Suffering is a fundamental experience of the human condition. Whereas the arts and humanities have struggled to make sense of this condition, no concerted effort has taken place in nursing. Suffering is painfully absent within the cancer nursing research literature, a place where suffering should be conspicuous. The purpose of this study was to explore suffering inherent in the cancer experience. The concurrent use of Travelbee's Human-To-Human Relationship Model and narrative theory provided the conceptual underpinning for this prospective ethnography. Narratives of suffering were explored among seven patients diagnosed with cancer (breast, n = 4; brain; malignant melanoma; and ovarian cancer). Five women and two men were interviewed weekly (N = 89 interviews) for a period of up to five months. Participant observation supplemented the interview data. Seven richly textured narratives revealed the suffering endured in the living-of-cancer. The narratives also detailed the informant as person, the cancer trajectory, and explanatory models of cancer causation. A second level analysis of the narratives provided an intra-group comparison of suffering. "Cascade of losses" was the overarching theme. The undermining of personhood, and a loss of faith and trust in the medical system characterized this cascade of losses. Losses were further encountered: the dismissal of symptoms presented to physicians, the failure of treatment as cure, the death of other cancer patients, and the false reassurance that "cancer can be beaten". The remaining themes were "cancer as torture" and "the work of suffering--the beauty of cancer". The findings of this study suggest that nurses may not be capable of alleviating patient suffering. Patients' lives intersect at the suffering experience; their suffering is shaped by the past, present, and future. Nurses may influence these intersections of suffering to some extent, however, it is the individual who ultimately determines the living and outcome (if any) of their suffering. In the lives of the informants, it was the love of spouses and children, faith and trust in God, and satisfaction with life's accomplishments which permitted the endurance of suffering. Competent, comfort-care provided by compassionate nurses is needed by patients who suffer with cancer.

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Thesis (MTech. degree in Nursing)--Tshwane University of Technology, 2010. / Cervical cancer, breast cancer and Kaposi's sarcoma are the three most common cancers in women in sub-Saharan Africa. The health care providers in developing countries regularly encounter women with advanced, incurable cervical cancer. Cervical cancer can however, be prevented, even among women at high risk for the disease, through screening using relatively simple technologies. The purpose of the study was to determine whether the supportive-educative role of the oncology nurse can contribute to the prevention of primary and secondary cervical cancer, breast cancer and Kaposi's sarcoma in women living in Soshanguve, South Africa.

The healthcare industry is undergoing rapid changes. Nursing is in the midst of this dynamic process and is experiencing increased stress as a result. This is especially true of the oncology nurse speciality. The responsibilities of the oncology nurses are becoming more complex. Methods to intervene or master the stress are needed. If mastery of the stress is not achieved, oncology nurses may abandon their speciality and enter another field of nursing or leave the nursing profession. The purpose of this study was to examine the relationship of the stress perceived by oncology nurses and the mastery of this stress.The conceptual framework used in this study was the theory of mastery developed by Younger. The Mastery of Stress Instrument (MSI) developed by Younger was used to measure the stress component and the mastery component. A descriptive correlational study design was used. The population for this study was a convenience sample of the responding members of a midwestern chapter of the oncology nursing society (n= 39). Participation in the study was voluntary, with the MSI and the demographic data being returned by self-addressed postage-paid envelope. The MSI was identified by number only. No names were assigned to the numbers to insure anonymity of the subjects. The data was discussed as group data. No risks to the participants were identified in this study. The benefit of this study was to contribute to the data base for the MSI and to increase the awareness of stress and mastery.The research question was analyzed using the Pearson Moment Correlation Coefficient. A small but significant correlation coefficient was found between the acceptance and the growth subscales of the Mastery of Stress Instrument (r=.33, p <.05). No other significant correlation were found.Rapid changes are occurring in the healthcare environment of today. Nurses are in the center of this change and must master the increased stress experienced. The author concluded that the oncology nurses in this sample have mastered the stress they experienced possibly due to the length of time in the oncology nursing speciality. Also, the high level of education in this sample of oncology nurses indicates that the oncology nurses are more efficient at the mastery of the stress they experience. / School of Nursing

M.Cur. (Nursing Administration) / Please refer to full text to view abstract

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Mange kreftpasienter ønsker å få omsorg i sitt eget hjem den siste perioden i livet. Pårørende har en nøkkelrolle i omsorgen for sin nærmeste. Samfunnet har et ansvar for å tilby helsetjenester for å gjøre dette mulig. Hensikten med studien er å få innsikt i pårørendes opplevelse av hvordan deres nærmeste fikk lindret sin lidelse av helsepersonell ved pleie og behandling i hjemmet. Gjennom deres perspektiv og erfaring søker man å få kunnskap om hvordan forholdene kan legges til rette for å gi best mulig omsorg til pasient og pårørende den siste tiden. Et kvalitativ design har blitt brukt for å beskrive og analysere pårørendes opplevelser. I denne studien har en Grounded theory tillempet metode blitt benyttet. Datainnsamlingen skjedde ved dybdeintervju som i hovedsak ble gjort i hjemmet. Alle familiene var blitt fulgt opp av offentlig helsetjeneste. De åtte pårørende ble intervjuet 2-11 måneder etter at den syke døde. De hadde hatt langvarige relasjoner som hadde vart fra 12-77 år . Analysen viser at det er mange områder som oppfattes som lidelse hos den alvorlig syke hjemmeboende kreftpasienten den siste tiden. Også for pårørende byr denne tiden på svært mange utfordringer av fysisk, psykisk, sosial og åndelig/eksistensiell art. Kjernekategorien ”En streben mot å gjenopprette hverdagslivets rytme og å mestre endring” beskriver at pasient og pårørende ønsker stabilitet og å leve så normalt som mulig. Dernest er strategien å mestre endringene som sykdommen fører til når den syke ikke kan opprettholde funksjons- og aktivitetsnivå. Pårørende har lite erfaring fra denne type omsorg og den som er syk har behov for kompetent hjelp til ”den kompliserte omsorgen”. Tilpasning og omsorg må bygge på det livet familiene har levd, slik at de kan mestre endringene ut fra egne ønsker, ressurser og muligheter. Til tross for at de pårørende synes sykdoms-perioden hjemme hadde vært krevende, angret ingen på at de hadde tatt på seg omsorgsoppgaven. Konklusjon: Omsorg til alvorlig syke og døende med kreft krever en stor innsats fra pårørende og helsepersonell for å møte utfordringene i hjemmet. Helsepersonell må møte endringene med tiltak som fremmer en mest mulig normal situasjon for den syke og familien, og hjelpe dem til å mestre endringene i livet / Many cancer patients prefer to be cared for at home the last period of their lives. The next-of kin has a key role in the care for their loved ones. The society has a responsibility to organise health care services to make this possible. The aim of the study is to explore the next of kin experiences in how their loved ones’ illness and suffering were met by professional health care workers in their home. Further through the relatives’ perspective and experiences to get knowledge about how the care for the ill person and the family should be performed to meet their needs in the terminal phase. A qualitative approach has been performed. The study was based upon principles of Grounded Theory. Data were collected by in-depth interviews, mainly performed in the deceased's home. Eight persons were interviewed. They had had close relationships lasting 12 to 77 years. The findings show that the seriously ill home living cancer patient considers many fields as sufferings in the last period of his life. Also for the next-of-kin there are many challenges of physical, social and spiritual/existential nature. The core category ”A strive towards restoration of every days rhythm and to cope with changes” describes that both the patient and the next-of-kin wants stability and to live as normal as possible. Secondly, the strategy is to manage the changes the illness leads to when the patients no longer can obtain their functional level and activities. The next-of-kin has little experience in this type of care, and the ill person has a need for professional assistance with “the complicated care”. Adjustments and care must be built upon the life the families have lived, in order to help them to cope with the changes in the perspective of their own wishes, resources and possibilities. Even though all of the next of kin felt it had been a challenging task, none of them regretted that they had decided to take care of their loved ones at home. Conclusion: Homecare for seriously ill and dying patients with cancer requires a great effort from the next-of-kin and the health personnel in order to meet the challenges in the home. The health personnel must meet the changes with strategies to promote a situation as normal as possible for the patient and the family, and help them to cope with the changes in life. / <p>ISBN 91-7997-137-7</p>

Simulation in nursing education involves an instructor observing students performing a specific task using an anatomical model, standardized patients, or high-fidelity simulation using a simulator. This education method allows creation of realistic clinical scenarios to allow nurses to perform tasks in a safe learning environment. However, accurate performance in the simulation lab must be replicated in the clinical environment to impact patient outcomes. Chapter 2 is a systematic literature review resulting in 21 articles addressing dependent variables, conceptual frameworks, study designs and outcomes measured in new nurses. Knowledge, simulation satisfaction, confidence, and clinical performance were common simulation outcomes studied. Only 7 research articles reported using a theoretical framework. Even though most of the studies used self-reported measures to demonstrate improvement in the studied variables after simulation, none of the studies used objective observation in the actual clinical setting after simulation. Assessing performance in the actual clinical environment after simulation is an opportunity to link simulation education to patient outcomes. Researchers should explore if learned skills in simulation are transferred to the real clinical setting resulting in safe and competent care. This gap in the literature was the impetus for the study described in Chapter 3. Chapter 3 focuses on a quasi-experimental study on new nurses hired at an oncology institution to determine if skills learned in the simulation lab transferred to the clinical setting. The study’s aim addressed if a difference exists in clinical observation scores between the intervention group (involved in simulation) and control group (not involved in simulation) when performing a central line dressing change. Fifty-six participants were consented with 19 nurses completing all data collection points. No significant differences were identified between groups. Chapter 4 is a narrative account applying the concept of resilience to the doctoral dissertation experience during a pandemic. Using Richardson’s Resiliency Model, the challenges of performing research on staff development during a pandemic are presented. The presence of a stressor (pandemic) and the resulting stages of disruption and reintegration are described resulting in resilient reintegration during the doctoral research process. Simulation is an educational methodology in academia and staff development. However, outcomes such as confidence, knowledge and simulation satisfaction are over-studied and there is a need for studies to focus on if skills performed during simulation are replicated accurately in the clinical setting. In addition, simulations should be designed to ensure they are addressing the identified construct (e.g. clinical judgement). In addition, the logistics involved in observing practice at the point of care is challenging due to unpredictable factors such as staffing, patient acuity, and operational decisions that may impact study design present unique challenges. Keywords: Simulation, new nurses, resilience

Despite a rise in breast cancer incidence, mortality rates have fallen. This improvement in mortality is due to the success of anti-cancer treatments such as chemotherapy and radiotherapy. Such treatments, however, are known to be associated with a range of symptoms. A number of studies exploring patients’ chemotherapy-related symptom experiences have shown that patients consistently rate nausea and fatigue highly, not only in relation to severity, but also in relation to the associated distress they experience. The subjective and non-observable nature of both nausea and fatigue complicates their assessment. While a range of assessment tools exists to evaluate patients’ experiences of these two symptoms, there is currently no gold standard assessment tool for assessing either symptom. Moreover, while a range of pharmacological and non-pharmacological interventions have been developed for both symptoms, further evaluation is often needed to provide the level of evidence required to recommend their implementation in real life clinical environments. The SNA↔P (structured nursing assessment into practice) study arose in response to this clinical situation. The SNA↔P study was a longitudinal study that evaluated the impact of a complex evidence-based intervention, incorporating structured multidimensional symptom assessment and multiple symptom management techniques, on patients’ experiences of nausea and fatigue during a course of chemotherapy for breast cancer. Using complementary quantitative and qualitative research methods not only allowed in-depth understanding of patients’ experiences and patterns of nausea and fatigue during a course of chemotherapy, but also facilitated a rounded evaluation of the intervention, incorporating both statistical elements and those of personal significance. The use of these methods showed that the implementation of the SNA↔P intervention in routine clinical practice has significant potential for improving patients’ symptom experiences during a course of chemotherapy. In so doing, it also highlighted a number of areas in which clinical practice can be influenced, and research conducted, to further improve patients’ symptom experiences.

Thesis (M. (Nursing)) -- University of Limpopo, 2022 / Caring for terminally ill cancer patients is considered stressful and heartbreaking. Oncology nurses often consider leaving the nursing profession because of the high levels of stress experienced by these health care professionals. The aim of this study was to investigate the experiences and the practices of nurses who care for terminally ill cancer patients in the Pietersburg Provincial Hospital in the Capricorn District of the Limpopo Province. The objectives of this study were to explore and describe the experiences and practices of nurses who care for terminally ill cancer patients and further to describe the relationship between certain demographic variables and nurses’ experiences of death. An additional objective was to develop recommendations and strategies that might assist management of the Pietersburg Provincial Hospital with the development of appropriate skills and the implementation of emotional support that could assist nurses who care for dying cancer patients in the oncology wards. The study followed a phenomenological, descriptive, exploratory and contextual research design, which assisted the researcher to describe and explore the experience and practices of nurses caring for terminally ill cancer patients. Semi-structured interview method was used to collect data, making use of an interview guide, was used because it is a more free-flowing approach, with its structure being limited only by focusing on the research. Field notes were captured during the data collection session by the researcher. A voice recorder was used to capture all the interview sessions. The initial data analysis started with the researcher listening to the recordings and transcribing verbatim all statements made by the participants. Tesch’s open coding data analysis method was used by following the proposed eight steps to analyse qualitative data as outlined in Creswell (2013). Ethical standards as set in Babbie (2013) were adhered to by the researcher. The researcher requested permission to conduct the study from the Limpopo Department of Health Ethics Research Committee and informed consent was obtained from the participants before collecting data. Privacy of the participants was ensured as participants were never called by their names. In the study participants shared different views with respect to caring for dying cancer patients. Some participants regarded caring for cancer patients as stressful and heartbreaking. Other oncology nurses blamed the management for not providing them with courses to assist them with caring for dying cancer patient, nor providing debriefing sessions for them. On the other hand, some oncology nurses believed that relocating to other wards was a better solution. The participants suggested the following improvements for caring for dying cancer patients; oncology nurses should be offered short courses to assist them with the challenges that they come across with regard to caring for dying cancer patients. Oncology nurses need support from the management and colleagues in order to cope with the workload. Oncology nurses need psychological assistance to help them with the psychological stressors they experience. Family members and patients need health education on how to deal anticipatory grief. / University of Limpopo