How do specialist breast nurses help breast cancer patients at follow-up?

BACKGROUND: As the proportion of survivors from breast cancer increases it is possible that follow-up care could be delivered wholly by generalists to relieve over subscribed hospital clinics. However, guidelines seldom take into account the nature of interactions between patients and health care professionals involved in hospital-based follow-up. METHODS: Consultations between four Specialist Breast Nurses (SBNs) and 21 consecutive women attending a hospital-based breast cancer follow-up clinic in Western Australia were audio recorded and subjected to a thematic analysis. Recording of consultations ceased with saturation of themes. We analysed the data with reference to theoretical frameworks which postulate that social support is a powerful factor in determining positive health outcomes. We also drew on theories focusing on biographical disruption, biographical reinforcement and biographical reinvention. RESULTS: The majority of participants were Australian born, married women in their sixties. The mean duration of the consultations was 19 min (SD = 7.5, min = 8, max = 43.5). A core theme was the established relationship between the woman and her SBN. Overall, the SBNs played an important role in facilitating the transition of patients by supporting the woman in adjustment to a new self-image and bodily functioning. The SBN accompanies each woman through this phase in her life, white supporting a new narrative, promoting her 'rebirth' as someone with ideas, concerns and expectations that have altered significantly after the diagnosis of cancer. Five key themes emerged to demonstrate this supportive role: normalising; facilitating access to services; prevention; promoting self-esteem and promoting a proactive approach. CONCLUSIONS: Many women with breast cancer claimed a new perspective on what was now possible, acceptable or desirable in a host of life domains. Our data suggest that the follow-up care of cancer patients is more than just dealing with a checklist of symptoms but requires an understanding of the biographical disruption occasioned by a diagnosis of breast cancer.

An exploration of experiences of living renal donors following donation.

The experiences of living renal donors in Western Australia were explored using the qualitative method of grounded theory. Data were collected through 18 tape-recorded interviews with donors. Two main categories were identified that related to the physical and psychological reactions that occurred following surgery. This study provides insights (both positive and negative) into the donation experience.

Development of a donor driven assessment protocol in Western Australia based on experiences of living renal donors.

A new protocol for the selection and work-up of living renal donors has been developed in response to recent findings from a grounded theory study that explored the experiences of 18 donors in Western Australia. This protocol is designed to enhance the feelings of personal control by the donor over participation in the process and the potential outcome. It includes the coordination of the work-up process by a Clinical Nurse Consultant.