The challenges and psychological impact of delivering nursing care within a war zone.

BACKGROUND: Between 2001 and 2014, British military nurses served in Afghanistan caring for both service personnel and local nationals of all ages. However, there have been few research studies assessing the psychological impact of delivering nursing care in a war zone hospital. PURPOSE: The purpose of the study was to explore the challenges and psychological stressors facing military nurses in undertaking their operational role. METHODS: A constructivist grounded theory was used. Semi-structured interviews were conducted with 18 British Armed Forces nurses at Camp Bastion Hospital, Afghanistan, in June to July 2013. DISCUSSION: Military nurses faced prolonged periods of caring for seriously injured polytrauma casualties of all ages, and there were associated distressing psychological effects and prolonged periods of adjustment on returning home. Caring for children was a particular concern. The factors that caused stress, both on deployment and returning home, along with measures to address these issues such as time for rest and exercise, can change rapidly in response to the dynamic flux in clinical intensity common within the deployable environment. CONCLUSION: Clinical training, a good command structure, the requirement for rest, recuperation, exercise, and diet were important in reducing psychological stress within a war zone. No formal debriefing model was advocated for clinical staff who appear to want to discuss traumatic incidents as a group, and this may have contributed to stigma and nurses feeling isolated. On returning home, military nurses reported being disconnected from the civilian wards and departments. The study raised the question of who cares for the carers, as participants reported a perception that others felt that they should be able to cope without any emotional issues. It is envisioned that the results are transferable internationally to nurses from other armed forces and will raise awareness with civilian colleagues.

Self-neglect consultation rates and comorbidities in primary care.

The aims of this study were, through secondary data analysis, to establish consultation rates for self-neglect by 100 000 of the Scottish population and by deprivation and to identify the main comorbidities associated with self-neglect. Data from a national dataset recording consultations in general practices where a self-neglect diagnoses was made were analysed. Rates of self-neglect in patients who consulted a Practice Nurse or General Medical Practitioners vary over time. Self-neglect is more common in the 75 years and over group but is found across the age spectrum. It is more common in males and is linked to higher levels of deprivation. Self-neglect is recorded as a diagnosis relatively infrequently in general practice. A wide range of comorbid conditions are found coexisting with self-neglect. Nurse interventions generally focus on comorbidities and not self-neglect. Self-neglect does present in primary care. Nurses need to be aware of its varied presentations. Practice Nurse interventions suggest we need to develop self-management interventions rather than respond to associated comorbid conditions.

An integrative literature review of student retention in programmes of nursing and midwifery education: why do students stay?

AIMS AND OBJECTIVES: The purpose of the review was to identify student characteristics and strategies in research studies investigating retention (why students stay) as opposed to attrition (why students leave) nursing and midwifery preregistration programmes. BACKGROUND: Retention in nursing and midwifery programmes is a serious international problem. Many governments are committed to diversifying both the student population and the health care workforce. This has led to higher education institutes in some countries offering places on nursing and midwifery programmes to students with non-traditional entry qualifications. There are suggestions that the policy of widening access has contributed to the challenges of retention in nursing and midwifery programmes. DESIGN: Integrative literature review. METHOD: Undertaken using electronic databases and specific search terms, 15 articles were identified and reviewed. The critical appraisal tools produced by CASP (2009) were used to evaluate the quality of the data. Findings from the identified research literature were analysed using qualitative content analysis. RESULTS: Two broad themes emerged from the analysis: Programme and Personal. Subthemes were identified in these that give clues as to why students stay: profession, support, student characteristics and family. CONCLUSIONS: Personal commitment and good support seem to be essential for students to remain on undergraduate programmes of nursing and midwifery. The term 'support' is rarely explicit and requires to be more clearly defined. Furthermore, studies reviewed fail to indicate clearly how to identify when students are most vulnerable and which interventions are most appropriate in different situations in supporting retaining students on programmes. RELEVANCE TO CLINICAL PRACTICE: Nursing and midwifery student retention is a political and professional problem. Collaboration between clinical placement providers, academic institutions, students and their families is required to address the issue. Illumination of factors that help students stay may help us devise interventions that prevent future students leaving.

Why students leave in the UK: an integrative review of the international research literature.

AIMS AND OBJECTIVES: The purpose of this integrative review of the literature was to find and review international research studies that explored student attrition to determine what is known about the topic and to identify gaps in the research with a view to addressing the situation in the UK. BACKGROUND: Attrition from nursing programmes is a serious problem in the UK. It is recognised as a complex phenomenon, not attributable to a single cause. Regardless of actual attrition rates and trends, departments of nursing are challenged to perform in a business-like manner. Consequently, every student lost to a programme of study equates to a financial penalty for the department and to the future workforce and community. DESIGN: Integrative review of the literature. METHOD: Using electronic databases and specific search terms, 18 articles were identified and reviewed. Findings from the identified international research literature were analysed using qualitative content analysis. RESULTS: Four broad themes that accounted for factors of relevance to attrition were identified: Social, Prediction, Programme and Personal. CONCLUSIONS: Retention studies are fraught with methodological problems. These include incomplete or inaccurate data and low response rates. Attrition early in programmes may be attributed to a failure to understand the roles of nurses in contemporary societies. This has led to dissatisfaction with programmes and academic failure, as students may underestimate the intellectual demands of their programmes. Attrition later in the programme may be attributed to a combination of personal factors that culminate in a personal crisis. RELEVANCE TO CLINICAL PRACTICE: The research literature suggests that stereotyping of nurses is a major factor in attrition. Both professions need to find ways of communicating contemporary roles to wider society.

Flying Start NHS™: easing the transition from student to registered health professional.

AIMS AND OBJECTIVES: To evaluate the impact and effectiveness of Flying Start NHS™ on the confidence, competence and career development of newly qualified practitioners. BACKGROUND: The first year of practice as a registered nurse, midwife, or allied health professional is recognised as challenging. This paper presents the findings of a two-year evaluation of Flying Start NHS™, a web-based programme developed by NHS Education Scotland to support newly qualified health professionals during the transition from student to qualified practitioner. DESIGN: Descriptive design with one to one and focus group interviews, plus a survey. METHODS: The evaluation employed a multi-method approach including telephone interviews with Flying Start NHS™ leads/coordinators (n=21) and mentors (n=22) and focus groups with newly qualified practitioners (n=95). An online survey was completed by 547 newly qualified practitioners. RESULTS: A majority of newly qualified practitioners reported that Flying Start NHS™ had been useful in terms of clinical skills development and confidence. Those who were able to take protected time were more likely to complete the learning units and report that the support they received was good. Both newly qualified practitioners and mentors reported a lack of time. Newly qualified practitioners who took up posts in the community expressed greater satisfaction with the support received. CONCLUSIONS: NHS Boards should ensure that there is an ethos of support at all levels, as well as an understanding of the purpose of Flying Start NHS™ and what newly qualified practitioners require to do to complete it. The expectation that newly qualified practitioners will enrol on Flying Start NHS™ should be accompanied by an expectation that they will complete the programme in their first year, coupled with support to enable them to do so. RELEVANCE TO CLINICAL PRACTICE: Undertaking Flying Start NHS™ in the first year of employment increases clinical skills development and confidence. Mentors require training and time to enable them to provide support.

Indicators of acute deterioration in adult patients nursed in acute wards: a factorial survey.

OBJECTIVES: The primary objective of the study was to determine which professional, situational and patient characteristics predict nurses' judgements of patient acuity and likelihood of referral for further review. A secondary aim was to test the feasibility of the factorial survey method in an acute area. BACKGROUND: There is increasing recognition that indicators of deterioration in acutely unwell adults are being missed and referrals delayed. The reasons for this are unclear and require exploration. Assessing nurses' clinical decision-making or judgements in a 'real-world' situation is problematic. DESIGN: The study used a factorial survey design where participants completed randomly generated paper-based vignettes on one occasion. METHODS: The dependent variables were assessment of patient acuity and likelihood of referral. Independent variables consisted of a number of patient characteristics, i.e. heart rate, blood pressure, nurse characteristics, i.e. clinical experience, and situational characteristics i.e. staffing. SETTING AND PARTICIPANTS: Participants were registered nurses working in acute areas excluding intensive care and theatre. Ninety-nine participants responded resulting in 1940 completed vignettes. RESULTS: An early warning score was the single most significant predictor of referral behaviour accounting for 9.6% of the variance. When this was not included in the vignette, nurses used physiological characteristics e.g. respiratory rate, urine output, neurological status. These explained 12% of the variance in the model predicting assessment of patient acuity and 9.4% or the variance predicting likelihood of referral. CONCLUSIONS: When given a series of vignettes, nurses appear to use appropriate physiological parameters to make decisions about patient acuity and need for referral. Our results support the use of early warning scoring systems. Education and professional development should focus more on developing and maximising clinical experience and expertise rather than knowledge acquisition alone. A factorial survey method is feasible to explore decision-making in this area. RELEVANCE TO PRACTICE: This study has several implications for practice. The emergence of an early warning scoring system as a significant individual predictor supports the use of such systems. However, the small amount of explained variance suggests that there are other influences on nurses' assessment of patient acuity and referral decisions that were not measured by the factorial survey approach. Educational provision might focus not just on knowledge acquisition but include educational delivery methods that incorporate or mimic real-ward settings.

Fitness for practice in nursing and midwifery education in Scotland, United Kingdom.

AIM: The aim of this paper is to report findings from a major study that evaluated the Fitness for Practice nursing and midwifery curriculum in Scotland, UK. BACKGROUND: The competence of student nurses and midwives at the point of registration has been the focus of debate and research. However, no major study, on such a large scale, had specifically evaluated pre-registration programmes to determine whether they enabled students to achieve 'fitness to practice'. DESIGN: The study had a broad evaluation design conducted in three phases using a mixed methodology. METHOD: Phase 1 involved questionnaires, Objective Structured Clinical Examination's (OSCE) and curriculum evaluation. Phase 2 involved semi-structured interviews (some telephone) and focus groups across main stakeholders: students (n = 78), mentors (n = 78), practice-education facilitators (n = 24), academics (n = 59), senior clinical (n = 46) and education managers (n = 16), service users and carers (n = 10). RESULTS: The findings suggest that the Fitness for Practice curriculum model in Scotland has on the whole been successful. The key finding is the predominant opinion of stakeholders that newly qualified nurses and midwives are perceived as being fit for practice at the point of registration. A perceived lack of confidence is, as with all transitions to new roles, an understandable outcome. CONCLUSIONS: Previous concern that student nurses and midwives are not 'fit for practice' has focused on the perceived lack of clinical skills at the point of registration, not on competence to practice in general. This study demonstrates that this is an important distinction and recognises that registration is only the beginning of a life long learning experience. RELEVANCE TO CLINICAL PRACTICE: Students need to be supported to develop their confidence following registration as well as additional skills in their chosen field of practice. Appropriate mentorship and a period of preceptorship should be in place to accommodate this.

Psychosocial health and health-related quality of life in school pupils 11-18 years.

AIM: To establish levels of mental health at a community level and to model the relationship between mental health difficulty, health-related impact and health related quality of life in school pupils aged 11-18 years old. BACKGROUND: The issue of psychosocial and mental health in school pupils is a topic of considerable academic and public interest. The incidence of mental health problems in children 11-18 years shows marked differences between countries and within countries. Much of the epidemiological literature has focused on diagnostic categories rather than population health. DESIGN: The study employed a cross-sectional survey. METHODS: A cross-sectional survey of 1786 school children aged 11-18 years was conducted in Scotland. Participants completed the strengths and difficulties questionnaire and the SF-10 for Children. RESULTS: This group of school pupils had similar levels of mental health needs and psychosocial health status as UK and age-related US norms. They had poorer levels of physical health status. The most important predictors of psychosocial health status were difficulty category, impact, physical health status and chronicity. The most important predictors of impact were difficulty category, chronicity and psychosocial health status. CONCLUSION: There is a need to tackle psychosocial health problems in schools. Problems are often chronic in nature and whilst still having an impact on the life of pupils may not be severe enough for a diagnosis which would trigger treatment in the conventional sense. Psychosocial health is predicted by physical health therefore nursing interventions which are focussed on both physical and psychosocial health may be needed. RELEVANCE TO CLINICAL PRACTICE: This study suggests that in some geographical areas in UK targeting of services to 'high-need' schools is not necessary and universal services are required. Problems need to be detected before they reach current treatment thresholds. Interventions should be school-based with a focus on impact on classroom learning and family difficulties.

What Are the Experiences of Men Affected by Prostate Cancer Participating in an Ecological Momentary Assessment Study?

BACKGROUND: Within the cluster of self-report methodologies, ecological momentary assessment (EMA) is a method used in health services research whereby a participant repeatedly reports on affect, behaviors, symptoms, and cognitions as they occur in real time in the participant's natural environment. However, little is known about the impact of participating in an EMA study on individuals' experiences who are affected by prostate cancer. OBJECTIVES: The aims of this study were to explore the lived experiences of men affected by prostate participating in an EMA study and assess whether their participation in EMA alters their representation of their condition. METHODS: Participants (n = 12) were purposively recruited from 2 university teaching hospitals in Scotland. Semistructured interviews were conducted with men affected by prostate cancer following the completion of EMA data collection. Data were analyzed using thematic analysis. RESULTS: The lived experience of prostate cancer included 6 superordinate themes: isolation in the healthcare system, lack of shared care plans, informational support, coping with prostate cancer, fear of death and dying, and vocational rehabilitation. The organizing theme electronic diary as an intervention included 4 superordinate themes: changing self-management behaviors, habitual experience, changing perceptions, and diary in daily life. CONCLUSION: We observed that men participating in the EMA study described several methodological complexities, which need to be addressed through future research. IMPLICATIONS FOR PRACTICE: Importantly, there is a need for the health system to prioritize research and develop a more holistic approach to prostate cancer care in line with men's preferences and needs in the future.

Practitioner assessments of 'good enough' parenting: factorial survey.

AIM: The aim of this study was to measure health visitors' professional judgements on 'good enough' parenting and identify what factors and combinations of these are important when making such judgements. BACKGROUND: The relationship between parenting and child health is unclear. Whilst agreement exists that 'good enough' parenting requires boundary setting, consistency and putting the child's needs first, attempting to define 'good enough' parenting in precise terms is complex. When faced with a complex situation, practitioners rely on relatively few factors to form judgements. DESIGN: Factorial survey methods were employed using vignette techniques. METHODS: Vignettes were constructed using previous research on those variables, which may influence nurses' judgements, for example, accommodation and child dentition. The level of factors was randomly varied. Two thousand vignettes were administered to a sample of 200 health visitors in two Health Boards who then made a judgement about this scenario. ANALYSIS: Data were analysed through multiple regression with dummy variables and one-way analysis of variance. Regression equations for both good enough mothering and good enough parenting are reported. RESULTS: The models used are significant predictors of parenting and mothering. Significant predictors on health visitor judgements' were boundary setting in sleep behaviours, type of housing inhabited and health behaviours. Although parenting and mothering are often conflated, health visitors appear to separate these aspects when making judgements based on type of housing. CONCLUSIONS: Most professionals can articulate what makes a 'good' parent, equally they may have strong views regarding what constitutes 'poor' parenting. The difficulty is in determining when parenting is 'good enough' to provide a child with a nurturing environment. RELEVANCE TO CLINICAL PRACTICE: This study suggests that practitioners move their thresholds of what is 'good enough' depending on a narrow range of factors. Awareness of the factors, which influence individuals' judgements is important in safeguarding children.

Associations between physical inactivity and a measure of social capital in a sample of Queensland adults.

How social capital is related to an increasingly important disease risk-physical inactivity has not yet been investigated. In the present study the associations between social capital and physical inactivity were investigated in a sample of Queensland (Australia) adults. Data was collected from 1278 persons by means of a computer-assisted-telephone-interview survey. The association between the social capital variables and physical inactivity was studied using logistical regression. Multivariate analysis adjusted for the effects of selected socio-demographic factors in the investigation of the association between physical inactivity and quartile groupings of social capital scores. Physical inactivity was negatively associated with the measure of social capital. Individuals in the top two quartiles of social capital were significantly less likely to be physically inactive than those in the two lowest quartiles. In summary, low social capital was associated with physical inactivity. The results offer implications for health promotion programs aimed at increasing levels of physical activity at the community or population level.

An evaluation of fitness for practice curricula: self-efficacy, support and self-reported competence in preregistration student nurses and midwives.

AIMS AND OBJECTIVES: This element of the larger Scottish evaluation aimed to explore differences between access routes, cohorts and higher education institutes (HEI) (universities and colleges) in levels of self-efficacy, student support and self-reported competence in a nationally representative sample of student nurses and midwives. BACKGROUND: This paper reports findings from the National Review of Pre-Registration Nursing and Midwifery Programmes in Scotland. Fitness for practice curricula have been the heart of many recent developments in nurse and midwifery education. Fitness for practice set out to map out the future direction of preregistration nursing and midwifery education with the aim of ensuring fitness for practice based on healthcare need. There have been no national evaluations of the effectiveness of this strategic objective. Previous major evaluations in the 1990s suggested that students may not have had the skills needed to be fit for practice. DESIGN: The study design was a cross-sectional survey of a stratified random sample of student nurses and midwives (n = 777). Data collected included demographic information, generalised perceived self-efficacy, student support and self-reported competency. RESULTS: Students reported high levels of self-reported competency. There were no significant differences between two cohorts or between students with different access routes. Students rated support from family and friends highest and support from HEI lowest. There was a significant difference in support levels between HEI. Self-efficacy scores were similar to other population means and showed small-moderate correlations with self-report competence. Similarly, self-reported competency appears to be at the higher end of the spectrum, although older students may have a more realistic perception of their competence. However, support from HEI was seen as less satisfactory and varied from one institution to another. CONCLUSIONS: This study portrays a relatively positive picture of preregistration fitness for practice curricula. Questions are raised about the relative value students place on support from educationalists and mentors and whether support from family and friends and from peers needs to feature more prominently in curricula. The study provides modest support for social cognitive theory. RELEVANCE TO CLINICAL PRACTICE: The major drivers for changes in preregistration curricula stemmed from fears about the competence of students. This study did not provide support for this viewpoint, and students' self-reports suggest that curricula are, in this respect, meeting their objectives. Nevertheless support from mentors and from educational institutes may need to be improved.

Associations between social capital and health status in an Australian population.

This study investigated the association between social capital and health related quality of life in a sample of Australian adults. Information was collected from a sample of adults in Queensland, Australia relating to health status, health related quality of life and related social determinants of health by computer-assisted-telephone-interview survey. Significant associations were observed between social capital and physical health when adjusting for selected demographic measures. No significant association was observed between social capital and mental health. The research produced equivocal results regarding the associations between social capital and the selected measures of health-related quality of life. Evidence is presented in support of the association between social capital and physical health status, whereas no associations were observed between mental health status and social capital. The role and relationship between health and social capital remains elusive. More work is required to clearly support social capital's role in physical and mental health and well-being.

The 'realities' of part-time nursing: a grounded theory study.

AIM: To develop a theory that explains the 'realities' of part-time nursing. BACKGROUND: While little is known about the phenomenon of part-time nursing, increasing numbers of nurses work in part-time employment. METHODS: Grounded theory. RESULTS: The problem that part-time nurses shared was an inability to achieve their personal optimal nursing potential. Motivators to work part-time, employment hours, specialty, individual and organizational factors formed contextual conditions that led to this problem. Part-time nurses responded to the challenges through a process of adaptation and adjustment. CONCLUSION: Harnessing the full productive potential of part-time nurses requires support to limit the difficulties that they encounter. The developed theory provides a valuable guide to managerial action. IMPLICATIONS FOR NURSING PRACTICE: Nurse Managers need to consider the developed substantive theory when planning and managing nursing workforces.

What do high academic achieving school pupils really think about a career in nursing: analysis of the narrative from paradigmatic case interviews.

As many Departments of Nursing within universities consider raising their academic entry requirements in an attempt to attract a more high academic achieving entrant and also endeavour to attract more school leavers one of the fundamental questions that needs to be answered is--are high academic achieving school pupils really interested in pursuing a career in nursing? The aim of this paper is to report on the findings from paradigmatic case interviews of high academic achieving school pupils who at one stage in their career choice process had considered nursing as a possible career choice but had ultimately disregarded nursing and had decided to pursue medicine or another health care profession. The study reports interview data from a sub-sample of (n=20) high academic achieving 5th and 6th year school pupils who participated in a larger survey of 5th and 6th year school pupils (n=1062). These were paradigmatic cases--high academic achieving school pupils who had considered nursing as a possible career choice within their career preference cluster but had ultimately disregarded nursing and decided to pursue medicine or another health care profession as a career choice. Participants reported that nursing was eventually not viewed as using their examination grades to the maximum benefit. Also the participants reported a belief that the work of the doctor is more important and academic as they cure patients whereas the work of the nurse is practical and routine as they only care for patients. The pupils in addition asserted a negative image of nursing and a low status level of nursing as a career. They also articulated the unremarkable typical school pupils they perceived would pursue nursing as a career choice and the type of school pupil that they had witnessed being encouraged toward nursing within their schools, both of which conflicted with their own typology. Ultimately the high academic achieving school pupils were doubtful and suspicious as to the credibility of a degree in nursing and nursing as a university programme. Nursing is a very contentious career choice consideration for high academic achieving school pupils. There is strong evidence from the interview data to suggest that attracting high academic achieving school pupils into nursing could be hugely problematic.

A review of curriculum evaluation in United Kingdom nursing education.

Recently we have witnessed several significant changes to the nursing curriculum in the United Kingdom (UK). This review forms part of a larger study evaluating the 'fitness for practice' elements of the nursing curriculum in Scotland. Systematic review methods were used including the following databases: CINAHL and BNI. Twenty six papers were retrieved and 14 remained after applying the review criteria, the main rationale being the empirical focus. It appears that there is a paucity of research in this area in the UK and papers dealt exclusively with either content, process or outcome evaluation of the nursing curriculum. National, well funded, multi-centre studies tended to be more rigorous. Results, where they were positive about curricular changes, tended to be limited. There is clearly a need for rigorous research into curriculum evaluation, both at the micro and macro level, which investigates content, process and outcome. Without such research, curriculum change will be uninformed.

Measuring competence, self-reported competence and self-efficacy in pre-registration students.

AIM: To measure competence, self-reported competence and self-efficacy; explore any differences between cohorts and student entry criteria; and explore the relationship between competence, self-reported competence, support and self-efficacy. METHOD: All students undertook a three-station objective structured clinical examination (OSCE) and had previously completed a questionnaire, which included measures of self-reported competence, support and self-efficacy. The performance of two single year cohorts enabled measurement of competence development and progression. RESULTS: Students were competent in the core generalist skills of communication and hand decontamination but demonstrated low levels of numeracy. CONCLUSION: Doubts are raised about the explanatory value or practical use of social cognitive theory in pre-registration curricula and questions are raised about the value of self-reported competence. This has implications for nursing and midwifery curricula, which emphasise the importance of self-assessment.

Nurses' motivators to work part-time.

There has been a trend of growth in part-time employment within the Australian nursing workforce and currently half of the profession work part-time. While the literature across disciplines has postulated reasons behind preferences for part-time employment, little is known about nurses' motivators to work part-time. In an era of nursing shortages that form considerable barriers to meeting healthcare service demands, a clear understanding of these motivators is critical for the effective planning and management of the nursing workforce. A grounded theory study that explored the phenomenon of part-time nursing found that nurses' motivators to work part-time were complex and identifiable with nursing, establishing that nurses' working time decisions are made in contexts that may be unique to the profession. This paper provides an exhaustive description and explanation of one cohort of part-time nurses that accounts for variations between nurses and provides an understanding of the complexity of factors that contribute to nurses' decisions to work part-time.

Self-neglect: a proposed new NANDA diagnosis.

PURPOSE: To propose a new NANDA diagnosis, self-neglect. DATA SOURCES: Research studies and literature published from a variety of disciplines including nursing as well as primary research. DATA SYNTHESES: This diagnosis can be used to describe a constellation of self-care problems of varying severity and impact on the health and well-being of people who self-neglect. Included are two subtypes of self-neglect based on the degree of intentionality. Clarification of self-neglect is long overdue because self-neglect presents conceptual, identification, and intervention problems for nurses, healthcare workers, and for medicolegal systems across settings and in many countries. CONCLUSION: The proposed diagnosis, self-neglect, fills a gap in current standardized terminology. This diagnosis will contribute significantly to nurses leading the way in the explication of an interdisciplinary and international health concern. PRACTICE AND POLICY IMPLICATIONS: Developing self-neglect as a recognized nursing label is vital to clinicians and policy makers within and across countries. Appreciating less serious/non-life-threatening presentations will give nurses a care perspective to improve the health and well-being of those in earlier stages of self-neglect. Definitions for this phenomenon will contribute to care planning and interventions, leading to consistency in practice and research.

What is the mechanism effect that links social support to coping and psychological outcome within individuals affected by prostate cancer? Real time data collection using mobile technology.

PURPOSE: Unmet support needs are prevalent in men affected by prostate cancer. Moreover, little is known about the optimal type of social support, or its mechanism effect between coping and emotional outcome in men affected by this disease to identify areas for clinical intervention. This study aimed to empirically test the propositions of social support theory in "real time" within individual men living with and beyond prostate cancer. METHODS: Purposeful sub-sample from a larger prospective longitudinal study of prostate cancer survivors, took part in real time data collection using mobile technology. Self-reports were collected for 31 days prompted by an audio alarm 3 times per day (a total of 93 data entries) for each of the 12 case studies. Electronic data were analysed using time series analysis. RESULTS: Majority of response rates were >90%. Men reported a lack of satisfaction with their support over time. Testing the propositions of social support theory "within individuals" over time demonstrated different results for main effect, moderation and mediation pathways that linked coping and social support to emotional outcome. For two men, negative effects of social support were identified. For six men the propositions of social support theory did not hold considering their within-person data. CONCLUSION: This innovative study is one of the first, to demonstrate the acceptability of e-health technology in an ageing population of men affected by prostate cancer. Collectively, the case series provided mixed support for the propositions of social support theory, and demonstrates that "one size does not fit all".