Decision-making for bilateral risk-reducing mastectomy for an increased lifetime breast cancer risk: A qualitative metasynthesis.

OBJECTIVE: Previvor is a term applied to a person with an identified, elevated lifetime cancer risk but without an actual cancer diagnosis. Previvorship entails the selection of risk management strategies. For women with a genetic mutation that increases their predisposition for a breast cancer diagnosis, bilateral risk-reducing mastectomy (BRRM) is the most effective prevention strategy. However, BRRM can change a woman's breast appearance and function. The purpose of this qualitative metasynthesis (QMS) was to better understand the decision-making process for BRRM among previvors. METHODS: A theory-generating QMS approach was used to analyze and synthesize qualitative findings. Research reports were considered for inclusion if: (1) women over 18 years of age possessed a genetic mutation increasing lifetime breast cancer risk or a strong family history of breast cancer; (2) the sample was considering, or had completed, BRRM; (3) the results reported qualitative findings. Exclusion criteria were male gender, personal history of breast cancer, and research reports which did not separate findings based on cancer diagnosis and/or risk-reduction surgery. RESULTS: A theory and corresponding model emerged, comprised of seven themes addressing the decision-making process for or against BRRM. While some factors to decision-making were decisive for surgery, others were more indefinite and contributed to women changing, processing, or suspending their decision-making for a period of time. CONCLUSIONS: Regardless of the decision previvors make about BRRM, physical and psychosocial well-being should be considered and promoted through shared decision-making in the clinical setting.

The Work of Breastfeeding Among Women of Low Socioeconomic Status: A Qualitative Metasynthesis.

A theory-generating qualitative metasynthesis was used to explore the questions: (a) How do mothers of low socioeconomic status in the United States express their attitudes and beliefs on breastfeeding? (b) How do mothers of low socioeconomic status in the United States describe the types of support received related to breastfeeding? Databases were searched from January 2000 to June 2022. Eleven qualitative studies were evaluated, and six themes were identified. A model was developed illustrating how the themes impact a mother's decision to breastfeed. Positive factors included shared narratives, knowledge of breastfeeding physiology, and social network. However, more negative influences were heard such as opinions passed on from family and friends, lack of teaching and anticipatory guidance, limited support and follow up, and the perception of conflicting messages from health care professionals. This model identifies constructs that can be used as starting points for interventions, policy development and/or health promotion education.

Breast cancer survivorship in rural settings: a systematic review.

PURPOSE: Rural breast cancer survivors (BCS) in the United States face unique challenges during survivorship, related to knowledge and accessibility of resources. Survivorship care plans should address five key areas that include surveillance and screening for new/reoccurring cancer; management of long-term effects of cancer treatment; health promotion; and care coordination/practice implications. To maximize the benefit of survivorship care for rural BCS, it is necessary to better understand their experiences and preferences. METHODS: A systematic review of the extant literature addressing the survivorship needs and interventions for rural BCS was conducted. The following databases were searched for reports published between January, 2007, and December, 2018: PubMed, CINAHL, SCOPUS, PsycINFO (EBSCO), CAB Direct, and Sociological Abstracts. Reports published after 2007 with samples including and comprised of rural BCS in the United States were included. Screening of the search results followed PRISMA guidelines using Covidence systematic review software. RESULTS: Findings were extracted from 30 reports disseminating findings of 14 research studies. The five areas of a survivorship care were counted/accounted for during data extraction. The included reports concentrated on health promotion (e.g., weight loss and exercise) and the management of long-term effects of cancer treatment as key outcomes. There is a gap in the literature addressing care coordination, surveillance, and screening. CONCLUSION: Additional research including interventions for rural BCS that address more survivorship care areas would benefit this population and improve survivorship quality of life for rural BCS.

Patient Safety Communication Among Differently Educated Nurses: Converging and Diverging Meaning Systems.

Studies that suggest an increased number of bachelor's prepared nurses (BSNs) at the bedside improves patient safety do not stratify their samples into traditional bachelor's and associates (ADN) to BSN graduates. This qualitative study investigated potential differences in patient safety meaning among BSNs and ADN to BSN graduates. Guided by the theory of Language Convergence/Meaning Divergence, interview data from eight BSN and eight ADN to BSN graduates were analyzed. Findings indicate there are two meaning levels or systems, the local level and the systemic level. At the local level, the meaning of patient safety is focused at the patient's bedside and regulated by the nurse. The systemic level included the notion that health system factors such as policies and staffing are paramount to keeping patients safe. More frequently, ADN to BSN graduates' meaning of patient safety was at the local level, while BSNs' meaning centered at the systemic level.

Body mass index trends and quality of life from breast cancer diagnosis through seven years' survivorship.

BACKGROUND: Weight gain is a potential negative outcome of breast-cancer treatment, occurring in 50%-to-96% of breast-cancer patients, although the amount of weight gain is inconsistently reported in the literature. Research has also shown a relationship between overweight/obesity and breast-cancer mortality. Correspondingly, weight management is a self-care approach known to benefit quality of life (QOL). These research questions and analysis add to existing literature by examining participants' body mass index (BMI) trend and its relationship with QOL indicators over seven years. AIM: To examine: (1) BMI trends among breast cancer survivors; and (2) The trends' relationship to QOL indicators over seven years. METHODS: During the Breast Cancer and Lymphedema Project, 378 patients' weight and height were recorded by nurses prior to or just after beginning breast cancer treatment and repeated at quarterly-to-semiannual intervals over seven years. Additionally, participants annually completed the 36-Item Short Form Health Survey (SF-36), a valid and reliable tool assessing QOL and health concepts, including physical function, pain, and emotional well-being. BMI trends, change in BMI, and change in SF-36 subscales over seven years were calculated using a random-intercept repeated-measures regression. Patients were placed into BMI categories at each time point: Normal, Overweight and Obese. As patients' weights changed, they were categorized accordingly. RESULTS: During the seven-year study and while controlling for age and residence, participants gained an average of 0.3534 kg/m2 (P = 0.0009). This amount remained fairly consistent across BMI categories with those in the normal-weight category (n = 134) gaining 0.4546 kg/m2 (P = 0.0003); Overweight (n = 190) gaining 0.2985 kg/m2 (P = 0.0123); and obese (n = 199) gaining 0.3147 kg/m2, (P = 0.0649). Age (under or over 55) and region (metro/micro vs small/rural) were significantly associated with BMI increase in both the normal and obese categories. There were statistically significant (P < 0.0100) changes in five of the eight SF-36 domains; however, the directions of change were different and somewhat divergent from that hypothesized. Controlling for age and region, these five were statistically significant, so there were no change or differences between the micropolitan/metropolitan and small town/rural groups. CONCLUSION: Although only modest increases in mean BMI were observed, mean BMI change was associated with selected QOL indicators, suggesting the continued need for self-care emphasis during breast cancer survivorship.

Associate Degree in Nursing-to-Bachelor of Science in Nursing Graduates' Education and Their Perceived Ability to Keep Patients Safe.

BACKGROUND: Associate Degree in Nursing (ADN)-to-Bachelor of Science in Nursing (BSN) programs are designed to advance the ADN-prepared RNs' clinical reasoning and analytical skills. However, little is known about exactly how their BSN education may improve their clinical practice, specifically in the area of patient safety. METHOD: During semi-structured one-to-one interviews, ADN-to-BSN graduates were asked about their educational process and the perceived affect their education made on their ability to keep patients safe. Content analysis were used to identify emerging themes and categories. RESULTS: Three themes emerged from the data: (a) an unaltered approach to keeping patients safe, (b) experience as an ADN matters, and (c) BSN degree as a stepping stone. CONCLUSION: The call to increase the number of BSN-prepared nurses at the bedside is supported in the evidence and noteworthy of pursuit. However, as ADN-to-BSN programs increase in numbers to meet this demand, the outcomes of graduates need to be considered. [J Nurs Educ. 2018;57(5):300-303.].

The RN to BSN Transition: A Qualitative Systematic Review.

Approximately 60% of registered nurses (RNs) still enter practice with an associate's degree or diploma in nursing (ADN). Due to recommendations to change entry level to practice to the bachelor's degree in nursing (BSN), there are now more than 700 RN to BSN programs in the United States. The purpose of this qualitative systematic review was to understand more about what occurs when an RN returns to school for a BSN and to develop a model of the transition. The qualitative findings of 19 research reports were included, which translates to approximately 445 RNs' perspectives on the RN to BSN transition. A visual representation of the RN to BSN transition was also generated. A seamless transition of the RN to a BSN does not exist at this time. The results are useful to nurses, academicians, and health care organizations as they move to meet current recommendations.