Abstract

In order to develop a nutritional nursing support program to maintain oral feeding in patients undergoing surgery for oral cancer, we introduced nutritional management for such patients and evaluated their experience and nutritional outcomes. Clinical records were examined for all 207 patients who underwent oral cancer resection at the Department of Oral Surgery, University Hospital A in the Tokyo metropolitan area during the last 3 years. In addition, 20 other patients diagnosed with oral cancer who were scheduled for surgical removal at out department participated in semi-structured interviews regarding eating was later examined. Data from the two groups of patients were integrated in a concurrent nested mixed methods design, analyzed comparatively, and systematized to understand the outcome of nutritional management. The results indicated that the patients’ nutritional state declined significantly following invasive surgery. Malnutrition and poor appetite continued because oral feeding was painful and unpleasant due to the symptoms, including pain. Although food intake increased with support from others and by the patients’ own initiative, as the day of discharge approached, the patients became anxious about eating after discharge. From the results of our nutritional management approach, we successfully identified the timing, requirements, and contents of intervention for oral cancer patients who generally can be treated with a wide range of treatments. Once these results are incorporated into our nutritional nursing support program, the program is expected to assist medical teams, centered around nurses, in the nutritional management of oral cancer patients.

Abstract

Purpose：The purpose of this research is to clarify the distress and coping strategies of women with breast cancer who are undergoing hormone therapy, and to consider their care.

Method：The participants were 7 women under the age of 50 with breast cancer who were undergoing hormone therapy on an outpatient basis. Verbatim recordings from semi-structured interviews were utilized as data and analyzed under the supervision of a qualitative researcher, while drawing on the Grounded Theory Approach.

Results：The following 7 categories of distress were extracted：“painful symptoms that interfere with living”, “uncontrollable emotional instability”, “reduced self-confidence”, “agitation over differences between the present and past”, “conflict concerning continuing treatment”, “a sense of social isolation” and “anxiety over being able to cope on one’s own”. Since women with breast cancer suffer side effects from treatment and also feel agitated and a sense of isolation, the core category was established as “agitation caused by painful symptoms and a reduced sense of control”. The following 6 categories of coping strategies were extracted：“rebuilding a lifestyle that comes to terms with my condition”, “coping while making changes to the road to progress”, “surrounding myself with supportive people”, “maintaining a feeling of conviction and keeping up my spirits”, “sustaining energy to avoid struggling” and “having a vision of the future and making preparations in advance”. Since the women adapt to distressful circumstances while gaining emotional support, the core category was established as “receiving emotional support and coping while altering the path to progress”.

Conclusions：Women with breast cancer who are receiving hormone therapy experience not only the side effects of treatment, but as survivors, they also experience distress caused by the agitation and sense of isolation derived from the process of adapting to their lifestyles and social environment. They cope with this distress by adapting and receiving emotional support.

Abstract

The purpose of this study was to clarify the extent of nurse involvement in cancer patients’ decision‒making about treatment, and the status of nursing practice. A self‒administered questionnaire survey was conducted among 930 nurses, with 767 responses and 666 valid responses. After descriptive statistics, a multiple logistic regression analysis was performed to examine the relationship between nurses’ involvement and their background. Differences in nursing practice for decision‒making support according to the type of hospital were analyzed using a one‒way analysis of variance. All analyses were performed using Statistical Package for the Social Sciences （SPSS） ver. 15.0, with a significance level of 5％ .

The survey results showed that 40.5％ of nurses answered that they could be involved in decision‒making about treatment. The results suggest that voluntary learning on decision‒making support and practical guidance by senior nurses according to the status of the hospital wards may lead to improvement of nurses’ awareness regarding decision‒making support and help to increase their self‒confidence. As for the status of nursing practice, it was revealed that patient‒nurse and nurse‒nurse interactions occurred to some extent, but physician‒nurse interactions were recorded less frequently. In addition, the mean scores for almost all items of nursing practice were significantly higher in prefectural core hospitals for cancer care than in regional core hospitals for cancer care and general hospitals, suggesting that the provision of information, guidance and support concerning cancer care and nursing by prefectural core hospitals for cancer care is necessary to improve nursing practice regarding decision‒making support in other hospitals.

Abstract

The present study aimed to clarify the aspects affecting employment continuation in male gastrointestinal cancer survivors undergoing outpatient chemotherapy. Using a qualitative descriptive approach, semi-structured interviews were conducted with 5 men continuing to work while undergoing outpatient chemotherapy for gastrointestinal cancer. Content relating to employment continuation was extracted from the interview transcripts and qualitatively and inductively analyzed, resulting in 8 categories and 21 subcategories derived from 86 codes. Aspects affecting employment continuation comprised ʻunderstanding and consideration from the workplaceʼ, ʻflexibility of work formatʼ, ʻtreatment location and contentʼ, ʻapproach to workʼ, ʻawareness of disease stabilityʼ, ʻsense of financial burdenʼ, ʻsupport from familyʼ, and ʻsupport from medical staffʼ. Understanding from company executives, superiors and colleagues affected desire to work, and the decision to undergo outpatient treatment facilitated the compatibility of everyday life and treatment. The cancer survivors reaffirmed their existence through the meaning provided by work, constructed coping methods unique to themselves and reconstructed a new lifestyle by switching to work that suited their physical condition while being aware of disease symptoms and adverse events associated with treatment. It was suggested that employment continuation in male cancer survivors was influenced by menʼs identity in Japan being strongly connected with their work ethic.

Abstract

Consultation of Certified Nurse Specialists in cancer is the introduction to their advanced practice, and it is an essential function requiring the spread of uniformly high‒quality cancer nursing. However, comprehension of the meaning of consultation in the nursing field is ambiguous. Therefore, concept analysis of “consultation of Certified Nurse Specialists in cancer” was conducted using the method of Walker ＆ Avant （2005） in order to promote the utilization, evaluation, and education of consultation. As a result, ‘Certified Nurse Specialists in cancer’, ‘General nurses’, ‘Issues of consultation’, ‘Process of relationship’ and ‘Outcomes’ were extracted as attributes, ‘Increasing complexity of life of cancer patients and their families’ and ‘Management system’ were extracted as antecedents, and ‘Improvement of system’ was extracted as a consequence. There is a need to recognize the existence of a gap among nurses in the use of the consultation concept and to explore the relationship of these attributes.

Abstract

The purpose of this study was to identify hope in patients with cancer through a life review and elucidate the influences on a patient of a life review. A researcher conducted four interviews of each patient using life review and analyzed the data using qualitative and inductive methods focused on hope.

It was identified that patients with cancer fostered hope all through their lives, and as they recalled to mind the past up to the present, they could think of the future. In other words, they could find ‘hope’ by undertaking a life review. And the worse their condition, the more limited was the future horizon that they could visualize. The influences of the life review were that patients deepened their understanding of themselves and attached new and different significance to various life events in the process of conducting a life review by talking with another person. It is suggested that the patients with cancer could maintain high levels of hope because they entrusted the future to their descendants or what they themselves had created.

Abstract

Aim of study : This study aimed to understand the awareness of outpatients regarding the influence on their daily life after total extirpation with reconstruction by retrosternal substitution of the esophagus.

Method of study : Semi-structured interviews were conducted with outpatients who had undergone radical surgery for esophageal cancer. The interview results were qualitatively and inductively analyzed. Before beginning research, approval of the Ethics Committee of the affiliated organization was obtained.

Subjects : Six male patients in their 50s, 60s or 70s were the subjects of the study. One was a stage 0 esophageal cancer patient, and the other five were stage I. 7 to 14 months had passed after surgery. Each patient was interviewed once for 41.5 minutes on average.

Interview analysis : The subjects’ awareness about the influence on their daily way of life after radical surgery is summarized in the following six items. 1. The feeling of being disturbed at finding it unexpectedly difficult to do things they had been able to do without difficultly before the surgery. 2. The need to make trial-and-error efforts to adapt to changes in diet, while having a recurring feeling of unease. 3. The need to make extra effort to adjust to postoperative life in order to carry on their normal life. 4. Withdrawal into themselves because they do not feel they have recuperated enough to go about their daily lives steadily and free from care. 5. The realization they have been recuperating as they gradually adapt themselves to gain weight and build their physical strength. 6. Belief that the surgery gave them a new lease on life, and determination to find a new way of life and reconcile themselves to their postoperative physical condition, without being impatient for quick recuperation.

Abstract

The purpose of this study is to clarify changes in the self‒concept of patients who underwent radical hysterectomy, comparing before they were affected by cancer and after the operation. Semi‒structured interviews were conducted with seven female patients who underwent radical hysterectomy and were receiving outpatient treatment, and qualitative content analysis was carried out on the data obtained. The patient’s self‒concept prior to being affected by cancer was classified into four upper categories：“a healthy self”, “a self who lives as she wishes”, “a self who lives as a female”, and “a self who fulfills her roles”. The self‒concept after operation was classified into four upper categories：“a self who feels painful about herself”, “a self who acquired a new way of living”, “a self who is aware of her femininity”, and “a self who lives in relationships with other people”. Changes in self‒concept by patients after the operation meant loss of self before being affected by cancer, acquisition of a new self, and changes in awareness of femininity.

Loss of self from before being affected by cancer was considered to relate to a decrease in reliance on the body due to disability of the sense of physical control, and acquisition of a new self was considered to relate to expansion of self‒recognition through painful experiences. Changes in awareness of femininity seemed to have been influenced by evaluation from other people. Based on the above, in order for a patient who underwent radical hysterectomy to see herself in a positive manner, assistance in reacquisition of the sense of physical control, expansion of self‒recognition and involvement to allow a patient to feel her femininity seems to be necessary.