A theoretical framework to guide a study exploring cancer related fatigue

This paper explicates how Orem's Self-care Deficit Theory of Nursing (Orem, 1995) was selected to guide a study to explore and measure cancer related fatigue (CRF), and determine the most effective self-care strategies used to combat CRF in a cohort of patients with a diagnosis of cancer (breast cancer, colorectal cancer, Hodgkin's and Non-Hodgkin's lymphoma). The secondary aim was to explore self-care agency and its relationship to CRF

Bowel symptom experiences and management following sphincter saving surgery for rectal cancer: A qualitative perspective

The aim of this research was to explore participants’ qualitative perspectives on bowel symptom experiences and management strategies following sphincter saving surgery for rectal cancer. Methods and sample The data presented in this paper were gleaned from a semi-structured question that formed part of a larger multi-site quantitative correlational study. From a sample of 143 participants, a total of 77 (62.6%) males and 46 (37.3%) females provided qualitative comments. Participants were aged 30–70 years and over, had undergone sphincter saving surgery for rectal cancer in the past 3–42 months. Data were analysed using pre-determined semi-structured categories. Key results The study demonstrated the subjective nature of the bowel symptoms experienced. It also highlighted the bowel symptoms that were most problematic and the effect of these symptoms on participants’ daily lives. In addition, the self-care strategies that worked best for individual participants in the management of bowel symptoms were identified. Conclusions There is a need to educate patients on the short-term as well as the long-term bowel symptoms experienced following sphincter saving surgery for rectal cancer. Nurses have an important contribution to make in facilitating patients to choose from a range of self-care strategies to help them manage their bowel symptoms postoperatively

Challenges in recruiting participants in a multi-centre study on symptom experiences and self care strategies of bowel symptoms following colo-rectal surgery

Aim: The purpose of this paper is to present some of the challenges found to be problematic in recruiting individuals following sphincter saving surgery for rectal cancer for a multicentre study. While the focus of the study is on symptom experiences and management of bowel symptoms following colo-rectal surgery, the paper will concentrate solely on the challenges experienced in recruiting a sample for the study. Background Recruitment of an adequate number of participants is a challenge for researchers in any area of research involving patients. Enrolment of patients treated for rectal cancer poses particular challenges because the total population of this group in a given country can be small. The use of multiple centres was required to obtain the required number of participants for the current study. Findings: In multicentre studies, researchers can encounter substantial challenges in obtaining ethical approval, accessing clinical sites and gaining direct access to patients. These challenges are embedded in a convoluted process involving many systems of communication, which can vary from one centre to another. Conclusions: The process of obtaining ethical approval is prolonged in the absence of a central ethical review committee. A review process based on a standard application for researchers seeking ethical approval for multi- centred studies central is necessary. Establishing and maintaining access to clinical sites requires co-operation from many individuals during the development of the proposal and continuing throughout the data collection process

A theoretical framework to guide a study of patients' bowel symptoms and self-care strategies following sphincter-saving surgery for rectal cancer

A paucity of research is available on patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer. Most research undertaken to date on patients' bowel symptoms following surgery for rectal cancer has been largely atheoretical. The purpose of this paper is to describe the process of choosing a theoretical framework to guide a study of patients' bowel symptoms and self-care strategies following sphincter-saving surgery for rectal cancer. As a result of a thorough literature review, we determined that the Symptom Management Theory provided the most comprehensive framework to guide our research

Patients’ bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer

Aims and objectives: To investigate patients’ bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer and the relationship between bowel symptom experiences and the self-care strategies used. Background: Earlier diagnosis of rectal cancer allows for less invasive surgical treatments such as sphincter-saving procedures to be performed. Although a permanent stoma is generally not required, patients experience changes in bowel function following this surgery. However, limited research exists on patients’ bowel symptom experiences and the self-care strategies used to manage symptoms following sphincter-saving surgery of rectal cancer. Design: Quantitative descriptive correlational. Methods: A convenience sample of 143 patients aged 30 to over 70 years was used. Data were collected (April 2010–December 2010) using the Illness Perception Questionnaires, the Difficulties of Life Scale and a researcher developed Self-care Strategy Measure. The research was underpinned by the Symptom Management Theory. Findings: Relating to the four most effective self-care strategies used respondents reporting more bowel symptom were more likely to use the self-care strategy proximity/knowing the location of a toilet at all times. Females, respondents with high timeline cyclical scores and respondents with high physiological responses scores were more likely to use protective clothing. Respondents reporting more bowel symptom and with high social responses scores were more likely to use bowel medication. Females were more likely to wear incontinence pads. Conclusion: This research provides insights into the daily bowel symptom experiences of patients following sphincter-saving surgery for rectal cancer. It demonstrates the range of self-care strategies that individuals use to manage their bowel symptoms and the self-care-strategies that were most effective for them. Relevance to clinical practice: Patients should be encouraged to report on-going bowel problems following sphincter-saving surgery for rectal cancer. Supportive care for patients should be comprehensive and tailored to meet individual needs

Nebulous intentioning – Acute hospital nurses’ struggle to deliver core nursing care

Aim: To explore the influences on nursing practice in acute hospital care. Design: A Classic Grounded Theory study. Methods: Data collection (2013–2015) was through interviews and non‐participant observations. Analysis was undertaken using constant comparative data analysis and theoretical sampling. Memo writing was used as an aid to understanding and conceptualizing data during analysis. Theoretical coding served to integrate emerging concepts. Results: This theory explains core nursing as a nebulous intention, an idea which acute care nurses retain throughout each shift, that they will nurse their patients fully when they have the opportunity. It reveals this as the resolution of their main problem which is the constant deferral of core nursing care. This study explains its two sub‐core categories, accommodating and integrity eroding. Conclusion: The theory highlights nurses’ attitudes towards their role, demonstrated by deferring it to accommodate the work of others, but offers a new perspective on the significant contribution nurses make to the safe and cohesive transition of patients through the acute healthcare system. Impact: The theory adds a new understanding of the unique contribution nurses make to patient health and safety in acute care environments. It also provides insight into nurses’ attitudes towards their own professional work. It explains the consequences of attitudes which undermine core nursing when it competes for priority with accommodating. Accommodating indicates a greater workload for nurses than has been previously understood in explaining the activities, additional to core nursing care, which nurses undertake to contribute safety and cohesion to the patient's acute care journey. These new insights suggest a role for managers in recognizing accommodating in decisions about staffing and resources and for educators in improving the profession's regard for its theoretical underpinnings and for its self‐image

The Preconscious Awareness to Action Framework: an application to promote testicular awareness

Objectives: The purpose of the study is to present a theory-focused analysis of the preconscious awareness to action framework (PAAF), developed to enhance testicular awareness and help-seeking intentions and behaviors among men. Methods: The following approach was used to develop the PAAF: The empirical literature on men’s awareness of testicular disorders was reviewed. A qualitative study was conducted to explore men’s awareness of testicular disorders, help-seeking intentions for testicular symptoms, and preferred learning strategies in relation to testicular disorders and symptoms. An iterative narrative review process of the theoretical literature on health promotion and symptom appraisal was undertaken. Results: The PAAF comprises seven steps: preconscious awareness, unconscious awareness, conscious awareness, unconscious appraisal, conscious appraisal, intention, and behavior. The concept of testicular awareness was developed to familiarize men with their own testes and promote timely help-seeking. Discussion: Researchers are encouraged to use the PAAF to design health-promoting interventions aimed at enhancing testicular awareness, symptom appraisal, and help-seeking

Males' awareness of benign testicular disorders: an integrative review

Disorders that affect the testes can range from painless and benign to debilitating and life threatening. Despite the availability of literature on the etiology, diagnosis, and treatment of benign testicular disorders (BTD), very little is known about men’s awareness of these conditions. The aim of this review was to extract and analyze evidence from studies that explored males’ awareness of BTD. Four e-databases (CINAHL, MEDLINE, PsychINFO, and PubMed) were thoroughly searched and four articles met the review inclusion criteria. The quality of the included studies was appraised and data were extracted and cross-checked using a standardized data extraction table. It was determined that participants lacked education about testicular self-examination and scrotal signs and symptoms which contributed to their lack of awareness of BTD. Help seeking in the event of scrotal abnormalities was suboptimal which is alarming given the acuteness of some BTD such as testicular torsion. Individuals who are at risk for health disparities were underrepresented in the reviewed literature. Findings from this review highlight the need to address barriers to BTD knowledge and help seeking. This could be achieved through making use of past interventions that succeeded in increasing men’s awareness of testicular cancer such as university campaigns and mass media. From a practical standpoint, clinicians must be encouraged to educate young men about BTD. This could be attained through tailoring creative educational interventions that are sensitive to the needs of individuals who are at risk for health disparities

Promoting testicular cancer awareness and screening: a systematic review of interventions

Background: Testicular cancer (TC) is a relatively curable malignancy that predominantly affects young males. Key decision makers discourage TC screening because of lack of evidence about the benefits of this practice, whereas others argue that men must be aware of normal versus abnormal testicular findings. Despite the debate on TC surveillance, a number of research efforts are still being made to increase men’s awareness of TC and its screening. Objective: The aim of this study was to systematically review studies that were conducted to enhance men’s knowledge and awareness regarding TC and its screening and increase their TC screening intentions and practices. Methods: Studies published in English between 2004 and 2014 were reviewed using 3 e-databases, and interventions that were in line with the review aims were selected. Results: A total of 3076 records were screened for eligibility, and 11 studies met the inclusion criteria. The majority of the reviewed interventions successfully enhanced men’s awareness of TC and its screening and increased their intentions to perform testicular self-examination. Examples include videos about TC, shower gel sachets, stickers, and posters, a television show, a university campaign, and high self-efficacy messages about TC screening. Men at risk of health disparities were underrepresented in the reviewed literature. Conclusions: A number of interesting channels through which men can learn about TC were identified. Examples include social media and mass media. Implications for Practice: Given the controversy that surrounds TC screening, nurses can play a key role in increasing men’s awareness of TC rather than advising periodical TC self-examination

Exploring awareness and help-seeking intentions for testicular symptoms among heterosexual, gay, and bisexual men in Ireland: a qualitative descriptive study

Background: The incidence of malignant and benign testicular disorders among young men is on the rise. Evidence from three reviews suggest that men's knowledge of these disorders is lacking and their help seeking intention for testicular symptoms is suboptimal. Qualitative studies have addressed men's awareness of testicular cancer, with none exploring their awareness of non-malignant diseases such as epididymitis, testicular torsion, and varicocele and none including sexual minorities. Objective: To explore, in-depth, heterosexual, gay, and bisexual men's awareness of testicular disorders and their help-seeking intentions for testicular symptoms in the Irish context. Design: This study used a qualitative descriptive approach. Data were collected via face-to-face individual interviews and focus groups. Settings: Participation was sought from a number of community and youth organisations and one university in Southern Ireland. Participants: Maximum variation and snowball sampling were used to recruit a heterogeneous sample. A total of 29 men partook in this study. Participants were men, aged between 18 and 50 years, and residents of the Republic of Ireland. Methods: All interviews were audio-recorded and transcribed verbatim. Reflective field notes were taken following each interview. A summary of the interview was shared with selected participants for member check. Data were analysed and validated by three researchers. Inductive qualitative analysis of manifest content was used. Latent content was captured in the field notes. Data analysis yielded two key themes. Results: The themes that emerged from the interviews were: Awareness of testicular disorders and their screening, and help-seeking intentions for testicular symptoms. Although most participants heard of testicular cancer, most did not know the different aspects of this malignancy including its risk factors, symptoms, treatments, and screening. Several men had a number of misconceptions around testicular disorders which negatively impacted their intentions to seek prompt help. Intentions to delay help seeking for testicular symptoms were often linked to a number of emotional factors including fear and embarrassment, and social normative factors such as machoism and stoicism. In this study, culture was perceived by some participants as a barrier to awareness and help-seeking. In contrast, many believed that young men, especially those who self-identify as gay, are becoming increasingly interested in their own health. Conclusion: Findings suggest the need to educate young men about testicular disorders and symptoms. This could be achieved through conducting health promotion campaigns that appeal to younger men, drafting national men's health policies, and normalising open discussions about testicular health at a young age