Deborah L. Volker

Sexual Dysfunction Related to the Treatment of Young Women With Breast Cancer

Women have a 13.4% chance of developing breast cancer over their lifetime, and an estimated 60,000 women aged 20-50 will develop breast cancer in 2005. Surgical, radiologic, and chemotherapeutic treatments used to treat breast cancer can alter womens body image and menopausal status, ultimately affecting sexual health. A diagnosis of breast cancer is more traumatic for young women because of psychosocial concerns, side effects of treatment, and a potentially shortened life expectancy. Alterations in sexual health interfere with intimate relationships. Nurses can play a pivotal role in improving the sexual health of young women with breast cancer. This article explores the potential side effects of treatment that can affect sexual health, the unique needs of young women, and nursing interventions that systematically address sexual health concerns.

Control and end-of-life care: Does ethnicity matter?

Patient control and autonomy are core values in Western bioethics and important components of end-of-life (EOL) care. However, the centrality of the patient as decision maker may not be relevant to culturally diverse groups of people. The purpose of this article is to present results of a literature review of patient control and ethnicity within the context of EOL care. The review revealed that the interplay between control and ethnicity in EOL care is complex and unpredictable. Implications for clinical care and future research are presented.

Living With Death and Dying: The Experience of Taiwanese Hospice Nurses

PURPOSE/OBJECTIVES To explore and describe the experiences of Taiwanese nurses who care for dying patients in hospices, a relatively recent healthcare option in Taiwan. RESEARCH APPROACH Qualitative, hermeneutic, phenomenologic approach. SETTING Six hospices in central and southern Taiwan. PARTICIPANTS 14 Taiwanese hospice nurses. METHODOLOGIC APPROACH Interviews were audiotaped and analyzed with Colaizzis guidelines. MAIN RESEARCH VARIABLES Caregiving experiences of Taiwanese hospice nurses. FINDINGS Four main themes emerged from the analysis: entering the hospice specialty, managing everyday work, living with the challenges, and reaping the rewards. Three subthemes of managing everyday work were providing holistic, meaningful care through close relationships; confronting and managing negative beliefs about hospice; and managing the dying process. CONCLUSIONS The fundamental structure of the caregiving experiences of Taiwanese hospice nurses is a dynamic, multidimensional process that evolved over time. The hospice nurses demonstrated how they achieved balance in their daily nursing practice within the Taiwanese cultural context. INTERPRETATION Improved end-of-life education for the Taiwanese public, nurses, and other healthcare professionals that includes hospice concepts is needed. Administrators should provide adequate support to encourage and empower their nursing staff in hospice settings.

Patient Control and End-of-Life Care Part II: The Patient Perspective

954 Deborah L. Volker, RN, PhD, AOCN, is an assistant professor, David Kahn, RN, PhD, is an associate professor, and Joy H. Penticuff, RN, PhD, FAAN, is a professor, all in the Austin School of Nursing at the University of Texas. Funding for this study was provided by an ONS Foundation Genentech Outcomes Research Grant. (Submitted August 2003. Accepted for publication January 29, 2004.) (Mention of specific products and opinions related to those products do not indicate or imply endorsement by the Oncology Nursing Forum or the Oncology Nursing Society.)

Cancer Patients’ Preferences for Control at the End of Life:

The achievement of a death consistent with personal preferences is an elusive outcome for most people with cancer. Maintaining a sense of control is a core component of a dignified death; however, control might be a Western bioethical notion with questionable relevance to culturally diverse groups. Thus, the purpose of our study was to explore the meaning of control and control preferences in a group of racially and ethnically diverse patients with an advanced cancer diagnosis. Using a hermeneutic, phenomenological approach, we interviewed 20 patients with advanced cancer and uncovered two themes: (a) preferences for everyday control over treatment decisions, family issues, final days of life, and arrangements after death, vs. (b) awareness that cancer and death are controlled by a higher power. Although the sample included non-Hispanic Whites, African Americans, and Hispanics, participants shared common views that are characteristic of American cultural norms regarding the value of autonomy.

Standards of Oncology Nursing Practice

Presented here are a set of 70 standards approved by the North American Association for the Classification of Nursing Diagnosis by which the nurse can plan, implement, and evaluate the nursing care of the patient with cancer. This undergraduate/graduate level text covers procedures of patient care during all phases of the disease, across developmental levels, in both inpatient and ambulatory settings. Also included is a treatment of specialized nursing challenges such as bone marrow transplantation and the patient with Acquired Immune Defiency Syndrome. All aspects of nursing care are addressed within each standard, providing the information needed to design individualized patient care.

Assisted Dying and End-of-Life Symptom Management

This qualitative study aimed to describe symptom management strategies oncology nurses have used in responding to and preventing requests of terminally ill patients with cancer for assisted dying (AD). The study involved secondary analysis of written stories from 36 nurses who agreed to describe their experiences with a request for assisted dying. Of the 36 nurses, 12 refused to support patient requests for AD and described their attempts to control the circumstances of dying by controlling symptoms. The remaining 24 nurses denied ever receiving requests for AD and described symptom management practices believed to prevent such requests. Data were analyzed using Denzins process of interpretive interactionism. Two themes emerged from the participants stories: alternative strategies for AD and prevention of requests for AD. The participants shared many examples of clinical interventions and other features of nursing responses to relieve or prevent suffering including physical, emotional, and spiritual care practices; comfort and medication management; and service as teacher-advocate. Both the nurses who had received requests for AD and those who had not used a variety of similar symptom management approaches to alleviate suffering. In doing so, these nurses upheld current standards of both their professional and specialty organizations.

Caring for Students with Type 1 Diabetes: School Nurses' Experiences.

This qualitative study used a Husserlian phenomenological approach to obtain an understanding of the essences of five experienced Taiwanese school nurses’ lived experience of caring for students with type 1 diabetes mellitus (T1DM). Audio-recorded, semi-structured, in-depth interviews were conducted. Data analysis entailed a modified method from Colaizzi. Four intertwined themes were discovered: (a) I try to put myself in the parents’ and students’ shoes, (b) I am not a diabetes expert, (c) managing T1DM requires teamwork, and (d) caring for students with T1DM is a struggle with practical limitations. The findings show that these school nurses encountered many challenges as they implemented their roles and responsibilities in caring for students with T1DM. The findings suggest that increasing school nurses’ competence in caring for students with T1DM and developing effective strategies to overcome the challenges faced may be useful. Multidisciplinary teamwork could benefit the diabetes management activities in school settings.

What constitutes a dignified death? The voice of oncology advanced practice nurses.

Purpose: The purpose of this study was to explore the concept of dignified dying from the perspective of oncology advanced practice nurses. Methodology: A naturalistic, hermeneutic approach was used to interview the study participants. A sample of 19 oncology advanced practice nurses was obtained by combining data sets from 2 larger studies of patient control and end-of-life care. Audiotaped interviews of the nurses were transcribed verbatim and were analyzed using a phenomenological approach. Results: The analysis revealed that dignified dying is an experience that includes the following themes: going in peace, maintaining bodily integrity, and dying on their own terms. Conclusions: Advanced practice nurses lend an important perspective that expands understanding of the concept of dignified dying. Future studies of patient and family perceptions will enhance knowledge of their needs and lead to intervention studies to promote an end-of-life experience that is consistent with patient priorities and values.

Advance Directives, Control, and Quality of Life for Persons with Disabilities

BACKGROUND Personal control over end-of-life (EOL) care via advance care planning is a key component of high-quality care. Although this desire for control has been well documented in some populations, EOL care issues are not well understood within the disabilities community. OBJECTIVE The objective for this study was to describe the relationships between individual demographic characteristics, health-related quality of life, health locus of control, and attitudes toward advance directives (ADs) in individuals who are disabilities activists. METHODS We surveyed 55 participants attending a disability conference. Instruments included a demographic data sheet, the Advance Directive Attitude Survey (ADAS), the Multidimensional Health Locus of Control scale, and the Functional Assessment of Non-Life Threatening Conditions quality of life (QOL) scale. RESULTS Most participants were Hispanic females with some college education. About 46% had a disability. Group means revealed a high level of QOL (M=75.72, SD=19.09) and a positive attitude about ADs (M=66.49, SD=8.03). On the Opportunities for Treatment Choices subscale of the ADAS, activists without disabilities (M=14.23) were more positive about their control over EOL decisions than were the activists with disabilities (M=12.97) [t(2,52)=2.116, p<0.05]. CONCLUSIONS Although participants were positive about ADs, differences in attitudes about control over opportunities for treatment choices between the nondisabled and disabled groups support previous findings that people with disabilities may have concerns regarding undertreatment for serious health conditions. Further study of EOL care issues for persons with disabilities is warranted.