Lorraine Tulman

Changes in functional status after childbirth.

Changes in functional status after childbirth were examined over a 6-month postdelivery period in 97 women who had delivered healthy full-term infants. Functional status was defined as the womans readiness to assume infant care responsibilities and resume her usual activities. Functional status was found to improve steadily from 3 weeks to 3 months postpartum, but no statistically significant changes were found between 3 and 6 months. However, by 6 months postpartum 6% of the women had not yet fully assumed the desired or required level of infant care responsibilities, nearly 20% had not yet fully resumed usual levels of household activities, 30% had not fully resumed usual levels of social and community activities, and more than 80% had not yet fully resumed usual self-care activities. Of the 57 women who had returned to work or school by 6 months postpartum, over 60% had not fully resumed their usual level of occupational activities. Canonical analysis revealed that different sets of health, psychosocial, family, and demographic variables were associated with functional status at each data collection point.

Treatment-Related Symptom Clusters in Breast Cancer: A Secondary Analysis

This study investigated treatment-related symptom clusters and the influence of selected demographic/clinical variables on symptom clustering in breast cancer patients across a treatment trajectory. A secondary analysis of 282 breast cancer patients receiving chemotherapy or radiotherapy was done to determine the clustering of oncologic treatment-related symptoms at selected time points of treatment. Two distinct clusters were identified: a psychoneurological cluster and an upper gastrointestinal cluster. The clustering of symptoms was generally stable across the treatment trajectory. The clustering, however, was weaker when the time lapse after the completion of treatment became longer. Demographic and clinical variables did not significantly influence symptom clustering. Psychoneurological symptoms had a tendency to occur together across the treatment trajectory, as did upper gastrointestinal symptoms. Effective symptom assessment/management strategies need to take into account this co-occurrence of symptoms. The findings from this study underscore the need for further investigation of the common biological basis of symptoms to attain more effective management of multiple symptoms.

DEVELOPMENT OF THE INVENTORY OF FUNCTIONAL STATUS AFTER CHILDBIRTH

Abstract The Inventory of Functional Status After Childbirth (IFSAC) contains five subscales designed to measure the mothers readiness to assume infant care and to resume selfcare, household, social and community, and occupational activities following childbirth. Content validity was established at 96.7%. Cronbachs alpha internal consistency reliability coefficients ranged from 0.56–0.98 for the five subscales. Average correlations for the subscale item to subscale total scores ranged from 0.51–0.78. Subscale to total IFSAC score correlations ranged from 0.53–0.90. Test-retest reliability coefficients for a 4–7 day interval ranged from 0.48–0.93. Initial construct validity testing was accomplished by comparing recovery rates for vaginally and cesarean delivered women. The multidimensionality of the concept of functional status after childbirth was supported empirically, with the magnitude of IFSAC subscale correlations ranging from 0.01–0.53. Further psychometric testing of the IFSAC with large samples of childbearing women is warranted. Clinicians may use the IFSAC to assess functional status following childbirth.

Effect of support groups with coaching on adaptation to early stage breast cancer

The effects of 8-week cancer support groups (CSGs) with and without coaching on adaptation were tested in a sample of 181 women with newly diagnosed early stage breast cancer. CSG participation with coaching resulted in higher quality of relationship with significant other at CSG conclusion; this effect was not sustained 8 weeks later. CSG participation had no effect on symptom distress, emotional distress, or functional status. On average, symptom distress was low, emotional distress was moderate, and functional status was relatively high. Independent of CSGs, symptom distress decreased and functional status increased over time from entry into the study to 16 weeks later. Further research is needed to determine the optimal starting time and length for CSGs.

Return of functional ability after childbirth.

Recovery of functional ability after childbirth was examined in a sample of 30 women who had vaginal deliveries and 40 who had cesarean births. Recovery of functional ability after childbirth was defined as the resumption of household, social and community, and occupational activities and assumption of infant care responsibilities. Only 51% of the women reported they had regained their usual level of energy by the end of the 6-week postpartum period; 72% of the vaginally delivered women reported regaining their physical energy within this period, but only 34% of the cesarean delivered women had done so. Differences were also noted between cesarean- and vaginally delivered women in the interval until assumption of infant care responsibilities and resumption of certain household tasks, socializing with friends, and participation in religious organizations. Recovery of functional ability was also found to be affected by maternal and neonatal complications, and their presence was associated with postponed return to employment. Findings suggest that the traditional 6-week recovery period from childbirth needs to be reconsidered, particularly for women experiencing cesarean deliveries or maternal or neonatal postdelivery complications.

The Effect of Telephone Social Support and Education on Adaptation to Breast Cancer During the Year Following Diagnosis

PURPOSE/OBJECTIVES To find the most effective methods of providing social support for women diagnosed with breast cancer by testing the effectiveness of a telephone social support and education intervention to promote emotional and interpersonal adaptation to breast cancer. DESIGN Multisite, two-group experimental study with repeated measures. SETTING Arkansas and New Jersey. SAMPLE The Arkansas sample consisted of 106 women who entered the study two to four weeks postsurgery for nonmetastatic breast cancer and were randomly assigned to an experimental or control group. The comparison group consisted of 91 women from New Jersey who had participated in a previously completed study that used the same interventions and found that telephone support resulted in more positive, statistically significant adaptation to the disease. METHODS The experimental group received 13 months of telephone social support and education. Both groups received educational materials via a mailed resource kit. The Profile of Mood States; Visual Analogue Scale-Worry; Relationship Change Scale; University of California, Los Angeles, Loneliness Scale-Version 3; and the modified Symptom Distress Scale provided data regarding the variables of interest. Data analysis included descriptive statistics, t tests, and multivariate analysis of variance with repeated measures. MAIN RESEARCH VARIABLES Mood, worry, relationships with significant others, loneliness, and symptoms. FINDINGS Data analysis showed no significant differences between groups, and both improved on some of the outcomes. Significant time-by-location interaction effects were found when comparing the Arkansas and New Jersey samples, thereby supporting the need to consider regional differences when developing interventions. CONCLUSIONS The mailed educational resource kit alone appeared to be as effective as the telephone social support provided by oncology nurses in conjunction with the mailed resource kit. IMPLICATIONS FOR NURSING Mailed educational resource kits may be the most efficient and cost-effective way to provide educational support to newly diagnosed patients with breast cancer, but their effect may differ according to region.

Recovery from childbirth: Looking back 6 months after delivery

Womens perceptions of their recovery from childbirth were investigated by open-ended interviews of 96 mothers of health, full-term infants 6 months after delivery. Data included factors affecting physical, mental, and emotional recovery; sources of help and hindrance; ideas of what each women would do differently after the delivery of another child; and overall evaluation of how the months after delivery compared with expectations. Content analysis of the data revealed that 25% of the women did not feel physically recovered from childbirth at 6 months postpartum. Husbands and other family members were major sources of help. Prolonged labor and cesarean delivery were the major hindrances to recovery. More household and child-care help was desired after delivery of another child. Almost half of the women found the first 6 months after delivery more difficult than anticipated. The findings suggest that pregnant women need more information about lifestyle adjustments after childbirth.

Methodological Issues in the Use of Published Cartoons as Data

When common understanding of a phenomenon is under investigation, mass media representation in general, and cartoon images in particular, are a useful source of data. Sample selection, data collection, and the analysis of constructed images differ from other kinds of data. Cartoonists may intend to stimulate multiple interpretations among readers. Uncovering these interpretations is essential to understanding public discourse of the phenomenon of interest. Semantic validation is used to assess the degree to which the meanings of text relative to their context are accurately represented. Analysis of the image and text of cartoons has the potential to yield important understanding of public discourse surrounding issues of the publics health and well-being.

Development and testing of the Symptom Experience Scale

The Symptom Experience Scale (SES) was designed to measure womens experience of symptoms associated with treatment for breast cancer. The SES, a modification of McCorkles Symptom Distress Scale, was developed and tested in a sample of 252 women with breast cancer. Exploratory factor analysis yielded six factors, which used all 24 SES items and accounted for 83.2% of the variance. The factors were nausea and appetite, fatigue and sleep, concentration, appearance, bowel pattern, and pain. Cronbachs alpha internal consistency reliability coefficients ranged from 0.92 to 0.96; the alpha for the total SES was 0.94. Subscale to subscale correlations ranged from 0.21 to 0.56. Additional research is recommended with samples large enough to permit confirmatory factor analysis and determine the stability of the factor structure identified in the present study. Additional research also is recommended to determine the applicability of the SES for men and women of diverse ethnic groups with various types of cancer and other chronic illnesses.

Women's Perceptions of the Effectiveness of Telephone Support and Education on Their Adjustment to Breast Cancer

PURPOSE/OBJECTIVES Social support is believed to be important in helping women adjust to breast cancer. Reports have suggested limited positive effects of social support on well-being, mood disturbances, and relationships with significant others for women who receive telephone support. Womens perceptions of the role of social support in recovery, however, has had limited study. The purpose of this study was to describe womens perceptions of their emotional and interpersonal adaptations to breast cancer after their involvement in a randomized clinical trial in which one group received educational materials and telephone support from oncology nurses and another group received educational materials only. RESEARCH APPROACH Content analysis was used to discover womens perceptions of their emotional and interpersonal adaptation to breast cancer following their participation in a study in which one group received educational materials and telephone support from oncology nurses and another group received educational materials only. SETTING All participants were interviewed by telephone in their homes. PARTICIPANTS 77 of 106 women with breast cancer from a randomized clinical trial were interviewed about their expectations of their adaptations and the effectiveness of the experimental and social support intervention delivered by telephone. METHODOLOGIC APPROACH Telephone interviews were recorded on audiotape and transcribed for analysis. Structured interviews were completed by a non-nurse interviewer. Frequency counts were obtained from the responses to items and comments were clustered for themes. MAIN RESEARCH VARIABLES Emotional and interpersonal adaptations to breast cancer, educational materials, and telephone support from oncology nurses. FINDINGS Fifty-four percent of the women who received the telephone support interventions reported improvement in attitude, whereas 43% of the interviewed women in the control group reported improvement. Only three participants, all in the control group, reported worsened emotional status. The percentage of those reporting improved or unchanged physical status was about equal in each group. The majority of participants in both groups indicated that their levels of involvement in activities remained the same or increased. Forty-six percent of participants in the intervention group reported improved relationships with their spouses compared to 38% in the control group. Women from both groups indicated that the diagnosis of cancer had caused them to review their lives and make changes in their relationships and activities. CONCLUSIONS Participants who received telephone support for one year, in addition to educational materials, reported improvement in their attitudes toward their breast cancer and better relationships with their significant others. INTERPRETATION The womens perceptions are consistent with quantitative results from the clinical trial. This article reports additional evidence that telephone support is an effective alternative to support groups and may be appropriate for those with limited access to such groups because of geography, work demands, or family situations.