Abstract

The purpose of this study was to identify by a survey questionnaire the factors related to self-efficacy in cancer outpatients receiving chemotherapy, and to discuss the appropriate nursing care for them.

The sample consisted of 169 cancer outpatients receiving chemotherapy at a chemotherapy center. The questionnaire covered the patient’s background, patient needs in terms of home care, a Screening Questionnaire (physical symptoms, a Severity Distress Thermometer, overall quality of life) and a Self-Efficacy Scale for Advanced Cancer (SEAC).

As the result of analyses, factors related to self-efficacy in cancer outpatients were clarified. First, the SEAC score was significantly lower among patients with the following backgrounds: under 40 years old, jobless, solitary life, performance status 1 or more, no hobby, no adviser, and difficulty in consulting doctors or nurses. These results suggest that such outpatients need selective support.

Second, the SEAC score was significantly lower in patients with the following needs: managing adverse effects / physical symptoms, going out / eating, and consulting. These results suggest that self-efficacy is enhanced by satisfying these needs.

Third, the severity of the following physical symptoms significantly affected the SEAC score: insomnia, inappetence, dyspnea, and fatigue. These symptoms are frequent and distressing for cancer patients. So a nursing system to improve symptom management and self-caring behavior should be established.

Finally, the SEAC score significantly affected the levels of overall quality of life and psychological distress. Nursing care that provides comprehensive support for outpatients enhances self-efficacy and is essential for cancer outpatients.

Abstract

In the present study, a narrative approach was applied to elucidat the processes providing stability in the face of changes caused in the narratives of cancer survivors receiving molecular targeting therapy for cancer at the outpatient department (hereafter, “survivors”).

The present study was a practical nursing study that combined nursing practice with research, and used a qualitative and inductive design. One of the nurse-researchers conducted a minimum of three interviews as an outpatient narrative approach, and analyzed the data using qualitative and inductive methods.

A total of 73 sequential and contextual narratives (subtitles) were identified. Narrative focused mainly on how survivors came to terms with the diagnosis of cancer and the beliefs they based their lives on, in other words the beliefs by which they lived their lives. In addition, narratives indicated that survivors realized that their emotions wavered on a daily basis despite their efforts to control them by maintaining similar routines to those they had prior to being diagnosed with cancer.

The narrative approach was thought to provide support that enables survivors, who must face the reality of a long and uncertain course of treatment, to accept and gain confidence in the way of life and beliefs they had discovered themselves in the face of various feelings. It is important in outpatient nursing to maintain an approach that supports the way of life and beliefs of survivors whenever possible, even if for only a limited time.

Abstract

The purpose of this study is to elucidate the particular skills employed by expert therapists in the care of cancer patients with lymphedema. Eleven therapists authorized by the Association of Lymph Drainage Therapists and who had provided Complex Physical Therapy for lymphedema patients participated in the study. Data were collected through semi-structured interviews, and analyzed by qualitative and inductive methods. Four skills were identified as important in the alleviation of lymphedema：“understand the patient including details of his/her life in the past, present and future”, “ascertain how lymphedema has impacted on the patient’s overall life”, “explore methods that have the greatest effect”, “perceive what has happened under the palms”. Three skills were also identified to support patient self care：“be positive about self-care”, “support to continue self-care”, “estimate the distance as an escort runner”. The participants in this study treated patients with lymphedema by understanding their physical symptoms and personal experience of the condition. In addition, they provided psychological support to enable the patients to adopt a positive attitude to self-care, and realize and continue self-care. Once lymphedema appears, it follows a chronic course. Therefore, it is important for the caregivers to care for patients appropriately and reduce their pain. At the same time, the caregivers need to support patients to help them accept their lymphedema and understand the importance of initiating and continuing self-care.

Abstract

The objective of this study was to clarify the status of nursing practice for cancer patients receiving chemotherapy and factors related to the practice of nursing. A self-written questionnaire survey was carried out on 205 nurses engaged in cancer chemotherapy nursing. Responses to the questionnaire were retrieved from 160 nurses, of which 21 incomplete responses were excluded. The remaining 139 responses were subjected to analysis using descriptive statistics, Spearman’s rank correlation coefficient, the Mann-Whitney U test and the Kruskal-Wallis test. The survey revealed a high degree of practice for care concerning comprehension of symptoms of adverse reactions, care about mental aspects of the patient and care about understanding of the patient, whereas the degree of practice was low for care to be taken by intensive assessment of self-management and daily living activities. Among factors affecting nursing practice, statistical differences were demonstrated for the number of years of experience in chemotherapy nursing, job title, experience of attending training courses on chemotherapy nursing, type of hospital, and the presence or absence of nurses certified in chemotherapy nursing. The analysis showed a positive correlation between interest in chemotherapy nursing and degree of practice. These results suggested a need for a strategy that would reflect the care taken by looking intensively at daily living activities and knowledge thereof in caring for individual patients. The results also suggest the need to make efforts to evoke the interest of nurses and to enrich the educational system as part of the medical institutions.