Successful HIV/AIDS prevention and control causes a decline in the incidence of newly acquired HIV/AIDS patients. The annual mortality rate from 2000 to 2018 has decreased by 37% and 45% respectively. 1 However, according to global figures the number of PLWHA remains high approximately 37.90 million, with 1.7 million new cases of HIV recorded in 2018. 1 In Thailand, there are 480,000 cases of HIV/AIDS with 6,400 new cases of HIV recorded in 2018. 2 HIV/AIDS has a significant impact on the complexity of physical, psychosocial, and spiritual dimensions. The influences on the physical result from a decline of the immunological system. Therefore, PLWHA are at risk of opportunity infections (OIs), the main cause of mortality. 3,4 Psychological problems include anxiety, depression and suicidal behaviors. [4][5][6] The social impacts are stigmatization, orphaned children, problems and financial troubles. In response, the government has invested more money in research and health care services for PLWHA. 4,5 The spiritual impact arises from suffering from diseases, stigmatization, guilt, fear of death and spiritual distress. 7 Spirituality has played an important role among PLWHA because it can promote peace and happiness, inner strength, understanding of the illness and self-acceptance, self-health care, a sense of compassion, purpose in life, hope, relationships and connection with a higher power,

The Roles of Spirituality in People Living with HIV/AIDS: A Qualitative Meta-synthesis T he spread of HIV/AIDS continues to be a major problem for public health around the world. People living with HIV/AIDS (PLWHA) steadily climbed from 35.6 to 36.9 million between 2015 and 2017, with 940,000 people dying from HIV/AIDS during the aforementioned period. 1 Similarly, the number of PLWHA in Thailand increased from 445,000 to 450,000 with approximately 15,000 people dying from HIV/ AIDS during the abovementioned period. 2 Due to the increasing numbers of people receiving antiretroviral therapy (ART), HIV-related deaths have dropped by 38%, 1 and AIDS has changed into a chronic disease drawing new challenges for health care providers. 3 PLWHA are faced with stressful life events related to the illness including physical health problems resulting from declining immune status, psychological distress related to stress, anxiety and depression, social isolation due to social stigma, fear and uncertainty about death, loss of self-control, self-blame, internalized conflict, and hopelessness. 3-9 The aforementioned problems might lead PLWHA to become spiritually distressed and commit suicide. 4,6,9 Spirituality is a broad concept consisting of several key features and it is the source of human beings that can help people to accept themselves and their illness, find meaning and purpose in life, create inner strength, maintain hope, improve the sense of selftrancendence, create relationships and connect with other people as well as a higher power, divine or God. 3,8,9-11 Moreover, spirituality can play a vital role in supporting PLWHA. According to the studies of Ironson et al (2006), 12 Ironson et al (2016), 13 and Black and Slavice (2016) 14 it was found that spirituality/religiousness significantly correlated with better CD4 cell count and controlling of viral load. Consequently, spirituality has a significant effect on controlling disease symptoms and slowing the progression of disease, 5,15 while ensuring life-satisfaction, quality of life, well-being, 5,16 and long-term survival. 13 According to the literature review, limited research studies have been conducted in Thailand about the role of spirituality among PLWHA. Most research studies were quantitative research studies and focused on the

Thai Nurses' Perceptions of a Good Death: An Integrative Review I n Thailand, there was a total population of approximately 66.4 million at the end of 2018, 1 with an increase of total death from 456,391 to 473,541 cases (from 2015 to 2018). 2 The five major causes of death in Thailand are aging, heart failure, sepsis, primary hypertension, and diabetes mellitus. 3 The place of death occurs mainly at hospitals and homes. Thus, health care providers, especially nurses, have an opportunity to prepare to care for people who are confronted with death and dying. 4,5 Death is a natural phenomena that everyone has to experience and there is no escape from this. 5,6 According to the Thai cultural context, death has been perceived as taboo by Thai people. Consequently, they do not talk about death and there is a lack of preparation for death. 6 Those nearing death may also face emotional turmoil, including fear of death. 4 It causes people to fight for prolonging life, increasingly dependent on medical care services including medicinal use, invasive medical instruments, and cardiopulmonary resuscitation. 7 Although these treatments can extend life, these treatments can cause patients physiological, psychosocial, and spiritual suffering. 4,6,8 A good death is an important goal of caring for patients with end of life conditions or receiving palliative care. 4-10 A good death has not been universally defined because of the differences in individual perception, belief, and sociocultural context. Moreover, the meaning of a good death is different depending on patient's views, families, and health care providers. This may affect the patients' care in promoting a good death. [4][5][6][8][9][10][11] Thailand is different from western countries, particularly when it comes to spiritual and religious beliefs that are integral to the Thai way of life from the beginning of life to the end of life. The majority of Thai people are Buddhist accounting for more than 90%, Muslims accounting for 4% of the population, and others. 9,11,13 The difference in sociocultural context and belief have influenced the perception of good death among patients, families, and health care providers, which may be different in their views. Nurses have played important roles to promote a good death for patients nearing death. [4][5][6] Deep understanding of a good death from a nurse's perception is crucial for providing care to promote a peaceful death.

he illness of a family member is recognized as a stressful life event that affects caregivers, spouses or other relatives. Furthermore, illness causes physical health problems for both patients and caregivers. 1,2 It also increases perceived stress, strain and depression. 1,3 Moreover, chronic illness with a high level of dependency is correlated with a sense of burden on family caregivers that significantly increases the sense of fatigue and burnout experienced by caregivers. 1 These above factors have an impact on the equilibrium of family systems and accelerate family adaptation. Family adaptation is a process in which families engage in direct responses to the extensive demands of a stressor, and realize that systemic changes are needed within the family unit, to restore functional stability and improve family satisfaction and well-being. 4,5 It means if the family has more function, that family can provide adaptation. Family functioning is defined as the extent to which a family operates as a unit to cope with stressors. The model of marital and family systems holds that family functioning is composed of three dimensions: cohesion, adaptability, and communication. Family cohesion refers to the emotional bonding among family members. Family adaptability represents the ability of a family to change its rules, the role of relationships, and power structure in response to developmental changes or situational stressors. Communication is a facilitating factor in cohesion and adaptability. 6 Families who exert tremendous effort toward coping with the daunting challenge of providing care for a family member during illness are actively engaged in the process of coping or adaptation. These families are well-aware of the requirement for a complete overhaul within the family in the transition from crisis back to sustainable family functionality with

This research aimed to develop a model of promoting knowledge and behavioral adjustment of hypertensive patients. MATERIALS AND METHODS: This action research was based on the concept of Kemmis and Mc Taggart (1988). The sample of 34 people consisted of 24 hypertensive patients and 10 community health volunteers. The research instruments were divided into the following two parts: 1) a general information questionnaire for older adults; 2) a qualitative data collection instrument consisting of semi-structured interviews, focus group discussions, and observations. The study was conducted between 30 November 2021-10 March 2022. Quantitative data were statistically analyzed by using frequency, percentage, mean and standard deviation. Qualitative data analysis used thematic analysis. RESULTS: A model of promoting knowledge and behavior adjustment was developed for hypertensive patients through community participation. Both cycles found that there were 4 development activities: 1) educating knowledge to hypertensive patients; 2) education about behavior modification; 3) providing models to transfer knowledge; 4) exchanging knowledge and using learning materials. Knowledge increased considerably, averaging from 14.87 ± 5.21 to 17.37 ± 4.65 (t = -2.882, p = 0.010, 95%CI -4.368 to -0.685). Hypertension complications prevention behavior of hypertensive patients was a high score, with diet control of 87.50 %, exercise at 91.70%. After the second round, hypertension patients were satisfied to develop a model of promoting knowledge and behavioral adjustment, at an higher number and percentage after developing a model from 18 (75.00%) to 21 (87.50%). After developing a model, and having completed the second round, community health volunteers classified the satisfaction of hypertension patients. This showed an increased satisfaction to develop a model of promoting knowledge and behavioral adjustment of hypertensive patients from 8 (80.00%) to 10 (100%). CONCLUSION: Nurses and healthcare workers should focus on educating and promoting the participation of patients and community health volunteers in encouraging hypertension patients to engage in self-care.