Melissa Oxlad

The psychosocial concerns and needs of women recently diagnosed with breast cancer: a qualitative study of patient, nurse and volunteer perspectives

Objective  To qualitatively identify the concerns and needs of Australian women recently diagnosed with breast cancer.

Psychological Risk Factors for Increased Post-Operative Length of Hospital Stay Following Coronary Artery Bypass Graft Surgery

To date, researchers have examined the role of psychological factors in longer-term adaptation to coronary artery bypass graft surgery (CABG), but few have investigated the role of such factors in the immediate post-operative period. Thus, the current study examined psychological risk factors for increased post-operative length of hospital stay in 119 consecutive elective CABG patients (100 men and 19 women). When controlling for operative/post-operative factors, medical factors accounted for 24.5% of the variance. However, pre-operative psychological factors accounted for a further 4.4% of the variance, with increased depression and lower PTSD symptomatology identified as significant independent risk factors for longer post-operative length of hospital stay. Hence, while post-operative length of hospital stay is largely determined by medical factors, psychological factors also influence this outcome. Further research is required to replicate the current findings and to determine the mechanisms through which these variables may act.

'I'm living with a chronic illness, not . . . dying with cancer': a qualitative study of Australian women's self-identified concerns and needs following primary treatment for breast cancer.

This study aimed to identify the current concerns and needs of Australian women who had recently completed primary treatment for breast cancer in order to develop a workbook-journal for this population. Focus groups were utilized to allow women to use their own frames of reference, and to identify and verbalize the topics that were important to them following treatment. All focus groups were conducted in a patient education and relaxation room, familiar to the women to assist them to feel more at ease. Ten women aged 36-68 years who had recently completed treatment for early-stage breast cancer at a South Australian public hospital took part in one of three focus groups. Topics covered included current physical, emotional and social needs. Participants reported a sense of apprehension about the future at the completion of primary treatment. In addition to this, five specific areas of concern were identified including physical sequelae of treatment, intimacy issues, fear of recurrence, benefit finding, and optimism versus pessimism about the future. Means of addressing post-treatment concerns were also discussed. Following the presentation of these findings, suggestions to aid health-care professionals in their clinical practice are provided.

Longitudinal Risk Factors for Adverse Psychological Functioning Six Months after Coronary Artery Bypass Graft Surgery

This research aimed to identify modifiable risk factors for poor psychological functioning six months post-operatively, using a chronic illness model to explain the relationships between risk factors. Consecutive elective CABG patients (N = 119) completed self-report measures including optimism, illness representations, self-rated health, social support, coping methods, depression, anxiety and PTSD symptomatology in a repeated measures design. Poor pre-operative psychological functioning was the strongest psychological risk factor for adverse psychological functioning six months post-operatively. Longitudinal support for the chronic illness model examined was limited. Further research to identify modifiable risk factors and pre-operative psychopathology screening to determine individuals at-risk of poor psychological outcome is recommended.

Managing accountability for domestic violence: Identities, membership categories and morality in perpetrators’ talk

Psychological research and popular discussion around domestic violence/intimate partner abuse have focussed on broad features of descriptive accounts such as victim precipitation, excusing of aggressors, and minimizing or denying the violence. Few studies have examined the finer detail of how such matters are routinely invoked in talk, and how they are regularly built in ways that make their authors appear credible and warranted. This study uses a discursive psychological approach to examine the talk of men recruited from domestic violence counselling groups who participated in one-on-one interviews about their violent/abusive behaviour. The analytic focus is on instances of situated identity categorization in these men’s accounts that involved the consequential moral assessment of self and partner in ways that justify or warrant violence/abuse. Routinely, in these men’s talk about their abused partner, subtle and particular categorizations associated with being a woman were worked up sequentially to depict her as having breached the normative moral order. These warranting practices were evident in the talk of both men who denied, and who overtly acknowledged, the wrongness of their violent/abusive actions. The findings raise important issues for understanding how commonsense reasoning around the causes of domestic violence and its justifiability is sustained, as well as having practical implications for theory, prevention and treatment.

Application of a chronic illness model as a means of understanding pre-operative psychological adjustment in coronary artery bypass graft patients

OBJECTIVES To increase understanding of the factors associated with pre-operative psychological adjustment in coronary artery bypass graft (CABG) patients by assessing the utility of a chronic illness model developed by Scharloo, Kaptein, Weinman, Willems, and Rooijmans (2000). DESIGN A cross-sectional design was employed. METHOD Elective CABG patients (N=119) completed self-report measures of illness representation, self-rated health, social support, coping methods, and pre-operative adjustment (depression and post-traumatic stress disorder (PTSD) symptomatology) an average of 30 days prior to surgery. Hierarchical multiple regression was used to assess the mediational relationships proposed by the chronic illness model. RESULTS Five 3-variable mediational chains were assessed. In all instances, the results conformed to the relationships suggested by the chronic illness model where the strength of the relationship between the independent and dependent variables was reduced when the mediator variable was controlled. However, a significant reduction of this relationship was found in three of the five chains examined. The most rigorous support for the model occurred, where increased use of avoidance coping mediated the relationship between poorer self-rated health and increased PTSD symptomatology, and also where increased use of avoidance coping partially mediated the relationship between a more negative illness representation and increased PTSD symptomatology, and poorer self-rated health and increased depression. CONCLUSIONS The chronic illness model of Scharloo and colleagues shows potential in explaining pre-operative adjustment in CABG patients. Longitudinal examination of the model is recommended.

Electroconvulsive Therapy, Children and Adolescents: the Power to Stop

The administration of electroconvulsive therapy (ECT) to children and adolescents remains an unresolved area of clinical debate for nurses. Thus, some nurses have refused to participate in the treatment of minors with ECT, invoking codes of conduct to justify their actions. Other nurses have supported the use of ECT with children and adolescents, via provision of technical assistance to medical colleagues. A cross-national comparison of ethical codes of conduct has confirmed that nurses should take decisive action in the clinical arena when the needs or rights of vulnerable minors are compromised. The provision of clinical guidelines is suggested as one method to enshrine the rights of at-risk children and adolescents.

Barriers and facilitators to effective type 2 diabetes management in a rural context: A qualitative study with diabetic patients and health professionals

Although effective type 2 diabetes management is essential for the prevention of complications, it is rarely carried out. Type 2 diabetes deaths in rural areas are higher than in metropolitan areas. A focus group (n = 8) and telephone interviews with patients (n = 10), and telephone interviews with health professionals (n = 18) in rural areas were conducted to examine this issue in a rural context. Inductive thematic analysis was used to generate 13 themes of barriers and facilitators to type 2 diabetes management at intrapersonal (denial of the illness, motivation, knowledge and skills and lack of time), interpersonal (stress and relationships), organisational (access to recommended foods, transport, health professionals, and exercise options) and societal (engagement and societal attitudes) levels of influence. Across all themes, participants highlighted the difficulty of maintaining management behaviours.

Predictors of Sun-Related Behaviors Among Young Women: Comparisons Between Outdoor Tanners, Fake Tanners, and Tan Avoiders

Abstract Objective: Skin cancer incidence continues to rise as a tanned appearance remains desirable, particularly among young women. Fake tanning provides a tanned appearance without exposure to ultraviolet radiation. In order to advance our understanding of the factors that contribute to long-term behavior change, this study explores determinants associated with different types of tanning. Participants: The sample included 162 female students from the University of Adelaide, Australia, aged 18–26 years. Data were collected in July 2010. Methods: The current study measured differences in skin type, skin cancer knowledge, unrealistic optimism, appearance motivation, and sun-protective and sun exposure behaviors amongst outdoor tanners, fake tanners, and tan avoiders through an online survey. Results: Differences were observed for skin type, skin cancer knowledge, unrealistic optimism, sun protection, and sun exposure. Conclusions: A “one-size-fits-all” approach to skin cancer prevention may not be appropriate; type of tanning behavior may need to be considered in health promotion work.

Melanoma and its relationship with solarium use: Health knowledge, attitudes and behaviour of young women

Despite growing evidence of a relationship between solarium use and melanoma development, few studies have examined knowledge, attitudes and behaviour towards solarium use among young women. Females aged 18—26 years attended one of six focus groups (N = 27, seven solarium users and 20 non-users). Three specific themes were endorsed: (1) melanoma knowledge; (2) perceptions of melanoma risk and ways to encourage behaviour change; and (3) health promotion and government regulation. Many young women appear to lack knowledge about melanoma and its relationship with solarium use. Knowledge deficits are highlighted and implications for health prevention/promotion campaigns and future research are discussed.