External breast prostheses in post-mastectomy care: women's qualitative accounts

GALLAGHER P., BUCKMASTER A., O’CARROLL S., KIERNAN G. & GERAGHTY J. (2009) European Journal of Cancer Care 19 , 61–71
External breast prostheses in post‐mastectomy care: women's qualitative accounts A good‐quality external breast prosthesis and prosthesis‐fitting service is an integral part of the recovery process post‐mastectomy. However, this is an area of care that has minimal information or research available. The aim of this research was to investigate women's experience of the provision, fitting, supply and use of breast prostheses in Ireland. To ascertain women's own personal and subjective experiences, five focus groups with 47 women recruited through national cancer advocacy/support organizations and four Follow‐up Breast Clinics throughout Ireland were conducted. As a result, five main themes emerged: (1) The fitting experience – Fitting? (2) Post‐mastectomy products – Having? (3) Cost – Affording? (4) Information – Knowing? and (5) Adaptation – Accepting? The emerging themes pinpointed the impact of the fitting experience, fitting environment and the qualities of a prosthesis fitter on a woman's experience in obtaining a first or replacement breast prosthesis; the importance of the physical characteristics of the prosthesis and mastectomy bras; cost, affordability and entitlements; a lack of and perceived difficulty in getting information; and the myriad of personal and social impacts of a breast prosthesis for the woman. These findings are integral for the development of standards of practice in the fitting and supply of external breast prostheses in post‐mastectomy care.     

Mental health crisis and respite services: service user and carer aspirations

There is emerging evidence that crisis resolution services can provide alternatives to hospital admission, reducing demand on inpatient beds. Following a public consultation exercise in Lancashire (England), a team of nurses undertook a study, using interactive research methodology, to gain an understanding of how users and carers define a crisis and what range of crisis services, resources and interventions service users and carers thought would help avoid unnecessary hospital admission. Data collection comprised postal questionnaires and 24 group meetings with service users and carers, which were held during 2006. Data were analysed, and seven themes were identified: (1) definitions of a crisis; (2) access to services; (3) interventions; (4) range of services required ( before , during and after crisis); (5) place of treatment; (6) recovery and rehabilitation; and (7) community support. We conclude that expressed preferences of service users and carers for pre-emptive services that are delivered flexibly will present a challenge for service commissioners and providers, particularly where stringent access criteria are used. Home-based pre-emptive services that reduce the need for unnecessary hospital treatment may avoid progression to social exclusion of service users.     

The side effects of evidence-based training

The mental health inpatient workforce has been targeted for continuing training to promote improved practice and enhance morale. The effects of intensive training and innovations in clinical practice on staff well-being are poorly understood. The aim of this paper is to measure the impact of a programme of team training and clinical practice development on levels of stress, job satisfaction and burnout in inpatient mental health workers. A repeated measures design was used in which participants acted as their controls. Participants were assessed before and after training using standardized measures of stress and burnout. During the training period, mean scores on all measures remained stable. Over the practice implementation period, there were significant increases in perceived stress and burnout and a significant reduction in job satisfaction. Training in novel psychosocial interventions had no impact on staff psychological well-being and satisfaction. Attempting to implement, these interventions did appear to have harmful effects. Intensive clinical support to sustain novel practices did not prevent these outcomes.     

Refocusing acute psychiatry, performance management, standards and accountability, a new context for mental health nursing

The term 'performance management' has an aversive 'managerial' aspect, is unappealing to many public sector staff and has an 'image problem'. Perhaps as a consequence, it has failed to make a significant impact on Irish public sector workers, notably mental health nurses. In this paper, performance management is introduced and examined within an Irish healthcare context and with reference to its use in other countries. Some of the challenges faced by Irish mental health nurses and the potential benefits of working within a performance managed workplace are discussed. The paper concludes that performance management is likely to increasingly affect nurses, either as active agents or as passive recipients of a change that is thrust on them. The authors anticipate that the performance management 'image problem' will give way to recognition that this is a fundamental change which has the potential to enable health services to change. This change will bring high standards of transparency, worker involvement in decision making, an explicit value base for health services and individual teams. It provides the potential for clear practice standards and high standards of transparency as well as worker welfare in all aspects, including supporting employment and career progression.     

Attitudes of nurse professionals and nursing students towards children with disabilities. Do nurses really overcome children's physical and mental handicaps?

Background:  Many health professionals and nurses, who are involved in the care of disabled children, do not exhibit the essential sensitivity and appropriate attitudes towards them, resulting in a poor quality of nursing care.
Aim:  The objective of this study was to investigate the attitudes of nurse professionals (paediatric nurses) and nursing students towards disabled children.
Patients and methods:  The present study is a comparative study. The sample consisted of 228 first-year nursing students, 90 post-diploma nurses attending MSc degree course and 123 nurse professionals who are employed in paediatric hospitals. After obtaining permission from the hospitals and the educational settings and informing about the subjects of the study, data were collected using the paediatric Attitude Towards Disabled Person Scale (ATDP).
Results:  Overall nurses' attitudes appeared to be poor (mean ATDP score 61.7 ± 14.2). However, the post-diploma nurses had significantly higher ATDP scores than first-year students and paediatric nurses ( P  < 0.001). In addition, first-year students had significantly higher scores than paediatric nurses ( P  = 0.047). Across the sample, females hold significantly more positive attitudes than males ( F  = 9.5, P  = 0.002), while age did not have any significant effect.
Conclusions:  Carefully designed curricula can influence the attitudes of nursing students towards children with disabilities. Special courses for treating disabled children should be integrated to the basic nursing studies. Moreover, continuing hospital education can change paediatric nurses' attitudes towards children with disabilities.     

Spirituality: A key factor in coping among Iranians chronically affected by mustard gas in the disaster of war

The present study aimed to explore the approach used by Iranians chronically affected by mustard gas in the disaster of war to cope with their chronic illness complications. A qualitative approach was adopted using content analysis of unstructured interviews carried out with 20 patients in a medical center in Tehran and an outpatient clinic in the North West of Iran. Two main themes that emerged from the study were "religious sentiment" and "patriotism". The subthemes that emerged were "divine will", "illness as a means of absolving sin", "saying prayers in the anticipation of divine rewards", "defending the motherland" and "self-sacrifice as a source of pride". To sum up, spirituality was recognized as a key factor among the participants in accepting and coping with their chronic illness complications.