Gail C. Davis

A randomised trial of nursing interventions supporting recovery of the postmastectomy patient

AIMS AND OBJECTIVES This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown. BACKGROUND Surgical removal of the breast may lead to activity limitation, self-image issues, discomfort and later complication of lymphoedema. Design.  This study used experimental and longitudinal design. METHODS One hundred and forty-five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty-six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2-way anovas were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p-values are two sided. All statistical analyses were performed using sas 9.2 for Windows. RESULTS The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge. CONCLUSIONS Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients.

Expanding the comfort of postmastectomy patients using the Papilla Gown.

PURPOSE To determine whether the Papilla Gown designed specifically to meet the needs of postmastectomy patients with a closed drainage system in place is more comfortable than is a typical hospital gown. BACKGROUND The closed wound drainage system used for breast cancer patients immediately following mastectomy requires external drainage tubes that connect to a pouch. The pins that are usually used to attach the drains to a patients gown create problems. The Papilla Gown (Papilla is the Latin term for breast) was designed with safety pouches for supporting the drains. METHODS A convenience sample of 13 postmastectomy patients participated in this preliminary study of the gowns use. Participants were taught how to properly wear the typical hospital gown and Papilla Gown before surgery. Patients were discharged with the gowns and two questionnaires that were to be returned approximately 1 week following surgery. Thirteen of the 38 (34%) who agreed to participate submitted usable forms. The Wilcoxon signed-ranks test was used for comparing the comfort scores of the Papilla with the hospital gown. FINDINGS Participants reported significantly higher scores (p<.003) for the Papilla Gown on all of Comfort Questionnaires 10 items, except one (p=.337) related to fear of pulling out the drainage tubes. Specifically, patients felt more comfortable about their appearance in the gowns, their ability to move, and the support of the drainage tubes. CONCLUSION The newly designed Papilla Gown shows promise for meeting the purpose of increasing the comfort of postmastectomy patients with closed drainage systems. CLINICAL RELEVANCE The Papilla Gown was designed to address the comfort, mobility, and body image issues that patients face during the first week following a mastectomy, when they are dealing with such issues as the cancer diagnosis, loss of a breast, and managing drainage tubes. Preliminary results show that nurses can improve patient satisfaction by providing clothing that is comfortable, attractive, and supports the drainage system in place during this critical time.