Evaluating the self-assessed support needs of women with breast cancer.

AIMS OF THE STUDY: The first aim of the study was to identify the self-assessed support needs of women with breast cancer at various points of illness and, secondly, to establish if these needs formed clusters which could provide the basis for developing a standardized scale of needs for use by breast care teams in the evaluation of care. BACKGROUND: It has been found that support given to women with breast cancer has a positive effect upon their reactions to the illness and may even prolong their survival. Given that breast cancer affects a large number of women it is obviously important that those affected receive, in addition to the best available medical treatment, the type of support that best meets their needs. This study aimed to provide information on the impact of breast cancer and the need for various types of support by examining women's own assessment of their needs at different stages of their illness. DESIGN AND METHODS: A purposive sample of 12 women with a diagnosis of breast cancer was selected in one health authority in England, United Kingdom (UK). Women selected represented a wide age range (between 26 and 58), were married or in long-term cohabiting relationships and were at different points on the illness trajectory. Women were invited to take part in a semi-structured interview about their experiences of breast cancer. The data from these interviews were analysed using the software package Qualitative Solutions and Research, Nonnumerical Data Indexing, Searching and Theorizing (QSR*NUDIST). Following this content analysis, a questionnaire was formulated which divided statements into seven categories: diagnosis, treatment, support, femininity and body image, family and friends, information and after care, to be rated on a Likert scale ranging from "of no importance" to "extremely important". Questionnaire data were analysed by means of a one-way analysis of variance (for three independent variables) or t-test for two independent variables. Results. The questionnaire was sent to 971 women and achieved a response rate of 50.4%. The mean score for statements of need reached the level of point 4 on the Likert scale (important) with three exceptions: having professional help with family problems and domestic upheaval, coping with feelings of anger and dealing with the question "why me?" CONCLUSION: With the above three exceptions, women experienced a high level of need associated with a diagnosis of breast cancer. Studies of this kind should enable resources to be targeted to areas of highest need.

Experiences of women with a diagnosis of breast cancer: a clinical pathway approach.

The study presented in this paper formed the first part of a large survey of breast cancer patients in one health authority in England, UK looking at individual needs expressed by women with a diagnosis of breast cancer. The paper provides an account of the experiences of 12 women with a diagnosis of breast cancer. The women represent a wide age range and different stages of illness. The transcribed accounts of the women were analysed by means of Qualitative Solutions and Research, Non-Numerical Unstructured Data Indexing Searching and Theorising (QSR*NUDIST). The study examined the individual experiences of women with a diagnosis of breast cancer and its aftermath as they passed through different stages related to it. The women's experiences are presented within the conceptual framework of the clinical pathway and their accounts represent their journey along the pathway. Various significant points in this journey are portrayed representing the women's reactions to diagnosis, treatment, femininity and body image, support, family and friends, information and after care.

District nurses' needs: palliative care for people with learning disabilities.

The aim of this article is to identify national palliative care issues, and current palliative care services provided by district nurses for people with a learning disability in North Staffordshire, UK. The professional and educational needs of district nurses in the role of palliative care providers for people with a learning disability were identified by two small focus groups involving district nurses. This resulted in the formulation of a questionnaire, which was circulated to 165 district nurses. While the initial part of the research is qualitative, the final survey involved a quantitative analysis using a questionnaire and a three-point Likert scale. This compared a number of independent variables such as age range, length of experience and number of contacts with clients who have a learning disability and palliative care needs. The results provide an overview of existing service uptake and a profile of the professional and educational needs of district nurses when caring for people with a learning disability who also have palliative care needs.

A comparative study of stress between pre- and post-Project 2000 students.

This paper reports upon a comparative study in an English health authority of stress experiences between 146 current Diploma in Nursing (Project 2000) Adult Branch students and a prior study of a sample of 146 students who undertook a certificate course leading to Registered General Nurse (RGN) in 1988. Both groups were administered the same questionnaire. The number of stressors common to both groups were two in education and nine in the clinical environment. Three prominent feelings of stress were expressed by both groups along with two methods of coping with stress. A constellation of 11 personality type characteristics labelled 'determination', which enabled students to sustain themselves, was identified. Three characteristics of 'determination', plus a feeling of uselessness and inability to contribute to the nursing team effort, and the intense amount of academic work were statistically significantly higher for Diploma students. Six prominent clinical stressors were experienced more intensely by third-year diploma students than first- or second-year students. Stress was found to increase with the level of training. This finding replicated the picture found among 324 students in 1988. Differences in stress experiences for different age groups were not statistically significant with the exception of physical hard work. A number of stressors experienced by students in 1988 were also experienced by students in 1997.

A complementary therapy approach to the management of individual stress among student nurses.

This paper examines the difference between qualitative and quantitative research approaches and applies the debate to assessing student nurses' stress coping styles. In particular, it looks at the value of the qualitative approach as a means of appreciating the individual nature of the stress experience. A pilot study was conducted among a small group of Project 2000 students. The results illustrate that a flexible model which appreciates the differences in individual perception is a successful way of enabling students to handle negative stress. The paper also reports on a new concept called Determination and the Hypnotic Interaction model which enables student nurses to utilize determined experiences from previous times and apply them to present and future negative stress. The model utilizes a wide range of complementary therapy approaches including relaxation, imagery and hypnosis, to enable students to appreciate positive stress and to discover and use their natural resources of determination to deal with negative stress.

Individual stress among nurses in training: why some leave while others stay.

This study involves 413 learners (student and pupil nurses) training in the general nursing field. The study explores the nature of individual stress experienced by learners in both the educational and clinical environment. The latter is found to be more stressful. Stress is found to increase as training progresses. A comparison between learners in this study and those in a previous study (who left training) was made. Individual stress experiences were similar for learners who left training as a result of stress and those who remained. The study also presents a number of individual strategies for coping with stress.

Individual stress and its relationship to termination of nurse training.

During interviews with 23 learners (student and pupil nurses) who left training as a response to stress, the following points were explored; knowledge of nursing before commencing training; reasons for wanting to nurse; situations which produced stress; the way in which individual stress responses were expressed; and methods for coping with stress. Clinical experiences had produced the most distress, related predominantly to negative attitudes of other nurses. Behavioural and physiological signs of stress were observed as well as psychological reactions such as worry. People had few adaptive coping strategies and received little support in their time of need. The majority expressed a desire to try nursing again.

Factors associated with student and pupil nurse wastage.

The records of student and pupil nurses who discontinued nurse training within the North Staffordshire Health Authority between the beginning of 1981 and the end of November 1986 were examined. The reasons for leaving were classified according to comments made by the learners themselves as well as impressions of tutorial staff. Nine categories for leaving were formed for students and pupils. Stress and unsuitability for nursing were significant factors in student wastage while stress was of high significance in relation to pupil wastage.