Stress and nursing care needs of women with breast cancer during primary treatment: A qualitative study

doi:10.1016/j.ejon.2009.07.002

European Journal of Oncology Nursing

Volume 14, Issue 1, February 2010, Pages 11-16

https://doi.org/10.1016/j.ejon.2009.07.002 Get rights and content

Abstract

Purpose

The primary surgical therapy for breast cancer represents a special phase in the course of the disease. The aim of this study was to find out the specific strains influencing the women affected during this time, and the needs and expectations they had of the nurses.

Method

In a semistructured interview, 42 women at an early stage of breast cancer were asked about their strains and care needs.

Results

The results show that the women interviewed suffer more from psychological strains than physical ones, and express the wish for, above all, emotional support. Analysis of the interviews provides 4 categories of strains: immediate strains regarding the surgery, fear through uncertainty, change of self-perception and the strains caused by the social environment. Care needs can be divided into 3 main areas: wishes for (a) the relationship to the nurses, (b) professional competence and (c) the external conditions of care.

Conclusions

Nurses can support the women well by listening to them, accepting their emotions and informing them in detail. Therewith, they can convey a sense of security to the women and help them to maintain hope and the ability to deal with reality.

Introduction

The number of breast cancer cases has been increasing consistently in all countries of Western civilisation over the past years. Approximately 57 000 women contract breast cancer in Germany every year (Robert Koch-Institut, 2008). Surgical support predominantly takes place in nearly 200 nationally certified breast care centres. Increasingly, the women are supported by specialized nurses called Breast Care Nurses. However, the professional qualification of nurses is not uniformly regulated. In addition to this, nursing is exclusively connected to the inpatient treatment of the women. Close care throughout the entire course of the disease does not exist.

The fact of having contracted breast cancer causes various strains for the affected women and their families. The therapy starts shortly after diagnosis, when the affected women do not have an overview of the degree and the grasp of their disease. Often, initial therapy involves the excision of the tumour. This primary surgical therapy represents a considerable step in the course of the disease for women with breast cancer. The specific strains connected to this therapy in hospital are not clear yet. Research shows that next to medical therapy, psychosocial care is important, whereby the psychosocial support of the affected women has a positive effect on how they deal with their disease (Knobf, 2007, Saares and Suominen, 2005). Alongside their family members, it is above all the nurses who support and accompany the women during the period of inpatient treatment. Nevertheless, it is unclear which caring needs the women have during their time of inpatient primary care and what they expect of the nurses. Therefore, it is important for nurses to identify the specific strains of primary therapy and to know which expectations and requirements the patients have regarding care, in order to guarantee the best possible support.

Section snippets

Current state of research

According to research literature, the diagnosis of breast cancer causes, first and foremost, the fear of the disease spreading and death (Aach, 1999, Kaufmann and Ernst, 2000, Spencer et al., 1999). But also the uncertainty about the future and fear of long suffering or adverse effects by possible chemotherapy affects the women (Aach, 1999, Fridfinnsdottir, 1997, Kaufmann and Ernst, 2000). Additional insecurities are caused by possible genetic predisposition of family members (Schlich-Bakker

Research Question

The aim of these parts of a substantial, explorative survey about the situation of women with breast cancer in the stage of surgical primary therapy which is presented here consisted of the survey of specific strains and subjective supporting requirements of these women.

Therefore, the guiding research questions were:

Which expectations and requirements do breast cancer patients have of nursing support staff during their hospital stay?

What concerns breast cancer patients during their hospital

Design

A qualitative design was chosen because the research interest was on the subjective view of affected women. This allows an open approach which is less affected by normative concepts as might be the case with quantitative methods.

Participants

All in all, 42 afflicted women were interviewed. The average age of the interviewed women was 55 whereby the youngest patient was 33, the eldest 79 years old. 59.5% of the women had breast conserving therapy, whereas 40.5% were given a mastectomy. The participants

Strains

The women tested show various strains during their inpatient stay for primary breast surgery. Thereby, psychological strains as a consequence of their operation took up more time during the interviews than physical strains. Strains are subdivided into four categories: immediate strains concerned with the surgery, fear through uncertainty, change of self-perception and the strains caused by the social environment.

Needs

The patients' needs were expressed to nurses as wishes, positive expectations and value concepts. These include a multitude of factors, which can be categorised as wishes for the relationship with the nurse, the professional competence of the nurse and the external conditions of care.

Discussion

Many of the strains which affect women during the time of primary surgical therapy are connected with existential fears and uncertainty caused by information about the diagnosis. According to other surveys, the diagnosis of breast cancer and the following primary therapy is traumatic for every second woman. They react with intense fear, helplessness or horror (Cordova et al., 2001, Mehnert and Koch, 2007). Fear of metastases, death and chemotherapy as well as worries about family members and

Limitations of the study

The results of the study are restricted by some methodical bias. Patients who seemed to be mentally unstable, or where nurses had the feeling that patients would be overtaxed with an interview, were excluded from the survey. It is also possible that heavily burdened patients refused an interview right from the beginning. Furthermore, the specific interview situation in hospital might have influenced the answers of the interview partners during their inpatient treatment insofar that patients

Conclusion

The source of caring support by nurses is in knowing the patients' specific situations and needs. However, they are only able to provide this support if they have adequate information about the strains and needs of the patients. Therefore, the results of this study provide nurses with valuable insight into the subjective significant strains and needs of women with breast cancer. Care, orienting itself on the needs of the patients, not only calls for knowledge about the needs, but also requires

Conflict of interest statement

None declared.

Acknowledgement

Primarily, our thanks go to those women interviewed who were willing to communicate their thoughts and experiences. Furthermore, we are indebted to the nurses, the head of nursing and the doctors responsible for the participating breast care centres, for their support. The survey was financed by Deutsche Krebshilfe e.V.

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Stress and nursing care needs of women with breast cancer during primary treatment: A qualitative study

Abstract

Purpose

Method

Results

Conclusions

Introduction

Section snippets

Current state of research

Research Question

Design

Participants

Strains

Needs

Discussion

Limitations of the study

Conclusion

Conflict of interest statement

Acknowledgement

Seminars in Oncology Nursing

Patient Education and Counseling

Brustkrebs: die Not einer Krankheit als Herausforderung an Glaube und Krankenhausseelsorge

Patients' and nurses' experiences of the caring relationship in hospital: an aware striving for trust

Scandinavian Journal of Caring Sciences

Affected self-respect and self-value: the impact of breast cancer treatment on self-esteem and QoL

Psycho-Oncology

Needs as expressed by women after breast cancer surgery in the setting of a short hospital stay

Scandinavian Journal of Caring Sciences

Mastectomy, body image and therapeutic massage: a qualitative study of women's experience

Journal of Advanced Nursing

Change in need for psychosocial support for women with early stage breast cancer

Journal of Psychosocial Oncology

Social constraints, cognitive processing, and adjustment to breast cancer

Journal of Consulting and Clinical Psychology

Dimensions of cancer locus of control scale as predictors of psychological adjustment and survival in breast cancer patients

Psychological Reports

Subjektive Krankheitstheorien und Selbstregulation von Tumorpatienten

Zeitschrift für Medizinische Psychologie

Icelandic women's identifications of stressors and social support during the diagnostic phase of breast cancer

Journal of Advanced Nursing

Needs during hospitalization: definitions and descriptions made by patients

Nursing Ethics

Was Frauen mit Krebs erfahren, empfinden, wissen und vermissen

Deutsches Ärzteblatt