., yielding, settlement of all necessary affairs, not being lonely), and peace of spirit (e.g., a meaningful life, a sense of completion, affirmation of the whole person) (Steinhauser et al., 2000).Among the domains of care, spiritual health is at the core of a patient’s existence and affects, connects, and transcends all aspects of being (Isaiah, Parker, & Mur row, 1999). Spirituality has long been acknowledged as a basic human need associated with quality of nursing care. The defining characteristics of spirituality include establishing belief systems; mastery of life’s challenges; experiencing a sense of love (e.g., belonging, protection, animation, being valued, giving life); and searching for meaning, purpose, and reconciliation (central to a good death) (Delgado, 2005; Dobratz, 2002; Hinshaw, 2002; Lin, 2003; Shih et al., 2001, 2006; Tseng et al., 2005). Spiritual needs of older patients in hospice care also are related to involvement and control, a positive outlook, companionship, completing necessary business, religion, and experiencing nature (Hermann, 2001). Awareness of spiritual concerns often is magnified when the patient faces emotional distress, physical illness, or death (Shih et al., 2001). However, spirituality is a nebulous concept, shaped by culture, and often is context dependent (Sellers, 2001). Western and Eastern medicine face challenges when providing quality cultural care for older patients with terminal cancer. A wide-ranging development of spirituality, including patients’ beliefs, world views, and rooted social principles, is needed to advance nursing knowledge (Dobratz, 2002).