published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

As breast cancer incidence and survival rates increase, there is an urgent need to make appropriate psychosocial support available to all women with breast cancer. In this qualitative study, narrative inquiry was used to examine how women with breast cancer used visual creative expression (art therapy and/or independent art making) to address psychosocial needs that arose for them after their diagnoses. Seventeen women, aged 37-82, participated in this investigation. Data analysis of in-depth interviews with these women focused on narratives they constructed about why they turned to art therapy and/or independent art making and how it helped to be involved in these activities. Particular attention was given to the issue of meaning making. Four storylines emerged from the analysis. "Art and art therapy as a haven" came from narratives about using art making or art therapy for comfort and affirmation. The narratives that comprised "getting a clearer view" were about using visual creative expression to create a clear picture of emotional experience. "Clearing the way emotionally" came from narratives about self-expression and about processing difficult emotions. The narratives that yielded "expanding and enlivening the self were about the women fortifying and energizing themselves through visual creative expression. Two minor themes related to the role of the art therapist and negative experiences with art therapy also emerged. In their narratives, the women portrayed visual creative expression as flexible, compelling, and powerful means of addressing multiple psychosocial needs simultaneously. Above all, the storylines show that the women valued visual creative expression as a way to reduce the feeling of threat to existence, to affirm present existence, and to promote the ongoing existence of both their psyches and their bodies. The results of this study contribute to the field of psycho-oncology by extending understandings of meaning making in relation to breast cancer, supplying detailed explanations from the perspectives of women with breast cancer of how visual creative expression can be helpful, and providing valuable insight into how psychosocial support services based on visual creative expression might meet needs of women with breast cancer that would not be met through other types of services.

Please read the abstract (Summary) in the section, 00front, of this document / Thesis (PhD (Psychology))--University of Pretoria, 2008. / Psychology / PhD / unrestricted

As breast cancer incidence and survival rates increase, there is an urgent need to make appropriate psychosocial support available to all women with breast cancer. In this qualitative study, narrative inquiry was used to examine how women with breast cancer used visual creative expression (art therapy and/or independent art making) to address psychosocial needs that arose for them after their diagnoses. Seventeen women, aged 37-82, participated in this investigation. Data analysis of in-depth interviews with these women focused on narratives they constructed about why they turned to art therapy and/or independent art making and how it helped to be involved in these activities. Particular attention was given to the issue of meaning making. Four storylines emerged from the analysis. "Art and art therapy as a haven" came from narratives about using art making or art therapy for comfort and affirmation. The narratives that comprised "getting a clearer view" were about using visual creative expression to create a clear picture of emotional experience. "Clearing the way emotionally" came from narratives about self-expression and about processing difficult emotions. The narratives that yielded "expanding and enlivening the self were about the women fortifying and energizing themselves through visual creative expression. Two minor themes related to the role of the art therapist and negative experiences with art therapy also emerged. In their narratives, the women portrayed visual creative expression as flexible, compelling, and powerful means of addressing multiple psychosocial needs simultaneously. Above all, the storylines show that the women valued visual creative expression as a way to reduce the feeling of threat to existence, to affirm present existence, and to promote the ongoing existence of both their psyches and their bodies. The results of this study contribute to the field of psycho-oncology by extending understandings of meaning making in relation to breast cancer, supplying detailed explanations from the perspectives of women with breast cancer of how visual creative expression can be helpful, and providing valuable insight into how psychosocial support services based on visual creative expression might meet needs of women with breast cancer that would not be met through other types of services. / Graduate and Postdoctoral Studies / Graduate

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy

M.A. (Social Work) / Cancer is a common condition and is becoming an important issue in South Africa. During their lifetime people may develop different forms of cancer such as lung -, throat -, skin -, colon -, and breast cancer. Cancer affects people of different age groups from small children up to older people. It cuts across different racial groups and different socio economic levels. The patient with cancer faces one of the greatest stress situations known to man. Cancer is frequently a chronic disease. Acute periods of illness or intensive therapy may interrupt periods of normality for months or years. Treatment may necessitate major alterations in lifestyle or normal body functions. The diagnosis of cancer is seen by many as synonymous with death. (Kellogg & Sullivan : 1978) Kellogg (1978) believes that the fear of loss of self determination, of being dependent and non - productive, can be more stressful than the prospect of death itself. The patient may also fear that the disease, the results of treatment, or the changes he presumes will result, will cause others to isolate or abandon him...

M.Cur. (Psychiatric Nursing) / A diagnosis of cancer causes certain fears to arise in a patient, as well as among his family, activating intense emotional responses in everyone concerned. Examples of such emotions are anger. self-reproach, gUilt, heartache, helplessness and mourning. An acceptance of the circumstances does not necessarily occur, and the phases of the mourning process may be continually interchanging. As a result of all these emotions experienced by the patient with cancer as well as his family, mental discomfort is likely to occur. The family has to adapt its usual mechanism for handling internal discomfort, in order to include the pressure and demands to which they will be exposed as a result of the cancer and treatment thereof. Family cohesion will not necessarily be advanced as a result of this heightened pressure, and additional pressure may be placed on relationships within the family. Members of a family often find it difficult to discuss openly their fears, worries and feelings. for the simple reason that they are scared of becoming upset themselves, or alternately upsetting the rest of the family. Holding themselves back in this way may lead to a feeling of being isolated, which in turn leads to feelings of uncertainty being experienced. In this way the members of a family may find themselves becoming less and less involved with each other and with the patient's treatment, all as a result of not being able to talk about their fears and other intense emotions and therefore not being able to realise all these feelings. As a result of the family's uncertainty concerning their handling of the situation, they experience a loss of control and a change in their ability to handle their situation. These factors contribute to their experience of mental discomfort. Mental discomfort is not visible to others, therefore it is very rarely treated by the multiprofessional team. If the members of the team notice the existence of such discomfort, they will still emphasise the medical treatment, since they themselves may be uncertain as to any effective treatment for such a family. The registered nurse who is in continuous contact with the patient and his family, therefore has the challenge to support the family who suffers from mental discomfort in order to lessen their suffering and facilitate their striving towards achieving wholeness once more, whether in hospital, at home or in a community centre. There are several methods of interaction available for the treatment of such a family. Mental discomfort can be reduced by psychiatric nursing accompaniment. The purpose of this study was to explore and describe the folloWing: the contribution made by psychiatric nursing accompaniment through the medium of a psychiatric nursing specialist, as regards lessening the mental discomfort of the family of a patient being treated in an oncology unit or at home. A further purpose was to set certain guidelines for the registered nurse, concerning her support of the family of a patient in an oncology unit or at home, thereby lessening their mental discomfort. An exploratory, descriptive, contextual study was done on a family with one member who has been diagnosed with cancer, and who received treatment in an oncological unit and at home. This family submitted themselves to psychiatric nursing accompaniment. A purposive, non-selective sample was used and the family had to satisfy certain specific criteria pertaining to mental discomfort...

M.A. / A diagnosis with cancer causes certain fears in a patient, as well as, their family. It activates intense emotional responses in everybody concerned. Reach for Recovery play a huge role in mastectomy patients and their family's lives. It is there to support the patient and to understand what the patient is experiencing. Reach for Recovery is a selfhelp group, functioning under the name of the Cancer Association of South Africa. The group was started in 1952 in the USA, at a time when there was a tendency to discourage patients from discussing their operations with other patients. Therese Lasser, a mastectomy patient, realized that not enough was being done for women whose life had changed dramatically in the span of a few hours. The goal of the study was to do training for Reach for Recovery volunteers. To assess if the Reach for Recovery volunteer is fulfilling in the need of the mastectomy patient. A qualitative approach, using an inductive strategy, was followed to achieve the aim of the study. Focus groups are being used to gather information about the functioning of the Reach for Recovery groups at present. Focus groups were held in the Far East Rand and the West Rand with the Reach for Recovery support groups. The purpose of the focus group was to identify the needs of the mastectomy patients, to enable the researcher to identify guidelines for the Reach for Recovery programme. A literature control was done after the central themes were identified. After having compared the results of the focus group with the relevant literature certain conclusions were drawn and recommendations made. In conclusion to this study, guidelines were designed to be used in the Reach for Recovery programme when the training is done.