David L. Kahn

Transcending breast cancer: making meaning from diagnosis and treatment.

Purpose: This qualitative approach study describes the experience of self-transcendence in women newly diagnosed with breast cancer. Method: Fourteen women participated from a larger sample of women in a support group project. Each woman was interviewed three times over an 8-month period. Audiotaped transcripts were analyzed using Colaizzi’s phenomenological techniques. Findings: Loss of a personal perception of good health and fear of dying from cancer forced women to reach both inside and outside of themselves for support and information. Bonding with other women with breast cancer led to further expansion of self-boundaries that brought comfort, a desire to modify life priorities, and enhanced appreciation of supportive others and of life itself. Over time, clarification and modification of values and behaviors assisted women to create meaning from their experiences. Implications: Nurse referrals to support groups or other resources (such as cancer advocacy organizations) where women interact with similar others may facilitate transcending breast cancer.

Resolution of spiritual disequilibrium by women newly diagnosed with breast cancer.

PURPOSE/OBJECTIVES To describe the experience of restoring and maintaining spiritual equilibrium over a 14-month period by women newly diagnosed with breast cancer. RESEARCH APPROACH Qualitative approach, longitudinal design. SETTING Urban breast cancer resource center. PARTICIPANTS 10 women initially one to five months from diagnosis, 5 of whom attended an eight-week self-transcendence theory-based breast cancer support group. METHODOLOGIC APPROACH Audiotaped interviews conducted within five months of diagnosis, two to three months later, and one year after that. Narratives were analyzed using Colaizzis phenomenologic approach. MAIN RESEARCH VARIABLES Spiritual disequilibrium resolution, breast cancer, self-transcendence. FINDINGS Spiritual disequilibrium characteristics, as described in several studies of women with breast cancer, were fear of dying and a sense of aloneness in a struggle to maintain self-identity. Disequilibrium triggered all participants to reach outwardly for information and support from other people and faith resources and to reach inwardly to examine life values. Shortly after diagnosis, and continuing throughout the study period, most participants also reached outwardly to support others and conduct breast cancer advocacy work. CONCLUSION Resolving spiritual disequilibrium for women with newly diagnosed breast cancer means restoring a sense of connection to self, others, and/or a higher power. Self-transcendence views and behaviors evolving over time help women to restore their sense of connectedness, maintain hope for a future, and find renewed purpose and meaning. INTERPRETATION An initial breast cancer diagnosis may be associated with spiritual disequilibrium that can be as problematic as the physical effects of cancer and cancer treatment. Women restore equilibrium through resolving their sense of disconnectedness and regaining a positive self-identity.

The significance of suffering in cancer care

Understanding suffering as a possible meaning of cancer for patients and families is a necessary part of cancer nursing care. This article presents a discussion of suffering as a possible meaning of cancer for patients and family members. Suffering is addressed in the context of its definition as an experience of the whole person. First, to illustrate suffering, a narrative of a young man treated for leukemia with bone marrow transplantation is presented. The narrative focuses on the mans suffering as he struggles to make meaning of what has happened to him, a struggle that ends with his death. The second part of the article presents eight aphorisms or succinct principles of suffering. Each aphorism is discussed with examples from the case narrative and related literature.

Ethical considerations in research with bereaved families.

This article describes a research project aimed at delivering an intervention to bereaved family members living in the community. The issues covered are access to subjects, recruitment and retention of subjects, and random assignment to control and experimental groups.

Disability rites: the cultural shift following impairment.

Persons with disabilities experience barriers to health within a culture. The local culture assigns meanings to those with impairments and their activities. In order to understand the experience of disability as influenced by culture, anthropological models of rites of passage and liminality have been used, but these can be extended further. The authors posit that local cultures should be the context for studying disability, and thus extend on previous work by Murphy 1 on the rites of passage for persons with disabilities. This article will: (1) review how disability has been culturally created and defined, (2) provide additional evidence for the argument regarding the existence of disability culture, and (3) extend the work on rites of passage for persons with disabilities. A brief discussion of how this expanded model might guide the understanding of disability and the understanding of barriers to health follows.

Making Use of Qualitative Research

Many have discussed the importance of using research in practice. To understand this issue, we examined what authors of qualitative research in oncology said about the uses of their research findings. Analysis of the authors’ implications sections was conducted with 42 articles published between 1995 and 2001 and indexed in either Medline or CINAHL. The two categories from this analysis were implications for future research and communication. The categories and related subcategories are illustrated with selected quotes from some of the articles. Findings confirm the importance of language in health and illness.

Nurses' views of the coping of patients

The findings of a study that explored the beliefs, assumptions and ideas nurses have about the coping of patients are presented. Interactive interviews with 26 nurses were used to elicit explanations of the meaning of coping and stories from their practice that illustrated coping. Analysis of the interview transcripts revealed three themes in the form of idioms or particular and different ways of talking about coping. Each idiom represented a different perspective or view of coping. The first idiom represented a view of coping as a rational, cognitive problem-solving response to illness. The nurses attributed, and thus valued, this view to science. In the second idiom the nurses spoke of coping as permeated with values that contrasted with the prior view of coping as a rational process. In the final idiom the nurses spoke of coping as courage--they told stories of patients who had faced existential situations with strength and will. The focus of this idiom was on issues of spirituality, struggle, personal meaning and acceptance. After each idiom is delineated and illustrated by data, the discussion is concentrated on the orientational and ontological metaphors that underlie them. Interpretation of the origin and construction of these different ways of talking about coping, and their underlying metaphorical meanings, is made in the context of cultural and subcultural influences.

No more the same: the lives of adolescents in Taiwan who have lost fathers.

This article offers a reconstruction of the life worlds of 30 adolescents, aged 9 to 18, from 20 families who have lost their fathers through death. Through interviews designed to measure the impact of culture on adolescent coping, six themes on rebuilding their lives, “no more the same,” were identified: (1) isolation from death, (2) incompleteness, (3) staying inside, (4) worrying with mother, (5) building connections with fathers, and (6) restructuring the family. By exploring the lives of fatherless adolescents in Taiwan, the findings of this study illustrate a metaphor “no more the same” to represent life after fathers death in such culture.

Coming to Terms with Perceived Danger A Researcher’s Narrative

Little attention has been given to the topic of perceived or imagined dangers in fieldwork, even though such dangers may significantly affect both collection and interpretation of data in qualitative research. Furthermore, methodological arguments persist in regard to interpreting qualitative research that gives voice simultaneously to the research participant and the researcher. In this article reflexivity and narrative methods were used to examine the concept of perceived danger(s) in a field setting using naturalistic inquiry. First, reflexivity and narrative methods were used to retrospectively construct a personal narrative that describes the impact of the field experience on the researcher. Then, narrative analysis was used to interpret this personal narrative and to further examine why the researcher “perceived” certain dangers, and how she came to know that these risks and dangers were presumed but unwarranted. This narrative is an example of how qualitative researchers can give voice to their field experiences.

Experiences of Bereavement in Rural Elders

This article reports the findings of a qualitative, longitudinal study of bereavement in 15 elders of low socioeconomic status living in the rural south. The bereaved elders were followed after the death of their spouse for an extended period time, ranging from 13 to 29 months. Multiple conversational interviews served as the method of data collection. Hermeneutic analysis revealed five themes that summarized the major concerns these widows and widowers had in the period following the death of their spouse. These themes included metaphors used to talk about grief, work that must be done while bereaved, concerns about home, getting on with their own lives including problems with aging, and that one is ultimately left unsatisfied in the face of grief.