An evaluation of comparative strategies for teaching breast self-examination

This study compared the effects of three alternative methods of breast self-examination (BSE) instruction (booklet, film and group discussion, individual teaching) on nurses' personal BSE practice A pre-test and follow-up questionnaire were administered to a convenience sample of 166 nurses from Western Australian hospitals The results demonstrated that each method of BSE instruction produced a significant improvement in the technique of BSE ( P < 0 0001) However, the nurses involved in the film and discussion had the greatest improvement in BSE proficiency Findings were analysed in terms of the Health Belief Model The variables 'barriers to action' and 'perceived susceptibility'(in this case, to breast cancer) were found to be predictive of BSE practice,'perceived barriers' at pre-test and 'perceived susceptibility' at follow-up The incidence of BSE was significantly higher in the older nurses A reminder to practice BSE was significantly associated with an effective BSE technique Implications for nursing practice are discussed     

Registered nurses' knowledge and practices of teaching and performing breast exams among elderly women.

This study was designed to identify registered nurses' knowledge and beliefs regarding breast cancer in elderly women, and to identify the practices of registered nurses in performing breast exams and teaching breast self-examination (BSE) to this client group. Correlational analysis using Pearson moment correlation showed a weak inverse relationship between nurses' attitudes toward the elderly and performing and teaching breast exams. As the nurse's negativism about aging increased, the incidence of teaching and performing exams decreased. A strong relationship was found between thorough and regular examination of the nurse's own breasts and performance of the exam on elderly women. As predicted, nurses were more likely to perform than teach exams. Using logistic regression, it was found that nurses who were employed full-time, married nurses, nurses who reported encouragement for themselves to do the exam, and nurses who were confident in examining themselves were more likely to examine the breasts of the elderly women. Nurses were more likely to teach BSE when they had a family history of breast cancer, spent greater than 50% of their time on direct care, reported belonging to a nursing association, were confident in detecting a lump in their own self-exams, and had a baccalaureate degree or higher.     

Teaching and breast self-examination: an insufficiency of instruction

Client teaching is recognised as an essential component of nursing and midwifery care, and all clinical areas provide opportunities for informal client teaching. This qualitative study aimed to explore registered nurses' professional practices with regard to teaching breast self-examination (BSE), and to identify factors that influenced their participation or non-participation in teaching about breast health. Participants' views were obtained using individual semi-structured interviews. The data were analysed inductively, that is, without imposing structure from the interview questions. Findings revealed that participants' perspectives of BSE and breast health, the dual symbolism of breasts, and the time constraints of clinical practice, were significant factors that impacted on participants' personal BSE practices and on their level of participation in teaching BSE. The results indicate that that nurses and midwives do not view teaching breast health as part of their role in client interaction, particularly in an acute care setting. Although nursing literature identifies midwives and nurses as ideally placed to promote health promotion activities, the image of BSE as linked to breast cancer, the dominant illness oriented model of care and a task orientated culture in health care facilities do not facilitate this.     

Is the hospital setting the place for teaching breast self-examination?

The purpose of this study was to investigate the effects of an instructional program for nurses educating them to teach breast self-examination (BSE) to hospitalized patients. Nurses' knowledge, attitudes, self-practice, and practice of teaching breast self-examination to patients were measured in a group who attended such a program and compared with those of a control group who did not attend. The researchers found that the instructional program increased nurses' teaching of BSE to their patients, but did not affect their own self-practice. Nurses' attitudes to teaching BSE were less favorable than for self-practice. Issues related to environments for teaching BSE are discussed.     

The nurse as health educator: the prevention and early detection of Cancer

To assess their potential as health educators 785 female hospital nurses (trained nurses, learners, auxiliaries and nursery nurses) were asked, by means of a postal questionnaire, to give their opinion of three measures of cancer control–the cervical smear test, breast self-examination (BSE) and not smoking. Eighty-four % thought the cervical smear test of definite value, 68% had this opinion of BSE, but only 59% thought that it was of definite value not to smoke. Most nurses saw all three measures as having some degree of benefit as few rejected any measure as being of no value. Factors related to whether they regarded a particular measure as being of definite, rather than a lesser degree of value, included (but not necessarily always for all measures) grade, training, age, professional experience of cancer nursing, acceptance of the curability of cancer, knowledge of survival rates, likelihood of reading an article about cancer, and smoking behaviour. It is suggested that nurses' relative assessment of the measures is not based on the intrinsic value of the measures themselves, but on the nurses' personal health behaviour and on the perceived difficulty in undertaking a measure. Furthermore, additional barriers to nurses' likelihood of recommending such measures to others include: lack of understanding of, and skills in health education and an inadequate knowledge base. Thus, simply exhorting nurses to engage in health education is unlikely to succeed. The barriers described have to be taken into account and in particular nurses need to be taught health education skills.     

Risk factors and health promotion in families of patients with breast cancer

Women with a family history of breast cancer have an increased risk of developing the disease. Women identified as "high risk" for developing breast cancer have been shown to exhibit increased levels of psychological distress and anxiety related to breast cancer. Oncology nurses can address this barrier and others, such as altered risk perception and lack of physician recommendation for screening. Oncology nurses also can identify high-risk families that may be candidates for genetic testing for breast cancer susceptibility, provide comprehensive teaching about breast self-examination (BSE), and clarify misconceptions about early detection. Primary prevention measures for hereditary breast cancer include prophylactic mastectomy and oophorectomy and chemopreventative agents. Secondary prevention measures include screening and early detection with mammography, clinical breast examinations, and BSE. Nurses have a responsibility to educate families of patients with breast cancer about risk factors, primary and secondary preventive measures, genetic testing, and screening recommendations.     

Nurses as Agents for Change in Teaching Breast Self-examination

The purpose of this quasi experimental, one-group pretest-post-test study was to determine the role of the nurses as agents for change in teaching breast self-examination (BSE) to healthy women in the community. The goals were to promote women's factual and proficiency knowledge in the areas of (1) signs and symptoms of breast cancer, (2) proper steps of BSE, and (3) frequency of BSE. Data were collected over four years in a large university teaching hospital. The sample was made up of 223 women. Teaching was provided by nurse clinicians. A 21-item written questionnaire was administered to all subjects three times: before BSE education session (treatment), immediately after education, and six months later. The questionnaire included four subscales: demographics, factual knowledge regarding signs and symptoms of breast cancer, proficiency of BSE practice, and frequency of BSE. Findings indicated that nurses influence positively the factual and proficiency knowledge base of clients and the frequency of BSE practice. Based on these findings and those of previous studies, the authors believe that nurses can be agents for change in promoting BSE.     

Evaluation of a breast examination facilitation device

Breast self-examination (BSE) is recommended in order to help women detect possible breast cancer early in its development Correct BSE performance has been shown tobe positively associated with breast lump detection ability Few women, however, report practising BSE, citing reasons such as dislike of touching one's own breasts, fear of finding a lump, lack of confidence in their-ability to perform BSE The purpose of this study was to test a breast examination facilitation device (BEFD) for women, which would provide a teaching/screening tool, as well as a shield between breast and fingers for women who are reluctant to touch their breasts A sample of 36 registered nurses in the United States was asked to perform BSE on three separate occasions using a BEFD made of latex, paper or cloth on which a wedge pattern for BSE had beenimprinted Subjects found the BEFD to be a useful tool for teaching/learning BSE, and expressed a clear preference for the latex material One size of BEFD is not adequate for all women A smaller size for women who wear A and B cup-size bras, and a larger size for women who wear C cup size and above, would be more acceptable     

Health beliefs,perceived self-efficacy,and breast self-examination among Thai migrants in Brisbane

BACKGROUND: Women in Thailand have a relatively low risk of developing breast cancer; however, death rates from breast cancer are increasing. Rates in many migrant groups are also known to be on the increase. Little is known about breast cancer screening, particularly breast self-examination (BSE), among Thai migrant women in other countries. In Australia, non-English-speaking-background migrants are known to be low users of preventive health services. AIMS: To investigate, using the health belief model (HBM) and self-efficacy as a theoretical framework, the use of BSE in a recent migrant group, Thai women in Australia, and to identify sociodemographic variables that influence the women's regular use of BSE. METHODS: In 1998, a cross-sectional study was conducted among 145 Thai women in Brisbane recruited through a snowball-sampling method, which used personal contacts and key persons within the Thai community. The study was approved by the University Human Ethics Review Committee. Data were collected through designed closed-ended questions. RESULTS: Only 25% of the women performed BSE regularly. HBM indices were strongly associated with BSE. Beliefs in high personal susceptibility to breast cancer strongly increased the likelihood of BSE. After adjusting for potential confounding factors, cues or triggers to undertake BSE and self-efficacy, or the ability to do BSE were found to be important determinants of regular BSE. Study limitations, including data collection methods, are discussed. CONCLUSION: A low percentage of women practised BSE regularly. The HBM is a useful framework for identifying factors influencing the use of BSE. Strategies that increase the confidence of women to undertake preventive health behaviour or increase self-efficacy are likely to increase their regular screening for breast cancer.     

Factors related to practice of breast self-examination in rural women

The purpose of this study was to examine variables related to breast self-examination (BSE) in rural women. The sample of convenience consisted of 347 women who were members of selected county-extension homemaker clubs. Champion's Health Belief Model Scale was used to measure susceptibility, seriousness, benefits, barriers, health motivation, sociodemographics, and knowledge variables and frequency of BSE. Multiple regression analysis indicated that the Health Belief Model concepts accounted for 26% of the variance in BSE practice. Women who perceived more benefits of BSE in reducing the severity of breast cancer were more likely to report more frequent BSE. Women who perceived fewer barriers to performing BSE and those who scored high on health motivation were also more likely to report performing monthly BSE. Pearson product-moment correlation indicated a significant positive relationship between the variables of BSE knowledge and BSE practice (r = 0.1216; p = 0.023). The lambda statistics showed weak or no association between the demographic variables of age, race, marital status, religion, education, personal experience with breast disease, and friend's experience with breast disease and BSE practice. These findings suggest that perhaps educational programs emphasizing benefits of BSE may be implemented for women represented in this sample in an attempt to increase the number of women practicing BSE. Assessment of women's perceptions of potential barriers would allow nurses to plan appropriate strategies that could reduce the barriers. Finally, assessment of women's general health practices may identify women motivated toward good health. These women may be likely to complete monthly BSE if encouraged to do so.     

Exploring the heart of ethical nursing practice: implications for ethics education

The limitations of rational models of ethical decision making and the importance of nurses' human involvement as moral agents is increasingly being emphasized in the nursing literature. However, little is known about how nurses involve themselves in ethical decision making and action or about educational processes that support such practice. A recent study that examined the meaning and enactment of ethical nursing practice for three groups of nurses (nurses in direct care positions, student nurses, and nurses in advanced practice positions) highlighted that humanly involved ethical nursing practice is also simultaneously a personal process and a socially mediated one. Of particular significance was the way in which differing role expectations and contexts shaped the nurses' ethical practice. The study findings pointed to types of educative experiences that may help nurses to develop the knowledge and ability to live in and navigate their way through the complex, ambiguous and shifting terrain of ethical nursing practice.     

Ethnic differences in breast self-examination practice and health beliefs

Thirty-two African American nurses (AAN) and 78 Caucasian nurses (CN) were compared on breast self-examination (BSE) practice and health beliefs. Relationships between these variables were also examined. The Health Belief Model provided the framework for the study. The sample is a subset of 269 women from a larger study. AANs were recruited from a professional nurses' group. CNs were recruited from a list of female employees of a university medical centre. The results of t -tests revealed no significant group differences on BSE frequency ( P =0·06) or BSE proficiency ( P =0·10). Noted was that 42% of AANs compared to 20% of CNs examined their breasts 12 or more times during the year. AANs were more likely to consider BSE beneficial ( P =0·002) and to feel confident ( P =0·006) about doing BSE; CNs perceived more barriers ( P =0·001) to BSE. For AANs, BSE frequency and proficiency were positively related to confidence and inversely related to barriers; BSE frequency was also related to health motivation. For CNs, BSE frequency and proficiency were inversely related to seriousness. Implications include additional research to validate findings and to increase the knowledge base of all nurses regarding BSE.     

Relationship of self-concept, health locus of control, and perceived cancer treatment options to the practice of breast self-examination

Breast cancer remains one of the most prevalent forms of cancer for women in the United States. Recognition of the fact that no more than 40% of women practice breast self-exam (BSE) is of major concern in that BSE has been identified as one method of early detection. The factors that encourage or discourage women to perform BSE need to be identified. The current study investigated the relationships between women's practice of BSE, self-concept, locus of control, and knowledge of treatment options for breast cancer. One mammogram screening center provided the 235 subjects who completed the questionnaires. Subjects who practiced BSE more frequently had a slightly higher self-concept score and were more aware of breast cancer treatment options (r = 0.16, p less than 0.05). Weak correlations were found between chance locus of control and BSE frequency of practice (r = 0.22, p less than 0.05). The majority of subjects reported irregular BSE practice, both as to whether they practiced BSE on a monthly basis and as to the time of the month for BSE.     

Jordanian nurses' knowledge and practice of breast self-examination

Title.  Jordanian nurses' knowledge and practice of breast self-examination.
Aim.  This paper is a report of a study to evaluate the knowledge and practice of Jordanian nurses in relation to breast self-examination.
Background.  Studies have shown that women who have learned about breast self-examination have positive attitudes toward breast cancer and practise breast self-examination more frequently, and that nurses who teach their clients about methods of early detection and breast self-examination are more knowledgeable about breast cancer screening and breast self-examination techniques than those who do not. Therefore, it is important to understand nurses' knowledge about breast cancer and its early detection.
Methods.  A cross-sectional design was used, with a convenience sample of 347 Registered Nurses at three large cities in Jordan (response rate 95%). Data collection took place in 2005 using a self-administrated questionnaire with three parts and based on the American Cancer Society's guidelines: demographics, knowledge, and practice of breast self-examination.
Results.  Nurses reported high levels of knowledge of breast self-examination (M = 7·6, sd . 2·7). A high proportion of nurses reported doing breast self-examination in the past 12 months (85%), but only 17·7% reported doing so on a monthly basis. None of the demographic characteristics was found to be associated with the practice of breast self-examination.
Conclusion.  More health education about monthly breast self-examination and prevention strategies is needed for nurses and their women patients, especially for Arabic women.     

Factors Affecting Women to Practise Breast Self-examination

The aim of the study was to identify factors of decisive importance for women's motivation to perform breast self-examination (BSE), which could form the basis of an intervention programme. Interviews were conducted in 1994 with 48 women focusing on four different areas: 1) why the women examined/did not examine their breasts, 2) the influence of their upbringing, 3) information or education previously received about the method of examination, and 4) other types of self-care. The findings were summarized under the following categories: feelings, experiences, and lifestyle. Anxiety/fear of discovering a lump and faith/trust in one's own ability to perform the examination were dominating factors influencing the practice or non-practice of BSE. However, there was a general need for knowledge, theoretical as well as practical, among the women studied. They also needed help to identify a strategy to enable them to remember to perform the examination. In order to make BSE a habit, education about BSE ought to be provided to girls at school. The important role of nurses in teaching women to examine their breasts themselves and in reminding them to perform the examination was emphasized.     

Breast cancer risk assessment and risk perception on nurses and midwives in Bornova Health District in Turkey

Risk perception is a significant component of awareness of breast cancer risks. It can be helpful to reduce deaths of breast cancer via increasing awareness risk level. This study aimed to discuss the level of perceived and calculated breast cancer risk and to provide data on the practice of breast self-examination and use of mammography among 215 nurses and midwives working in the 23 primary healthcare centers in Turkey. Participants were asked to assess their personal lifetime breast cancer risk by a 4-item Likert scale ("no risk," "usual," "moderate," and "strong" risk), which determined "perceived breast cancer risk." Gail model was used to assess the "calculated breast cancer risk," which was calculated by the tool provided by the National Cancer Institute, version 7. Perceived and calculated risk levels were compared. The relation between sociodemographic and risk factors with "perceived risk" was examined. In addition, the influence of perceived risk on breast cancer screening practice was also assessed. The level of perceived risk of nurses and midwives was higher than that of calculated risk. Considering the fact that participants were healthcare professionals, the use of breast self-examination and mammography practices as a preventive behavior by nurses and midwives was lower than expected. Implications are discussed with regard to breast cancer risk and preventive behavior.     

The effect of training on the knowledge levels and beliefs regarding breast self-examination on women attending a public education centre.

The aim of this study was to evaluate the effect of subject training on the level of knowledge about breast self-examination (BSE) and breast cancer in women attending a public education centre. This research was structured according to pre-test-post test, one group research design principles. The study involved 91 course attendees at the Erzincan Public Education Centre (73.4%). The average age of study subjects was 21.4+/-5.4. Of the 91 participants in the study, 3.3% (n=3) had a family history of breast cancer and 5.5% (n=5) have had a lump in their breasts. In pre-test questions, the rate of correct answers was between 13.2% and 68.1%. After training, the rate of correct answers increased to between 79.1% and 96.7% and attendees demonstrated an increase in the accuracy of their beliefs about breast cancer (health risk, susceptibility). The perception of self-efficacy, an important variable in the process of behaviour change, is a necessary component of changing and maintaining the practice of BSE. The results of this work and others demonstrate that education administered by nurses can increase positive perceptions about BSE self-efficacy. Education in BSE is easily administered, requires no special tools, could lead to early diagnosis of breast cancer if performed regularly and should be taught to all women aged 20 years and above.     

护理人员乳房自检实施及宣教情况的调查

目的了解护理人员乳房自检相关知识的掌握和实施情况,以及对周围人群的宣教情况。方法采用自制问卷对某医院140名护士进行调查,主要包括一般情况、乳房自我检查的相关知识、乳房自检的实施情况及对周围人群进行乳房自检相关知识的宣教情况。结果（1）被调查护士对乳房自检知识的平均掌握程度为59.1%;（2）51.4%的护士知道5个以上的乳腺癌高危因素;（3）50.7%的护士知道乳腺自检的频率和时间,36.4%的护士知道望诊的3~4个步骤,88.6%和61.4%的护士知道触诊手法和按压顺序;（4）仅5.7%的护士每月规律自检;（5）50%的护士曾接受过他人咨询,其中47.1%未给予咨询者指导。结论应加强护理人员乳房自检相关知识的培训,重点是乳腺癌高危因素、乳房自检频率和望诊方法等;同时,作为妇女健康的教育者和咨询者,护理人员应加强责任心,做好对周围人群乳房自检的宣传普及工作,积极维护自身及广大妇女的身心健康。