Shirley S. Y. Ching

Reframing: Psychological Adjustment of Chinese Women at the Beginning of the Breast Cancer Experience

In this article, we present findings from a larger study that explored how Chinese women cope with breast cancer. We report on the process of early psychological adjustment, along with contextual factors and how they influence the womens coping mechanisms at the beginning of the cancer experience. Twenty-four women with diagnoses of breast cancer were interviewed. The grounded theory method was adopted in data collection and analysis. “Reframing” was the core category of the early adjustment process. Focus and approach were the two contextual conditions. Women adopted “fighting,” “following the natural course,” “struggling,” and “bearing” modes in coping with the disease. These findings highlight the significance of focusing on coping and realizing the role of the self in creating a subjective positive interpretation, which subsequently enhances acceptance of the disease at the beginning of the cancer experience. Characteristics of the Chinese people with respect to coping include the collaborative meaning of control and the philosophy of acquiescence to fate.

Quality of life measurement in women with cervical cancer: implications for Chinese cervical cancer survivors

BackgroundWomen with cervical cancer now have relatively good 5-year survival rates. Better survival rates have driven the paradigm in cancer care from a medical illness model to a wellness model, which is concerned with the quality of womens lives as well as the length of survival. Thus, the assessment of quality of life among cervical cancer survivors is increasingly paramount for healthcare professionals. The purposes of this review were to describe existing validated quality of life instruments used in cervical cancer survivors, and to reveal the implications of quality of life measurement for Chinese cervical cancer survivors.MethodsA literature search of five electronic databases was conducted using the terms cervical/cervix cancer, quality of life, survivors, survivorship, measurement, and instruments. Articles published in either English or Chinese from January 2000 to June 2009 were searched. Only those adopting an established quality of life instrument for use in cervical cancer survivors were included.ResultsA total of 11 validated multidimensional quality of life instruments were identified from 41 articles. These instruments could be classified into four categories: generic, cancer-specific, cancer site-specific and cancer survivor-specific instruments. With internal consistency varying from 0.68-0.99, the test-retest reliability ranged from 0.60-0.95 based on the test of the Pearson coefficient. One or more types of validity supported the construct validity. Although all these instruments met the minimum requirements of reliability and validity, the original versions of these instruments were mainly in English.ConclusionSelection of an instrument should consider the purpose of investigation, take its psychometric properties into account, and consider the instruments origin and comprehensiveness. As quality of life can be affected by culture, studies assessing the quality of life of cervical cancer survivors in China or other non-English speaking countries should choose or develop instruments relevant to their own cultural context. There is a need to develop a comprehensive quality of life instrument for Chinese cervical cancer survivors across the whole survivorship, including immediately after diagnosis and for short- (less than 5 years) and long-term (more than 5 years) survivorship.

Meaning Making: Psychological Adjustment to Breast Cancer by Chinese Women

Based on a study exploring the phenomenon of coping among Hong Kong Chinese women afflicted with breast cancer, from diagnosis to completion of treatment, we report the findings on meaning making by the informants. Using the grounded theory method, we conducted 35 interviews with 24 women suffering from breast cancer. Among them, we followed and interviewed 5 women thrice, from diagnosis to 3 months after completion of treatment. We noted the evolution of reframing as the key category in the adjustment process through which the women identified meaning at different points of time in the cancer experience, to achieve different outcomes. Chinese women identified a sustaining force from minimizing social disturbance during treatment. The integration of cancer into their lives after completion of treatment was achieved through positive transformation in their philosophy of life and social relationships. Nurses should aim to understand the cancer patients’ interpretation of the situation, explore personally meaningful sustaining forces, and reflect on their cancer experience.

Quality of Life in Cervical Cancer Survivors: A Review of the Literature and Directions for Future Research

PURPOSE/OBJECTIVES To describe the most current trends in quality-of-life (QOL) research in cervical cancer survivors and to discuss directions for future research. DATA SOURCES A literature search was conducted among five electronic databases using the terms cervical or cervix cancer, quality of life, survivors, survivorship, measurement, and instruments. Articles were published either in English or Chinese from January 2005 to June 2009. DATA SYNTHESIS Thirty-one articles were identified. The major QOL issues among cervical cancer survivors were categorized at the individual and systemic levels. The most current trends include research into the positive and negative aspects of cancer survivorship; studies that examine unhealthy lifestyle behaviors, which contribute to poor QOL; studies concerned with the impact of cervical cancer survivorship on male partners and family caregivers; and three primary types of instruments used for assessment. CONCLUSIONS Future research directions should include (a) exploring and optimizing the positive outcomes of cervical cancer survivorship, (b) using interventions to reduce risky lifestyles or unhealthy behaviors, (c) conducting exploratory studies to determine the impact of cervical cancer survivorship on families, (d) conducting longitudinal studies to document the ongoing changes in QOL among cervical cancer survivors, and (e) developing new instruments to assess the systemic level of QOL. IMPLICATIONS FOR NURSING Expanding the understanding of QOL and related factors in cervical cancer survivors would enable nurses to assess and develop interventions to improve QOL and overall survival outcomes for this population.

Exploring the Synergic Effects of Nursing Home Work on Work-Related Musculoskeletal Disorders Among Nursing Assistants:

Little is known about how nursing assistants (NAs) perceive the nature of their work and how their work contributes to work-related musculoskeletal disorders (WMSDs). This qualitative study addressed these gaps. Twenty-four NAs with WMSDs working in four nursing homes participated in semistructured focus group interviews. Their WMSDs were not limited to the lower back but involved several body parts. The risk factors for WMSDs included physical, psychosocial, organizational, and personal factors as well as coworkers and clients. However, it is the synergistic effects of long work hours without sufficient rest, work even with musculoskeletal pain because of staff shortages, ineffective management with insufficient prework training and inadequate equipment maintenance, and an aging workforce with strong commitment to resident care that play a crucial role in WMSDs among NAs working in nursing homes. The study found that multidimensional intervention strategies using engineering, administrative, and personal controls should be developed to reduce WMSDs among NAs working in nursing homes.

Prevalence of and Factors Associated with Work-Related Musculoskeletal Symptoms in Nursing Assistants Working in Nursing Homes

The prevalence of work-related musculoskeletal symptoms (WRMSs) in different body parts for nursing assistants (NAs) working in nursing homes is currently unknown. The aim of this study was to determine the extent of WRMSs in nursing assistants and the factors associated with them. Four hundred and forty NAs from 52 nursing homes, recruited by convenience sampling, participated in this cross-sectional study in 2014–2015. A valid and reliable study questionnaire was used to collect data. The results of our study found that 88.4% of NAs reported at least one body part with WRMSs. These NAs reported more symptoms in the shoulders than lower back. Adverse workstyle (OR = 1.04, 95% CI = 1.01–1.08) was the only factor associated with WRMSs after adjustment for potential confounders using multivariable logistic regression. This adverse workstyle could be developed because of physical and psychological work demands. Efforts should be directed at integrating “workstyle intervention” into lifestyle physical activity training to this group of healthcare workers.

Psychometric Evaluation of the Workstyle Short Form among Nursing Assistants with Work-Related Musculoskeletal Symptoms

The Workstyle Short Form (24 items) (WSF-24) has been tested for its psychometric properties on work-related upper-extremity musculoskeletal symptoms (WRUEMSs) among office workers. However, the impact of workstyle should not only be limited to WRUEMSs and the sedentary workforce. The purpose of this study was to test the psychometric properties of the modified 24-item Chinese WSF (C-WSF-24) to identify work-related musculoskeletal symptoms (WRMSs) in various body parts among nursing assistants (NAs) working in nursing homes. Four hundred and thirty-nine NAs participated in the study. The results of the factor analysis were that a four-factor solution (working through pain, social reactivity at work, demands at work and breaks) accounted for 56.45% of the total variance. Furthermore, validation against known groups showed that the total score and subscale scores of the C-WSF-24 had the ability to discriminate between NAs with and without WRMSs in various body parts (such as low back and lower extremities). Additionally, C-WSF-24 had a statistically significant association with the contributing factors to WRMSs. This is the first study to examine the psychometric properties of the C-WSF-24 in the non-sedentary workforce, with a focus on various body parts of WRMSs. The results demonstrated that C-WSF-24 is reliable and valid for assessing WRMSs in various body parts among NAs.

An ethnographic inquiry into the psychosocial care for oncology patients in the community: Healing from the 4Es

PURPOSE The aim of this study was to explore how the provision of community care in a cancer support center can help cancer patients and survivors cope with the demands of cancer and its treatment. METHODS A focused ethnographic approach was adopted. Data were collected through participant observations and focus groups with various stakeholders. The data from the focus groups were transcribed verbatim and analyzed using constant comparative analysis. RESULTS Four main themes emerged: 1. Enabling users to achieve mental well-being on their coping journey, 2. Empowering users to deal with their uncertainties, 3. Enhancing meaningful nurturing interactions through the design of spaces and colors in the Centre, and 4. Evolving through seeing more value in themselves. These 4Es occurred through intimate human interaction in the Centre, which resulted in psychological renewal and the rebuilding of a sense of self among the users. CONCLUSIONS This study provides insights on the provision of community support services for cancer patients/users, specifically on how to help them to regain control over their lives, not only through providing services for psychosocial renewal by engaging in intimate human interactions, but also by contributing to an understanding of the effect of the physical environment and space on healing. The results also reveal a virtuous circle of the 4Es as the synergies from the services, activities and the environment in the Centre, which provide a harmonious context for the users in coping with their cancer journey.