Managing the illness experience of women with advanced breast cancer: hopes and fears of cancer‐related insecurity

The cultural significance of a diagnosis of advanced breast cancer is important in Pakistan particularly due to the high incidence in women, limited breast cancer screening, healthcare resources and cancer educational programmes in Pakistan. The psychological impact of breast cancer is therefore an important concern for women. This qualitative study explored the psychological impact of advanced breast cancer in Pakistani women. Twenty‐one women with advanced breast cancer were interviewed. Women acknowledged feelings related to the insecurity of health, resistance to cancer, the impact of their illness on their physical and emotional well‐being and marital relationships and emotions related to cultural discrimination. The majority of women had metastatic spread to bone, liver or lungs. More effort is needed to educate women on the aetiology of cancer, breast self‐examination and mammographic screening to ensure that all Pakistanis are educated that cancer is not a communicable disease or one that is transmitted by personal contact.     

‘Seamless care? Just a list would have helped!’ Older people and their carer’s experiences of support with medication on discharge home from hospital

Background Many older people use one or more prescribed medicines on a daily basis. Effective medicines management at hospital discharge can support appropriate use of medicines following discharge and help avoid unnecessary hospital re‐admission. Many people, however, feel they receive insufficient information about medicines on discharge from hospital. Objectives To explore older people and their family carers’ experience of hospital discharge in relationship to the organization and management of medicines. Design Qualitative interviews with older people over 75 years old, taking four or more medicines, and their carers, following discharge from hospital in the United Kingdom (UK). Participants completed medication diaries prior to the interview. Setting Interviews took place in the participant’s home. Results Nineteen interviews were conducted involving 12 carers and seven older people. Participants were generally not satisfied with the discharge process, particularly concerning perceived delays in discharge. Inadequate explanations about medicines at discharge were commonly reported and led to omission of medicines, incorrect dosage, anxiety and confusion. Poor communication between the hospital and general practitioners or community pharmacists was also evident. Conclusions Despite significant policy recommendations and research in this area, many problems with the management of medicines during hospital discharge were shown, and a lack of partnership was evident between hospital staff and patients/family carers regarding the use of medicines post‐discharge. Improved medicines management during hospital discharge is required to ensure older people take their medications as prescribed and to protect them from the adverse effects of medicines not being taken correctly.     

Core temperature measurement in adults: a literature review

This paper provides a comprehensive review of the literature related to the clinical assessment of core body temperature in adults It does not attempt to address temperature measurement in children It considers temperature-taking instruments used in current practice, and predominantly investigates the use of the three main sites of rectum, mouth and axilla     

The persistence of ritual in nursing practice

As nursing attempts to become a research based profession, ritual has become stigmatized and associated with thoughtless repetition. Articles condemning ritualistic practice are frequently seen in nursing journals. Despite this condemnation, ritualistic practice appears to persist. This paper examines the origins and purpose of ritual, giving reasons for the negative association. It explores the role of ritual within western culture and nursing. This paper then draws on anthropological method to analyze the purpose of ritual within nursing and suggests reasons for its persistence. The paper concludes that there are cultural influences that promote a technical, rational approach to the study of the human condition. This worldview with its emphasis on cognition devalues the important emotional aspects of humanity by associating them with the primitive. The examination of factors which contribute to the persistence of ritual in nursing concludes that nursing work involves emotional encounters and breaches of the taboo aspects of culture. Rituals serve to normalize these transgressions. It helps the nurse and patient deal with emotions generated by these, the breaches of taboo, by re-labelling situations as caring rather than transgressing. Because they serve these emotional and social functions, rituals endure.Rationale for the article: my interest in ritual was re-awakened on reading Parker's (1999) article entitled Reason or ritual. It stimulated me to reflect on three questions: firstly, why do rituals persist when the nursing literature condemns them? Secondly, does ritual serve a purpose that ensures its survival in the face of criticism? Thirdly, why do the disciplines of nursing and anthropology perceive ritual in such different ways?This paper takes an anthropological approach to ritual, drawing on secondary anthropological and nursing data, in an attempt to answer the questions outlined above.     

An exploration of anticipatory grief: the lived experience of people during their spouses' terminal illness and in bereavement

An exploration of anticipatory grief: the lived experience of people during their spouses' terminal illness and in bereavement Anticipatory grief has been the subject of much debate since Lindemann first coined the term to describe premature mourning. Much of the research in this area takes a positivist approach focusing on the effect of anticipatory grief on bereavement. In contrast, this study, explores anticipatory grief through a Heideggerian phenomenological approach to elicit the experience of anticipatory grief. Unstructured interviews were conducted with four participants. The resulting data were interpreted using hermeneutics and evaluated using the criteria identified by Madison. The themes arising from this interpretation identify the change the participants experienced. Although these findings are limited to four participants, they are offered to raise awareness of the impact of multiple role loss and the impact of diagnosis on supporting partners. The findings also raise ways in which nurses might support people experiencing loss.     

How do nurses deal with their own grief when a patient dies on an intensive care unit,and what help can be given to enable them to overcome their grief effectively?

There is an expectation that nurses are good at caring for relatives on the death of a patient. Who, though, cares for the nurses? Using both a quantitative and a qualitative approach, this study looks at how nurses overcome their own grief when a patient dies on an intensive care unit. Information was first collected using a questionnaire. Personal grief, however, is a very emotive area, so a proportion of the nurses from the initial study were then asked to take part in a semi-structured interview, to explore their feelings in more depth. The quantitative data were analysed using the computer software Statistical Package for the Social Sciences and the results were related to the interview responses. This showed how nurses deal with their grief, and that many, but not all, felt that the Informal support network already present was sufficient. Some nurses, however, felt that a support group would also be helpful and some felt the availability of a counsellor would be useful. All nurses felt that more training about how to deal with their own grief was needed.     

The Lead Lecture as an adjunct to experiential learning (an appropriate modality for the introduction of issues related to death, loss and change)

Issues related to gref in response to loss and developmental changesare of significance to palliative care cancer nurses. This paper is essentially an educational debate although the issues effect all who concerned with palliative cance care nursing. it reviews selected literature related to the lecture method of teaching. The author makes a case for using the Led Lcture approch with experiential learning. It is considered an appropriate means through which to introduce palliative nurses to sensitive issues intimately connected to grief. The author explores experiential and student centred methods of learning, concluding that we should appraoch them with a certain amount of caution; we can expose the learner to too much too soon. The central recommendation of the paper is for an intergrated approach, harnessing the potential of group led tutorials and clinical supervision. An outline seminar plan provides a conceptual route map.