Josephine Hegarty

The undergraduate education of nurses: looking to the future.

Societal change historically has presented many challenges for nursing. The challenge to nurse educators is to ensure that professional education remains relevant and keeps abreast of both societal and healthcare changes. These challenges include globalization, changing patient characteristics, science and information technology advancements, the increasing complexities of healthcare, and recent policy and economic developments. The aim of this paper is to consider possible future societal and healthcare changes and how these may impact the preparation of future graduates in general nursing. A clear understanding of these factors is essential if nursing is to meet the challenges presented by tomorrows healthcare environment within a global context.

Help seeking for cancer symptoms: a review of the literature.

PURPOSE/OBJECTIVES To define help seeking and identify a theoretical framework to explain the help-seeking process of patients with self-discovered cancer symptoms. DATA SOURCES Literature published in English from 1998-2008. DATA SYNTHESIS Findings highlighted genders role in help-seeking behavior. Delayed help seeking for cancer symptoms was common, with many associated influencing factors. To date, research on intentions to seek help has facilitated the development of health-promotion programs that target those who are likely to delay. CONCLUSIONS Help seeking was defined as a response to health changes as well as a part of the broader process of health-seeking behavior. Reviewed frameworks and models provided knowledge and understanding about help-seeking behavior in various contexts. However, an all-encompassing framework explaining the entire process was not identified. IMPLICATIONS FOR NURSING Nurses are in a unique position to promote prompt help seeking for patients with self-discovered cancer symptoms. Gaining clarity on the concept and identifying a theoretical framework may help nurses understand the complex nature of help seeking in patients with self-discovered cancer symptoms.

Measuring illness uncertainty in men undergoing active surveillance for prostate cancer

BACKGROUND AND PURPOSE Uncertainty is an aversive experience and plays an important role in the lives of men undergoing active surveillance (AS; earlier referred to as watchful waiting) for early-stage prostate cancer. Yet reliable and valid measures of uncertainty have not been fully tested in this population. This secondary analysis therefore tested the reliability of the Mishel Uncertainty in Illness Scale Community Form (MUIS-C; M.H. Mishel, 1997b) for use with men undergoing AS for prostate cancer. METHODS Item-Total correlations were conducted on the 23 items of the MUIS-C with four samples of men undergoing AS. RESULTS Cronbachs alpha for the full MUIS-C was .908; 22 of 23 items showed significant positive correlations with the total score. Removing the item without a significant correlation from the reliability analysis increased Cronbachs alpha to .913. CONCLUSIONS The Mishel Uncertainty in Illness Scale-Community Form for Active Surveillance is a reliable and valid tool for measuring uncertainty with men undergoing AS for prostate cancer.

Uncertainty and Quality of Life Among Men Undergoing Active Surveillance for Prostate Cancer in the United States and Ireland

Background. Prostate cancer continues to be the most common site of male cancers, particularly among older men in Europe and the United States, and the second most common male cancer worldwide. Active surveillance involves the use of no local or systemic therapy once prostate cancer has been diagnosed. A description of uncertainty and quality of life among men undergoing active surveillance in samples from both the United States and Ireland has the potential to enhance global health care delivery. Methods. The specific aim of this study is to enhance the understanding of the experience of active surveillance for prostate cancer among Irish and American men by measuring quality of life and levels of uncertainty among men over the age of 65 in receipt of the active surveillance management option for prostate cancer. A quantitative, descriptive survey design was used. Results. Twenty-nine men completed questionnaires. The results reveal that men undergoing active surveillance in the United States have slightly higher levels of uncertainty. Primary appraisal, opportunity, and danger appraisal were consistent between samples from both countries. Total affective and health-related quality-of-life scores were similar among active surveillance participants in both countries, but subscale scores identified both similarities and differences. Irish men had lower mean role and social function than U.S. men, and higher general health and energy. Irish men reported more urine bother and less sexual bother than U.S. men. Conclusion. To assist men with prostate cancer who are treated with the active surveillance management option, health care professionals must develop an awareness of how prostate cancer affects the mans physical and psychological health care outcomes.

Sexuality in Irish Women With Gynecologic Cancer

PURPOSE/OBJECTIVES To investigate sexual self-concept, sexual relationships, and sexual functioning, and the relationship between these and certain demographic variables of Irish women, following a diagnosis of gynecologic cancer. DESIGN Descriptive, correlational. SETTING Outpatient gynecologic oncology clinic in a large university hospital in Southern Ireland. SAMPLE 106 women with a diagnosis of and treatment for various gynecologic cancers (cervical, ovarian, endometrial, and vulvar). METHODS The Body Image Scale, Sexual Esteem Scale, and Sexual Self-Schema Scale were administered to women a minimum of six weeks postdiagnosis of any form of gynecologic cancer to measure sexual self-concept; the Intimate Relationships Scale to measure sexual relationships; and the Arizona Sexual Experiences Scale to measure sexual functioning. MAIN RESEARCH VARIABLES Sexual self-concept, body image, sexual esteem, sexual self-schema, sexual relationships, and sexual functioning. FINDINGS Participants reported negative changes in relation to their sexual self-concept, sexual relationships, and sexual functioning. Participants reported negative changes in relation to all stages of the sexual response cycle. CONCLUSIONS Gynecologic cancer has the potential to negatively affect a womans sexual self-concept, sexual relationships, and sexual functioning. Sexuality is a multidimensional construct and must be measured in this way. IMPLICATIONS FOR NURSING Healthcare professionals must use a holistic approach when providing information and support to patients with gynecologic cancer. Information must be provided to women on how cancer and its treatment has the potential to affect their sexual self-concept, sexual relationships, and sexual functioning, including information on how to overcome these alterations.

Facilitated peer support in breast cancer: a pre- and post-program evaluation of women's expectations and experiences of a facilitated peer support program.

Background: Peer support programs are associated with the provision of emotional, informational, and appraisal support. The benefits of peer support for women with breast cancer include reduced social isolation, enhanced coping, and access to information. Objective: The aim of this study was to conduct a pre- and post-program evaluation of a 7-week facilitated breast cancer peer support program in a cancer support house. Methods: Women with primary breast cancer (n = 8) participated in pre- and post-program focus groups. The interviews were recorded and were transcribed verbatim by the researcher. The data were analyzed using content analysis. Eight themes were identified. Results: The key themes emerging from the pre and post programme focus groups included: The need for mutual identification; Post-treatment isolation; Help with moving on; The impact of hair loss; Consolidation of information; Enablement/empowerment; The importance of the cancer survivor; Mutual sharing. Conclusion: It is essential that facilitated peer support programs are tailored to meet the support needs of women with breast cancer. There is a particular need to facilitate mutual sharing and support for hair loss within these programs. Implications for Practice: Implications for practice emerging from this study include the importance of pre- and post-program evaluations in identifying whether peer support programs meet the expectations of women with breast cancer, the need for peer/professional programs to support women with treatment-induced hair loss, the importance of including cancer survivors in support programs, and the need to allow more informal sharing to occur in facilitated peer support programs.

Testicular Cancer Awareness and Screening Practices: A Systematic Review

PURPOSE/OBJECTIVES To critically appraise empirical evidence gathered from studies that (a) explored mens knowledge, awareness, and attitudes toward testicular cancer (TC) and its screening; (b) addressed their testicular self-examination (TSE) practice; and/or (c) highlighted barriers and facilitators to this practice.
. DATA SOURCES MEDLINE®, CINAHL®, and EMBASE®.
. DATA SYNTHESIS 25 articles met the inclusion criteria. Knowledge deficits regarding TC and its screening were seen. Participants who did not perform TSE often were uninformed about this practice. The majority of men perceived TC education as a positive step toward raising awareness about this malignancy.
. CONCLUSIONS Very few men were informed about TC and TSE. Future studies should include valid and reliable tools to assess TC knowledge and screening, address the means through which TC knowledge is delivered, explore the individuals experience with TC screening, and focus on TC awareness and screening among minority groups. 
. IMPLICATIONS FOR NURSING Although regular screening for TC is a controversial issue, nurses should encourage young men to seek medical attention in the event of discovering scrotal abnormalities.

Shedding light on women's help seeking behaviour for self discovered breast symptoms

PURPOSE To describe womens help seeking behaviour (HSB) and the associated influencing factors on self-discovery of a breast symptom. METHODS A descriptive, correlational survey design was used. Following ethical approval, survey data were collected from women (n = 449) attending the breast clinics of two large urban hospitals within the Republic of Ireland. RESULTS The majority of women (69.9%; n = 314) sought help (by visiting their General practitioner, GP) within one month, 30.1% (n = 135) delayed help seeking for more than one month following symptom discovery and 16.7% (n = 75) delayed for three months or more. The factors most significantly associated with delayed HSB were knowledge around symptom identity (Odds Ratio (OR) = 4.80, p = 0.005); ignoring the symptom and hoping it would go away (OR = 10.72, p < 0.001) and womens belief that the symptom would persist for a long time (OR = 1.18, p = 0.023). Being afraid on symptom discovery (OR = 0.37, p = 0.005) was associated with reduced risk of delayed HSB. CONCLUSIONS It is encouraging to see that the majority of women who find a breast symptom seek help promptly. However, a small cohort of women delay seeking help from their GP. HSB is influenced by multiple factors which can impact on patient outcomes. Findings are important for oncology nurses who have a key role to play in promoting breast awareness, prompt help seeking and early detection and treatment of breast cancer, amongst women.

Nurses’, midwives’ and key stakeholders’ experiences and perceptions of a scope of nursing and midwifery practice framework

AIM This paper reports on the qualitative findings from a national review of a nursing and midwifery scope of practice framework. BACKGROUND Scope of professional practice frameworks offers a system of rules and principles to regulate its members and demonstrate its responsibility to society. Key issues in reviewing the scope of practice include notions of specialist and advanced practice, accountability, autonomy, competence, supervision, continuing professional development and delegation. Evaluation of scope of practice frameworks has particular application value to nurses, midwives, regulatory bodies and healthcare employers across the globe. DESIGN A mixed methods approach was used. This included a national survey of nurses and midwives and focus groups and interviews with key stakeholders. The qualitative data are reported in this paper. METHODS Focus groups and interviews were conducted among a convenience purposive sample of key stakeholders, including nurses and midwives working in the widest range of services and settings in 2014. The participants contributed to thirteen focus groups and thirteen interviews. FINDINGS Six global themes, as follows: Evolution of the nursing and midwifery professions and practice; Scope of practice: understanding and use; Expanding scope of practice; Professional competence; Practice setting and context; Reflections on the current framework. CONCLUSION Practitioners understand the scope of professional practice and while some see it as empowering others see it as potentially restrictive. Nurses and midwives are generally willing to expand their scope of practice and see it as resulting in improved patient care, improvement in overall quality of standards and increased job satisfaction.

A review of nursing and midwifery education research in the Republic of Ireland.

This literature review aims to (a) provide a summary of the research conducted in the Irish nurse/midwifery education field, (b) identify key recommendations from the research reviewed and (c) examine the policy, theory and methodological implications of the research conducted. The electronic databases of CINAHL (EBSCO host 1982-2006) and PubMed (1950-2006) were searched for the relevant literature. Sixty-one studies satisfied the criteria for inclusion which were based on; quality of research design, sampling, data analysis, scientific merit, and authorship (registered nurse/midwife who conducted research in the Republic of Ireland). Findings demonstrated diversity in relation to aims, methods and results highlighting a need to formulate a collaborative research agenda in nurse and midwifery education.