Suzanne S. Dickerson

THE DIAGNOSIS OF BREAST CANCER: TRANSITION FROM HEALTH TO ILLNESS

PURPOSE/OBJECTIVES To gain a better understanding of the common meanings and shared experiences that women encounter after a diagnosis of breast cancer. RESEARCH APPROACH Qualitative using Heideggerian hermeneutics. SETTING Tertiary breast care center in suburban Buffalo, NY. PARTICIPANTS Purposive, convenience sampling recruited 30 women. METHODOLOGIC APPROACH Secondary analysis on tape-recorded interviews of women receiving their last cycle of chemotherapy. Narratives were interpreted using the seven-stage hermeneutic process. MAIN RESEARCH VARIABLES Life experiences, shared meanings, and perceptions. FINDINGS Four themes emerged: Changing Health Overnight, Erasing of a Former Self, Appraising of Illness, and Approaching the Future Now What? The constitutive pattern was transitioning from health to illness. CONCLUSIONS Women experience a precipitous change in their lives after a diagnosis of breast cancer. How they mentally and emotionally approached diagnosis and treatment affected their symptom experience and outcomes. INTERPRETATION This study provides oncology nurses with the awareness that beyond physical symptoms, women experience profound and precipitous emotional transformation following a diagnosis of breast cancer. It gives meaning to the devastation and symptom distress women experience that may be lessened if they are given adequate information and support. Women in the study who approached diagnosis and treatment more positively better incorporated the breast cancer process into their lives and better managed the side effects of treatment.

Effects of a 6-week Walking Program on Taiwanese Women Newly Diagnosed With Early-stage Breast Cancer

Background: In Western culture, evidence has shown that in women with breast cancer exercise decreases fatigue and improves quality of life. However, only 1 pilot study about the effect of exercise has been examined in the Asian breast cancer population that indicated feasibility. Therefore, it is important to further study the effect of an exercise program for Taiwanese women with breast cancer. Objective: The purpose of this study was to test the effects of a walking program on Taiwanese women newly diagnosed with early-stage breast cancer. Methods: This was an experimental, longitudinal study with 4-time repeated measures based on Banduras Self-efficacy Theory, with the aim of implementing interventions to boost exercise self-efficacy and to evaluate research outcomes. SPSS 17.0 with descriptive statistics using frequency, percentage, mean, and SD as well as inferential statistics such as t test, &khgr;2 test, hierarchical linear model, repeated-measures analysis of variance, and analysis of covariance was used for data analysis. Results: Results of this study indicated that subjects in the exercise group had significantly better quality of life, less fatigue, less sleep disturbances, higher exercise self-efficacy, more exercise behavior, and better exercise capacity compared with those in the usual-care group after the intervention. Conclusions: This program was effective and feasible, but more research studies with experimental, longitudinal design to verify the effects of this exercise program on Taiwanese women with breast cancer will be needed. Implications for Practice: Nurses, depending on skill and knowledge, can encourage physical activity, refer patients to rehabilitation programs, and prescribe and monitor exercise in breast cancer population.

Focus Groups Nursing Staffs Experiences Using Restraints

A phenomenological approach was used to examine nursing staffs experiences using physical restraints. A total of 12 nurses from a tertiary hospital participated in one of three focus groups. Exploring the attitudes of nurses can contribute to a better understanding of how decisions are made concerning restraints. An analysis of the focus group data resulted in a description of the lived experiences of nurses using restraints. Seven themes emerged from the data, one of which reflected that the nurses felt ambiguous about restraints, yet they made judgments and justified their decisions after assessing patient characteristics, environmental safety, and unit traditions. Nurse clinicians could use the focus group method to sensitize themselves to the staffs needs and to allow staff the opportunity to share ideas and to dispel misconceptions about restraints.

Sleep, mood, and quality of life in patients receiving treatment for lung cancer.

PURPOSE/OBJECTIVES To distinguish relationships among subjective and objective characteristics of sleep, mood, and quality of life (QOL) in patients receiving treatment for lung cancer. DESIGN Descriptive, correlational study. SETTING Two ambulatory oncology clinics. SAMPLE 35 patients with lung cancer. METHODS The following instruments were used to measure the variables of interest: Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Treatment-Lung (FACT-L), a sleep diary, and a motionlogger actigraph. MAIN RESEARCH VARIABLES Sleep, mood, and QOL. FINDINGS Significant differences were found between sleep diary and actigraph measures of sleep efficiency (p = 0.002), sleep latency (p = 0.014), sleep duration (p < 0.001), and wake after sleep onset (p < 0.001). Poor sleepers (PSQI score greater than 5) were significantly different from good sleepers (PSQI score of 5 or lower) on sleep diary measures of sleep efficiency and sleep latency and the FACT-L lung cancer symptom subscale, but not on mood or actigraphy sleep measures. CONCLUSIONS Although patients with lung cancer may report an overall acceptable sleep quality when assessed by a single question, those same patients may still have markedly increased sleep latencies or reduced total sleep time. The findings indicate the complexity of sleep disturbances in patients with lung cancer. Lung cancer symptoms had a stronger association with sleep than mood. Research using prospective methods will help to elucidate their clinical significance. IMPLICATIONS FOR NURSING Patients receiving treatment for lung cancer are at an increased risk for sleep disturbances and would benefit from routine sleep assessment and management. In addition, assessment and management of common symptoms may improve sleep and, ultimately, QOL. KNOWLEDGE TRANSLATION A high frequency of sleep disturbances in patients receiving treatment for lung cancer was evident, and poor sleepers had lower QOL. Sleep disturbances may be more related to lung cancer symptoms than anxiety or depression. Improving lung cancer symptoms such as dyspnea may improve sleep.

Factors related to quality-of-life pattern changes in recipients of implantable defibrillators

PURPOSE The implantable cardioverter defibrillator (ICD) has proven life-saving, yet it is important to understand its psychological effects on recipients. This study examined longitudinal changes in patterns of quality-of-life (QOL) scores in the first 3 months after an implant, and determined what variables tested as predictors of patterns. METHODS This longitudinal, prospective, descriptive, correlational survey study followed 80 ICD patients, with data collection at a baseline preinsertion, and 1 and 3 months after implant. RESULTS Findings revealed eight patterns of QOL change that were recoded into 3 groups: no change (44.7%), worse (20.7%), and improved (34.2%). No significant difference was evident in groups according to age at implant, gender, education, ejection fraction, number of device discharges, and comorbidities. State anxiety was significantly higher for the worsening group. CONCLUSION This finding supports the practice of identifying and supporting patients with anxiety, which correlates with a worsening QOL.

Sleep-wake disturbances in cancer patients: narrative review of literature focusing on improving quality of life outcomes.

Purpose Evidence suggests a high prevalence of sleep–wake disturbances in patients with cancer, occurring at diagnosis, during treatment, and continuing to survivorship. Yet associations between sleep–wake disturbances and the impact on quality of life outcomes is less clear. The purpose of this narrative review of the literature is to evaluate sleep–wake disturbances in patients with cancer, to describe the influence of poor sleep on quality of life as an outcome, and to evaluate the evidence to recommend future interventions. Framework and methods This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Four databases (CINAHL, MEDLINE, PsycINFO, and Embase) were searched using terms “cancer OR neoplasm”, “sleep, sleep disturbance, sleep disorders or insomnia”, and “quality of life”; the search included all years, English language, and peer-reviewed articles on research studies. Studies included measurements of sleep and quality of life in cancer patients at a minimum of two time points and demonstrated relationships between sleep and quality of life. Data were collected on date, patient demographics, cancer type and treatment, timeframe, design, measurement, variables, and results. Results This narrative review demonstrates that sleep–wake disturbance is a major problem/symptom in patients with cancer. Of the 18 studies included, measurement of sleep-related variables included objective and subjective measures; however, direct measurement of the associations between sleep and quality of life was not common. Cognitive behavioral therapy for insomnia and mind–body interventions demonstrated feasibility when implemented into cancer care settings. In addition, the majority of interventions exhibited moderate effectiveness in improving sleep–wake disturbance and quality of life outcomes. Conclusion The studies predominantly reported that poor sleep negatively impacts quality of life. The intervention studies included nonpharmacologic interventions such as cognitive behavioral treatment and mind–body and exercise interventions with moderate-to-high levels of evidence for improvement in sleep measures and quality of life.

Exploring common meanings of social support as experienced by Jordanian women with breast cancer.

Background: Research addressing social support among women diagnosed with breast cancer has been explored in several Western cultures, but there is a lack of such research in Jordanian women diagnosed with breast cancer. Objective: The purpose of this study was to explore common meanings of social support as experienced by Jordanian women with breast cancer. Methods: A qualitative interpretive phenomenological research design was used for this study. A purposive sample of 20 women diagnosed with stage I, II, or III breast cancer was recruited from 2 hospitals located in Jordan. Data were collected using individual semistructured interviews and analyzed using the Heideggerian hermeneutical methodology. Results: Six related themes and 1 constitutive pattern describe the meaning of social support for Jordanian women with breast cancer: (a) breast cancer as a stigmatized disease among Jordanian women with breast cancer, (b) social support from social network members, (c) being strong for self and others, (d) resources influence availability and need for social support, (e) controlling information for protection, and (f) using spiritual meaning as support. The constitutive pattern was labeled: culture influencing the meaning of social support. Conclusion: Jordanian women with breast cancer rely primarily on other women for social support, most of whom are in their family network. Need for social support can vary by resources available to these women. Implications for Practice: Health care providers who give care to Jordanian women with breast cancer need to consider the influence of culture, religion, and clinical and personal characteristics of each woman on her need for social support.

GENDER DIFFERENCES IN STORIES OF EVERYDAY INTERNET USE

This study is a secondary analysis of data collected from four web-based focus groups of nurses and computer scientists who were frequent Internet users. Our aim in this secondary study was to examine gender differences and shared practices in the interpretation of narratives when using this technology. We found that women have different values than men when using the Internet. We can use this information to inform nurses of the gender values that are reflected in Internet usage to increase their understanding of the potential gender stereotyping practices that occur on a medium that is theoretically bias-free.This study is a secondary analysis of data collected from four web-based focus groups of nurses and computer scientists who were frequent Internet users. Our aim in this secondary study was to examine gender differences and shared practices in the interpretation of narratives when using this technology. We found that women have different values than men when using the Internet. We can use this information to inform nurses of the gender values that are reflected in Internet usage to increase their understanding of the potential gender stereotyping practices that occur on a medium that is theoretically bias-free.

Women Receiving News of a Family BRCA1/2 Mutation: Messages of Fear and Empowerment

PURPOSE Communication of genetic test results to healthy at-risk family members is complicated considering family dynamics and the complexity of cancer genetics. The purpose of this study was to understand the experience of family communication of BRCA1/2 results from the perspective of young and middle-aged women receiving the news. THEORETICAL RATIONALE: Individuals are self-interpretive beings influenced by family culture, history, and communication patterns. Humans express meaning through language and stories. METHODS Heideggerian hermeneutics guided in-depth interviews and team interpretation of data. Using purposive and network sampling, 19 women 18 to 50 years of age who received news of a family BRCA1/2 mutation from a biologic relative were recruited from support groups and two health facilities in upstate New York. FINDINGS Five themes emerged: (a) situating the story, (b) receiving the message from family, (c) responding to receipt of the message, (d) impacting family communication, and (e) advice for communicating risk. Two constitutive patterns were identified: (a) communicating risk as a message of fear and empowerment and (b) integrating the message by taking one step at a time. CONCLUSIONS/IMPLICATIONS Healthcare professionals (HCPs) have an important role in provision of anticipatory guidance for communication of genetic test results, including the potential behavioral and emotional responses to family risk communication. Future research is indicated to understand the role of HCPs in family risk communication. CLINICAL RELEVANCE Presentation of comprehensive and balanced information and the use of patient-centered communication is essential. HCPs need to view women as whole rather than as a person at risk. Continued support is needed for women who subsequently test positive or negative for the family BRCA1/2 mutation from HCPs and others, often outside the family network.

Sleeping with the enemy: sleep and quality of life in patients with lung cancer.

Background: Patients with lung cancer have the poorest sleep quality compared with other patients with cancer and noncancer control subjects. However, few studies have examined sleep longitudinally. Objective: The objective of this study was to characterize and correlate sleep quality, daytime sleepiness, sleep-wake actigraphy, and quality of life (QOL) before, during, and after chemotherapy for non–small cell lung cancer (NSCLC). Methods: Using a prospective repeated-measures 1-group design, patients scheduled to receive chemotherapy for NSCLC were recruited. Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Functional Assessment of Cancer Treatment–Lung (FACT-L), and Motionlogger Actigraph were used for data collection. Results: Poor nocturnal sleep and QOL were evident among 29 patients with NSCLC before treatment. The FACT-L subscale scores worsened and then improved significantly from baseline through 2 rounds of chemotherapy. Objective sleep duration and sleep efficiency were positively associated with FACT-L scores, whereas objective sleep latency and wake after sleep onset were negatively associated with FACT-L scores. Sleepy patients had significantly worse FACT-L scores than did nonsleepy patients. The FACT-L subscale items that demonstrated significant worsening and then improvement over time were shortness of breath, weight loss, coughing, and chest tightness. Lung cancer patients experience early and middle insomnia before and during treatment. Conclusion: Poor sleep quality is common in patients receiving treatment for NSCLC and is related to poorer QOL and respiratory symptoms. Implication for Practice: Patients with NSCLC require routine screening for sleep disturbances. A positive screen for sleep disturbance warrants a thorough sleep assessment using practice guidelines and, if necessary, referral to a sleep specialist for diagnosis and treatment.