**5. Conclusion**

*Quality of Life - Biopsychosocial Perspectives*

useful for people who are currently suffering. (6) The nurses at the sanatorium were the listeners of their life review. This book has also recorded the nursing practices. This interaction also increased the ability of the nurses to listen, empathize, understand, and deepen the relationship between them and the survivors. Through this, the nurses also got the opportunity to care for the survivors who do not have their own children. (7) The book was made by using qualitative and inductive methods in order to arrange the composition and express it in a narrative tone, therefore even elementary students can read it to learn about human rights. (8) New patients of Hansen's disease have been found only in developing countries like India, Brazil, and Indonesia. They account for about 80% of the total patients. The developed countries are not concerned about the disease. We hope that by increasing the awareness in developed countries, through the stories of the survivors, the wisdom

*(a) View of the entirety of the Ōshima Seishoen (in the background are Yashima and Takamatsu harbor); and* 

and strength for solving problems in future will be shared.

**244**

**Figure 6.**

**Figure 7.**

*(b) view of Ōshima Seishoen.*

*Hansen's disease sanatoria nationwide.*

This study comprises the first report and the second report. In the first report, we describe the conceptual structure of spirituality, the relationship of spirituality and QOL, and the history of Hansen's disease. Spirituality was developed as a part of the studies relating to terminal cancer patients who must confront their own death. When our daily lives are calm and mundane, we do not notice spirituality. However, when we confront hardships of life, for example, when we are exposed to the dangers of life, we notice spirituality as an existential distress. On the other hand, the development of individuality and imperturbability by overcoming hardship is spiritual well-being. Spirituality serves as the existential foundation for human existence and is important for the relationship with "something greater than self." In common understanding, QOL is evaluated not objectively but subjectively, and not as a single dimension but as multiple dimensions. Spiritual well-being is one of multiple dimensions of QOL.

In the second report, we will show the spiritual pain and spiritual well-being of Hansen's disease survivors who have lived harsh lives via an analysis of their life review based on the findings of spirituality and QOL from the first report.

### **Acknowledgements**

This work was supported by JSPS KAKENHI Grant Number 18H03075. We would like to thank Editage (www.editage.com) for English language editing.

#### **Conflict of interest**

We have no financial relationships to disclose.

*Quality of Life - Biopsychosocial Perspectives*
