Abstract

This study identified the psychological process of how cancer patients, who experienced a total hysterectomy, recognized their self-worth and then, after their operation, rebuilt the relationship with their partners, and examined nursing support for them. Data was collected from a purposive sample of nine participants through semi-structured interviews and analyzed qualitatively, guided by a modified-grounded theory approach (M-GTA).

The cancer patients who had a total hysterectomy rebuilt their relationships through two key experiences: “rebuilding their sexual relationship” and “intensifying partner intimacy”. Rebuilding their sexual relationship revealed two stages: discomposure of sexual self-worth and overcoming the loss of sexual self-worth. The stage of the discomposure was characterized by six sub-categories: a sense of losing sexual self-worth; awareness of a change in sexual function; anxiety about penetration touching their wound; hesitation to search for sexual information; respect for the sexual needs of their partner and the dilemma caused by the medical approval of resuming sexual intercourse.

As patients were overcoming the loss of their sexual self-worth, three types of experiences revealed how they regained their self-worth: (1) making efforts to reduce pain during sexual intercourse because they recognized that engaging in sexual intercourse was important (re-recognition of sexual self-worth); (2) recognizing there was no change in the relationship with their partner regardless of sexual intercourse (re-recognition of sexual self-worth by being free from the conventional value of sexual intercourse), and (3) they did not feel sexually motivated and had guilt feelings for avoiding sex life they made an anguished choice to not engage sexually and reached a re-recognition of self-worth.

Patients received understanding and support from their partner and they cared about their partner. These two experiences made their sense of solidarity strong and deep.

Nurses need to understand the psychological and emotional suffering that cancer patients endure after a total hysterectomy. This research adds to the body of knowledge that will assist nurses in creating systems to support a smooth rebuilding of the relationship with their partners. Central to this nursing care is providing pertinent sexual information and psychological and emotional support.

Abstract

Recipients with allogeneic hematopoietic cell transplantation (allo-HCT) have to manage their daily living for a long time. Although patient education is very important for such recipients, no guidelines have been defined for daily living after allo-HCT. This study aimed to identify the contents of patient education that should be provided by nurses to allo-HCT recipients and to present the contents of patient education according to the level of importance.

The Delphi process was used to explore areas of agreement regarding importance among respondents. The questionnaire survey contains 80 items concerning five categories: “increased susceptibility to infection”; “GVHD”; “late complications”; “self-management of daily living”; and “contact information”. Subjects comprised 240 Japanese nurses with experience in hematopoietic cell transplantation nursing at 18 institutions that participated in this study.

Two iterations of the survey resulted in a response rate of 53 % (126 respondents), and reached consensus on 75 items as requisite information. Nine items out of the requisite information were assigned to the level of “most important information”, with contents concerning coping with life-threatening problems. Thirty items among the requisite information were assigned to the level of “considerably important information”, with contents regarding practical behaviors that were commonly helpful for most recipients. Thirty-six items from among the 75 items were assigned to “information that should be provided”, including theoretically recommended behaviors and knowledge about behavior. Poor agreement was found for another five items.

In conclusion, contents of patient education that should be provided by nurses to allo-HCT recipients were clarified and presented according to the level of importance. The results provide reference data for patient education about post allo-HCT.

Abstract

The objective of the present study was to elucidate the relationship between self-care behavior and self-efficacy of cancer patients undergoing outpatient chemotherapy. A self-report questionnaire survey was conducted on a total of 56 cancer patients undergoing outpatient chemotherapy who were given explanations on their disease condition and chemotherapy at one of two hospitals in Prefecture A. Patients had a mean age of 62.1 ± 13.4 years, and 80% of them had digestive system cancer or breast cancer. The mean score for self-care behavior was 142.9 ± 14.8 (range, 101-170), which was higher compared to previous studies, and approximately half of the patients were in the “overall high score group” based on cluster and discriminant analysis. Self-care behavior was related to personal variables of gender, duration of intervals between chemotherapy cycles, and source of guidance (doctor). Specifically, scores for self-care behavior were significantly higher for women compared to men (p<.05), patients with a long interval between chemotherapy cycles compared to those with a short interval (p<.05), and for patients who consult doctors compared to those who consult other sources (p<.01). The mean score for self-efficacy was 27.6 ± 4.2 (range, 20-39), which was lower compared to previous studies for cancer patients. No significant correlations were observed between self-care behavior and overall self-efficacy as well as the efficacy of daily living activities and emotional control.

These findings indicate that patients undergoing outpatient chemotherapy were sufficiently aware of the importance of preventing side effects during chemotherapy which is highly aggressive, and that they engaged in self-care behavior despite having a low self-efficacy. Nurses must provide care by considering the background of patients undergoing outpatient chemotherapy as well as the burden of self-care.

Abstract

The purpose of this study was to clarify the process of acquiring techniques for coping with impaired excretion by patients with familial adenomatous polyposis after total colectomy. A semi-structured interview was used to obtain relevant data from five patients with this disease who underwent surgical treatment. The data were then analyzed. Subject mean age was 34 ± 7.96 years; the postoperative period was 14.8 ± 8.61 months.

The process of finding techniques for coping with impaired excretion after surgical treatment included the following six categories: assessment of symptoms; adaptation of behavior to their physical condition; recovery of sensation of control; development of indexes on the basis of parents’ experience; searching for preventive strategies; discovery of signs leading to social rehabilitation. It was demonstrated that patients with this disease who undergo surgical treatment consider their parents’ experience, as well as general coping techniques, in the process of learning how to cope with postoperative impaired excretion.

The results of this study suggest that nurses engaged in caring for familial adenomatous polyposis patients are expected to provide continuous support by supplying useful information and demonstrating the importance of coping techniques, so that the patients can learn the sensation of control according to the indexes, based on their parents’ experience, and overcome impaired excretion.

Abstract

The purpose of this study was to describe the family bonds of a terminally ill cancer patient living at home and his family. Six caregivers lived with the patient in the terminal stage of cancer. The study data was collected by semi-structured interviews and analyzed qualitatively. Six subcategories of family bonds were allocated as follows relating to living with the truth that the illness is incurable: ‘acceptance of the condition of the patient fading fast’, ‘acceptance of the patient’s feelings of anguish about the cancer’, ‘feeling the end of the family relationship’, ‘expressing love for the patient in the terminal stage of cancer’, ‘to feel the proof of having lived as a family’, and ‘to be with the patient until the end’. Three subcategories were found for the family strategy to maintain the culture particular to the family: ‘to live at the pace characteristic of that family’, ‘to carry out the patient’s wishes for the future’, and ‘to foresee family life after the patient has died’. The terminally ill cancer patient and his family now used to living together in the face of impending death intended to reflect back on their shared history as a family, reaffirm their existence as a family unit, and carry forward their particular family characteristics into the future.

Abstract

The purpose of this study was to examine the association of anxiety and depression with demographic characteristics, disease-related characteristics, and social participation in cancer outpatients. Furthermore, the extent that cancer outpatients received psychological support and its relationship with anxiety and depression for those receiving chemotherapy was identified.

Self-reported questionnaires were distributed to 90 cancer outpatients and responses obtained from 77 of these patients were analyzed. The Hospital Anxiety and Depression Scale revealed that patients with partners had lower depression scores. Those with more severe side effect symptoms, those taking sick leave, and those who did not engage in social activities had higher anxiety and depression scores. Approximately 70～90 percent of patients received psychological support. Obtaining enough information was associated with lower anxiety and depression scores, expressing emotions was associated with lower depression scores, and receiving advice from medical staff was associated with higher anxiety scores. There was an interaction effect between the extent of side effect symptoms and psychological support on anxiety levels. [KT1]

Our findings suggest that a thorough understanding of these factors will assist nurses in maintaining the psychological well-being of cancer outpatients who receive chemotherapy.