Margaret Chamberlain Wilmoth

The aftermath of breast cancer: an altered sexual self

&NA; The literature lacks descriptions of the effect that breast cancer treatments have on sexuality from the perspective of women who have lived through this experience. The purpose of this study was to describe aspects of sexuality that were important to women after breast cancer treatment. Participants in this study were 18 white women with breast cancer between the ages of 35 and 68 years (mean, 50.5 years). Time since diagnosis ranged from 6 months to more than 10 years. Primary surgical treatment for seven women (39%) had been lumpectomy, and for 11 women (61%) mastectomy. Most of the participants also received adjuvant chemotherapy. This qualitative descriptive study used grounded theory methods. Two primary categories (losses and influencing pieces) emerged from the data analysis. The losses category had four components: missing parts, loss of bleeding—becoming old, loss of sexual sensations, and loss of womanhood. The influencing pieces were relationships and information control. The core concept identified was an altered sexual self. Central to the task of adjustment to living with breast cancer was coming to terms with a new sexual self that emerged after treatment. Women who sought information about the sexual side effects of cancer treatment, and who had strong intimate relationships appeared to experience a more successful adjustment.

Fatigue, Weight Gain, and Altered Sexuality in Patients With Breast Cancer: Exploration of a Symptom Cluster

PURPOSE/OBJECTIVES To identify the symptom cluster of fatigue, weight gain, and altered sexuality caused by treatment for breast cancer. DATA SOURCES Published research and literature review articles. DATA SYNTHESIS Fatigue, weight gain, and altered sexuality commonly occur after breast cancer chemotherapy. Each symptom has a significant impact on quality of life; however, viewing them as a symptom cluster magnifies their impact. CONCLUSIONS These symptoms have yet to be studied as a cluster. Exercise appears to be an intervention common to each that may be effective in reducing the severity of these treatment side effects. IMPLICATIONS FOR NURSING Nurses should view symptoms caused by breast cancer treatment holistically, keeping in mind that a reciprocal relationship often exists among symptoms. Identification of symptom clusters with empirically derived interventions may enhance quality of care and quality of life for patients.

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.

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.

The Middle Years: Women Sexuality the Self

Nurses caring for women in middlescence need to be aware that this is a period of much change and growth. The years between 35 and 60 years in women are characterized by psychologic growth and alteration in the hormonal environment. Successful negotiation through this developmental stage includes disassembling and evaluating the self, adjusting to the changing self, adapting to alterations in sexuality caused by hormonal shifts, and finally, acknowledging the new self that has evolved. Nurses can play important roles during this tumultuous stage by supporting women as they do the psychologic work necessary for growth, by expanding their view of middlescence beyond menopause, and by including sexuality with other aspects of health promotion and education. JOGNN , 25 , 615–621; 1996.

The Readiness Estimate and Deployability Index and Psychometric Properties in Army Reserve Nurses and Medics

The Readiness Estimate and Deployability Index measures the level of individual deployment readiness in Army Nurse Corps officers. The primary purposes of this pilot study were to determine the psychometric properties of the measure for Army Reserve component nurses and enlisted medical personnel and to compare the reliability between groups. The convenience sample consisted of 92 subjects. Internal consistency reliability for three of the six competencies and construct validity using the contrasted-groups approach were examined. Nurses reported greater competency than enlisted personnel in clinical and operational nursing skills but were lower in their self-assessment of soldier and survival skills. Findings suggest that more training in warrior tasks and drills is needed for both groups and that enlisted soldiers must enhance their clinical and operational skills. Unit commanders can use the Readiness Estimate and Deployability Index to measure individual readiness.

Reliability of the Deployment Resiliency Assessment.

This article describes the reliability of the instruments embedded in a mental health screening instrument designed to detect risky drinking, depression, and post-traumatic stress disorder among members of the Armed Forces. The instruments were generally reliable, however, the risky drinking screen (Alcohol Use Disorders Identification Test-Consumption) had unacceptable reliability (α = 0.58). This was the first attempt to assess psychometric properties of a screening and assessment instrument widely used for members of the Armed Forces.

Clinical IssuesThe Middle Years: Women Sexuality the Self

Nurses caring for women in middlescence need to be aware that this is a period of much change and growth. The years between 35 and 60 years in women are characterized by psychologic growth and alteration in the hormonal environment. Successful negotiation through this developmental stage includes disassembling and evaluating the self, adjusting to the changing self, adapting to alterations in sexuality caused by hormonal shifts, and finally, acknowledging the new self that has evolved. Nurses can play important roles during this tumultuous stage by supporting women as they do the psychologic work necessary for growth, by expanding their view of middlescence beyond menopause, and by including sexuality with other aspects of health promotion and education. JOGNN , 25 , 615–621; 1996.