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BACKGROUND: Increased breast cancer survival means that many women live with long-term consequences of their cancer and treatment. Knowledge about their coping is important. OBJECTIVE: This qualitative follow-up study describes survivors' coping experiences 9 years after primary breast cancer surgery. METHODS: Seventeen of the 21 women interviewed 9 years earlier were invited to participate. Fifteen agreed and were interviewed individually between January and June 2015. Qualitative meaning condensation analysis was used. RESULTS: Three themes emerged: (1) Changed life: some felt healthy and beyond cancer; others suffered from reduced energy, joy of life, and self-esteem. Being affected by a life-threatening illness made their fundamental values clearer. Using cancer experiences to help others was emphasized. (2) Positive thinking, distancing the negative: striving to maintain positive thinking and distancing themselves from insecurity and fear of recurrence. A step-by-step strategy was important to cope with their new life situation. (3) Need for understanding and recognition: support was experienced as necessary and challenging. Recognition of posttreatment ailments was emphasized. Being more socially selective and preferring positive people were essential. CONCLUSIONS: Cancer experiences changed the women's lives. Their coping varied. Fewer but selected supporters were preferred. Understanding and recognition from others for the women's changed life situation was essential. IMPLICATIONS FOR PRACTICE: Healthcare professionals should prepare women for a changed life situation because of illness experiences and the adverse effects of treatments. The support and information offered must be adjusted to each woman's individual needs, coping capacity, and life situation. Further clinical intervention studies are needed.
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Actitud Frente a la Salud , Neoplasias de la Mama/psicología , Supervivientes de Cáncer/psicología , Autoimagen , Adaptación Psicológica , Adulto , Neoplasias de la Mama/rehabilitación , Neoplasias de la Mama/cirugía , Emociones , Miedo/psicología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Noruega , Cuidados Paliativos/psicología , Investigación CualitativaRESUMEN
AIM: The aim of this qualitative follow-up study was to describe women's individual experiences of social support during their first year after primary breast cancer surgery. METHOD: Individual semi-structured interviews with 10 women 1 year after surgery analysed by Kvales' meaning condensation method. FINDINGS: Sharing experiences, being understood as an individual, continuity, and information and explanations were themes identified. Sharing mutual experiences increased the women's knowledge regarding cancer, increased experience of support and minimised rumination. After 1 year, the women felt that the network around them had 'normalised' and was less supportive. Being seen as a person, not as 'a diagnosis being treated', and continuity of professional support were important, giving feelings of security and trust. The women felt uncertainty after loss of professional support post-treatment. Information and explanations regarding treatment and treatment-related problems were essential. CONCLUSIONS: Mutual sharing of experiences is an important part of social support. Continuity, availability, information and respect were essential aspects of experienced professional support.
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Neoplasias de la Mama/cirugía , Apoyo Social , Anciano , Neoplasias de la Mama/psicología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
PURPOSE: The purpose of this qualitative follow-up study was to describe women's individual coping experiences and reflections following their first year after primary breast cancer surgery. METHODS: Using a qualitative descriptive design, we collected data through individual interviews with ten women at a Norwegian university hospital between August 2007 and April 2008. We employed Kvale's method of qualitative meaning condensation analysis. RESULTS: Themes identified were: existential concerns and finding meaning, ways of thinking and feeling about the disease, taking action, and returning to normal life. Most women experienced an increased appreciation of life and greater confidence in themselves, were more caring and compassionate towards others, and focused more on their life priorities. Their family and close relationships became more important. They accepted their situation and made the best of it. Positive thinking, physical activity, self-care, nature, hobbies and work helped. Generally, they were optimistic despite a fear of cancer recurrence and uncertainty about their future. The women wanted to return to a "normal" and healthy life by distancing themselves from both the cancer environment and information about cancer. CONCLUSION: Uncertainty and anxiety about a potential future cancer relapse was a major undercurrent one year following surgery. Our findings emphasize the richness in these women's coping strategies, their different coping profiles and different needs, as well as some general adaptive strategies, which all fluctuated over time. Not all managed to cope equally well. Through awareness of these women's individual experiences and coping strategies, healthcare professionals can enhance these women's coping endeavours.
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Adaptación Psicológica , Neoplasias de la Mama/psicología , Neoplasias de la Mama/cirugía , Emociones , Anciano , Empatía , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Noruega , Satisfacción Personal , Autoimagen , Factores de TiempoRESUMEN
OBJECTIVES: This study investigated the relationship between patients' self-reported illness, daily afflictions, and the frequency of home nursing care, and whether patients' coping resources influenced the allocation of care. DESIGN, SAMPLE AND MEASUREMENTS: A cross-sectional survey was adopted. Two hundred and forty-two people aged 75 years and above receiving home nursing care participated in the study. Binary logistic regression model was used to test the effects of the independent variables on home nursing care. RESULTS: Poor capacity to perform activities of daily living and high level of education were directly associated with a high frequency of home nursing care. Lack of perceived social support affected the amount of home nursing care allocated only when feelings of loneliness were connected with poor activities of daily living functioning. Interaction effects revealed that perceived social support influenced the amount of home nursing care in persons with higher education, in persons with low education, no such association were found. No associations were found between coping resources and home nursing care. CONCLUSIONS: Impaired capacity to perform activities of daily living was the main reason for care allocation. Education was associated with more formal care. Patients with low perceived social support combined with a low education level was a particularly vulnerable group.
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Enfermería en Salud Comunitaria/métodos , Enfermería Geriátrica/métodos , Evaluación de Necesidades , Autoinforme , Actividades Cotidianas , Adaptación Psicológica , Anciano , Anciano de 80 o más Años , Envejecimiento/psicología , Enfermería en Salud Comunitaria/normas , Estudios Transversales , Femenino , Enfermería Geriátrica/normas , Viviendas para Ancianos , Humanos , Masculino , Noruega , Pacientes Ambulatorios/psicología , Apoyo Social , Factores SocioeconómicosRESUMEN
AIM: This article is a report of a qualitative study of women's experiences after having received a breast cancer diagnosis and awaiting primary surgery. BACKGROUND: Breast cancer is experienced as an important stressor and a major challenge. How women appraise the diagnosis affects their postsurgery adaptation. Although studies have documented the presurgery period as stressful, in-depth understanding of women's experiences while awaiting surgery studied during this stressful period is still needed. METHOD: Twenty-one women with newly diagnosed breast cancer were interviewed individually the day before surgery at a Norwegian university hospital, between February 2006 and February 2007. Interviews were analysed using the qualitative meaning condensation method. FINDINGS: Feeling healthy, but having to adapt to disease, waiting, uncertainty, having to tell and existential awareness were themes identified. Having to wait was experienced as frightening, painful, long and difficult - but also necessary. Some expressed apprehension because they could not do anything about their situation. Others emphasized that it was good to have some time between diagnosis and surgery to become personally prepared and spend time with loved ones. Informing others about the diagnosis was a great burden for most of them. Social networks could both give and crave support. CONCLUSION: Healthcare professionals need to be sensitive to the individual experiences of women awaiting breast cancer surgery to give support to ease their situation. Setting the date for surgery will alleviate anxiety. Follow-up studies about the potential impact of presurgery experiences on later experiences of living with breast cancer and intervention studies are needed.
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Adaptación Psicológica , Actitud Frente a la Salud , Neoplasias de la Mama/psicología , Mastectomía/psicología , Adulto , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/cirugía , Depresión , Emociones , Femenino , Humanos , Persona de Mediana Edad , Noruega , Investigación Cualitativa , Revelación de la Verdad , Incertidumbre , Mujeres/psicologíaRESUMEN
AIM: This paper is a report of a descriptive study of coping strategies used by women between diagnosis of breast cancer and surgery. BACKGROUND: Although research has suggested that the initial phase of breast cancer is important in the overall process of coping, there have been few qualitative studies conducted in the period between diagnosis and surgery to describe women's experiences and coping efforts in the midst of stress. METHOD: Individual interviews were conducted with 21 women with newly diagnosed breast cancer who were awaiting surgery. Data were collected from February 2006 to February 2007 at a Norwegian university hospital. Transcripts were analysed using methods of qualitative content analysis. FINDINGS: Prominent themes about coping between diagnosis and surgery were: step-by-step, pushing away, business as usual, enjoying life, dealing with emotions, preparing for the worst and positive focus. The women were highly aware of the threat of death, but at the same time hopeful and optimistic. In general, they wanted to be treated as usual. Pity and compassion could increase their feelings of fear and vulnerability. Emotions were dealt with either by openness or by holding back. CONCLUSION: Avoiding being overwhelmed by emotional reactions was a major goal for the women. Their coping strategies displayed similar patterns but diverged on some points. In general they needed to manage the situation in their own way. By being aware of women's individual needs and different coping strategies, nurses and other healthcare professionals can improve support to women in this vulnerable situation.
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Adaptación Psicológica , Actitud Frente a la Salud , Neoplasias de la Mama/psicología , Adulto , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/cirugía , Emociones , Femenino , Humanos , Persona de Mediana Edad , Noruega , Encuestas y CuestionariosRESUMEN
AIMS: The aims were to investigate the factor structure of the Subjective Health Complaints Inventory (SHC) in a population of 75 years and above and to identify whether somatic, psychosocial, and coping factors were associated with the SHC factors. METHODS: Data from 242 elderly persons were analyzed. The measures were: the SHC Inventory, Sense of Coherence, Social Provision Scale, Self-Rated Health, General Health Questionnaire, Clinical Dementia Rating, Reported Illness, Barthel ADL Index, sex, age, and education. RESULTS: The factor analysis resulted in four subgroups: musculoskeletal pain (15% of variance), gastrointestinal problems (12% of variance), respiratory/allergy complaints (11% of variance), and pseudoneurology (11% of variance). The occurrence of complaints was 76% for musculoskeletal complaints, 51% for gastrointestinal complaints, 30% for flu, 43% for allergy, and 93% for pseudoneurology. Self-rated health and reported illness were significantly associated with musculoskeletal complaints (15% of variance), impairment in activities of daily living (ADL) with gastrointestinal complaints (3% of variance), and finally sense of coherence, self-rated health, and psychological distress were associated with pseudoneurology (32% of variance). No variables were associated with respiratory/allergy complaints. CONCLUSIONS: This study supports the stability of the SHC's factor structure. The low occurrence of health complaints could possibly be due to survival effects, or that old people to a greater extent than younger people compare themselves with aged peers. The subscales focusing on somatic symptoms were explained by reported illnesses and functional impairments to a limited degree only. The pseudoneurology subscale score was associated with psychological measures, particularly ability to cope.
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Adaptación Psicológica , Estado de Salud , Morbilidad , Actividades Cotidianas , Anciano , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Noruega/epidemiología , AutoimagenRESUMEN
OBJECTIVES: This study examined psychological distress in older people receiving home nursing care. The influence of risk factors and personal resources on their perceived psychological distress was also examined. METHOD: A linear regression analysis was applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological distress was measured using the General Health Questionnaire (GHQ). The independent variables were sex, education, age, living arrangement, household composition, reported illnesses, Barthel ADL Index, self-rated health, Subjective Health Complaints, Clinical Dementia Rating Scale, Sense of Coherence and Revised Social Provision Scale. RESULTS: Of the 214 participants, 23 (10.7%) reported experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score. Sense of coherence, education and subjective health complaints were the only factors that were significantly related to psychological distress in the multivariate analysis. CONCLUSION: The general level of psychological distress was low. Low psychological distress was related to an inner strength conceptualized as sense of coherence. Commonly reported risk factors such as sex, household composition and perceived social support, and objective measures of somatic and mental health and bodily dysfunctions were not related to psychological distress. Suggested reasons for this are greater acceptance of bodily and functional shortcomings and of changes related to goal achievement in old age, according to the model of selective optimization with compensation.
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Actividades Cotidianas/psicología , Adaptación Psicológica , Apoyo Social , Estrés Psicológico/epidemiología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Evaluación Geriátrica , Servicios de Atención de Salud a Domicilio , Hogares para Ancianos , Humanos , Masculino , Análisis Multivariante , Noruega/epidemiología , Casas de Salud , Análisis de Regresión , Características de la Residencia , Factores de Riesgo , Estrés Psicológico/psicología , Encuestas y CuestionariosRESUMEN
Objectives. This study examined predisposing, enabling and need variables (Andersen's Behavioral Model) influencing the need for nursing home admission (NHA) in older people receiving home nursing care. In particular, the potential role of coping ability, measured as 'sense of coherence' (SOC), was studied. Design, sample, and measurements. A survey with baseline- and follow-up data after a 2-year period was undertaken with 208 patients aged 75+. The measures used were: gender, education, age, social visits, SOC, social provision scale (SPS), self-rated health (SRH), general health questionnaire (GHQ), clinical dementia rating (CDR), Barthel activities of daily living (ADL) index, and registered illnesses (RI). A Cox proportional model was used to examine factors that could explain risk of NHA. Results. Measures with predictive properties were Barthel ADL index, SPS, SRH, and gender. SOC, along with subjective health complaints, general health questionnaire, RI and social visits did not predict NHA. Conclusions. It is concluded that the patients' subjective evaluations of both their health and perceived social support were important predictors of future NHA needs, and should be seriously taken into consideration, along with the more commonly used objective measures of ADL and CDR.
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AIM: This paper reports a study examining the relationships between demographic characteristics, social support, anxiety, coping and defence among women with possible breast cancer. BACKGROUND: Awaiting a possible breast cancer diagnosis is an anxiety-provoking situation that demands coping. Social support and demographic characteristics have been reported to influence coping and well-being, but the interconnection is insufficiently understood. DESIGN: A survey design was used, and self-administrated questionnaires were returned by a convenience sample of 117 women in Norway who had undergone breast biopsy. The data were collected from September 1998 to February 2000. INSTRUMENTS: The instruments consisted of: the Social Provisions Scale, State-Trait Anxiety Scale, Utrecht Coping List and Defence Mechanisms Inventory. In addition, data on age, level of education, employment, marital status, and household status were collected. RESULTS: Social support was positively related to instrumental-oriented coping and emotion-focused coping, unrelated to cognitive defence and defensive hostility. Educational level was positively related to instrumental-oriented coping. Educational level, employment and marital status were negatively related to cognitive defence. Educational level was the most important contributor to social support. Attachment and education were the most important contributors to instrumental-oriented coping, with education as the strongest predictor. CONCLUSION: Better coping was linked primarily to education, and secondly to attachment. Unemployment, low level of education and single/divorced/widowed status were related to greater use of cognitive defence. Women who used a defensive hostile style tended to receive poor social support. Nurses need to be aware of the influence of demographic characteristics on social support, coping and defence and to identify poor copers, as these patients are most in need of professional support.
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Adaptación Psicológica , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/psicología , Apoyo Social , Adulto , Anciano , Ansiedad/etiología , Ansiedad/enfermería , Biopsia/psicología , Neoplasias de la Mama/enfermería , Mecanismos de Defensa , Escolaridad , Femenino , Humanos , Modelos Lineales , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
Many models of pain give coping an important role in understanding adaptation to chronic pain. Among these, Lazarus and Folkman's cognitive-phenomenological model of stress and coping provides a theoretical framework to conceptualise stress phenomena and coping strategies related to chronic pain. Chronic pain often necessitates new coping skills. An understanding of the concept of coping and how the patients cope is therefore crucial for the success of rehabilitation. The current study examined how coping, as measured by the Ways of Coping Checklist, was related to medical variables, depression measured by the Short Zung depression rating scale, and Rosenberg's self-esteem scale. The study sample consisted of 88 people who were recruited for a multidisciplinary pain management programme. Data were collected as part of a routine pre-treatment evaluation. Results indicated that the most predominant stressors were related to family life and social activities. We also recognised on the one hand, appraising pain as a challenge was predictive of problem-focused coping, while on the other hand, appraising pain as a threat, experiencing depression, and reduced self-esteem were predictive of emotion-focused coping. Clinical implications of these results in nursing are discussed.
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Adaptación Psicológica , Actitud Frente a la Salud , Dolor/prevención & control , Dolor/psicología , Adulto , Anciano , Enfermedad Crónica , Depresión/diagnóstico , Depresión/etiología , Depresión/psicología , Emociones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Análisis Multivariante , Noruega , Rol de la Enfermera , Investigación Metodológica en Enfermería , Dolor/complicaciones , Valor Predictivo de las Pruebas , Solución de Problemas , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Autoimagen , Apoyo Social , Estrés Psicológico/diagnóstico , Estrés Psicológico/etiología , Estrés Psicológico/prevención & control , Encuestas y Cuestionarios/normasRESUMEN
Chronic pain, when not effectively treated and relieved, may have a harmful effect on all aspects of health-related quality of life (HRQL). Furthermore, pain beliefs are considered an important mediating psychological factor in chronic pain. The present study focused on HRQL as measured by the Medical Outcomes Survey-Short Form (SF-36) and addressed possible relationships between pain beliefs as measured by the Pain Beliefs and Perceptions Inventory (PBAPI). The possible impact of background variables such as age, gender, social support, pain intensity, pain duration, and analgesics on HRQL were controlled for in the analyses. The study sample consisted of 81 people who were recruited from a multidisciplinary pain management program. Data were collected as the first part of a routine pretreatment evaluation. The chronic-pain patients reported lower scores on all dimensions of HRQL compared to normal controls and other patient groups. No significant association was found between pain beliefs and the physical health dimension of HRQL whereas gender, pain duration, and pain intensity were significant predictors of that dimension. In addition, one of the dimensions of pain beliefs (i.e., mystery) was found to be predictive of the mental health dimension of HRQL. Social support made an additional contribution to the explained variance in mental health. The implications of these results for assessing HRQL and pain beliefs in chronic pain are discussed.
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Actitud Frente a la Salud , Dolor/psicología , Calidad de Vida , Encuestas y Cuestionarios/normas , Adulto , Anciano , Estudios de Casos y Controles , Enfermedad Crónica , Análisis Factorial , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Análisis Multivariante , Noruega , Dolor/diagnóstico , Dolor/prevención & control , Dimensión del Dolor , Valor Predictivo de las Pruebas , Psicometría , Análisis de Regresión , Factores de Riesgo , Índice de Severidad de la Enfermedad , Apoyo Social , Factores SocioeconómicosRESUMEN
Blood donors must respond to standard control questions and comply to certain demands before donating blood, to exclude possible recent contamination. This study investigates whether donors had adequate knowledge about 'the immunological window period', and whether the standard questionnaire in use was understandable and clear. It was found that nearly 40% of the donors had inadequate knowledge about 'the immunological window period' and that 10-40% of the donors would respond in various ways to different interpretations of the formulations of the questionnaire, indicating that the questionnaire was ambiguous. It was concluded that these factors could increase the risk of donating on wrong conditions. Demands and control questions posed to donors must be void of ambiguous formulations and take proper account of actual human sexual behaviours and life styles. Finally, it is suggested that blood banks must offer practical solutions (such as a 'fake donation') for temporarily rejected donors in order to respect their private integrity.
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Donantes de Sangre/educación , Donantes de Sangre/psicología , Consentimiento Informado/normas , Semántica , Encuestas y Cuestionarios/normas , Adulto , Actitud Frente a la Salud , Sesgo , Escolaridad , Femenino , Humanos , Control de Infecciones , Estilo de Vida , Masculino , Persona de Mediana Edad , Noruega , Factores de Riesgo , Conducta Sexual , Reacción a la TransfusiónRESUMEN
Traditional theories about grief and bereavement have been fundamentally and thoroughly challenged, primarily by Stroebe and Stroebe (1987), Wortman and Silver (1989), and Bonanno and Kaltman, (1999). In contrast to the old grief work perspective with its working through, depression, social disclosure of distress, and termination of the relationship to the dead, a completely different new perspective focusing on repression of depressive emotions and thoughts, display of positive emotions, moderate social disclosure, and continuation of the relationship to the dead has been proposed and scientifically supported. Still, the grief work perspective is very popular. In this article, both the old and the new views are challenged, and a more moderate perspective is suggested. Rational and irrational reasons for the old perspective's popularity are suggested. Consequences for therapeutic work (psychotherapy, counseling, nursing) are outlined. Finally, it is underlined that grief may be a meaningful, enrichening experience.