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Fan, a shy nineteen-year-old with shimmering, long, black hair, was diagnosed with chronic myeloid leukemia. Originally, she had been diagnosed with influenza, but subsequent testing found leukemia. Since often I had been the nurse assigned to in-hospital recreational activities for the teenage patients, I was acquainted with her. I planned to use the 4A's of spiritual care (table one, page 23). In every phase of her care, I shared the gospel with Fan and discussed the value of life.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.
Table one. The 4As o... - Click to enlarge in new windowTable one. The 4A's of Spiritual Care


Because her white blood cells abruptly increased and most were premature, she received chemotherapy for six months. Then she was prepared for allogenic bone marrow transplantation (BMT). Fan's sister, Ling, who had the same cell surface antigens and human leukemia antigen (HLA) matches, volunteered to donate her bone marrow. These two sisters had been inseparable since childhood.



During Fan's three-month hospitalization, I shared my faith in Christ with her. Fan seemed to enjoy listening to the good news. As her physical condition allowed, my Nurses Christian Fellowship group members visited with her and brought her Christian books so she could learn more about God's love. The seed of the gospel was planted in her mind. Her father encouraged this interaction between us. Sometimes he was too busy to stay with Fan, and he would entrust her to my care.


Over the course of her treatment, I grew to know Fan well. I tried to encourage her by explaining the overall treatment plan and telling her about other patients with successful outcomes after BMT. Fan and I often prayed together about her disease process. We often used the words of Hebrews 10:36, "For you need endurance, so that when you have done the will of God, you may receive what was promised." This verse helped Fan to consider the meaning and value of her life.



During the period of bone marrow engraftment, an intern collected a blood specimen from Fan's Hickman catheter every other day. In conversation each time, I tried to update the interns about Fan's clinical responses, as well as her characteristics and hobbies. After discovering her passion for computer games, some doctors even gave her computer magazines to take her mind off the treatment.


I also suggested that together we assemble a 1,000-piece puzzle as a means of building her confidence. My colleagues and Fan's classmates who visited were also involved in this project. Everyone was enthusiastic, and it created a sense of community and renewed our hope. Eventually, Fan finished the wonderful puzzle picture of Japanese scenery as a remembrance of this period of time.


The first week that Fan was released from the protective environment, a laminar air-flowing room where patients are isolated from infection, her mother experienced a devastating cerebral vascular accident. However, after acknowledging that her mother would not recover, Fan scarcely cried. She thought death was a way to end her mother's bitterness.


Since her immunologic recovery was not complete, Fan could not attend her mother's funeral. We feared that this repressed grief might impede Fan's recovery. We wondered how we could help her release the emotion of losing her mother. My colleagues all tried to help her walk through this difficult period. Some nurses stayed with Fan after their shifts were over, and some bought dessert for her and still others tried to boost her spirits with conversation.


I began to wonder what unique help I could offer as a Christian nurse. My answer was to provide excellent physical, psychosocial and spiritual care. In the beginning, I tried to help Fan acknowledge her feelings and examine the meaning and purpose of her life. The next step was to help her clarify what she wanted to do with her life.

Figure. Fan, after d... - Click to enlarge in new windowFigure. Fan, after discharge from the hospital

Through prayers and reading the Scripture, especially Hebrews 10:36, Fan started to believe that God had a plan for her life and that she needed to pursue it. I encouraged Fan to learn more about prayer and hand her burden over to the Lord. Whenever we prayed together, we would find the same smile on each other's faces. At that moment we knew that we had God's peace in our hearts.


After her discharge, I kept in contact with Fan through phone and mail, encouraging her to pray. I was also able to follow up on her in the outpatient department. Our friendship continued to grow. Whenever a new patient was scheduled for BMT, I told Fan, so she could come and share her experience with the person. Her visits to the unit have not only been a great help to others, but she enjoys talking with my colleagues about her activities.



Working with bone marrow transplant patients has been delightful, because the long course of treatment allows friendships to develop. As my colleagues and I have seen the results of Fan's whole-person care, we are encouraged to maintain a positive attitude in our clinical care and enhance its quality.


During the preoperative period, the surgery and post-transplantation period of Fan's BMT, we have learned what patients and their families need. Fan needed stable emotions and a confident attitude toward her disease and treatment plan. Her family sought a positive outcome. Fan's family appreciated the persistence and patience of our health care team. I am now working to develop appropriate teaching guidelines for patients and their families to understand the treatment process.


Throughout the treatment process, the relationship I had with Fan was built on faith. The more we trusted in God, the more we experienced his abundant love. The more attention we gave to Fan's total needs, the more we learned about nursing interventions for the future. Because I firmly believe God loves and cares for the whole person, we as nurses must also care for all of our patient's needs-physical, psychosocial and spiritual. Fan has taught us well.


After working in the cancer unit for four years, I am convinced that spiritual care is essential to patients. In giving it I often taste God's grace. Moreover, I believe that God uses nurses to heal the spiritual hunger of our patients, and he gives love and mercy to the weak.


*Bone Marrow Transplant [Context Link]