The Relationship Between Attitudes Toward Death, Rumination, and Psychological Resilience of Oncology Nurses.

OBJECTIVES: The study aimed to examine the relationship between attitudes toward death, rumination, and psychological resilience of oncology nurses. METHODS: The study design was cross-sectional. Data were collected from 118 oncology nurses using the Demographic Data Form, Work-Related Rumination Scale, Connor-Davidson Resilience Scale Short Form, and Death Attitude Profile-Revised Scale. For data analysis, correlation and regression analyses were performed. RESULTS: The study findings showed that oncology nurses` work related rumination score was moderate, while psychological resilience score was severely high. More than two-thirds of the work-related ruminations of oncology nurses were explained by psychological resilience and attitudes toward death. Even though there is a negative correlation between negative attitudes toward death and psychological resilience, the acceptance of death scores showed positive relations with psychological resilience. CONCLUSION: Nurses with positive attitudes toward death can also develop psychological resilience and experience fewer work-related ruminations. This result reveals the necessity of determining oncology nurses' attitudes toward death in order to protect their psychological resilience and reduce work-related ruminations. It is also evident that the results are valuable in presenting how nurses' work-related ruminations relate to psychological resilience and attitudes toward death. IMPLICATIONS FOR NURSING PRACTICE: Nurses are the main care providers in oncology settings, and they are witnessing the suffering process of their patients and experiencing the loss of their patients. These challenges bring work-related ruminations that lower the psychological resilience of nurses and affect attitudes toward death. Therefore, nurses can build an awareness of their ruminations and develop coping skills with intrusive ruminations.

"What doesn't defeat me makes me stronger" A Qualitative Study drawing on the Perspectives of Syrian Refugee University Students in Turkey.

Education is one of the most crucial instruments for refugee youth to remove the disadvantages and enhance their social and structural integration into society. However, the unequal education opportunities concerning the barriers avoid the integration of refugee students into society and make them prone to discrimination. This qualitative descriptive design study aimed at describing the experiences of the subjective perspectives of Syrian refugee students about higher education. The participants were final-year undergraduate Syrian refugee students. Data were collected by conducting in-depth semi-structured face-to-face interviews using a pilot-tested interview guide. The researchers followed a systematic data analysis procedure. The themes were finalized once the researchers had reached a consensus. The responses of the students were subsumed under the following three main themes: (1) Being 'other', (2) Hopes vs Realities, and (3) What doesn't defeat me makes me stronger. The participants reported feeling ignored and worthless due to the biases and assumptions of society, which result in stigma and discrimination. Additionally, refugee students revealed that their peers and even educators may sometimes share the same beliefs. However, the study also underlined the value of resilience in shaping the perspectives, even though they faced many challenging experiences.

Association of Rumination and Metacognition with Posttraumatic Growth in Parents of Children with Cancer.

OBJECTIVE: The primary objective of this study was to examine the association of rumination, metacognition, and posttraumatic with growth in parents of children diagnosed with cancer. DATA SOURCES: The study adopted a descriptive correlational design, and participants (N = 103) were parents of children with cancer. The study was conducted online through the social media platforms of three cancer associations. Data were collected using the Metacognitions Questionnaire-30, the Event Related Rumination Inventory, and the Posttraumatic Growth Inventory. CONCLUSION: The findings revealed a positive correlation between deliberate rumination and metacognition with posttraumatic growth, while a negative correlation was observed between intrusive rumination and posttraumatic growth. Furthermore, deliberate rumination, intrusive rumination, and metacognition collectively accounted for 30% of the variance in posttraumatic growth among parents of children with cancer. These results underscore the significant influence of rumination and metacognition in facilitating posttraumatic growth in this specific population. Consequently, interventions aimed at fostering deliberate rumination hold substantial potential for promoting posttraumatic growth among parents of children diagnosed with cancer. IMPLICATIONS FOR NURSING PRACTICE: This research guides nurses in addressing rumination, metacognition, and posttraumatic growth in parents of children with cancer. By adopting a holistic approach, nurses can enhance parents' well-being and resilience in the face of a child's cancer diagnosis.

'Ageing well': Discursive constructions of ageing and health in the public reach of a national longitudinal study on ageing.

Established in 2006, the Irish Longitudinal Study on Ageing (TILDA) investigates the health, economic and social circumstances of a nationally-representative sample of people aged fifty years and older in a series of biennial data collection waves. Irish newspapers have been reporting the results of TILDA for over a decade and a half, and their texts represent reports of scientific research distilled through the pen of journalists. In their totality, their texts constitute a public discourse on ageing and health. Using critical discourse analysis, we examined the discourse within the texts of a purposive sample of two national daily newspapers. As sites of public discourse, newspapers reflect social life and are influential in forming and legitimating public attitudes. Like other sites of discourse, their language-in-use is contextually located, is rarely neutral and may employ strategies to discursively construct, sustain and privilege particular social identities, including ageing identities. Discursively constructed as 'ageing well', our analysis of newspaper texts revealed a discernible meta-discourse on ageing and health in which ageing was framed as a life course stage that may be cultivated, diligently self-nurtured and exploited for its positive aspects. When considered in light of literature on health and social inequalities, the consequences of this broadly positive ageing discourse can, somewhat perversely, frame older adults in unintended negative ways, including homogenising them and attributing to them capacities for ageing well that they may not possess. Discursively constructing older adults as a social and economic resource can also impose unrealistic expectations on them and may legitimise exploitation and demonstrate how normative ideologies of ageism and ableism are conveyed through legitimising language. Despite these potentially unintended consequences, the available media resources associated with TILDA may represent one of the most important contributions of the study, in terms of informing positive public attitudes towards ageing.

"I am in a Fight with My Brain": A Qualitative Study on Cancer-Related Ruminations of Individuals with Cancer.

OBJECTIVE: This study aimed to determine the cancer-related ruminations from the subjective perspectives of individuals with cancer. DATA SOURCES: The study adopted a qualitative design, and participants (N = 16) were individuals with cancer. The analysis and interpretation of data were carried out according to the phenomenological-hermeneutical method. CONCLUSION: The following four themes emerged as a result of the analysis of qualitative data revealing the experiences of individuals with cancer: (1) attributed meanings to cancer-related ruminations, (2) perceived ruminations toward an uncertain future, (3) losing against intrusive ruminations, and (4) fighting with ruminations. The results underline the negative impact of ruminative thoughts on the disease process and social life of individuals with cancer. Individuals with cancer struggle with intense thoughts about the cause, treatment, and future of the disease from the moment they are diagnosed with cancer. In order to stop ruminative thoughts, individuals with cancer have tried solutions such as distracting activities and avoiding thoughts. IMPLICATIONS FOR NURSING PRACTICE: Nurses have an important role in catching verbal and nonverbal cues for rumination, as they are constantly together with individuals with cancer and make observations. Therefore, nurses can raise awareness about their ruminative thoughts and teach coping skills to individuals with cancer.

"Cancer Never Goes Out of Your Mind Even for a Single Second". Cancer-Related Ruminations From the Perspectives of Cancer Survivors.

OBJECTIVE: This study aimed to explore a deeper understanding of how cancer survivors experience and manage ruminative thoughts. DATA SOURCES: A descriptive qualitative design. The study was conducted with cancer survivors (n = 21). A semistructured interview guide was used for data collection, and content analysis method was implemented to gain a better understanding from the collected data. The study procedure and reporting adhere to the guideline for reporting qualitative research COnsolidated criteria for REporting Qualitative research (COREQ) checklist. CONCLUSION: Three main themes were developed: "Struggling within cognitions", "Coping", and "Required needs". The results highlight that cancer survivors have intrusive ruminative thoughts about cancer and need support to cope with these thoughts. It was also found that over time, they experienced changes in their perspectives, gained meaning, and were able to use deliberate ruminations. IMPLICATIONS FOR NURSING PRACTICE: Nurses have an effective role in providing care and determining the needs of individuals. Nurses can easily recognize intrusive ruminations, help cancer survivors raise awareness about the effects of ruminative thoughts on them, and support them in coping with intrusive ruminations using effective interventions.

Covid-19-related ruminations: A qualitative study based on the perspectives of the cancer survivors.

Cancer survivors can develop repetitive ruminations due to the unexpected and challenging effects of Covid-19. This qualitative descriptive design study aimed to comprehend the Covid-19-related ruminations from the subjective perspective of cancer survivors (n = 33), accessed via online Facebook self-help groups of a cancer association. A semi-structured interview guide was used for data collection followed by systematic analysis. Based on the descriptive analysis of the data, three main themes emerged-"Welcome to my life," "Cancer versus Covid-19," and "Fight versus lose"-based on cancer survivors' experience and having two subthemes each. The findings suggested that cancer survivors have many ruminations about cancer and the pandemic. Their ruminations were mainly concerned with the possibility of suffering from cancer again and catching Covid-19. Nonetheless, participants also had positive cognitions that they could overcome the pandemic as they have previously beat cancer. The findings may also offer a promising resource for nurses to understand the ruminations of cancer survivors and develop novel approaches and interventions to help cancer survivors replace their intrusive ruminations with deliberate ones.

Association between resilience, self-esteem and suicide probability among university students in Turkey.

PURPOSE: This descriptive and correlational study was conducted to determine whether the self-esteem and resilience levels of students were predictors of suicide probability. DESIGN AND METHODS: The survey included the demographic data sheet, Resilience scale for adults, the Rosenberg self-esteem scale, the Suicide probability scale. FINDINGS: Resilience and self-esteem scores of the students were high, while the suicide probability was low. Self-esteem and resilience levels were predictors of suicide probability. PRACTICE IMPLICATIONS: This highlights the need for assessing the ongoing adjustment of students' resilience and self-esteem levels over a period and providing effective programs to help them improve their resilience and self-esteem.

The relationships among psychological resilience, intercultural sensitivity and empathetic tendency among teachers of Syrian refugee children in Turkey.

Within the provision of education, teachers typically have the closest contact and play a key role in meeting the needs of refugee children through effective communication to achieve culturally qualified education and the provision of more humanistic approach. This descriptive cross-sectional design study is aimed to explore the relationships among psychological resilience, intercultural sensitivity and empathetic tendency in teachers of Syrian refugee children in Turkey. Data were collected from 367 teachers of Syrian refugee children. Teachers of Syrian refugee children who participated in the study had a high level of psychological resilience, moderate level of empathic tendencies and a high level of intercultural sensitivity. Statistically significant relationships were found among study variables. The data reveal that there is a relationship among psychological resilience, intercultural sensitivity and empathetic tendency among teachers of Syrian refugee children in Turkey. Furthermore, regression analysis revealed that psychological resilience significantly supports intercultural sensitivity and empathic tendencies.

"I Wish I Could Have My Leg": A Qualitative Study on the Experiences of Individuals With Lower Limb Amputation.

Amputation is commonly regarded as a lifesaving procedure. However, the loss of a body part can lead to permanent disability that can impact patients physically, psychologically, and socially. The aim of this study was to describe and understand the perspectives of patients with lower limb amputation (LLA) about their condition. The study uses a descriptive phenomenological design. Data were collected from 12 patients. The researchers conducted interviews using semi-structured questions. MAXQDA was used for qualitative software support in managing the interview data. Data were transcribed. The participants were aged 61.3 ± 10.8 years. Three themes emerged from the qualitative data: (i) losing control over one's own life, (ii) dreams versus the realities of life, and (iii) future perceptions. Most of the participants emphasized that they face undesirable experiences in their post-amputation lives. The findings of the present study provide novel insight into how individuals subjectively experience life after LLA.

Achieving culturally competent mental health care: A mixed-methods study drawing on the perspectives of UK nursing students.

PURPOSE: This study aimed to examine the degree of cross-cultural competency among UK mental health student nurses, and the care delivery challenges arising from their internalized cultural assumptions. DESIGN AND METHODS: This study adopted a mixed-methods design. Participants were final-year nursing students in the United Kingdom. FINDINGS: The results revealed participants had a moderate level of cultural awareness and competency but highlighted many challenges to providing cross-cultural care arising from the meanings, enablers, and values they attributed to culturally competent mental health care. PRACTICE IMPLICATIONS: As cultural competency is considered an essential characteristic of effective nursing care, greater attention should be paid to how student nurses assimilate cultural awareness to develop confidence in their day-to-day practice.

Psychological Resilience, Metacognitions, and Fear of Recurrence Among Cancer Survivors and Family Caregivers.

BACKGROUND: Cancer is a life crisis that can have devastating consequences not only on the affected individual but also on his/her caregivers. OBJECTIVE: The aim of this study was to investigate the influence of psychological resilience and metacognitions of cancer survivors and their family caregivers (FCs) on fear of recurrence (FoR). METHODS: This study used a cross-sectional design while adhering to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Data were collected from 112 cancer survivors and 112 FCs recruited from 5 oncology hospitals. RESULTS: The cancer survivors and caregivers reported low levels of psychological resilience, which we found to be correlated with great fear of recurrence in cancer survivors and FCs. It was also in relation with metacognitions in cancer survivors and FCs.The findings showed that psychological resilience negatively predicted the fear of recurrence, whereas the metacognitions positively predicted the fear of recurrence in cancer survivors and FCs. The total effects of psychological resilience on the FoR in cancer survivors and FCs were 0.920 (confidence interval [CI], -2.059 to 0.072) and 0.061 (CI, -0.475 to 0.474), respectively. The total effects of metacognition on the FoR in cancer survivors and FCs were 1.164 (CI, 0.217-2.371) and 0.486 (CI, 0.016-1.058), respectively. CONCLUSIONS: The findings underline the direct and indirect mediating role of psychological resilience and metacognition of cancer survivors and FCs on FoR. IMPLICATION FOR PRACTICE: The findings are particularly important to oncology nurses, who as 24-hour care providers are important sources of psychosocial care. Their awareness of factors influencing FoR is critical for achieving positive outcomes.

The relationship between resilience, moral sensitivity, and cultural competence among nurses.

This study aimed to examine the relationships between resilience, moral sensitivity, and cultural competence among nurses. A descriptive correlational design was employed. The study comprises 120 nurses. The resilience total scores and most of its domain scores were significantly and positively associated with the cultural competency total and domain scores. Additionally, the resilience total scores and some of its domain scores were significantly in relation to the moral sensitivity total and domain scores. Resilience total and domain scores were significantly and positively related to the moral sensitivity total and domain scores. The emergent correlations underscore the role that resilience plays in nurses' moral sensitivity and cultural competence. The emergent correlations underscore the role that resilience plays in nurses' moral sensitivity and cultural competence. The present findings suggest that nurse managers should develop delivery models that nurture resilience in nurses.

The relationship between rumination, fatigue and psychological resilience among cancer survivors.

AIM AND OBJECTIVES: The study's purpose was to examine the association between rumination, fatigue and psychological resilience among cancer survivors. BACKGROUND: Cancer is a disease that causes difficult lives in individuals. Individuals can struggle with cancer-related fatigue (CRF) and ruminative thoughts during and after the disease process. However, it can also be seen that some individuals make sense out of their cancer experience and turn into stronger individuals. DESIGN: A cross-sectional design. METHODS: This study was conducted from February through November 2020. Data were collected from 159 cancer survivors using Event Related Rumination Inventory, Cancer Fatigue Scale and Connor-Davidson Resilience Scale. RESULTS: The findings showed that intrusive rumination significantly and negatively mediated psychological resilience but significantly and positively mediated with CRF. In contrast, deliberate rumination was significantly and positively mediated psychological resilience but significantly and negatively mediated with CRF. The effects of intrusive and deliberate rumination on fatigue were .431 (CI =0.042-0.635) and -.285 (CI = -0.163 to 0.491), respectively. In addition, the effects of intrusive and deliberate rumination on psychological resilience were -.253 (CI = -0.177 to 0.447) and .304 (CI = 0.045-0.124), respectively. CONCLUSIONS: The findings underline the mediating role of rumination on CRF and psychological resilience among cancer survivors. The findings also delineate the associations between rumination, CRF and psychological resilience, which differ based on rumination type. RELEVANCE TO CLINICAL PRACTICE: The findings are particularly important to oncology nurses, who are the main sources of psychosocial care. To support cancer survivors and mobilise their resources, oncology nurses should be made aware of the different types and effects of rumination. With the help of this awareness, oncology nurses can enhance managing intrusive rumination, replacing intrusive ruminations with deliberate ones, mobilising resources and promoting psychological resilience.

"For Years I lived in a Cage. Now the Cage Is Open and I Am Just Learning to Fly." Perspectives of Cancer Survivors on Psychological Resilience.

BACKGROUND: Transitioning from treatment to survivorship engenders several challenges that cancer survivors must learn to manage. These challenges are commonly associated with struggling to manage reentry into postcancer life. Thus, balance is restored after cancer, and postcancer experiences should be considered along with all previous life experiences. This balancing process surrounding cancer causes some cancer survivors' life to deteriorate, whereas other cancer survivors begin a psychological resilience process. OBJECTIVE: The aim of this study was to investigate the way that psychological resilience is experienced by cancer survivors. METHODS: The present descriptive qualitative design study was conducted from August 2019 through January 2020. A total of 12 cancer survivors were sampled from the follow-up clinics of a hospital. Data were collected through semistructured, pilot-tested, face-to-face interviews using an interview guide. RESULTS: Three main themes were clarified based on the descriptive analysis of the data on cancer survivors' experiences: "fight vs lose," "balancing uncertainties," and "learned to fly." The results demonstrate the importance and influence of psychological resilience in the overall cancer experience. CONCLUSION: This study provides insight into the subjective psychological resilience process of cancer survivors. Nurses may use this knowledge in fostering effective strategies enabling cancer survivors to develop psychological resilience. IMPLICATIONS FOR PRACTICE: The results offer a promising resource for nurses to assess and address the risk and protective factors of cancer survivors to identify unique needs and to provide individualized care. In this context, nurses can develop novel approaches and interventions for cancer survivors in accordance with Kumpfer's resilience framework.

'Who would even want to talk about death?' A qualitative study on nursing students' experiences of talking about death with terminally ill patients with cancer.

OBJECTIVES: This study aimed to describe nursing students' experiences of talking about death with terminally ill patients with cancer. METHODS: The study adopted a qualitative design, and participants (n = 28) were final-year undergraduate nursing students. Data were collected by conducting in-depth semi-structured face-to-face interviews using a pilot-tested interview guide. The researchers followed a systematic data analysis procedure which is an appropriate method of analysis when aiming to create knowledge based on experiences and meanings from cross-case analysis. RESULTS: The responses of the nursing students were subsumed under the following three themes: (1) 'balance on the rope', (2) 'who would even want to talk about death' and (3) 'need to talk but …'. The findings suggest that many nursing students do not believe that they are competent enough to talk about death with terminally ill patients with cancer, even though they believe it is essential to end-of-life care. CONCLUSION: The findings underscore the importance of examining students' perspectives on death, which not only shapes their experiences of caring for terminally ill patients but also influences the quality of care. Further, students feel unprepared for talking to terminally ill patients with cancer and require support to avoid ignoring calls to speak about death.

Effects of interventions on rumination among individuals with cancer: A systematic review and meta-analysis.

AIM: This study aimed to examine the effects of interventions on rumination among individuals with cancer. DESIGN: A systematic review and meta-analysis. DATA SOURCES: Six databases (Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), PsyArticles, CINAHL, PubMed and Web of Science) were searched for relevant articles published between January 2000 and April 2020. REVIEW METHODS: The findings of experimental studies (including both experimental and control groups) related to interventions to effect rumination of individuals with cancer were included. Comprehensive meta-analysis was used to analyse the data. Hedges' g and 95% confidence intervals (CIs) were computed to estimate the effect. Additionally, funnel plots were created and heterogeneity was analysed using the I2 test. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used. RESULTS: Eight studies, which included a total sample of 856 individuals with cancer, were included. Half of the studies (n = 4) were randomised controlled trials, and six of them had conducted mindfulness-based interventions. The interventions had significant effects on rumination among individuals with cancer (z = -2.356, Q = 167.663, p < 0.001, I2  = 95.825%). The effect size was -0.894 (95% CI = [-1.638, -0.150]) and statistically significant (p < 0.001). CONCLUSION: The interventions had reduced rumination among individuals with cancer. These effects should be interpreted with caution because there was a high level of heterogeneity. However, only a few studies were included, and the findings underscore the need for further research. IMPACT: Many individuals are likely to benefit from rumination-focused interventions, especially mindfulness-based interventions. Nurses should utilise available opportunities to facilitate the optimal management of cancer-related rumination.

"Now I keep my feet on the ground. Earlier, I was arrogant and felt too big for my boots." Perspectives of people with cancer and oncology nurses on the psychological empowerment process.

PURPOSE: A deeper understanding of the psychological empowerment process of people with cancer can provide improved practical strategies for healthcare professionals to assist the patients in maintaining hope and overcoming difficulties. This study aimed to describe, interpret, and understand the phenomenon of the psychological empowerment process related to cancer from the perspectives of people with cancer and oncology nurses. METHOD: The present descriptive qualitative design study was conducted between May 2017 and August 2017, in the oncology clinics of a university hospital. A purposive sampling method was applied to recruit adult patients diagnosed with different types and stages of cancer. The semi-structured interviews were conducted with thirteen patients and sixteen nurses. The data were transcribed, themes were identified, and the COREQ (Consolidated criteria for Reporting Qualitative Research) Checklist was used to ensure quality reporting in this study. RESULTS: This study categorized quotes of patients and nurses into four main themes including "gains and losses", "meaning of life", "presence and contact", and "need to be understood". Both patients and nurses shared similar thoughts toward the factors associated with the psychological empowerment process during the cancer experience. CONCLUSION: Being aware of patients' requirements along with raising effective support to help them grow stronger while preventing the disparity between the support that patients require and receive are some of the aspects that need to be considered for the provision and organization of healthcare services related to the psychological empowerment of people with cancer.

Descriptive phenomenological study on ego-integrity among older people in nursing homes.

This study aimed to describe, interpret, and understand the phenomenon of ego integrity among nursing home residents using a descriptive phenomenological approach. Data were collected by conducting in-depth face-to-face interviews with 18 nursing home residents with the aid of a pilot-tested semi-structured interview guide. The authors followed a systematic analytic procedure. Key themes and subthemes emerged when the codes were combined. The responses of the residents were classified under three themes: (i) existential well-being, (ii) future expectations, and (iii) regrets regarding past life stages. The results underscored the important role of ego integrity in structuring one's life in the later years. A lack of ego integrity had resulted in negative perceptions of life, a lack of future plans, and existential suffering. The findings underscore the importance of assessing ongoing temporal changes in the ego integrity of nursing home residents and providing effective programs that enhance their sense of ego integrity.

A PRISMA-Driven Systematic Review for Determining Cross-Cultural Mental Health Care.

PURPOSE: The study aimed to determine how culture can affect mental healthcare delivery in order to make recommendations for improving care pathways supported by culturally competent care. METHODS: Three international databases were systematically and independently searched by two researchers. FINDINGS: The results were grouped under three themes-quality of cross-cultural mental health care, expectations of people receiving cross-cultural mental health care, and perspectives of healthcare providers on cross-cultural mental health care. CONCLUSIONS: The study indicates how important it is for nurses to understand the complex interplay between culture and mental health and to develop cultural awareness and sensitivity. PRACTICE IMPLICATIONS: The study seeks to identify best practice and make recommendations for enhancing positive attitudes toward the cultural needs of people with mental health problems.