We encountered a terminally ill patient, who had resigned as hospital nurse soon after she had fallen ill. As a former health professional, she was acting the good patient and performing her part as a member of the family. The patient was suffering social pain, so much so that she seemed to be unable to express what was really on her mind. One day, the ex-nurse gave us her precious nurse pin. It was when it occurred to us that what the patient had said and behaved was an expression of spiritual pain. Then, we started exploring the meaning of what she had said and done and tried to get at the structure of her spiritual pain referring to Murata's three structures of the spiritual pain of terminally ill patients: “time existence,” “relational existence” and “autogenic existence.” Eventually, we found that her behavior to respond to the wish of her family and to keep a good relationship with her physicians, which she herself regarded as social pain, was to sweep away uneasiness about and fear of being left alone, that is, the spiritual pain associated with “relational existence.” We also found that the spiritual pain associated with “time existence” intermingled with her wish to continue to be a nurse as expressed in the handing over of her nurse's pin.
Pain ; Patients ; Nurses ; seconds ; SOCIAL

Abstract
Purpose : We provided a lecture on medical expenses related to the “dispensing fee” for health insurance pharmacies for the local residents in order to determine if there was a change in their preferred community pharmacies' pre- and post-lecture.
Methods : Questionnaires were provided to 34 participants, pre- and post-lecture, with responses analysed from 29 participants who completed the questionnaires in full.
Results : The percentage of respondents who had not observed receipts with National Health Insurance points was 34.5％, while 25.0％ responded that they had paid with the foreknowledge of the existence of such points. Following completion of the lecture, “drug administration guidance” showed an increase of 55.2％, and “dispensing” , “medication history management” and “pharmaceutical inquiry to the doctor” had also increased to 27.6％, 27.6％ and 20.7％, respectively.. Reasons for the selection requirements of participants' preferred community pharmacies' showed a decrease of 37.9％ related to there being “a pharmacy in the vicinity of a hospital” , whereas “a pharmacy with good administration guidance” and “a pharmacy with good counseling” increased by 72.5％ and 20.7％, respectively.
Conclusion : Through the provision of explanation of the medical insurance “dispensing fee” as explained by community pharmacists to local residents, this may induce favorable effects on their selection requirements for use of community pharmacies.