Marja Kaunonen

A systematic review of professional support interventions for breastfeeding

OBJECTIVES The objectives of this systematic review were first, to describe how breastfeeding is professionally supported during pregnancy, at maternity hospitals and during the postnatal period. Secondly, to find out how effective interventions are in supporting breastfeeding. BACKGROUND Breastfeeding is an effective way to promote the health of infants. In many countries, the rates for breastfeeding remain lower than recommended. Many studies have examined breastfeeding promotion interventions; some of them are successful and some fail. It is important to find effective combinations of support. DESIGN Systematic review. METHODS Search of CINAHL, Medline and Cochrane Central Register databases were conducted for data collection. The search was limited to articles published in Finnish, Swedish and English between the year 2000 and March 2006, focusing on breastfeeding and breastfeeding support interventions. Two reviewers independently analysed 36 articles in the final analysis. RESULTS Interventions expanding from pregnancy to the intrapartum period and throughout the postnatal period were more effective than interventions concentrating on a shorter period. In addition, intervention packages using various methods of education and support from well-trained professionals are more effective than interventions concentrating on a single method. CONCLUSIONS During pregnancy, the effective interventions were interactive, involving mothers in conversation. The Baby Friendly Hospital Initiative (BFHI) as well as practical hands off -teaching, when combined with support and encouragement, were effective approaches. Postnatally effective were home visits, telephone support and breastfeeding centres combined with peer support. Relevance to clinical practice. Professionals need breastfeeding education and support of their organisations to act as breastfeeding supporters. The BFHI -programme is effective and it would be wise to include the core components of the programme in breastfeeding promotion interventions. Mothers benefit from breastfeeding encouragement and guidance that supports their self-efficacy and feelings of being capable and empowered, and is tailored to their individual needs.

Changes in quality of life in patients with breast cancer.

AIM To describe and compare changes in quality of life in two groups of patients with breast cancer and to identify factors predicting negative changes in quality of life within six months. BACKGROUND Women with breast cancer suffer from various treatment side-effects, from psychological and social symptoms as well as decreased quality of life, creating a need for support that may persist throughout the breast cancer experience. DESIGN This six-month longitudinal study involved a sample of 164 women, who were quasi-randomized between intervention (n = 85) and control groups (n = 79) after breast cancer surgery. Intervention group received support and education via telephone one week after the breast cancer surgery and face-to-face support six months after the surgery. Quality of life was estimated one week and six months after breast cancer surgery, using the Quality of Life Index-Cancer Version (QLI-CV) and the European Organisation for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire (EORTC QLQ-BR23). METHOD Data were analysed statistically using descriptive statistics and non-parametric tests. Factors predicting negative changes in quality of life within six months were investigated using logistic regression models with the enter method. RESULTS Significant group difference in the magnitude of changes within six months was found in future outlook. Logistic regression analyses revealed six significant predictors of negative changes in quality of life within six months: education, employment status, having underaged children, chemotherapy, radiotherapy and hormonal therapy. CONCLUSION The results of this study underline the importance of identifying quality of life changes in patients with breast cancer and paying attention to those women with difficulties in adapting to being a cancer survivor. RELEVANCE TO CLINICAL PRACTICE The findings of this study provide evidence which may help to create appropriate supportive interventions for both acute and long-term settings.

Effect of social support on changes in quality of life in early breast cancer patients: a longitudinal study

BACKGROUND Breast cancer diagnosis as well as diversity of the treatment process deteriorates womens quality of life (QOL). Researchers have examined social support and its relations with QOL overall, but less is known about effects of social support on changes in QOL. AIMS The aim of this study was to examine social support received from social network and nurses within 6 months and QOL in women with breast cancer. METHODS Women (N = 164) after breast cancer surgery were quasi-randomized to the intervention (n = 85) and control groups (n = 79). Participants completed two well-known QOL questionnaires, and the questionnaire measuring received social support from network and from nurses both 1 week and 6 months after the breast cancer surgery. Data were analysed using descriptive statistics and nonparametric tests. Logistic regression model with the enter method was employed to identify associations between social support and negative changes in QOL. RESULTS Affect and aid from network decreased in both groups and affirmation in the intervention group within 6 months. No significant changes in received social support from nurses were found within groups. Furthermore, no statistically significant difference in the magnitude of changes over time was found between groups. Received social support had an effect on changes in sexual functioning, global QOL and health and functioning. CONCLUSIONS Received social support decreased in both groups within 6 months. Significant effects of social support on negative changes on QOL were found. Social support tailored to womens individual needs is an essential part of the care in patients with breast cancer. For further research, longitudinal designs for longer period should be established to explore social support and its effects on QOL.

The impact of supportive telephone call intervention on grief after the death of a family member.

This study describes the impact of a supportive telephone call on grief 4 months after the death of a family member. The study design involved a quasi-experimental intervention group (n = 70) and a control group (n = 155). The intervention was a supportive telephone call after the death of a family member. Grief reactions were measured with the Hogan Grief Reactions Checklist. Results were completed by content analysis of family members’ experiences of the intervention. Chi-square and t tests were used to compare the associations with demographic data, and logistic regression analysis was used to compare the responses. The results pointed to differences in despair and personal growth between the groups. The participants experienced the supportive telephone call positively for the most part. Negative experiences were associated with promises to call in which the call never reached the participant. Grieving family members’ positive experiences of the call indicate that there is a need for individual support after the death, given by nurses of the wards in which the deceased received care.

Oncology ward nurses' perspectives of family grief and a supportive telephone call after the death of a significant other.

To improve family nursing in oncology wards, a new nursing intervention was created: a supportive telephone call after the death of the patient. Nurses who participated in the intervention kept diaries after the call (n = 95). Data were collected also from hospital records. The numerical data were analyzed by using descriptive statistical analysis and the qualitative data by using content analysis. In the diaries, nurses described family grief and mourning as well as content of the supportive telephone call after the death of a family member. Multidimensionality described the family members grief. The funeral was an important part of the culturally dictated mourning. Support for the family during the patients last days at the hospital was meaningful with regard to the grief and the onset of coping. Closeness of the nurse-family relationship varied from a close relationship to an uncertain one. A supportive atmosphere during the call made it possible for the survivor to ask questions and talk. During the call, nurses were able to evaluate the familys coping. They also got feedback concerning the nursing care delivered. The call served as a finishing analysis of the family nursing process. The implications of these results for supporting the grieving family by a telephone intervention are considered.

Patients' and significant others' health-related quality of life one month after coronary artery bypass grafting predicts later health-related quality of life

OBJECTIVE To describe and compare the health-related quality of life (HRQoL) of patients (N = 367) and significant others (N = 367) and to identify factors associated with HRQoL after coronary artery bypass grafting (CABG). METHODS HRQoL was measured by the 15D in 3 stages: 1, 6, and 12 months after CABG. The focus in this study is on HRQoL at the second (6 months) and third (12 months) stages of the recovery process. Stepwise linear regression analysis was used to identify the associations of independent variables with HRQoL. RESULTS Patients had a lower HRQoL than significant others in both stages after CABG. The HRQoL of patients and significant others was explained by their HRQoL 1 month after the operation. Other significant explanatory factors among patients were cardiac symptoms on physical exertion and other additional diseases. Among significant others, chronic diseases were associated with HRQoL. CONCLUSION The HRQoL of patients and significant others differed from each other at both 6 and 12 months after CABG. Previous HRQoL affects later HRQoL in both patients and significant others.

The quality of life and social support in significant others of patients with breast cancer--a longitudinal study.

The purpose of this study was to evaluate prospectively the quality of life (QOL) and received social support from the network and nurses in significant others of breast cancer patients and identify factors predicting negative changes in their QOL within 6 months. The quasi-random longitudinal study conducted for the breast cancer patients and their significant others. Patients were quasi-randomised to supportive intervention group (via telephone at baseline and face-to-face at follow-up) and control group. This paper reports results of significant others (N = 165). The QOL data were collected using the Quality of Life Index - Cancer Version (QLI-CV). Support from network in aid increased the risk of negative changes in health and functioning. Retired significant others had a greater risk of more negative changes in their global and in socio-economic QOL than other. Relatives had a smaller risk to negative changes both in their global and in their family QOL than spouses/partners/boyfriends of patients with breast cancer. QOL of the significant others should be supported more intensively and enhanced by the use of individually tailored methods on the basis of significant others and their family needs.

Individual face‐to‐face support and quality of life in patients with breast cancer

Living with breast cancer significantly affects womens quality of life (QOL) creating a need for support that might persist throughout the breast cancer experience. The aim of this study was to assess the effect of individual face-to-face support on womens QOL and identify factors associated with their QOL. A two-group quasi-experimental design was used with a sample of 204 women who was assigned to the intervention (n = 112) or the control group (n = 92) in hospital after breast cancer surgery. Data of this study were collected 6 months after the surgery by structured questionnaires and analysed statistically using descriptive statistics and non-parametric tests. Factors predicting poor QOL were investigated using logistic regression models with enter-method. Women in the intervention group reported less arm symptoms and clinically better sexual functioning. Factors related to QOL were age, education, employment status, lymph node status, type of surgery, type of axillary surgery, received chemotherapy, hormonal therapy and ongoing therapy. Factors, predictive of poor QOL, included control group, age, education, type of surgery, type of axillary surgery, chemotherapy and ongoing therapy. Short-term face-to-face education and support intervention might have decreased arm symptoms and increased sexual functioning. Women with breast cancer should be offered systematic support and education, which is tailored to womens individual needs.

Methodological tools for the collection and analysis of participant observation data using grounded theory.

AIM To give clarity to the analysis of participant observation in nursing when implementing the grounded theory method. BACKGROUND Participant observation (PO) is a method of collecting data that reveals the reality of daily life in a specific context. In grounded theory, interviews are the primary method of collecting data but PO gives a distinctive insight, revealing what people are really doing, instead of what they say they are doing. However, more focus is needed on the analysis of PO. DATA SOURCES An observational study carried out to gain awareness of nursing care and its electronic documentation in four acute care wards in hospitals in Finland. REVIEW METHODS Discussion of using the grounded theory method and PO as a data collection tool. DISCUSSION The following methodological tools are discussed: an observational protocol, jotting of notes, microanalysis, the use of questioning, constant comparison, and writing and illustrating. Each tool has specific significance in collecting and analysing data, working in constant interaction. CONCLUSION Grounded theory and participant observation supplied rich data and revealed the complexity of the daily reality of acute care. In this study, the methodological tools provided a base for the study at the research sites and outside. The process as a whole was challenging. It was time-consuming and it required rigorous and simultaneous data collection and analysis, including reflective writing. Using these methodological tools helped the researcher stay focused from data collection and analysis to building theory. IMPLICATIONS FOR RESEARCH/PRACTICE Using PO as a data collection method in qualitative nursing research provides insights. It is not commonly discussed in nursing research and therefore this study can provide insight, which cannot be seen or revealed by using other data collection methods. Therefore, this paper can produce a useful tool for those who intend to use PO and grounded theory in their nursing research.

Family involvement in emergency department discharge education for older people.

AIMS AND OBJECTIVES To report findings concerning family involvement in emergency department discharge education for older people. BACKGROUND The current trend of population ageing in Western countries has caused an increase in emergency department visits. Due to the continuing improvement in the mental and physical status of older people, they are frequently discharged home. Proper discharge education enables older people and their families to better understand how they can cope with the medical issue at home. Given the lack of research, we know relatively little about the significance of family involvement in older peoples emergency department discharge education. DESIGN A descriptive qualitative design was used. METHODS Qualitative thematic interviews of seven older patients, five family members and fifteen nurses were conducted. Data were analysed using content analysis. RESULTS Family involvement in discharge education was seen as turbulent. The experiences were twofold: family involvement was acknowledged, but there was also a feeling that family members were ostracised. Families were seen as a resource for nurses, but as obliged initiators of their own involvement. CONCLUSIONS Our findings suggest that family members are not considered participants in emergency department care. For a family-friendly approach, actions should be taken on both individual and organisational levels. RELEVANCE TO CLINICAL PRACTICE The findings support healthcare providers and organisation leaders in promoting family involvement in discharge education for older people. Families can be encouraged to be involved without feeling responsible for the interaction.