[Using Time Management and Quality Improvements to Decrease the Incidence of Unexpected Skin Defects in Post-Mastectomy Breast Cancer Patients].

BACKGROUND & PROBLEMS: When patients with breast cancer undergo radical mastectomy, seromas are often caused due to the large area of excised breast tissue and the resulting cavity that fills with blood and water. Therefore, strong adhesive elastic tape and large amounts of gauze are needed to compress the wound. Our clinical experience shows that repeatedly removing dressings during dressing changes significantly increases the risk of unexpected skin defects. However, the increased duration of hospital stays required for these patients with skin defects exposes them to high risk environments, which may result in nosocomial infections and even longer hospitalization durations. PURPOSE: This project aimed to decrease the incidence of unexpected skin defects in patients after mastectomy to below 15%. RESOLUTION: After a review of the literature, we implemented this project to: (1) build up a standard operating procedure for post-mastectomy wound compression; (2) use narrow girdles instead of strong adhesive elastic tape; (3) use soft elastic bandages to replace the single layer of gauze for wound compression; (4) use a skin examination form as a continuous monitoring tool. We expected that these measurements would effectively decrease the incidence of unexpected skin defects in post-mastectomy patients. RESULTS: After implementing this project, the incidence of unexpected skin defects in post-mastectomy patients decreased from 100% to 13% and the time required by clinical nursing staff to perform wound dressing care decreased from 25 mins to 15 mins per care instance. CONCLUSIONS: We hope that this project helps effectively improve postoperative wound care quality in post-mastectomy patients and decreases the time spent by clinical nursing staff on wound dressing care.

The Trajectory of Postoperative Pain Following Mastectomy with and without Paravertebral Block.

Evidence to support the argument that general anesthesia (GA) with paravertebral block (PVB) provides better pain relief for mastectomy patients than GA alone is contradictory. The aim of this study was to explore pain and analgesia after mastectomy with or without PVB during acute inpatient recovery. A retrospective study was conducted in a single hospital providing specialist cancer services in metropolitan Melbourne, Australia. We explored pain and concomitant analgesic administration in 80 consecutive women recovering from mastectomy who underwent GA with (n = 40) or without (n = 40) PVB. A pain management index (PMI) was derived to illustrate the efficacy of management from day of surgery (DOS) to postoperative day (POD) 3. Patients who reported no pain progressively increased from DOS (n = 12, 15%) to POD 3 (n = 54, 67.5%). Most patients were administered analgesics as a combination of acetaminophen and a strong opioid on DOS (n = 53, 66.2%), POD 1 (n = 45, 56.2%), POD 2 (n = 33, 41.2%), and POD 3 (n = 21, 26.2%). Less than 6% of patients on any POD were administered multimodal anlagesics. PMI scores indicate some pain in the context of receiving weak and strong opioids for GA patients and more frequent use of nonopioid analgesics in PVB patients during recovery. These findings highlight the need for data describing patterns of analgesic administration in addition to reports of postoperative pain to determine the most effective means of avoiding postoperative pain in patients who require mastectomy.

Sentimentos de mulheres sobre as alterações causadas pela mastectomia / Women´s feelings about the changes caused by mastectomy / Los sentimientos de las mujeres acerca de los cambios causados por la mastectomía

Objective: To analyze the feelings of women in a support group for the changes caused by mastectomy. Method: descriptive study with a qualitative approach, performed in a support group for women with mastectomies in Cajazeiras, in the state of Paraíba, Brazil, in June and July 2014, with 20 subjects. It was used a semi-structured interview for data collection. The analysis was performed using the methodological process of the Collective Subject Discourse. Results: it was evident that women have adopted a unique way of face the breast cancer varying between negative feelings, concern about a move away from their children, closer spirituality and natural acceptance of the disease. Conclusions: importantly, from the understanding of these feelings, the nurse can build an appropriate care plan for the health needs of this target audience, thus providing a more efficient, effective and humane action.

Objetivo: Analisar os sentimentos de mulheres de um grupo de apoio sobre as alterações causadas pela mastectomia. Métodos: estudo do tipo descritivo com abordagem qualitativa, realizado em um grupo de apoio a mulheres mastectomizadas em Cajazeiras, no estado da Paraíba, Brasil, em junho e julho de 2014, com 20 sujeitos. Utilizou-se uma entrevista semiestruturada para coleta de dados. A análise foi feita através do processo metodológico do Discurso do Sujeito Coletivo. Resultados: evidenciou-se que as mulheres adotaram uma maneira singular de enfrentamento do câncer de mama variando entre sentimentos negativos, preocupação em se afastar dos filhos, maior aproximação da espiritualidade e aceitação da doença com naturalidade. Conclusão: é importante destacar que a partir da compreensão destes sentimentos, o enfermeiro poderá construir um plano de cuidados adequado às necessidades de saúde deste público-alvo, proporcionando, assim, uma ação mais eficiente, eficaz e humana.

Objetivo: Analizar los sentimientos de las mujeres en un grupo de apoyo sobre los cambios provocados por la mastectomía. Método: estudio descriptivo con enfoque cualitativo, realizado en un grupo de apoyo para mujeres con mastectomía en Cajazeiras, en el estado de Paraíba, Brasil, en junio y julio de 2014, con 20 participantes. Se utilizó una entrevista semiestructurada. El análisis fue a través del Discurso Del Sujeto Colectivo. Resultados: mostraron que las mujeres han adoptado una forma única enfrentar al cáncer de mama que van desde los sentimientos negativos,la preocupación por los niños lejos, más espiritualidad y la aceptación de la enfermedad naturalmente. Conclusiones: es importante destacar que, a partir de la comprensión de estos sentimientos, la enfermera puede construir un plan de atención adecuada a las necesidades de salud de este público objetivo, proporcionando así una acción más eficiente, eficaz y humana.

Aspectos que podem influenciar a qualidade de vida da mulher mastectomizada / Aspectos que pueden influir en la calidad de vida de la mujer mastectomizada / Aspects that may influence on the quality of life of a mastectomized woman

RESUMO A retirada da mama pode influenciar nas dimensões da qualidade de vida da mulher com câncer de mama. Objetivou-se desvelar fatores que influenciam a qualidade de vida de mulheres mastectomizadas. Estudo descritivo de abordagem qualitativa, realizado com 21 mulheres submetidas à cirurgia de mastectomia, no período de junho a setembro de 2013, em um ambulatório de mastologia em Fortaleza/CE, Brasil, por meio de entrevistas semiestruturadas. Da análise de conteúdo emergiram duas categorias: Influência positiva e Influência negativa na qualidade de vida. Fatores que influenciam positivamente surgiram: apoio familiar, social e profissional, condição financeira e assistência médica; negativamente: assistência médica, condição financeira, hábitos de vida não saudáveis, doença e medo de morrer. Conclui-se que conhecer fatores que influenciam na qualidade de vida da mulher mastectomizada favorece uma melhora na prática do cuidado por fortalecer ações específicas, colaborando com a qualidade de vida dessas mulheres.

RESUMEN La remoción de la mama puede influir en las dimensiones de la calidad de vida de la mujer con cáncer de mama. El objetivo del estudio fue aclarar los factores que influyen la calidad de vida de mujeres mastectomizadas. Estudio descriptivo de abordaje cualitativo, realizado con 21 mujeres sometidas a la cirugía de mastectomía, en el período de junio a septiembre de 2013, en un ambulatorio de mastología en Fortaleza/CE, Brasil, a través de entrevistas semiestructuradas. Del análisis de contenido surgieron dos categorías: Influencia positiva e Influencia negativa en la calidad de vida. Factores que influyen positivamente surgieron: apoyo familiar, social y profesional, condición financiera y atención médica; negativamente: atención médica, condición financiera, hábitos de vida no saludables, enfermedad y miedo de morir. Se concluye que conocer los factores que influyen en la calidad de vida de la mujer mastectomizada favorece la mejora en la práctica del cuidado por fortalecer acciones específicas, colaborando con la calidad de vida de estas mujeres.

ABSTRACT The breast removal can influence the dimensions of women's quality of life with breast cancer. This study aimed to uncover factors that influence the quality of life of mastectomized women. Descriptive study, with a qualitative approach, conducted with 21 women undergoing mastectomy surgery from June to September 2013, in a mastology clinic in Fortaleza/CE, Brazil, through semi-structured interviews. Two categories emerged from the content analysis: positive influence and negative influence on quality of life. Factors that positively influence emerged: family, social and professional support, financial condition and medical care; negatively: medical assistance, financial condition, unhealthy lifestyle habits, disease and fear of dying. One concludes that knowing factors that influence the quality of life of mastectomized women favors an improvement in care practices to strengthen specific actions, contributing to the quality of life of those women.

Trajetória de vida de mulheres mastectomizadas à luz do discurso do sujeito coletivo / Trayectoria de vida de mujeres mastectomizadas a la luz del discurso del sujeto / Life trajectory of mastectomized women based on the collective subject discourse

To examine the life trajectory of women with mastectomy members of a self-help group. Method: descriptive and exploratory study, with a qualitative approach, using the approach of the oral history of life as a methodological benchmark, meeting the operational phases. The participants were 20 women with mastectomy, whose narratives, considered discursive manifestations were submitted to the analysis of the collective subject discourse. Results: three thematic axes were elaborated, supported by their respective core ideas, each one was referent to before, during and after mastectomy: “to face life bravely” – “normal life”, “separation”, “change”, “work” and “children”; “I have talked to God” – “prevention/care procedures”, “diagnosis/treatment”, “feelings/emotions” and “changes”; “reorganization with more objectivity and experience” – “creed”, “change” and “feelings/emotions”. Conclusion: it is recognized the need for studies into the mastectomy women to support public policies, or simply to enable health professionals to a humanized care...

Analisar a trajetória de vida de mulheres mastectomizadas integrantes de um grupo de autoajuda. Método: estudo exploratório-descritivo, com abordagem qualitativa, utilizando-se do enfoque de história oral de vida como referencial metodológico atendendo às fases operacionais. Participaram 20 mulheres mastectomizadas cujas narrativas, consideradas manifestações discursivas, foram submetidas à análise do Discurso do Sujeito Coletivo. Resultados: emergiram três eixos temáticos, sustentados por suas respectivas ideias centrais, cada um referente ao antes, durante e o depois da mastectomia: encarar a vida de frente - vida normal, separação, mudança, trabalho e filhos; falei com Deus - prevenção/cuidados, diagnóstico/tratamento, sentimentos/emoções e mudanças; reorganização com mais objetividade e experiência - crença, mudança e sentimentos/emoções. Conclusão: reconhece-se a necessidade de estudos voltados para as mulheres mastectomizadas a fim de subsidiar políticas públicas ou, simplesmente, capacitar os profissionais da saúde para um atendimento humanizado...

Analizar la trayectoria de la vida de las mujeres con mastectomías miembros de un grupo de autoayuda. Método: un estudio exploratorio descriptivo con abordaje cualitativo, utilizando el método de la historia oral de la vida como un marco metodológico teniendo en cuenta las fases operativas. Con la asistencia de 20 mujeres que se sometieron a la mastectomía, cuyas narraciones, considerados manifestaciones discursivas se presentaron al Discurso del Sujeto Colectivo. Resultados: tres temas principales surgieron, con el apoyo de sus respectivas ideas centrales, cada una en referencia al antes, durante y después de la mastectomía: encarar la vida - la vida normal, la separación, el cambio, el trabajo y los niños; Hablé con Dios - prevención / atención, diagnóstico / tratamiento, sentimientos / emociones y los cambios; reorganización con más objetividad y la experiencia - creencia, cambio y sentimientos / emociones. Conclusión: con se reconoce la necesidad de estudios sobre las mujeres mastectomía para apoyar las políticas públicas, o simplemente para permitir a los profesionales de la salud a una atención humanizada...

A vida da mulher após a mastectomia à luz da teoria adaptativa de Roy / La vida de las mujeres después de la mastectomía teniendo en cuenta la teoría de adaptación de Roy / The woman’s life after mastectomy in the light of Roy Adaptive theory

Objective: check the adaptation methods of mastectomies women; raise the presence of changes in the habits of life of women after mastectomy; correlate the adaptive process outlined by the woman with the theory presented by Roy and investigate the care provided by nurses to women with mastectomies. Method: For carrying out the survey was used to type descriptive qualitative approach. Results: The role of nursing in the care the woman, who had been subjected to breast surgery, encompasses care for maintenance of their bodily functions as well as support to those who are involved in the process, the individual as a whole and family. Conclusion: Roy's theory is the bases for hypotheses that can be tested.

Objetivo: verificar os métodos de adaptação de mulheres mastectomizadas; levantar a presença de mudanças nos hábitos de vida da mulher após a mastectomia; correlacionar o processo adaptativo exposto pela mulher com a teoria apresentada por Roy e averiguar a assistência prestada pelos profissionais de enfermagem às mulheres mastectomizadas. Método: Para a realização da pesquisa foi utilizada a abordagem qualitativa do tipo descritiva. Resultados: O papel da enfermagem no cuidado a mulher que fora submetida à cirurgia mamária, engloba cuidados para manutenção de suas funções orgânicas assim como apoio aos que estão envolvidos no processo, o indivíduo como um todo e familiares. Conclusão: A teoria de Roy constitui as bases para hipóteses que podem ser testadas.

Objetivo: Compruebe los métodos de adaptación de mastectomías mujeres; aumentar la presencia de cambios en los hábitos de vida de las mujeres después de la mastectomía; correlacionar el proceso adaptativo esbozado por la mujer con la teoría presentada por Roy e investigar a la atención proporcionada por enfermeras a las mujeres mastectomizadas. Método: Para llevar a cabo la encuesta se utilizó para el tipo de enfoque cualitativo descriptivo. Resultados: El papel de enfermería en el cuidado de la mujer que había sido sometida a cirugía de mama, abarca la atención para el mantenimiento de sus funciones corporales, así como el apoyo a quienes están involucrados en el proceso, el individuo como un todo y familia. Conclusión: La teoría de Roy son las bases para las hipótesis que pueden ser probadas.

Local treatment of breast cancer.

OBJECTIVES: To describe the local control of breast cancer, including initial biopsy, lumpectomy or mastectomy, and sentinel node biopsy or axillary node dissection, and to discuss the role of radiation therapy following lumpectomy or mastectomy in advanced cancer. DATA SOURCES: PubMed, Scopus, Cochran. CONCLUSION: The local treatment of breast cancer is an essential component of primary breast cancer treatment. Residual cancer cells may increase the risk of recurrent ipsilateral disease. IMPLICATIONS FOR NURSING PRACTICE: Nurses and advanced practice nurses who provide care for cancer survivors should possess the skills to patiently teach information, empathetically understand the flagrant or suppressed emotional turmoil, explain the full complement of treatment options, appreciate the rationale behind choices made, and help patients navigate the educational and decisional byways.

Reconstruction of the breast following mastectomy.

OBJECTIVES: To review immediate and delayed breast reconstructive options following surgery for high-risk or cancer-related unilateral or bilateral mastectomy and examine restorative interventions to promote a positive body image and long-term survivorship. DATA SOURCES: Review of PubMed, Scopus, and Cochran Review. CONCLUSION: For women facing mastectomy, a consultation with a plastic/reconstructive surgeon is a first step toward recovery with restoration of a missing body part. Nursing interventions are integral to physical and psychosocial healing. IMPLICATIONS FOR NURSING PRACTICE: An understanding of the reconstructive process can be beneficial in the care of women facing and recovering from a mastectomy. Psychological and physical issues occur whether the woman is undergoing bilateral prophylactic mastectomies for a high-risk condition or mastectomy as treatment for a malignant tumor.

Sentimentos e fontes de apoio emocional de mulheres em pré-operatório de mastectomia em um hospital-escola / Feelings and sources of emotional support for women in pre-operative mastectomy in a teaching hospital / Sentimientos y fuentes de apoyo emocional de mujeres en preoperatorio de mastectomía en un hospital-escuela

O estudo objetivou identificar os sentimentos frente ao diagnóstico de câncer e a mastectomia e as fontes de apoio emocional. Estudo descritivo e de campo com abordagem qualitativa, realizado na Clínica Cirúrgica de um hospital-escola de referência no Estado da Paraíba, localizado na cidade de João Pessoa – PB, desenvolvido com sete internas, durante o período de fevereiro a maio de 2011. Para análise dos dados foi utilizada a técnica do Discurso do Sujeito Coletivo. As ideias centrais geradas foram: Sentimentos de consternação; Estado de tranquilidade; Acolhimento familiar; Conforto espiritual e fé no tratamento/cura; Tensão relacionada à cirurgia. Conclui-se que frente ao diagnóstico de câncer, a mulher apresenta diversos sentimentos negativos como preocupação, medo e tristeza, sendo necessárias estratégias viáveis que favoreçam à mulher o enfrentamento ao câncer e a mastectomia.

The study aimed at identifying feelings in face of the diagnosis of cancer and mastectomy as well as sources of emotional support. Descriptive and field study with qualitative approach, conducted with seven women patients at the Surgical Clinic of a reference Teaching Hospital in the city of João Pessoa, Paraíba, Brazil, from February to May, 2011. For data analysis the technique of collective subject discourse was used. Central ideas generated were as follows: Feelings of helplessness; State of tranquility; Foster care; Spiritual comfort and trust in the treatment / cure; Surgery-related stress. In conclusion, in view of the diagnosis of cancer, the woman has many negative feelings such as worry, fear, and sadness, requiring viable strategies to help her cope with cancer and mastectomy.

El estudio procuró identificar los sentimientos frente al diagnóstico de cáncer y la mastectomía y las fuentes de apoyo emocional. Estudio descriptivo y de campo con abordaje cualitativo, realizado en la Clínica Quirúrgica de un hospital-escuela de referencia en el Estado de Paraiba, situado en la ciudad de João Pessoa, PB, desarrollado con siete internas, durante el periodo de febrero a mayo de 2011. Para análisis de los datos se empleó la técnica del Discurso del Sujeto Colectivo. Las ideas centrales generadas fueron: Sentimientos de consternación; Estado de tranquilidad; Conforto espiritual y fe en el tratamiento/cura; Tensión relativa a la cirugía. Se concluye que frente al diagnóstico de cáncer, la mujer presenta diversos sentimientos negativos como preocupación, miedo y tristeza, siendo necesarias estrategias viables que favorezcan a la mujer para enfrentar el cáncer y la mastectomía.

[Nursing experience with a schizophrenic breast cancer patient after mastectomy].

This case study used cognitive therapy to improve the life quality of a 46-year-old woman with chronic schizophrenia who had undergone a mastectomy for breast cancer. This case had suffered from schizophrenia for over 24 years and was hospitalized in the chronic ward of our hospital. Breast cancer was revealed during an annual comprehensive physical checkup. In May 2012, this case received a right mastectomy at a local hospital. After the surgery, she was readmitted to the psychiatric acute ward for further care from May 30th to August 28th, 2012. A holistic nursing assessment was conducted that addressed five major aspects. The major nursing problems found during hospitalization were: acute pain, body image disturbance, and low self-esteem. A decline in pain score from 10 to 4 was achieved by developing rapport with the patient, empathizing with her distress, and providing active care to the wound. Her body image changed because of loosing her breast. Her acceptance of the loss improved through helping her to explore her feelings of change. To improve her self-esteem, we offered cognitive therapy to change her negative thinking process. She became more sanguine and cheerful. Moreover, her dependence in terms of activities of daily living decreased. This individualized intervention contributed to the recovery of a post-mastectomy, schizophrenic patient from low self-esteem.

Cuidar integral da equipe multiprofissional: discurso de mulheres em pré-operatório de mastectomia / Multi-professional team care: discourse of women in preoperative mastectomy

Objetivo: Investigar a atuação da equipe multiprofissional, no que tange a preparação de mulheres em pré-operatório de mastectomia. Métodos: Trata-se de uma pesquisa exploratória com abordagem qualitativa, realizada na clínica cirúrgica de um hospital público, em João Pessoa - PB. A amostra foi composta por sete mulheres que iriam se submeter à mastectomia. A coleta de dados foi iniciada após parecer favorável do Comitê de Ética em Pesquisa nº 751/10 e CAAE nº 0578.0.126.000-10, no período de fevereiro a maio de 2011, por meio da técnica de entrevista gravada. Resultados: Os dados obtidos foram analisados mediante a técnica do Discurso do sujeito coletivo, gerando quatro ideias centrais, destacando a atuação da equipe multiprofissional, contemplando orientações pertinentes ao procedimento cirúrgico, pré-operatórias, apoio psicológico, espiritual e nutricional. Conclusão: Conclui-se que existe a necessidade de uma maior integração da equipe multiprofissional, para propiciar melhor assistência à mulher no período pré-operatório de mastectomia.

Living with breast cancer-related lymphedema: a synthesis of qualitative research.

PURPOSE/OBJECTIVES: To describe the experience of female patients living with breast cancer-related lymphedema (BCRL) to gain a comprehensive understanding of this experience. The review is designed as a qualitative meta-synthesis. DATA SOURCES: Electronic searches were conducted in MEDLINE®, CINAHL®, EMBASE, PsycINFO, and Social Sciences Citation Index. Articles were included where researchers used qualitative research methods and when a comprehensive description of methods and the study's findings were provided. DATA SYNTHESIS: From 2,185 references, 13 articles were included. A total of 94 author and participant aggregations were extracted, qualitatively assessed, and assigned to one of 14 categories. Four themes relating to the experience of living with BCRL were identified: experience of everyday life, energy sapping, personal empowerment, and contribution of others. CONCLUSIONS: Requirements of living with BCRL may only be influenced to a limited extent by the women themselves. They struggle with their situation, appearance, and the concomitant uncertainties. They feel strengthened where they succeed in developing a helpful view of their situation and where support structures are available to them. IMPLICATIONS FOR NURSING: Professionals can employ this meta-synthesis by contextualizing it as part of a process of critical reflection on their own endeavors to meet the requirements of women living with BCRL.

The impact of an external breast prosthesis on the gait parameters of women after mastectomy.

BACKGROUND: An integral part of the recovery process after mastectomy involves the consideration of restorative options, including external prosthesis use; however, only few studies regarding the influence of breast prostheses on functional status have been done. OBJECTIVE: This study aimed to determine whether wearing an external breast prosthesis affects gait in women after a mastectomy. METHODS: Spatiotemporal gait parameters were collected in 40 women, postmastectomy, aged 37 to 70 years, divided into age subgroups of 37 to 54 years and 55 to 70 years, and in 38 healthy controls, women aged 38 to 69 years. Gait parameters were assessed with and without the breast prosthesis, including walking velocity, cadence, step length, step time, and left-right step time asymmetry. RESULTS: Significant differences were found in the gait parameters of the younger age group with and without a prosthesis. No significant differences were found in the women of the older group with and without the prosthesis. CONCLUSION: Gait parameters of the younger age group were closer to those of the healthy control group when they were wearing an external prosthesis, as compared with when they were not. This suggests a positive influence of breast prosthesis use on the functional status of women after mastectomy. IMPLICATIONS FOR PRACTICE: Clinical practitioners should be aware of the study results suggesting a positive influence of breast prosthesis use on gait parameters after mastectomy surgery, which could improve the patient's functional status after surgery; however, further research is still needed on factors affecting changes in gait with a larger study population.

Diagnósticos de enfermagem no pós-operatório de mastectomia / Nursing diagnoses after mastectomy

O objetivo desse estudo foi identificar os diagnósticos de enfermagem, no período pós-operatório de mastectomia, entre mulheres internadas em uma Unidade de Internação em Oncologia de um hospital de ensino público do interior paulista. Tratou-se de um estudo descritivo e retrospectivo, realizado em prontuários de mulheres submetidas a mastectomia. Os dados foram coletados por meio de um instrumento contendo: dados sociodemográficos, dados sobre a doença, diagnósticos de enfermagem, prescrição e evolução de enfermagem. Foram analisados 185 prontuários. Os cinco diagnósticos de enfermagem mais frequentes foram: Risco de Infecção (95,1%), Ansiedade (48,6%), Medo (41,6%), Dor Aguda (14,5%) e Mobilidade Física Prejudicada (11,3%). Conclui-se que diagnósticos que exigem uma abordagem psicossocial para serem identificados como Distúrbio na Imagem Corporal e Angústia Espiritual foram registrados com baixa frequência, sendo mais frequentes aqueles de âmbito biomédico.

Controlling fear: Jordanian women's perceptions of the diagnosis and surgical treatment of early-stage breast cancer.

BACKGROUND: Despite the fact that breast cancer is the most prevalent cancer among Jordanian women, practically nothing is known about their perceptions of early-stage breast cancer and surgical treatment. OBJECTIVE: The objective of this study was to gain understanding of the diagnosis and surgical treatment experience of Jordanian women with a diagnosis of early-stage breast cancer. METHODS: An interpretive phenomenological approach was used for this study. A purposive sample of 28 Jordanian women who were surgically treated for early-stage breast cancer within 6 months of the interview was recruited. Data were collected using individual interviews and analyzed using Heideggerian hermeneutical methodology. RESULTS: Fear had a profound effect on Jordanian women's stories of diagnosis and surgical treatment of early-stage breast cancer. Women's experience with breast cancer and its treatment was shaped by their preexisting fear of breast cancer, the disparity in the quality of care at various healthcare institutions, and sociodemographic factors (eg, education, age). CONCLUSIONS: Early after the diagnosis, fear was very strong, and women lost perspective of the fact that this disease was treatable and potentially curable. To control their fears, women unconditionally trusted God, the healthcare system, surgeons, family, friends, and/or neighbors and often accepted treatment offered by their surgeons without questioning. IMPLICATIONS FOR PRACTICE: Jordanian healthcare providers have a responsibility to listen to their patients, explore meanings they ascribe to their illness, and provide women with proper education and the support necessary to help them cope with their illness.

A randomised trial of nursing interventions supporting recovery of the postmastectomy patient.

AIMS AND OBJECTIVES: This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown. BACKGROUND: Surgical removal of the breast may lead to activity limitation, self-image issues, discomfort and later complication of lymphoedema. Design. This study used experimental and longitudinal design. METHODS: One hundred and forty-five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty-six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2-way anovas were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p-values are two sided. All statistical analyses were performed using sas 9.2 for Windows. RESULTS: The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge. CONCLUSIONS: Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients.

The home healthcare nurse as a patient.

When it is our turn as a home healthcare nurse to be a patient, it is gratifying to know that home healthcare is as wonderful as we say it is.

Análise da produção científica nacional sobre a utilização de grupos na reabilitação de mastectomizadas / Analysis of the national scientific production regarding the use of groups in the rehabilitation of women experiencing mastectomy / Análisis de la producción científica nacional sobre la utilización de grupos en la rehabilitación de mastectomizadas

Revisão integrativa da literatura que objetivou identificar as evidências disponíveis na literatura científica nacional sobre a temática de grupos de reabilitação para mulheres mastectomizadas O referencial teórico utilizado foi a Prática Baseada em Evidências, utilizando a questão norteadora: qual a temática das publicações sobre grupos de reabilitação para mulheres com câncer de mama? As bases acessadas foram: LILACS, BDENF e MEDLINE, com os descritores controlados "mastectomia", "grupos de autoajuda", "enfermagem em reabilitação" ou "serviços de reabilitação", sendo selecionados cinco estudos. Resultados evidenciaram que a inserção de mulheres com câncer de mama em grupos colabora substancialmente para sua reabilitação integral, ou seja, física, psíquica e social. Apesar de não fornecer evidências científicas consideradas fortes, o estudo permitiu a identificação de um conjunto de variáveis que auxiliarão na abordagem a esta clientela, melhorando assim a qualidade da assistência a mulheres mastectomizadas...

This integrative literature review aimed at identifying the evidence available in the national scientific literature regarding the theme of rehabilitation groups for women experiencing mastectomy. The theoretical referential used was evidence-based practice, with the following guiding question: what is the thematic of the publications regarding rehabilitation groups for women with breast cancer? The databases accessed were: LILACS, BDENF and MEDLINE, with the controlled descriptors "mastectomy", "self-help groups", "nursing in rehabilitation" and "services for rehabilitation". Five studies were selected. Results showed that the inclusion of women with breast cancer in groups substantially assists their integral rehabilitation; in other words, physically, psychically and socially. Despite not providing scientific evidence considered to be strong, the study allowed the identification of a set of variables that can help in the approach to this public health issue, thus improving the quality of the care provided to women experiencing mastectomy...

Revisión integrativa de la literatura que objetivó identificar las evidencias disponibles en la literatura científica nacional sobre la temática de grupos de rehabilitación para mujeres mastectomizadas. Se utilizó la Práctica Basada en Evidencias como referencial teórico, utilizando la pregunta orientadora: ¿Cuál es la temática de las publicaciones sobre grupos de rehabilitación para mujeres con cáncer de mama? Las bases investigadas fueron LILACS, BDENF y MEDLINE, con los descriptores controlados "Mastectomía" and "Grupos de Autoayuda" or "Enfermería en Rehabilitación" or "Servicios de Rehabilitación", seleccionándose cinco estudios. Los resultados evidenciaron que la inserción de mujeres con cáncer de mama en grupos colabora sustancialmente en su rehabilitación física, psíquica y social. A pesar de no ofrecerse evidencias científicas de fuerte consideración, el estudio permitió la identificación de un conjunto de variables que ayudarán a abordar a éstas pacientes, mejorándose así la calidad de atención a mujeres mastectomizadas...

Effects of being a patient on student development.

Service-user involvement is a growing aspiration for health professionals and those involved in nursing education. This article describes one approach to integrating theory and practice through service-user involvement in a teaching setting. Gwen Carter, a student nurse, tells her story of becoming a patient and how reflecting on this experience affected her approach to patient care. By sharing her experience with peers and mentors, she was able to influence their approach to care, and made a difference to how mentors worked with students in practice.