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A descriptive study was conducted to describe the quality of life among mastectomy patients receiving radiotherapy. There were 20 mastectomy patients receiving radiotherapy at Oncology Hospital of Peking Union Medical College, and the First, and the Second Teaching Hospital of Beijing Medical University, in Beijing according to the criteria. The instrument used for data collection was Quality of Life Index-Cancer Version (QLI-CV). Finding of the study revealed that the quality of life among mastectomy patients had changed a little during the course of radiotherapy. Within four domains,family domain received the highest satisfaction, while psychological/spiritual domain seeded to get the lowest satisfaction in this group of people. The findings of the study may provide the baseline knowledge for understand quality of life among mastectomy patients.

The fitting of soft breast prostheses is an essential nursing duty on breast cancer surgery wards, but it appears to be performed on an ad hoc basis, without evidence-based guidelines. A diagnosis of breast cancer carries enormous implications for the patient in terms of physical and psychological health. For this reason, it is vital that nurses respond sensitively to these needs and assist women to cope with the changes in body image. This includes ensuring that knowledge underpins practice when fitting the soft breast prosthesis. This article outlines a 12-point plan devised by the authors, giving guidance on how to fit temporary breast prostheses.

Although up to 90% of women who have had a mastectomy use breast prostheses, significant gaps exist around current breast prosthesis services for Australian women. These gaps include the timeliness and quality of information provision, the disparity in financial assistance, and the lack of knowledge regarding the determinants of what constitutes a "quality" breast prosthesis. Revised policy initiatives are central to addressing these gaps to ensure equitable access to quality breast prosthesis services.

This study was performed to describe women's satisfaction with body image before and 8 weeks after the surgical treatment of breast cancer compared with women without breast cancer. Additional aims were to describe women's perceived participation in decisions regarding choice of surgical procedure to treat their breast cancer, and postoperative satisfaction with their breast cancer treatment, as well as to explore factors influencing women's decisions regarding choice of surgical procedure. The design was prospective with a descriptive, comparative design. The convenience sample included 31 women with breast cancer from an urban breast health center, and 30 women without breast cancer from the community. The majority were college educated, white, ranging in age from 29-82 years. Women with breast cancer completed instruments before and 8 weeks after surgery. Women without breast cancer completed the instruments two times 8 weeks apart. Three instruments measuring body image satisfaction were used. Participation in treatment decision-making, having a treatment choice, and posttreatment satisfaction, along with a description of important factors in decision making, were measured with open and closed-ended questions. During the study period, women with breast cancer experienced a significant decrease in satisfaction with body image after surgery (p < .004). Satisfaction with body image remained constant in the women without breast cancer. Most (94%) of the women with breast cancer reported participating in treatment decisions about the type of surgical procedure used to treat their breast cancer, had a treatment choice (77%), and were moderately to very satisfied with the outcome of their surgeries (94%). Qualitative data results suggest that women's treatment decisions were based on their perceptions of "survival," that is, which type of surgery offered the best chance for long-term survival. These data suggest that satisfaction with body image is disturbed by surgery for breast cancer despite active participation in decisions regarding selection of treatment or postoperative satisfaction with type of surgical treatment received. These outcomes suggest that women need assistance in adjusting to alterations in body image from nurses and the need for research to describe effective interventions. Future studies of body image and breast cancer treatment should be conducted with larger samples, and at different points after surgery to determine the effects of mastectomy and breast-conserving surgery on the body image of breast cancer survivors over time.

Cancer and cancer therapies impair sexual health in a multitude of ways. The promotion of sexual health is therefore vital for preserving quality of life and is an integral part of total or holistic cancer management. Nursing, to provide holistic care, requires research that is meaningful to patients as well as the profession to develop educational and interventional studies to promote sexual health and coping. To obtain meaningful research data instruments that are reliable, valid, and pertinent to patients' needs are required. Several sexual functioning instruments were reviewed for this study and found to be lacking in either a conceptual foundation or psychometric validation. Without a defined conceptual framework, authors of the instruments must have made certain assumptions regarding what women undergoing cancer therapy experience and what they perceive as important. To check these assumptions before assessing women's sexuality after cancer therapies in a larger study, a pilot study was designed to compare what women experience and perceive as important regarding their sexuality with what is assessed in several currently available research instruments, using the focus group technique. Based on the focus group findings, current sexual functioning questionnaires may be lacking in pertinent areas of concern for women treated for breast or gynecologic malignancies. Better conceptual foundations may help future questionnaire design. Self-regulation theory may provide an acceptable conceptual framework from which to develop a sexual functioning questionnaire.

Women diagnosed with breast cancer have many physiological and psychological adjustments to make following mastectomy. The present study described in this article sought to determine the decision-making patterns used by two groups of women. Nurses need to be well informed and professionally confident to provide the individualized care and support deserved by women throughout the breast cancer trajectory. A major outcome of such professional care is confident women who understand their disease, treatments, and methods to manage stresses as they occur.

An anaesthetic nurse intervention was performed in order to evaluate the effects of extended preoperative information, given by anaesthetic nurses, on perioperative stress in patients operated on for breast cancer or total hip replacement (THR). Forty-six consecutive patients scheduled for surgery for breast cancer, and 55 for THR, were randomized into two groups which were given different modes of preoperative information. Patients in the control group were informed about pre- and postoperative routines by a ward nurse. Patients in the intervention group were given extended formalized information by an anaesthetic nurse. Wilcoxon rank sum test was used to show relations between variables. There were no significant differences between the intervention group and control group for patients with breast cancer or for patients with THR. Breast cancer patients in the intervention group were significantly more anxious than THR patients in the intervention group (P < 0.01). Breast cancer patients in the intervention group showed the highest anxiety scores on the Hospital Anxiety and Depression Scale (HADS) scale on the day of surgery. This information may reflect an increased level of anxiety due to the extended information given preoperatively. The information may thus have had a negative effect on breast cancer patients, resulting in an increased state of anxiety. The result indicates a need for individualized modes of information to provide a proper balance between enough and too much information.

Purpose/objectives: To identify and measure the information needs of the husbands of women newly diagnosed with breast cancer and to determine the extent to which these needs are being met., Design: Descriptive survey., Setting: Five surgical inpatient units at four urban hospitals in Winnipeg, Manitoba, Canada., Sample: 84 husbands of women recently diagnosed with breast cancer., Method: Subjects completed the Family Inventory of Needs--Husbands., Main Research Variables: Information needs and extent to which these needs were met., Findings: Husbands' highest ranked needs were those related to immediate care needs and communication issues. Their lowest ranked needs were those related to family relationship issues and their practical involvement in caring for their spouse. No differences existed between type of surgery (lumpectomy versus mastectomy) and number of needs and whether or not needs were met. However, husbands whose wives had undergone their first mastectomy reported approximately three times more unmet needs than husbands whose wives had undergone previous surgery for breast cancer. Husbands at greatest risk for not having their needs met were those whose occupational classification was listed as retired or laborers, those with less than a high school education, and those whose wives had only undergone one surgery for breast cancer., Conclusions: Results of this study provide a profile of the husbands' most and least important information needs and the degree to which these important needs were met., Implications for Nursing Practice: With a clearer idea of the type of information important to husbands of women with breast cancer, intervention studies to determine how to best address these information needs can be designed.

Purpose/objectives: To describe the mental and emotional impact of treatment for breast cancer with a focus on the ways the body is experienced., Design: Phenomenologic, descriptive, and interpretive., Setting: An outpatient treatment area of a comprehensive cancer center in the southwestern United States., Sample: 20 women, ages 20-68 (mean = 50 years), who had mastectomies (including both modified radical mastectomies and lumpectomies, with some having reconstruction) for breast cancer., Methods: Content analysis of verbatim transcriptions of open-ended interviews using hermeneutic phenomenology and descriptive and interpretive presentation of a paradigm case., Main Research Variables: Reaction to breast cancer and its treatment., Findings: Informants' descriptions demonstrate that the body can be viewed as having three aspects: (a) the body as symbol or social expression (i.e., how bodies make a social statement and tell others who you are); (b) the body as a way of being in the world, including sensations and symptoms such as nausea, fatigue, and pain; and (c) the existential sense that one needs a body to be in the world (i.e., the body expresses existence), which led to more awareness of the possibility of death., Conclusions: Women treated for breast cancer view their bodies in ways that go beyond what is suggested by the literature on body image and breast cancer, encompassing a wide range of responses., Implications for Nursing Practice: The contribution of this study is the documentation of the complexity of the meaning of "body" for women with breast cancer. Appropriate interventions differ for each aspect of the body: for the body as social symbol, programs such as Look Good ... Feel Better or image centers; for the body's sensations and symptoms, information about what to expect and about symptom prevention and management; for the existential body, active listening to fears and concerns and providing assistance as needed.

Purpose/objectives: To describe women's perspectives on factors that influenced their decision to have reconstructive surgery after a breast cancer diagnosis., Design: Exploratory, descriptive, qualitative study., Setting: A comprehensive cancer center in an urban setting., Sample: Eleven women who underwent mastectomy and reconstruction. Six participants had autologous transverse rectus abdominis musculocutaneous-flap reconstruction, four had saline implants, and one had a silicone implant. All but one reconstruction was performed at the time of mastectomy., Methods: Open-ended, face-to-face interviews using an interview guide were conducted within one month of reconstruction. One to two follow-up interviews were conducted approximately six months later., Main Research Variables: Decision making about reconstruction, perceptions of information needs and sources, sources of support, and factors important to decision making., Findings: The main theme identified was Getting My Life Back. The participants described this in terms of the themes of Information Seeking, Talking It Over, and Seeking Normality. The interactive skills of the healthcare provider played an important role in the women's decision making., Conclusions: Reconstruction minimized the negative consequences of breast cancer and its treatment for the women in the study. The decision-making process was aimed at getting the person's life back as close to what it was before the diagnosis as possible or improving it. The three themes of decision making are interactive in nature, with participants returning to information Seeking and Talking It Over as necessary to increasing their understanding and clarifying their "normality goals.", Implications for Nursing Practice: Healthcare professionals should determine how a woman wants to participate in decision making as well as the kind, amount, and sources of information the individual with breast cancer wants to have to make her decisions. Healthcare providers are key sources of information about treatment options, and they are critical to patient satisfaction with the decision-making process and with the final results of the surgical procedure. Family members, friends, and other women with breast cancer play a crucial role in talking it over.

During this study the use of a nurse-developed, patient-oriented critical pathway and its effects on two indicators of cost were analyzed at St. John Hospital and Medical Center in Detroit, Michigan. Financial data for 64 mastectomy cases were tracked and analyzed. Findings showed improved length of stay with substantial decreases in cost per case.

A medical center's nursing units were asked to develop care maps for s elected DRGs, with the goal of improving the level of patient care, reducing cost, and curtailing length of stay. However, none of the efforts provided a tangible way to measure the results. After a comprehensive study effort, the medical team decided that the missing element was better management of the emotional aspects of care.

This paper, the second in our four-part series on sexuality and patient care, discusses how people's sexuality is affected by illness and how nurses can help.

A therapeutic nurse-patient relationship is based upon the effective management of professional practice boundaries. Boundary violations may be difficult to detect and manage because they often are subtle and driven by one's own needs. Early detection and response is critical to preventing boundary relaxation and violation. Self-assessment is an important aspect of boundary management. Identification of vulnerability to boundary violation may assist the nurse in determining the need for supervision or consultation.

As a consequence of mastectomy, women may experience disruptions in four domains of life: the physical, the psychological, the social, and the spiritual. Mastectomy trauma syndrome refers to these lifestyle disruptions. This ethnographic research study explores the major lifestyle disruptions associated with mastectomy. Holistic concepts and strategies are suggested to assist postmastectomy women toward self-actualization.

Narrative storytelling is a means by which knowledge embedded in nursing practice is uncovered and examined. Benner uses this method to study and explore skill acquisition and experience-based knowledge in nursing practice. By sharing these stories, knowledge that is unique to the experienced clinician is preserved and extended. The narrative presented here describes the expert coaching, discretionary judgment, and skilled involvement in the care of a patient in the PACU.

The purpose of this study was to determine the relationship between uncertainty and anxiety in women after mastectomy for breast cancer and to describe women's responses to partial or complete mastectomy for breast cancer during the early rehabilitative phase after surgery. A theoretical framework for the study was derived from the Scott, Oberst, and Dropkin Stress-Coping Model and from a review of the literature. Major study variables and variable measures were uncertainty, measured by the Mishel Uncertainty in Illness Scale (MUIS), and anxiety, measured by the State-Trait Anxiety Inventory (STAI). Twenty-five women admitted to two acute-care teaching hospitals for their first partial or modified radical mastectomy made up the convenience sample of this study. Data were collected 1-2 days before and 1-2 weeks after hospital discharge. From study findings, it was shown that only at the postdischarge testing was there a significant positive correlation between uncertainty and state anxiety. The development of appropriate interventions to assist breast cancer patients in dealing with the fears of recurrence and uncertainties regarding treatment effectiveness and sequelae has relevance for nursing practice.