Treatment withdrawal experiences of women with breast cancer: A phenomenological study.

AIM: To obtain an in-depth understanding of the lived experiences, values, and beliefs of Taiwanese women with breast cancer who withdrew from cancer treatment. BACKGROUND: Fear of side effects, negative experiences and personal beliefs were identified as reasons for withdrawing from cancer treatments. Body-mind consciousness and body autonomy play a crucial role in cancer treatment decisions. DESIGN: Descriptive phenomenological approach. METHODS: We conducted semi-structured, face-to-face and in-depth interviews with 16 women diagnosed with breast cancer. Participants were purposefully selected from the Cancer Registry database. Employing a phenomenological approach, our aim was to explore the lived experiences of these individuals. Data analysis followed Giorgi's five-step process. To ensure a comprehensive report the COREQ checklist was applied. FINDINGS: 'The Determination to Preserve Me' is the essence of treatment withdrawal, identified by three themes and seven sub-themes. 'Raising Body-Mind Consciousness' was generated using body autonomy and preventing repeated psychological trauma from the participant's view. Their lifestyles, maintaining the family role, and returning to a normal trajectory help develop 'Maintaining Stability for Being a Patient and a Family Carer'. 'Self-Defending Against the Body Harm' was generated by concerns about maintaining health and preventing harm. CONCLUSION: Women's behaviours became transformed by suffering. Actions were influenced by physical and psychological distress, misconceptions about treatments, and appearance changes by self-determination through self-protection. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should respect women's autonomy and work collaboratively to ensure their decision-making with accurate information and awareness of the potential risks and benefits of treatment withdrawal need to concern.

Predictors of cancer-related fatigue in women with breast cancer undergoing 21 days of a cyclic chemotherapy.

BACKGROUND: Breast cancer is the most common diagnosis and the leading cause of cancer death among women worldwide and ranks first among Asian and Taiwanese women. Cancer-related fatigue (CRF) affects patients' functioning significantly. AIMS: The aim of this study was to examine changes in cancer-related fatigue (CRF) and related factors among women with breast cancer undergoing a single chemotherapy, and to identify predictors of CRF's change over the course of the chemotherapy cycle. METHODS: Four self-report questionnaires were administered to assess CRF, sleep quality, depression and anxiety, and symptom distress. Heart rate variability (HRV) was assessed to evaluate autonomic nervous system activation related to CRF. Data were collected four times: (1) before initiation of the single chemotherapy cycle (T0), (2) after completion of the single cycle (T1), (3) 1 week post-chemo (T2), and (4) 3 weeks post-chemo (T3). Repeated measurement of variance and generalized estimating equations (GEE) were conducted to estimate the trajectories and predictors. RESULTS: One-hundred women with breast cancer (mean age 50.4 ± 9.42) participated. CRF (F = 7.46), sleep quality (F = 2.74), symptom distress (F = 9.99), anxiety (F = 5.72), and depression (F = 4.14) varied significantly over the single cycle of chemotherapy (p < .001), which the trajectories showed exacerbating at T2. HRV indicated a higher variation only on the day of injection (T0, T1). Results of the GEE revealed that anxiety, depression, and symptom distress were predictors of CRF's change over the single cycle of chemotherapy. LINKING EVIDENCE TO ACTION: CRF worsens at 1 week after a chemotherapy injection among Taiwanese women with breast cancer. Based on the risk predictors in CRF that included anxiety, depression, and symptom distress, multistrategy CRF-alleviating interventions should be provided prior to chemotherapy and targeted at the most disturbed period, that is, 1 week after injection.

Determinants of High-Sodium Food Intake Among Indonesian Patients With Hypertension.

BACKGROUND: Sodium restriction is difficult for most individuals with hypertension. Intention to limit sodium intake predicts behavior. Information on the determinants of intention to restrict sodium intake is limited. OBJECTIVES: The aims of this study were to identify (1) determinants of intention to restrict high-sodium food intake and (2) sources of sodium consumed by patients with hypertension in Indonesia. METHODS: A cross-sectional study was conducted among adult patients with hypertension (n = 206) attending cardiac clinics. A researcher-developed and tested, self-administered questionnaire that included questions about sodium restriction and a high-sodium food inventory was distributed. The quantile regression method was used to identify determinants of intention to restrict dietary sodium. RESULTS: The mean age of the patients with hypertension was 59 ± 10 years, and more than three-fourths were obese (n = 162, 78%). The determinants of intention to limit sodium intake included gender (ß = 0.737, P = .036), attitude (ß = -0.141, P = .050), and subjective norm (ß = -0.283, P = .005). Men reported higher sodium consumption, while attitudes and subjective norm were negatively correlated with sodium intake. These determinants predicted 13.2% of the variance in intention to restrict dietary sodium. Subjects reported frequently consuming snacks (n = 82, 39.7%) and seasoning condiments (n = 65, 31.6%). CONCLUSIONS: High-sodium snacks and condiments added while cooking were frequently consumed among patients with hypertension in Indonesia. Understanding the factors associated with intention to follow a low-sodium diet will assist nurses to design effective interventions that promote adherence to the low-sodium diet among those with hypertension.

Living alone, loneliness, and depressive symptoms among Indonesian older women.

In this study, the researchers aimed to investigate the factors associated with loneliness and depressive symptoms among Indonesian older women. A secondary data analysis of the Indonesian Family Life Survey-5 was conducted. Data from 1233 women aged 60 years or above were analyzed using logistic regression. Results indicated fewer than one in five older women lived alone, half reported loneliness, and 16% reported depressive symptoms. Living alone was significantly associated with loneliness and depressive symptoms. Different factors were associated with loneliness and depressive symptoms. Loneliness and depression were found to be independent constructs of older women living alone in Indonesia.

Decreasing Duration of Mechanical Restraint Episodes by Increasing Registered Nurse Assessment and Surveillance in an Acute Psychiatric Hospital[Formula: see text].

INTRODUCTION: The application of mechanical restraints is a high-risk emergency measure that requires psychiatric intensive care to assure patient safety and expedite release at the earliest opportunity. While current Centers for Medicare & Medicaid Services regulations require trained staff to continuously observe restrained individuals, assessment by a registered nurse is required only once an hour. The experience of an acute psychiatric hospital demonstrates that more frequent registered nurse assessments can decrease duration of mechanical restraint episodes. AIMS: The aim of this three-part quality improvement project was to decrease duration of mechanical restraint episodes by increasing the frequency of registered nurse assessment and surveillance. METHODS: First, the requirement for frequency of face-to-face registered nurse assessment during episodes of mechanical restraint was increased from once every hour to once every 30 minutes. Second, the frequency of assessment was increased on half the hospital's units, from every 30 minutes to continuous registered nurse presence during restraint. Finally, the remaining units adopted 1:1 registered nurses during restraint. Mean hours of restraint per episode were measured and compared before and after each practice change. RESULTS: Mean duration of restraint episodes decreased 23% in the first change cycle, 12% in the second, and 44% in the third. Overall, there was a statistically significant 30% decrease in mean duration of restraint episodes. CONCLUSIONS: Increased frequency of registered nurse assessment and surveillance can significantly decrease duration of mechanical restraint episodes. Nurses are encouraged to adopt mechanical restraint practice standards that provide continuous psychiatric intensive care by a registered nurse.

Self-Management Behaviors in Relation to Psychological Factors and Interdialytic Weight Gain Among Patients Undergoing Hemodialysis in Indonesia.

PURPOSE: The purpose of this study was to understand the influence of demographic and psychological factors on self-management behaviors and interdialytic weight gain (IDWG) as a fluid adherence marker among patients undergoing hemodialysis in Indonesia. DESIGN: A quantitative correlational study. METHOD: A convenience sample of 145 patients undergoing hemodialysis was recruited from the dialysis units in two hospitals in Jakarta from September to December 2015. Questionnaires were used to examine self-management behaviors, depression, anxiety, and stress. Data for IDWG were obtained by subtracting the individual's predialysis weight from his or her postdialysis weight from the previous session. Hierarchical multiple linear regression identified the predictors of IDWG. RESULTS: Self-advocacy was ranked the least performed self-management behavior, while medication adherence was ranked the most likely to be performed. Among the subscales of the Self-Management Behavior Indices, positive correlations were found between the communication dimension with all psychological factors (depression, anxiety, and stress), while self-advocacy had positive correlation with anxiety. Subjects gained a mean of 4.5% of their postdialysis weight, with over 50% exceeding the recommended 4% IDWG. Overall, 53.6% of the IDWG was explained by the weekly duration of hemodialysis, level of depression, communication, partnership in care, and self-advocacy. CONCLUSIONS: Self-management behaviors are potential predictors that can be modified by nephrology nurses in order to enhance clinical outcomes, with the specific outcome being IDWG. Self-management behaviors contribute to the promotion of appropriate IDWG. Depressed patients are less likely to adhere to weight gain restrictions. CLINICAL RELEVANCE: Education combined with training in self-management behaviors-particularly communication, becoming a partner in care, and advocating for care-may improve adherence to IDWG guidelines among Indonesian hemodialysis patients. Interventions targeting depressed patients are needed.

Effectiveness of a Pre-emptive Preoperative Belladonna and Opium Suppository on Postoperative Urgency and Pain After Ureteroscopy.

PURPOSE: Postoperative ureteroscopy patients can develop bladder spasms, complaints of pain, and the urgent need to void during emergence from anesthesia. Discomfort leads to patient agitation, resulting in a risk to patient safety. The purpose of this study was to determine the effectiveness of a preemptive preoperative belladonna and opium (B + O) suppository on postoperative bladder comfort, narcotic requirements, and length of stay of ureteroscopy patients. DESIGN: A prospective double-blind study was conducted. METHODS: Fifty adult outpatients scheduled for ureteroscopy were assigned to routine care or a B + O suppository immediately after anesthesia induction. Urinary urgency and pain were assessed every 15 minutes. FINDINGS: Urgency significantly decreased in the B+O group, with less than half reporting urgency at discharge. CONCLUSIONS: Pre-emptive preoperative administration of a B + O suppository before ureteroscopy results in decreased urinary urgency during the postoperative recovery. Pre-emptive preoperative interventions can result in positive outcomes before discharge.

Decreasing Physical Restraint in Acute Inpatient Psychiatric Hospitals: A Systematic Review.

OBJECTIVE: A systematic review was conducted to identify methods used to decrease the application of physical restraints in acute inpatient psychiatric hospitals. METHOD: A literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using key words related to physical restraint. RESULTS: Three data-based studies met eligibility criteria. CONCLUSIONS: Findings suggest that multimodal intervention strategies may reduce the number of hours of physical restraint used in inpatient psychiatric settings, but quality evidence to support specific strategies is lacking. The search highlights the need for more quality research using standardized restraint reporting measures.

Longitudinal psychosocial adjustment of women to human papillomavirus infection.

AIM: The aim of this study was to examine the psychosocial adjustment trajectory, focusing on psychological distress, sexual relationships and healthcare information, and factors which have an impact on adjustment on receiving a positive diagnosis of human papillomavirus infection. BACKGROUND: Human papillomavirus is a common sexually transmitted infection in females. To date, knowledge of the longitudinal psychosocial response to the diagnosis of human papillomavirus is limited. DESIGN: A prospective longitudinal design was conducted with a convenience sample. METHODS: Women aged 20-65 years old were followed at one, 6 and 12 months after a diagnosis of HPV. Participants completed measures of initial emotional distress and followed up psychosocial adjustment. A mixed-effects model was applied to analyse the longitudinal changes in psychosocial adjustment. RESULTS: Seventy human papillomavirus positive women participated in the study with nearly 20% of the women reporting emotional distress during their first visit. Mixed-effects model analyses showed that a trajectory of psychosocial adjustment in healthcare orientation, sexual relationship and psychosocial distress occur from one to 6 months after HPV diagnosis. However, a declining trend from 6 to 12 months was significant in healthcare orientation. Initial emotional distress was associated with changes in psychological adjustment. CONCLUSIONS: Psychosocial adjustment to human papillomavirus was worse at 1 month compared with 6 and 12 months after diagnosis. Healthcare providers should offer health information and psychosocial support to women according to their disease progression.

Perception of Spirituality and Spiritual Care among Muslim Nurses in Indonesia.

This cross-sectional study was conducted to examine 256 Muslim nurses' perception of spirituality and spiritual care in Indonesia. The Spirituality and Spiritual Care Rating Scale (SSCRS) was translated and culturally adapted. Moderately high degrees in five domains and total SSCRS were found. Specialty, education level, clinical seniority, having spiritual training, and previous spiritual caring experience could impact on the SSCRS. Most nurses have cared for patients with spiritual needs, but denied having any formal training in providing spiritual care. Providing adequate curriculum and on-job training to equip nurses' knowledge and competence of spiritual care is urgent in Muslim healthcare environment.