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Competing Interests: The authors have no conflicts of interest to disclose.

Background & Problems: When patients with breast cancer undergo radical mastectomy, seromas are often caused due to the large area of excised breast tissue and the resulting cavity that fills with blood and water. Therefore, strong adhesive elastic tape and large amounts of gauze are needed to compress the wound. Our clinical experience shows that repeatedly removing dressings during dressing changes significantly increases the risk of unexpected skin defects. However, the increased duration of hospital stays required for these patients with skin defects exposes them to high risk environments, which may result in nosocomial infections and even longer hospitalization durations., Purpose: This project aimed to decrease the incidence of unexpected skin defects in patients after mastectomy to below 15%., Resolution: After a review of the literature, we implemented this project to: (1) build up a standard operating procedure for post-mastectomy wound compression; (2) use narrow girdles instead of strong adhesive elastic tape; (3) use soft elastic bandages to replace the single layer of gauze for wound compression; (4) use a skin examination form as a continuous monitoring tool. We expected that these measurements would effectively decrease the incidence of unexpected skin defects in post-mastectomy patients., Results: After implementing this project, the incidence of unexpected skin defects in post-mastectomy patients decreased from 100% to 13% and the time required by clinical nursing staff to perform wound dressing care decreased from 25 mins to 15 mins per care instance., Conclusions: We hope that this project helps effectively improve postoperative wound care quality in post-mastectomy patients and decreases the time spent by clinical nursing staff on wound dressing care.

Evidence to support the argument that general anesthesia (GA) with paravertebral block (PVB) provides better pain relief for mastectomy patients than GA alone is contradictory. The aim of this study was to explore pain and analgesia after mastectomy with or without PVB during acute inpatient recovery. A retrospective study was conducted in a single hospital providing specialist cancer services in metropolitan Melbourne, Australia. We explored pain and concomitant analgesic administration in 80 consecutive women recovering from mastectomy who underwent GA with (n = 40) or without (n = 40) PVB. A pain management index (PMI) was derived to illustrate the efficacy of management from day of surgery (DOS) to postoperative day (POD) 3. Patients who reported no pain progressively increased from DOS (n = 12, 15%) to POD 3 (n = 54, 67.5%). Most patients were administered analgesics as a combination of acetaminophen and a strong opioid on DOS (n = 53, 66.2%), POD 1 (n = 45, 56.2%), POD 2 (n = 33, 41.2%), and POD 3 (n = 21, 26.2%). Less than 6% of patients on any POD were administered multimodal anlagesics. PMI scores indicate some pain in the context of receiving weak and strong opioids for GA patients and more frequent use of nonopioid analgesics in PVB patients during recovery. These findings highlight the need for data describing patterns of analgesic administration in addition to reports of postoperative pain to determine the most effective means of avoiding postoperative pain in patients who require mastectomy., (Copyright © 2017 American Society for Pain Management Nursing. All rights reserved.)

Objectives: To review immediate and delayed breast reconstructive options following surgery for high-risk or cancer-related unilateral or bilateral mastectomy and examine restorative interventions to promote a positive body image and long-term survivorship., Data Sources: Review of PubMed, Scopus, and Cochran Review., Conclusion: For women facing mastectomy, a consultation with a plastic/reconstructive surgeon is a first step toward recovery with restoration of a missing body part. Nursing interventions are integral to physical and psychosocial healing., Implications for Nursing Practice: An understanding of the reconstructive process can be beneficial in the care of women facing and recovering from a mastectomy. Psychological and physical issues occur whether the woman is undergoing bilateral prophylactic mastectomies for a high-risk condition or mastectomy as treatment for a malignant tumor., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: To describe the local control of breast cancer, including initial biopsy, lumpectomy or mastectomy, and sentinel node biopsy or axillary node dissection, and to discuss the role of radiation therapy following lumpectomy or mastectomy in advanced cancer., Data Sources: PubMed, Scopus, Cochran., Conclusion: The local treatment of breast cancer is an essential component of primary breast cancer treatment. Residual cancer cells may increase the risk of recurrent ipsilateral disease., Implications for Nursing Practice: Nurses and advanced practice nurses who provide care for cancer survivors should possess the skills to patiently teach information, empathetically understand the flagrant or suppressed emotional turmoil, explain the full complement of treatment options, appreciate the rationale behind choices made, and help patients navigate the educational and decisional byways., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This case study used cognitive therapy to improve the life quality of a 46-year-old woman with chronic schizophrenia who had undergone a mastectomy for breast cancer. This case had suffered from schizophrenia for over 24 years and was hospitalized in the chronic ward of our hospital. Breast cancer was revealed during an annual comprehensive physical checkup. In May 2012, this case received a right mastectomy at a local hospital. After the surgery, she was readmitted to the psychiatric acute ward for further care from May 30th to August 28th, 2012. A holistic nursing assessment was conducted that addressed five major aspects. The major nursing problems found during hospitalization were: acute pain, body image disturbance, and low self-esteem. A decline in pain score from 10 to 4 was achieved by developing rapport with the patient, empathizing with her distress, and providing active care to the wound. Her body image changed because of loosing her breast. Her acceptance of the loss improved through helping her to explore her feelings of change. To improve her self-esteem, we offered cognitive therapy to change her negative thinking process. She became more sanguine and cheerful. Moreover, her dependence in terms of activities of daily living decreased. This individualized intervention contributed to the recovery of a post-mastectomy, schizophrenic patient from low self-esteem.

Purpose/objectives: To describe the experience of female patients living with breast cancer-related lymphedema (BCRL) to gain a comprehensive understanding of this experience. The review is designed as a qualitative meta-synthesis., Data Sources: Electronic searches were conducted in MEDLINE®, CINAHL®, EMBASE, PsycINFO, and Social Sciences Citation Index. Articles were included where researchers used qualitative research methods and when a comprehensive description of methods and the study's findings were provided., Data Synthesis: From 2,185 references, 13 articles were included. A total of 94 author and participant aggregations were extracted, qualitatively assessed, and assigned to one of 14 categories. Four themes relating to the experience of living with BCRL were identified: experience of everyday life, energy sapping, personal empowerment, and contribution of others., Conclusions: Requirements of living with BCRL may only be influenced to a limited extent by the women themselves. They struggle with their situation, appearance, and the concomitant uncertainties. They feel strengthened where they succeed in developing a helpful view of their situation and where support structures are available to them., Implications for Nursing: Professionals can employ this meta-synthesis by contextualizing it as part of a process of critical reflection on their own endeavors to meet the requirements of women living with BCRL.

Background: An integral part of the recovery process after mastectomy involves the consideration of restorative options, including external prosthesis use; however, only few studies regarding the influence of breast prostheses on functional status have been done., Objective: This study aimed to determine whether wearing an external breast prosthesis affects gait in women after a mastectomy., Methods: Spatiotemporal gait parameters were collected in 40 women, postmastectomy, aged 37 to 70 years, divided into age subgroups of 37 to 54 years and 55 to 70 years, and in 38 healthy controls, women aged 38 to 69 years. Gait parameters were assessed with and without the breast prosthesis, including walking velocity, cadence, step length, step time, and left-right step time asymmetry., Results: Significant differences were found in the gait parameters of the younger age group with and without a prosthesis. No significant differences were found in the women of the older group with and without the prosthesis., Conclusion: Gait parameters of the younger age group were closer to those of the healthy control group when they were wearing an external prosthesis, as compared with when they were not. This suggests a positive influence of breast prosthesis use on the functional status of women after mastectomy., Implications for Practice: Clinical practitioners should be aware of the study results suggesting a positive influence of breast prosthesis use on gait parameters after mastectomy surgery, which could improve the patient's functional status after surgery; however, further research is still needed on factors affecting changes in gait with a larger study population.

Background: Despite the fact that breast cancer is the most prevalent cancer among Jordanian women, practically nothing is known about their perceptions of early-stage breast cancer and surgical treatment., Objective: The objective of this study was to gain understanding of the diagnosis and surgical treatment experience of Jordanian women with a diagnosis of early-stage breast cancer., Methods: An interpretive phenomenological approach was used for this study. A purposive sample of 28 Jordanian women who were surgically treated for early-stage breast cancer within 6 months of the interview was recruited. Data were collected using individual interviews and analyzed using Heideggerian hermeneutical methodology., Results: Fear had a profound effect on Jordanian women's stories of diagnosis and surgical treatment of early-stage breast cancer. Women's experience with breast cancer and its treatment was shaped by their preexisting fear of breast cancer, the disparity in the quality of care at various healthcare institutions, and sociodemographic factors (eg, education, age)., Conclusions: Early after the diagnosis, fear was very strong, and women lost perspective of the fact that this disease was treatable and potentially curable. To control their fears, women unconditionally trusted God, the healthcare system, surgeons, family, friends, and/or neighbors and often accepted treatment offered by their surgeons without questioning., Implications for Practice: Jordanian healthcare providers have a responsibility to listen to their patients, explore meanings they ascribe to their illness, and provide women with proper education and the support necessary to help them cope with their illness.

Aims and Objectives: This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown., Background: Surgical removal of the breast may lead to activity limitation, self-image issues, discomfort and later complication of lymphoedema. Design.  This study used experimental and longitudinal design., Methods: One hundred and forty-five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty-six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2-way anovas were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p-values are two sided. All statistical analyses were performed using sas 9.2 for Windows., Results: The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge., Conclusions: Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients., (© 2012 Blackwell Publishing Ltd.)

When it is our turn as a home healthcare nurse to be a patient, it is gratifying to know that home healthcare is as wonderful as we say it is.

For women of all ages, a mastectomy can affect their body image and femininity. Poor management, both physical and emotional, of a breast removal, can have major consequences on a patient's intimate, family and social life. In the framework of the multi-disciplinary treatment of breast cancer, a team in Lyon carried out a study on the impact of including socio-aesthetic practices in the overall care.

Unlabelled: Breast cancer is the most common type of cancer among women. In Sweden, about 40% of women diagnosed with breast cancer undergo a mastectomy; breast reconstruction (BR) may be an option for these women. However, the experience of undergoing reconstructive surgery appears to be only very scarcely researched, despite its importance in clinical nursing., Aim: The purpose of this study was to explore women's experiences of undergoing breast reconstructive surgery after mastectomy due to breast cancer., Methods: Six women participated in narrative interviews about their experiences of reconstructive surgery, and the interview data were analysed using thematic narrative analysis., Results: All six women were unprepared for the strenuous experience of undergoing a BR. They described the process as difficult and painful, entailing several operations and an unexpectedly long recovery period. They were also unprepared for how arduous it would be, both physically and emotionally. However, getting a BR had been important to all the women. The BR process was captured in four themes: (1) uninformed care; (2) arduous experiences; (3) body alterations; and (4) moving on., Conclusions: Obtaining adequate information and being involved in the decision-making process along the pathway of a BR could help the women to prepare physically and emotionally for the strenuous experiences related to reconstructive surgery., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Purpose/objectives: To describe the experience of viewing oneself in a mirror following a mastectomy., Research Approach: Ricoeur's hermeneutic phenomenology., Setting: Three hospitals in a nonprofit healthcare system in the southwestern United States., Participants: Purposive sample of 12 women 3-12 months postmastectomy., Methodologic Approach: Structural analysis and phenomenologic interpretation of tape-recorded interviews., Main Research Variables: Viewing oneself in the mirror after a mastectomy., Findings: Viewing or not viewing one's own body, energizing and dispiriting thoughts, and supportive and unsupportive others helped to explain the experience of women who have had a mastectomy. The phenomenologic interpretation yielded four themes: I am, I decide, I see, and I consent., Conclusions: The current study offers an understanding of the multifaceted experience of women postmastectomy. Mirrors appear to be essential in viewing and caring for the mastectomy site., Interpretation: Nurses should consider discussing the mirror experience with women who are having a mastectomy pre- and postoperatively. Nurses also may choose to offer a mirror to their patients when doing the initial dressing change and teaching wound care. Educational materials are needed for patients and nurses. In addition, future research is warranted on the use of mirrors when caring for patients who have had a mastectomy.

Service-user involvement is a growing aspiration for health professionals and those involved in nursing education. This article describes one approach to integrating theory and practice through service-user involvement in a teaching setting. Gwen Carter, a student nurse, tells her story of becoming a patient and how reflecting on this experience affected her approach to patient care. By sharing her experience with peers and mentors, she was able to influence their approach to care, and made a difference to how mentors worked with students in practice.

The authors report their experience as teacher-nurse for years in oncologic hospital with the aim of enabling reflection on the development of nursing therapeutic communication at the hospital preoperative unit for mastectomized women. It was found that the practice of therapeutic communication becomes a favorable practice, because establish the nurse-patient relationship, with patient producing his own care. Understanding the fragility of the patient at this stage, the nurse takes commitment to predefine the nursing care in partnership, in order to meet the patient needs, aiming to, mainly, the autonomy of care. In this way, the authors present a proposal for nursing managed care based on a mutual relationship, human and participatory care.

Purpose/objectives: To describe whether levels of health-related quality of life (HRQOL) differ by sociodemographic characteristics and time since breast cancer diagnosis in women in Korea., Design: A descriptive, cross-sectional study of women with breast cancer., Setting: An outpatient clinic of one large hospital in Seoul, Republic of Korea., Sample: A convenience sample of 244 women with breast cancer after mastectomy., Methods: Study participants completed sociodemographic characteristics and HRQOL questionnaires. Medical charts were reviewed to determine time since breast cancer diagnosis., Main Research Variables: Sociodemographic characteristics (age, marital status, employment status, education, monthly household income, and religion), time since diagnosis, and HRQOL., Findings: The psychological well-being domain scored the lowest among domains of HRQOL. Women who are younger, married, unemployed, highly educated, or religious, with higher monthly household income or with greater than one year elapsed time since diagnosis, had higher HRQOL., Conclusions: Study findings will be useful to establish priorities in planning nursing interventions to enhance HRQOL in care of women with breast cancer., Implications for Nursing: Nursing interventions can be provided to Korean women with breast cancer who are not religious, who are older, single or widowed, or employed, with lower education level, with lower monthly household income, or with one year or less elapsed time since breast cancer diagnosis.

This evaluation research focused on methods for improving simulation instruction by determining if students' knowledge about simulation subject matter improved and was retained following a simulation experience. Using a pretest/posttest approach, NCLEX-style questions pertaining to the simulation subject matter content were administered to nursing students from two prelicensure nursing courses immediately preceding the simulation, immediately following the simulation, and then again at their final examinations. These findings have helped faculty determine when their simulation instruction is effective and have provided a guide for revising their simulation teaching. While this pretest/posttest method offers insight into student learning outcomes, it perhaps more importantly creates a systematic approach for evaluating simulation instruction.

The goal was to understand the nurse/patient communication process, emphasizing nursing care to mastectomized women. Symbolic Interactionism and Grounded Theory were used to interview eight nurses from a referral institution in cancer treatment, using the guiding question: how do nurses perceive their communication process with mastectomized women? Data analysis allowed for the creation of a central theory: the meaning of communication in nursing care to women, constituted by three distinct but inter-related phenomena: perceiving communication, the relationship nurse/mastectomized woman and rethinking the communication nurse/mastectomized woman. With a view to satisfactory communication, professionals need to get involved and believe that their presence is as important as the performance of technical procedures that relieve situations of stress.

"You have breast cancer" may be some of the most devastating words a woman may hear. Breast cancer is the most common cancer among women and the second leading cause of cancer death in women behind lung cancer in the United States (). According to ACS, more than 180,000 U.S. women will be diagnosed with breast cancer in 2008 and more than 40,000 will die from this disease. Although the incidence of breast cancer has increased, death rates are on the decline due to early detection and improved treatments ().

Purpose/objectives: To explore the pretreatment thoughts and behaviors of women newly diagnosed with breast cancer regarding their surgical treatment decision-making experience., Research Approach: Qualitative, descriptive., Setting: A multispecialty breast center in the midwestern region of the United States., Participants: 18 English-speaking women, aged 37-87 years, mean of 12 days postdiagnosis of clinical stage 0-11 breast cancer., Methodologic Approach: Open to semistructured interviews were conducted during the period following surgical consultation but prior to surgical treatment. Transcribed interviews, originally analyzed to identify the psychological processes of women in response to breast cancer diagnosis, were additionally analyzed using directed content analysis focusing on women's thoughts and behaviors related to their surgical treatment decision-making process., Main Research Variables: Breast cancer surgery and decision making pretreatment., Findings: Women's pretreatment thoughts and behaviors related to surgical treatment decision making were characterized by information processing, contemplating options, and interacting with others. Breast cancer information was used by women before the surgical consultation and after treatment decisions had been made. Treatment options were contemplated and preferences formed often before the initial surgical consultation. Women associated having options with a better prognosis. Age was a factor primarily in the type of information women desired., Conclusions: Most women made their own surgical treatment decisions with ease, supported by the confidence instilled by their surgeons and oncology nurses., Interpretation: The findings provide oncology nurses with insight regarding women's desire for and use of information and their contemplation of surgical options, therefore suggesting areas on which to focus clinical assessment and to test tailored interventions.

Breast cancer is the most common cancer in women in the United States, and the second leading cause of cancer death in women after lung cancer. In 2008, about 182,460 women were expected to be diagnosed with either invasive or noninvasive breast cancer. Because most breast cancers are diagnosed at an early stage, thanks to the success of mammography screening, many women have several treatment options. Breast conserving surgery (a lumpectomy or partial mastectomy followed by radiation therapy or chemotherapy) is the most common local treatment for breast cancer. However, mastectomy, which involves removal of all the breast tissue, is still performed in some situations; for example, if the tumor is 5 cm or larger, if the tumor is large compared with breast size and a lumpectomy would result in a poor cosmetic outcome, if clear margins couldn't be obtained with a reexcision of a lumpectomy site, or if the procedure is being done for breast cancer risk reduction. A woman undergoing mastectomy will need more nursing care than one undergoing lumpectomy, as well as extra emotional support and extensive patient education about postoperative care. Let's look at what you'll need to know.

Aim: The purpose of this study was to examine the incidence of lymphoedema and to identify risk factors of lymphoedema in patients with breast cancer undergoing mastectomy in Korea., Background: Lymphoedema is a serious problem for many breast cancer survivors. Although the potential impact of lymphoedema is extensive, it is largely unrecognised., Methods: Women with breast cancer (n = 450) receiving mastectomy were recruited from outpatient breast cancer clinics of two university hospitals in Seoul, Korea from October 2004 to May 2005. Lymphoedema was defined by circumferential measurement. This study examined the risk factors associated with lymphoedema through the literature review. A descriptive design was used for this study and data were collected using structured questionnaire. Data were analysed by chi-square test and multiple logistic regression., Results: Among the 450 cases of breast cancer, 24.9% had developed lymphoedema. There were significantly increased risks of lymphoedema if women were with higher staging, had modified radical mastectomy, had axillary lymph node dissection, received axillary radiotherapy and were with body mass index greater than 25 kg/m(2). A significantly decreased risk of lymphoedema was found in women who exercised regularly, received pretreatment education of lymphoedema and had performed preventive self-care activities., Conclusions: Lymphoedema is recognised as an unpleasant and uncomfortable consequence of breast cancer-related treatment. Patients should be advised of the risk of lymphoedema and educated to detect its symptoms. Relevance to clinical practice. It is of importance to recognise breast cancer patients at risk for lymphoedema. Nurses should inform patients with breast cancer about their risk for lymphoedema and guidelines to reduce the risk and to emphasise self-care activities for prevention.

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.

Many factors may interfere with the ability of women newly diagnosed with breast cancer to cope with treatment. Nurses should be aware of patients' needs during this critical time. The purpose of this study was to identify the educational needs and concerns of newly diagnosed patients with breast cancer after surgery. A phone interview with patients was conducted approximately one week after breast cancer surgery. A convenience sample of 200 patients was recruited from four hospitals within a large midwestern healthcare system. The subjects were interviewed by breast health specialists and navigators involved in their education and support and were asked to participate in a short interview during a surgical follow-up phone call. Study results indicate that fear of recurrence and anxiety regarding postoperative treatments accounted for more than 65% of the responses to the question "What concerns you most about your new diagnosis?" Emotional, social, and physical limitations were identified as most important in dealing with a breast cancer diagnosis. As breast health specialists and navigators, nurses can improve the quality of care for women with breast cancer and their families by providing additional support services and post-treatment information during the initial education and follow-up call.

Little is known both about how women suffering from breast cancer cope with their illness in the perioperative phase and about the ability of nurses to assess this. By means of the self-rating and external rating versions respectively of the Bernese Coping Modes (BEFO), it was determined how breast cancer patients cope with their illness during primary surgical therapy. External rating was carried out by the nurses and two researchers. The nurses' rating based on their daily care experiences, and the researcher's rating based on a half-standardized interview. Participants were given the BEFO self-rating questionnaire. As with the patients themselves, the nurses and team members rated attention and care (H(A) 90,5-100%), tackling (H(A) 66,7-100%), passive co-operation (H(A) 59,5-100%) and acceptance/stoicism (H(A) 64,3-97,6%) as the strongest forms of coping. In ranking order of coping modes the researchers rated dissimulation and isolation/suppression and the nurses rated altruism much higher than the patients themselves. Several forms of coping revealed a clear dependence on age. The discrepancy between the ranking order of the nurses' rating versions and the patients' self-ratings were discussed on the basis of empirical findings on communication events between nurses and patients.

The aim of this study is to explore the subjective care needs, specially directed at nurses, of women with breast cancer during primary surgical therapy. Investigations have revealed that psychosocial support of affected women can have a positive effect on how they cope with the disease and on the course of the disease. Guideline-aided qualitative interviews with 42 affected women were conducted for the study. Data analysis was performed according to the criteria of an embracing content analysis. The needs of those women interviewed concern three levels: the emotional level encompassing the aspects of nurturance, emotional support and communication in line with patients' needs, the problem level, in which reliable and professionelly correct care is important, and the organisational level, which stands for a patient-friendly organisational culture. Patients' expectations and needs toward nurses are varied, encompassing a wide spectrum of professional nursing care.

Purpose: To determine whether the Papilla Gown designed specifically to meet the needs of postmastectomy patients with a closed drainage system in place is more comfortable than is a typical hospital gown., Background: The closed wound drainage system used for breast cancer patients immediately following mastectomy requires external drainage tubes that connect to a pouch. The pins that are usually used to attach the drains to a patient's gown create problems. The Papilla Gown (Papilla is the Latin term for breast) was designed with safety pouches for supporting the drains., Methods: A convenience sample of 13 postmastectomy patients participated in this preliminary study of the gown's use. Participants were taught how to properly wear the typical hospital gown and Papilla Gown before surgery. Patients were discharged with the gowns and two questionnaires that were to be returned approximately 1 week following surgery. Thirteen of the 38 (34%) who agreed to participate submitted usable forms. The Wilcoxon signed-ranks test was used for comparing the comfort scores of the Papilla with the hospital gown., Findings: Participants reported significantly higher scores (p<.003) for the Papilla Gown on all of Comfort Questionnaire's 10 items, except one (p=.337) related to fear of pulling out the drainage tubes. Specifically, patients felt more comfortable about their appearance in the gowns, their ability to move, and the support of the drainage tubes., Conclusion: The newly designed Papilla Gown shows promise for meeting the purpose of increasing the comfort of postmastectomy patients with closed drainage systems., Clinical Relevance: The Papilla Gown was designed to address the comfort, mobility, and body image issues that patients face during the first week following a mastectomy, when they are dealing with such issues as the cancer diagnosis, loss of a breast, and managing drainage tubes. Preliminary results show that nurses can improve patient satisfaction by providing clothing that is comfortable, attractive, and supports the drainage system in place during this critical time.

A study to evaluate the effectiveness of a planned teaching programme on rehabilitation of cancer breast patients after mastectomy in terms of knowledge and expressed practices of nursing personnel working in a selected hospital of Delhi.

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.

Discussions with student nurses when they have been on placement on the breast cancer surgery ward highlighted their lack of knowledge about breast cancer surgery. This lack of knowledge by student nurses necessitated the development of a computer-based learning tool. A distance-learning tool was found to be an effective way of providing education, due to lack of facilities and workload on the ward. The student nurses using this tool will have better understanding of the treatments their patients are undergoing, leading to improved patient care.

Breast surgery can be highly stressful for women due to the high symbolic value that it represents in bio-psycho-social terms. Before setting up a nurses' breast disease clinic, nurses felt that women were being discharged after surgery with excessive worries and doubts. The aim of this study was to describe the organization, structure, functions, and activities of the nurses' breast disease clinic in Hospital Palmós (Gerona, Spain) between 2002-2005, as well as to promote this kind of clinic. The clinic provides postsurgical care, health education, and psychological support, thus contributing to the integral care of women with this important health problem. The clinic is a resource for the follow-up of patients with breast disease. Moreover, it facilitates outpatient surgical treatment and early discharge and reduces mean length of hospital stay.

Purpose/objectives: To explore the sexuality and intimacy experiences facing women with breast cancer., Data Sources: Published articles; OVID, PsycINFO, and Florida Atlantic University databases; Web sites; and books., Data Synthesis: Patient perceptions and knowledge of mastectomy and chemotherapy-induced menopause in regard to lifelong sexual experiences are lacking. Healthcare providers must institute much-needed education and open lines of communication., Conclusions: The physical and psychological results of breast cancer diagnosis and treatment alter human sexuality. Breast cancer's survival rate is at an all-time high, increasing the number of people who will be living with such issues on a daily basis and shifting the focus from acute care concerns to chronic disease concerns., Implications for Nursing: Healthcare providers should assess individual patients for potential issues they may face. By identifying problems, they can challenge health care to focus on the long-term problems associated with sexuality and intimacy issues facing patients.

This study aimed at knowing the scientific production concerning the care to the mastectomized woman, focusing the revealed feelings, the difficulties faced and the care strategies adopted by the nursing, a bibliographical search was carried out with 23 published articles since 1990, in national periodics. Using the proposed methodology by Salvador, the main women's feelings identified was fear, rejection, guilty and loss; amongst the difficulties, stand out the auto-image acceptance, the confrontation of the prejudice and the collateral effect of chemotherapeutic treatment, specially the alopecia, the pain and the physical difficulties. As main care strategy, it was identified the group activities, aiming at promotin the mastectomized woman self-esteem and to contribute for her quality of life.

The aim of the study was to compare and evaluate a multidisciplinary educational programme with traditional follow-up visits to a physician after breast cancer surgery in terms of well-being, aspects of self-care and coping ability 1 year after diagnosis. A reduction in the intensity of follow-up after breast cancer surgery is recommended. New follow-up models are being debated and could be of interest. The study design was non-randomised and comparative. Ninety-six consecutively selected women with newly diagnosed breast cancer, classified as stage I or stage II, participated in either a multidisciplinary educational programme (n=50), or traditional follow-up by a physician (n=46). Three questionnaires were used: Functional Assessment of Cancer Therapy-General (FACT-G), a study specific questionnaire regarding self-care aspects (SCA) and Sense of Coherence (SOC). With the exception of physical well-being at baseline there was no significant difference between the groups. The women in the multidisciplinary educational programme increased their physical and functional well-being (P<0.01). The women in traditional follow-up by a physician increased their functional well-being while social/family well-being (P<0.01) decreased over time. There was a statistically significant difference in SOC (P<0.001) in the traditional follow-up by a physician between baseline (mean=74.4, SD=12.4) and the 1-year follow up (mean=67.7, SD=11.4). Thus, women in the traditional follow-up by a physician scored lower in the area of SOC 1 year after diagnosis. A multidisciplinary educational programme may be an alternative to traditional follow-up by a physician after breast cancer surgery, but more research is needed about the financial benefits and effectiveness of such a programme.

The purpose of this study was to explore the roles of continuing supportive care in increasing the social support and reducing the perceived uncertainty among women newly diagnosed with breast cancer in Taiwan. A longitudinal, quasi-experimental design was used in this study. Sixty-one women younger than 60 years, newly diagnosed with breast cancer and undergoing surgery, were recruited from 2 urban teaching hospitals in northern Taiwan. The experimental group was provided with additional continuing supportive care for 3 months. Two instruments, including the Social Support Questionnaire and an uncertainty questionnaire, were administered to participants at 3 time points: presurgery within 2 weeks after diagnosis, 1 month after surgery, and 3 months after diagnosis. The experimental group reported significantly higher social support and lower disease uncertainty compared with the control group at 1 month after surgery and 3 months after diagnosis. With knowledge of the role that continuing-care intervention plays in social support and disease uncertainty, nurses and other healthcare professionals can continue to explore and strengthen strategies to enhance the coping ability of women with breast cancer in Taiwan.

Breast cancer is the most common cancer diagnosis for North American and Western European women. Increased knowledge in availability of genetic testing has helped to identify those women at high risk of eventually developing breast cancer. This has resulted in more women considering bilateral prophylactic mastectomy as a viable preventative option. Although the efficacy of the procedure has been established, much less is known about the psychological impact of undergoing this procedure. In order to assess these factors, we reviewed what is currently known about the psychological impact of undergoing bilateral prophylactic mastectomy. Searches were conducted and inclusion criteria revealed articles that focused on the psychological components involved with undergoing a bilateral prophylactic mastectomy. The findings are summarized and fell broadly into one or more of the following three areas: (1) satisfaction or regret following the surgery, (2) psychosocial functioning after the surgery, and (3) predictors of quality of life. Plastic surgery nurses have a unique opportunity to impact important psychological considerations, such as expectations of the early postoperative period, body image concerns, and psychological distress.

Purpose/objectives: To determine racial and ethnic differences in the range and number of post-treatment symptoms among women who have undergone surgical and postsurgical treatment for breast cancer., Design: Retrospective study., Setting: Community-based social services agency and public health clinic., Methods: Face-to-face interview of 116 women who had undergone breast cancer surgery., Sample: Primarily low-income women in an urban area in northern California. Participants were recruited via posted flyers regarding the study., Main Research Variables: Outcomes (depression, fatigue, pain, and swelling from lymphedema) and demographics (ethnicity, age, income, insurance, education, and marital status)., Findings: The typical participant was 47 years old, had 12 years of education, and was a parent (74%), unmarried (67%), heterosexual (88%), uninsured (68%), and employed (66%). Thirty percent were Caucasian, 30% African American, 25% Latina, and 15% women of other ethnic backgrounds. African American women and Latinas reported increased rates of pain and an increased number of symptoms. Latinas also reported higher rates of fatigue and depression. In multivariate analyses, an increased number of symptoms were associated with decreased income, with receiving chemotherapy, with having a mastectomy, and with Latina ethnicity., Conclusions: These data suggest an increased rate of post-treatment symptoms experienced by low-income and ethnic minority women., Implications for Nursing: A need exists for affordable, culturally appropriate symptom management interventions. Nursing will have a vital role in designing, testing, and offering such interventions.

Women diagnosed with breast cancer treated by mastectomy can choose breast reconstruction. The information needs of women undergoing this procedure have only been addressed in the research literature to a limited extent. A qualitative approach was used to explore the experiences of women who had undergone breast reconstruction with a specific focus on their views on how they considered their information needs could best be met. A purposeful sample of eight women was recruited to participate in two focus groups, each lasting 2 hours. Framework analysis was used to develop an index of key themes and sub themes which transformed the data into a structured record which facilitated systematic analysis. This paper will present the emergent key themes regarding information giving and the content of information that women perceive as important when preparing for breast reconstruction. Process, delivery and patient factors are presented in the category of information giving. Several sub themes are discussed concerning the content of information considered to be relevant. Those involved in imparting information to women about such surgery should be aware of the type of information that is considered relevant, the manner in which it should be delivered and timing factors that implicate on the process.

This essay received first prize in the Third Nursing Conferences organized by the Sanitary Consortium of the Alt Penedés County in Catalonia. In a very clear, simple way, this essay deals with those questions which most concern women who have undergone an axillary extirpation. The authors describe their everyday experiences in health education for women who have undergone this surgery.

This reflection approaches aspects related to the ontic and ontological dimensions that constitute and, therefore, permeate nursing care delivered to the client with breast cancer submitted to mastectomy. This reflexive analysis was developed considering the author's professional experience as a clinical nurse at the Cancer Hospital III and at the National Cancer Institute (INCA) as well as using the theoretical frameworks studied during her master and doctoral courses. Through a comprehensive attitude and using phenomenological interpretation, this study aimed at reflecting about nurse's clinical actions in the routine of an institution, pointing out possibilities for a care based on the existential dimension of the involved persons. Therefore, the author emphasizes nurse's performance with the client that is not only translated in the application of scientific techniques, orientations and information but also considering the perception, understanding and care provided by a human being in his/her singularity.