1College of Nursing, Kyungpook National University, Daegu
2Institute of Nursing Science, Kyungpook National University, Daegu, Korea
Corresponding author: Ha, Young Sun, Institute of Nursing Science, Kyungpook National University, 680 Gukchabosangro, Jung-gu, Daegu 700-422, Korea. Tel: +82-2-53-420-4925, Fax: +82-2-53-421-2758, E-mail: hajin24@hanmail.net
• Received: March 17, 2014 • Revised: May 29, 2014 • Accepted: June 5, 2014
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
This study examined the effectiveness of a forest-experience-integration intervention in community dwelling cancer patients.
Methods:
The study was done with a nonequivalent control group pretest-posttest design. The subjects of the present study were 53 community dwelling cancer patients who were registered in a community health center in Gyeongsangbuk-do. The subjects were divided into an experimental group (n=26) who participated in the forest-experience-integration intervention and a control group (n=27) who did not participate. Data were collected from May to June in 2011. Collected data were analyzed using SPSS PC+ 19.0 through x2 test, and independent t-test.
Results:
There were significant differences between the groups in depression (t=-4.51, p<.001), self-regulation resilience (t=6.95, p<.001), interpersonal resilience (t=10.10, p<.001), positivity resilience (t=9.67, p<.001), and total resilience (t=13.93, p<.001) measurements.
Conclusion:
The forest-experience-integration intervention delivered to community dwelling cancer patients was an effective method for relieving depression and enhancing self-regulation resilience, interpersonal resilience, positivity resilience, and total resilience, and can be utilized as an effective nursing intervention for community dwelling cancer patients.
Introduction, friendship, abdominal breathing, stretching, safety training, respiratory and heart rate measurements, checking the necessary
30
Execution phase
Physical intervention
All session
Walking and abdominal breathing
20
Psychological intervention
1st session
Learn to forest activities: Description of trees and landscape
20
2nd session
Activities to get close to the forest: Touching wood, touching natural objects and expressing the feeling of body
3rd session
Accompany with forest: Lying in the woods, viewing the sky, expressing the feeling
4th session
Utilizing forest: Create self-image by leaves
5th session
Promotion activities in sensitive: Meditation
6th session
Promote self-esteem activities: Write a letter to me
7th session
Promote cooperativity activities: Treasure hunt
8th session
Promote empathy activities: Talk about lifestyle
Physical intervention
All session
Walking and abdominal breathing
20
Completion phase
All Session
Friendship, abdominal breathing, stretching, respiratory and heart rate measurements Next session guide
30
Total
2 hour (120)
Table 2.
Homogeneity Test for General Characteristics between Groups
Variables
Categories
Total (n=53)
Exp. (n=26)
Cont. (n=27)
x2
p
n (%)
n (%)
n (%)
Age (year)
50~59
20 (37.7)
10 (38.5)
10 (37.0)
0.02
.915
≥60
33 (62.3)
16 (48.5)
17 (51.5)
Gender
Male
15 (28.3)
6 (23.1)
7 (25.9)
0.69
.407
Female
38 (76.9)
20 (66.7)
20 (74.1)
Diagnosis
Digestive system cancer
18 (34.6)
9 (34.6)
9 (33.3)
0.06
.971
Female cancer
22 (41.5)
11 (42.3)
11 (40.7)
Others
13 (24.5)
6 (23.1)
7 (25.9)
Periods of struggle against disease (year)
1~2
24 (45.3)
10 (38.5)
14 (51.9)
0.96
.618
3~4
11 (20.8)
6 (23.1)
5 (18.5)
≥5
18 (34.0)
10 (38.5)
8 (29.6)
Type of medical insurance
Insurance payment
36 (67.9)
18 (69.2)
18 (66.7)
0.04
.842
Health insurance
17 (32.1)
8 (30.8)
9 (33.3)
Education
<Elementary
40 (75.5)
20 (76.9)
20 (74.1)
0.06
.810
≥Middle school
13 (24.5)
6 (23.1)
7 (25.9)
Living together
Spouse
31 (58.5)
15 (57.7)
16 (59.3)
0.01
.908
Offspring
22 (41.5)
11 (42.3)
11 (40.7)
Exp.=experimental group; Cont.=control group.
Table 3.
Homogeneity Test for Dependent Variables between Groups
(N=53)
Variables
Categories
Exp. (n=26)
Cont. (n=27)
t
p
M±SD
M±SD
Depression
45.8±7.06
46.7±6.66
−0.48
.637
Resilience
Self-regulation
60.4±8.12
60.2±7.84
0.09
.928
Interpersonal
60.6±5.15
60.1±5.94
0.33
.742
Positivity
52.0±3.71
51.7±3.75
0.29
.774
Total
173.0±11.37
172.0±10.97
0.33
.746
Exp.=experimental group; Cont.=control group.
Table 4.
Comparison of Scores between Pretest and Posttest in Two Groups
(N=53)
Variables
Groups
Pretest (n=26)
Posttest (n=27)
t
p
M±SD
M±SD
Depression
Exp.
45.8±7.06
41.4±5.66
−4.51
<.001
Cont.
46.7±6.66
48.3±5.45
Resilience
Self-regulation
Exp.
60.4±8.12
68.5±5.15
6.95
<.001
Cont.
60.2±7.84
57.3±6.53
Interpersonal
Exp.
60.6±5.15
68.3±2.81
10.10
<.001
Cont.
60.1±5.94
57.7±4.55
Positivity
Exp.
52.0±3.71
58.7±2.67
9.67
<.001
Cont.
51.7±3.75
50.5±3.42
Total
Exp.
173.0±11.37
195.4±7.10
13.93
<.001
Cont.
172.0±10.97
165.5±8.46
Exp.=experimental group; Cont.=control group.
References
1. National Cancer Information Center. Cancer survival rate [Internet]. Gyeonggi-do: National Cancer Information Center; 2014. [cited2014 March 17]. Available from:. http://www.cancer.go.kr/mbs/cancer/sub-view.jsp?id=cancer_040301000000.
2. Park JA, Choi KS. Experience of colorectal cancer survival journeys: Born again after going through an altered self image. Asian Oncology Nursing. 2013;13(3):163–173. ArticlePDF
3. Somerset W, Stout SC, Miller AH, Musselman D. Breast cancer and depression. Oncology (Williston Park). 2004;18(8):1021–1048. PubMed
4. Turner J, Kelly B, Clarke D, Yates P, Aranda S, Jolley D. . A randomised trial of a psychosocial intervention for cancer patients integrated into routine care: The PROMPT study (promoting optimal outcomes in mood through tailored psychosocial therapies). BMC Cancer. 2011;11:48http://dx.doi.org/10.1186/1471-2407-1148ArticlePubMedPMCPDF
5. Ramachandra P, Booth S, Pieters T, Vrotsou K, Huppert FA. A brief self-administered psychological intervention to improve well-being in patients with cancer: Results from a feasibility study. Psycho-oncology. 2009;18(12):1323–1326. http://dx.doi.org/10.1002/pon.1516ArticlePubMed
6. Lee SJ, Kim JH, Park, YM. Influence of depression on cancer metastasis. Journal of Korean Oncology Nursing. 2008;8(2):105–110.
7. Jang EH, Choi KS, Kwon SJ. A meta-analysis of intervention on depression in cancer patients. Asian Oncology Nursing. 2013;13(1):1–10. ArticlePDF
8. Kim JH. Resilience. Seoul: Wisdomhouse; 2011. p. 268 p.
9. Kwak SY, Byeon YS. Factors influencing resilience of patients with hematologic malignancy. Korean Journal of Adult Nursing. 2013;25(1):95–104. http://dx.doi.org/10.7475/kjan.2013.25.1.95ArticlePDF
10. Kim JI, Byeon YS. A study on the factors affecting resilience in patients with colon cancer. Asian Oncology Nursing. 2013;13(4):256–264. http://dx.doi.org/10.5388/aon.2013.13.4.256ArticlePDF
11. Cho HS, Kim NH. Physical activity and fatigue in patients with cancer. Journal of Korean Oncology Nursing. 2010;10(1):30–37.
12. Hong MA, Lee HG, Han EK, Kwon YK. A states about forest therapy program in Korean and the prospect for the fusion of Korean medicine with forestry. Korean Journal of Oriental Medicine. 2010;16(3):95–105.
13. Shin WS, Yeoun PS, Lee JH, Kim SK, Joo JS. The relationships among forest experience, anxiety and depression. Journal of Korean Institute of Forest Recreation. 2007;11(1):27–32.
14. Yeoun PS. The relationships between forest experience and depression. Journal of Korean Institute of Forest Recreation. 2007;11(3):1–6.
15. Cha JK, Kim SJ. Healing effects of the forest experience on alcoholics. Journal of Korean Academy of Nursing. 2009;39(3):338–348. http://dx.doi.org/10.4040/jkan.2009.39.3.338ArticlePubMed
16. Cho HS, Cho SM, Cha JK. Therapeutic effects of the forest-healing program on alcohol dependance patients and their families. The Korean Journal of Health Psychology. 2008;13(3):727–743. Article
17. Lee MS, Ka JN, Kim SA, Park MW, Lee JW, Park BJ. . Effect of walking at the urban arboretums on psychological stability of male university students. Journal of Korean Society for People, Plants and Environment. 2011;14(5):271–277.
18. Cho YM, Shin WS, Yeoun PS, Lee HE. The influence of forest experience program on children from low income families, sociality and depression. The Journal of Korean Institute of Forest Recreation. 2011;15(2):69–75. Article
19. Song JH, Shin WS, Yeoun PS, Choi MD. The influence of forest therapeutic program on unmarried mothers' depression and self-esteem. Journal of Korean Forestry Society. 2009;98(1):82–87.
20. Lee ED, Park SJ, Yoo RH, Hong SJ. Analysis on the activity contents of forest healing programs in Korea. The Journal of Korean Institute of Forest Recreation. 2011;15(2):101–109.
21. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007;39(2):175–191. http://dx.doi.org/10.3758/BF03193146ArticlePubMedPDF
22. Cho HS, Kim SJ, Cha JG, Cho SM. Development of a scale for measuring effectiveness of forest experience. The Korean Journal of Stress Research. 2009;17(2):143–153.
23. Shin WS. Trip into the forest. Seoul: Jisungsa; 2007. p. 240 p.
24. Dugan W, McDonald MV, Passik SD, Rosenfeld BD, Theobald D, Edgerton S. Use of the zung self-rating depression scale in cancer patients: Feasibility as a screening tool. Psycho-oncology. 1998;7(6):483–493. ArticlePubMed
25. Yi MS, Park EY, Kim DS, Tae YS, Chung BY, So HS. Psychosocial adjustment of low-income Koreans with cancer. Journal of Korean Academy of Nursing. 2011;41(2):225–235. http://dx.doi.org/10.4040/jkan.2011.41.2.225ArticlePubMed
26. Yang MH, Yoon KJ. A study on the development and effectiveness verification of a program designed to strengthen family resilience of inpatients with cancer and their families. Journal of the Korean Home Economics Association. 2012;50(1):121–139. http://dx.doi.org/10.6115/khea.2012.50.1.121Article
27. Kim BS, Kim HY, Lee SJ. The effect of forest experiences on happiness and positive psychology of Korean middle-aged women in Seoul and the surrounding metropolitan cities. The Journal of Korean Institute of Forest Recreation. 2013;17(3):65–73. Article
28. Cho HS, Kim BG, Lee HJ, Lee BY. Perceived social support as influencing factors on quality of life among cancer patients. Journal of Korean Society for Health Education and Promotion. 2010;27(4):51–59.
29. Min HS, Park SY, Lim JS, Park MO, Wom HJ, Kim JI. A study on behaviors for preventing recurrence and quality of life in breast cancer survivors. Journal of Korean Academy of Nursing. 2008;38(2):187–194. ArticlePubMed
Figure & Data
References
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