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In palliative care between 13.9 and 25 percent of all patients suffering from cancer show signs of anxiety disorders. Up to 75 percent of these patients suffer from non-pathologic anxiety, which has a negative impact on the patients' quality of life. Therefore it is important to provide interventions that are able to reduce anxiety of cancer patients. Massage and music therapy are effective interventions for minimizing anxiety of cancer patients in palliative care. An empathic attitude of the nurse increases the effect of the mentioned interventions. While there is evidence of the interventions mentioned it is yet necessary to further explore these in additional clinical trials to consolidate the already existing results.

This article reports the second part of a comprehensive study examining patient satisfaction with nursing care in ambulatory patients of a Swiss emergency department. A descriptive cross-sectional study examined patient satisfaction, using a revised version of the questionnaire <> in a convenience sample of 114 patients. The occurrence and intensity of anxiety, insecurity, worry, pain, dyspnoea, nausea, thirst and hunger, and their correlation with patient satisfaction were analyzed. The patients also reported if effective nursing interventions were carried out. Patients suffered from the following states or symptoms: Pain (70%), thirst (45%), insecurity (44%), anxiety (38%), hunger (25%), and nausea (12%). Despite the occurrence of these states or symptoms, not all patients reported receiving effective nursing interventions. Dyspnoea and pain were detected well by nurses and patients received effective nursing interventions. Anxiety, insecurity, nausea, thirst and hunger were not detected well by nurses; and patients often evaluated the nursing interventions they received as ineffective. These results were analyzed and compared with the findings measured by the instrument "Patient satisfaction with nursing care" applying correlations and ANOVA. Patients who suffered from the states or symptoms described above and reported receiving ineffective nursing interventions showed significantly lower patient satisfaction scores than patients not suffering from these states or symptoms. Statistically significant correlations were found between worry, pain, anxiety and patient satisfaction. The results of both studies (part 1+2) (Müller-Staub, Meer, Briner, Probst & Needham, 2008) are discussed, conclusions drawn and implications for practice and research presented.

In-patient hospital stays and primary breast cancer operations put a strain on the affected women, about which little is known to date. In order to gain a better understanding of this stress situation, 42 primary operated breast cancer patients were surveyed in qualitative interviews during their in-patient hospital stay. Besides suffering from existential anxieties and uncertainties, typical stresses for the perioperative area are the fear of the anaesthesia and operation, the uncertainty felt while waiting for the histological findings, the first change of dressing and the fitting of a prothesis as well as post-operative physical ailments. The area of psychological strain by far exceeds that of physical strain. For this reason, professional care in the perioperative senological area should include the qualified psychosocial support of the affected women, in addition to their classic physical care.

The findings illustrated in this article, are part of a larger research project funded/financed by the Deutsche Krebshilfe e.V., with the aim of gaining understanding of the stresses and strains, coping strategies and needs of women suffering from breast cancer during their surgical primary treatment. Breast cancer leads to a variety of burden for women and their families. To cope with the disease women use different strategies. External assessment and self-assessment of burden and coping sometimes result in different outcomes, such as experts overestimating their patients' fear or depression or uncovering coping strategies oblivious to the interviewees. Qualitative interviews with twelve nurses in three Northern German hospitals were conducted. The content analysis of the interviews followed Mayring's approach. Uncertainty and anxiety are common characteristics for the affected women. The observed strategies can be classified into five categories: to deny the disease, to withdraw from others, to communicate, to comprehend the disease, to accept the disease. Coping strategies such as withdrawal and denial present a challenge to the nurses' communication behaviour. The findings of the survey at hand indicate a demand for suitable care interventions, further education, and training for professionals nursing women with breast cancer. Scientifically supported nursing concepts and specialised nurses are expected to comply with the affected women's special requirements.

Unlabelled: Fatigue is recognised as one of the most frequent and distressing symptoms of patients with cancer. Whilst causal relationships mainly remain unclear, researchers meanwhile acknowledge its multidimensional nature. Causes and manifestations are complex and multifaceted and therefore, measurement in the past has been difficult. In recent years, some instruments have been developed in the English language. It is the aim of this article to describe the development of a new fatigue measurement instrument in the German language, the Fatigue Assessment Questionnaire. The following steps are described: 1. Concept analysis, 2. Identification of measurement criteria, 3. Comparison of these criteria with those described in the literature available, 4. Construction of a measurement scale, 5. Testing the new instrument, 6. Use of the instrument in a large study population. Steps 5 and 6 primarily deal with validity and reliability testing while step 6 also tests the hypothesis that patients with some types and stages of cancer suffer more from distressing fatigue than patients with other types and stages., Conclusion: Validity of the measurement items in the Fatigue Assessment Questionnaire was supported by the fact that they were derived from qualitative interviews with cancer patients. The first test with 77 cancer patients and 77 healthy individuals led to small adaptations and the following study, including 592 cancer patients, supported the reliability and validity of the Fatigue Assessment Questionnaire. It was able to distinguish between different populations. Factor analyses supported the earlier generated model of physical, affective and cognitive fatigue. Internal consistency of the questionnaire was supported by the Alpha Coefficient 0.90 (Cronbach). A difference was found in physical tiredness for patients with different types of cancer (p = 0.008) but this was not the case for affective and cognitive tiredness. More fatigue feelings were experienced by cancer patients with advanced disease than by patients in remission and this was true for physical fatigue (p = 0.0001), affective fatigue (p = 0.01), cognitive fatigue (p = 0.02) as well as for fatigue intensity (p = 0.0001) and distress (p = 0.0001). This group of patients also experienced significantly higher levels of depression and anxiety (p = 0.0001). The Fatigue Assessment Questionnaire, developed in the German speaking part of Switzerland, can be used for further activities in the field of quality of life and nursing care in oncology. The instrument and a proposed scoring system are published as an addendum to this article.