Health beliefs and personality correlates of breast cancer: from screening to mastectomy adjustment - a cross-cultural study between Scotland and Greece

The present thesis consists of three thematic parts in relation to breast cancer: (a) practice of breast self - examination (BSE), (b) screening mammography attendance and (c) adjustment to breast cancer surgery / mastectomy. The aims of the respective studies are (a) to examine attitudes, beliefs and practices regarding BSE in younger (30 years old or under) and older women (over 30 years old), (b) to explore attitudes and beliefs regarding mammography and identify factors associated with screening mammography attendance and (c) to explore factors associated with adjustment to breast cancer surgery. The above aims are explored in two different cultural contexts, by comparing samples from Scotland and Greece. Samples consisted (a) of 205 younger and 258 older women, university staff and students in Scotland and 85 younger women, university students in Greece, (b) 283 women who attended and 72 women who did not attend the National Breast Screening in Scotland, and 72 women undergoing mammography in Greece and (c) 19 women in Scotland and 27 women in Greece, who have undergone surgery for breast cancer. All participants were assessed on a variety of measures. These included demographics, health history, health beliefs and health - related personality variables. Results indicated that: 1. BSE was predicted by different variables across age and cultural groups. 2. In particular, practice of BSE in younger women was predicted by knowledge about breast cancer, perceived barriers, health motivation and cues for action, whereas practice in older women was predicted by knowledge about BSE, perceived barriers and cues for action. 3. BSE rates in both countries were higher than previously reported but did not differ between women in Scotland and Greece. However, the two groups differed in knowledge and attitudes, regarding BSE, and in personality. Women in Scotland appeared more knowledgeable regarding BSE, felt less susceptible to breast cancer and were less active in coping with health issues than women in Greece. Women in Greece valued their health more and scored higher in chance health locus of control beliefs than women in Scotland. 4. The best predictor of breast screening mammography attendance in Scotland was knowledge about mammography. Attenders appeared to have more knowledge about breast cancer and about mammography and to focus more on emotional coping, in order to deal with health stresses. 5. The two cultural groups differed in health-related decision making and health - related coping styles. Attenders in Scotland were more knowledgeable about risk factors related to breast cancer and about mammograms and perceived significantly more pain/discomfort associated with the procedure, than attenders in Greece. Attenders in Greece resorted more to acceptance and denial and were more likely to seek emotional support, in order to cope with health stressors than attenders in Scotland. 6. Health beliefs of breast cancer patients, in relation to their condition, and their style of coping with threatening information, concerning their breast problem, are highlighted as important factors to their adjustment in both cultures. However, adjustment to breast cancer surgery appears culture-specific, as different factors seem to determine it in different cultural contexts. 7. Patients in Scotland and Greece did not differ in their overall adjustment. However, Greek patients were significantly less well adjusted sexually postoperatively than patients in Scotland. Findings are discussed in relation to theoretical and practical implications

Three issues for mental health nurse educators preparing new preregistration programmes

Universities across the UK must develop and have in place new preregistration programmes by 2020. Unlike in the rest of the world, where initial nurse preparation is generic, preregistration education in the UK allows students to specialize in one of four specific fields of practice - adult, mental health, child or learning disability. To the relief of many , the new standards confirmed the continued survival of the specialist fields at undergraduate level. Educators across the UK now have an opportunity to fully review existing provision and address areas of significance. This paper explores three such issues. These are: •How best to respond to adverse life experiences or trauma.•The ethical tension which we believe is inherent in the use of coercive practice.•The potential to make a difference to the appalling mortality statistics which indicate that people with long standing mental health problems die much younger than their contemporaries In each case we make tentative suggestions for how they might be approached

‘It’s been a long haul, a big haul, but we’ve made it’: hepatitis C virus treatment in post-transplant patients with virus recurrence: An interpretative phenomenological analysis

The lived experience of both interferon-based and new interferon-free treatments in patients with hepatitis C virus remains understudied. To explore their journey through hepatitis C virus treatment, we interviewed seven post-transplant patients with recurrent hepatitis C virus. Three themes were identified using interpretative phenomenological analysis. Participants reported an ongoing sense of ontological uncertainty characterized by lack of control over their condition and treatment. Furthermore, an apposition of scepticism and hope accompanying each stage of hepatitis C virus treatment was described. A staged approach to psychological intervention tailored to the needs of the patient and their associated ‘stage’ of hepatitis C virus treatment was recommended

Suicide risk assessment in the emergency department:an investigation of current practice in Scotland

Background: Suicide is a global public health issue. Approximately one third of individuals who complete suicide have attended an emergency department in the year preceding their death. The aim of this study was to investigate current suicide risk assessment practices across emergency department clinicians in Scotland.Methods: A mixed‐methods design was employed. A total of 112 surveys for emergency department clinicians were posted to 23 emergency departments in Scotland between March and September 2016. Follow‐up semi‐structured interviews were also conducted exploring clinician's experiences of suicide risk assessment. Interviews were analysed using thematic analysis.Results: Fifty‐one emergency department clinicians across 17 emergency departments completed the survey. Thirty‐five (68.6%) participants were currently using a suicide risk assessment tool; with most using locally developed tools and proformas (n = 20, 62.5%) or the SAD PERSONS scale (n = 13, 40.6%). Remaining participants (n = 16, 31.4%) did not use suicide risk assessment tools during assessment. Variation in practice was found both across and within emergency departments. Six clinicians participated in follow‐up interviews, which identified four major themes: Clinician Experiences of Suicide Risk Assessment; Components of Suicide Risk Assessment; Clinical Decision‐Making; and Supporting Clinicians.Conclusions: There is substantial variation in current practice, with around two‐thirds of clinicians using a variety of empirically and locally developed tools, and a third using their judgement alone. Clinicians find suicide risk assessment a challenging part of their role and discuss the need for increased training, and appropriate and helpful guidelines to improve practice

Therapeutic interventions with child and adolescent survivors of sexual abuse:a critical narrative review

This is a narrative review of literature on therapeutic interventions with child and adolescent survivors of childhood sexual abuse (CSA). This is a step towards investigating the existing evidence-base for the therapeutic interventions, including various approaches to therapy and modalities, practiced by professionals with child and adolescent survivors of CSA. The key objective of this review was to examine treatment outcomes, established evidence-base and gaps in extant knowledge of different therapeutic interventions documented as being practiced within this population for CSA trauma. A number of individual studies, systematic reviews and meta-analyses were identified through a wide range of databases, including appropriate reference search. Findings reflected an absence of culturally-specific, clear guides to therapy for CSA survivors, particularly for child and adolescent survivors. Further, inconclusive, conflicting and contradictory evidence-base of therapeutic approaches, with limited scope and methodological flaws, was revealed. Based on these findings, it is argued that the factors that inform decisions regarding the therapeutic practice of practitioners, including mental health professionals, in real settings with child and adolescent survivors of CSA are not clearly defined and often take place in absence of a coherent and consistent evidence-base for existing therapeutic practices documented for CSA. Implications for research and practice are discussed

Experiences of diagnosis, stigma, culpability, and disclosure in male patients with hepatitis C virus: an interpretative phenomenological analysis

The current study aimed to explore the lived experience of patients with hepatitis C virus infection. Semi-structured interviews were conducted with seven male participants living with hepatitis C virus and were analysed using interpretative phenomenological analysis. Two master themes were identified: (1) diagnosis and the search for meaning and (2) impact of stigma on disclosure. Participants reported fears of contaminating others, feelings of stigma and concerns of disclosing the condition to others. Response to diagnosis, stigma and disclosure among the participants appeared to be interrelated and directly related to locus of blame for virus contraction. More specifically, hepatitis C virus transmission via medical routes led to an externalisation of culpability and an openness to disclosure. Transmission of hepatitis C virus as a direct result of intravenous drug use led to internalised blame and a fear of disclosure. The inter- and intra-personal consequences of hepatitis C virus explored in the current study have potential implications for tailoring future psychological therapy and psychoeducation to the specific needs of the hepatitis C virus population

Life Interrupted: Experiences of adolescents, young adults and their family living with malignant melanoma

AimMelanoma is one of the most common human malignancies; yet, it is often thought of as a disease of adulthood rather than one affecting adolescents and young adults. This study sought to understand the experiences of adolescents, young adults and their family living with malignant melanoma.DesignA qualitative study using Interpretive Phenomenological Analysis, through a multi-perspective design.MethodsData collection was conducted between January and August 2018 in each participant's Primary Care Centre when they were attending for an outpatient appointment. Each young person and a nominated family member were interviewed (n = 10) either individually (n = 4) or as a dyad (n = 6) according to their personal choice. In-depth semi-structured interviews were conducted and audio-recorded with the participant's consent. Interview data were transcribed verbatim and analysed.FindingsThe metanarrative ‘Life Interrupted’ was the core conceptual thread woven throughout the findings. It represents the interconnections and interrelationships between the adolescent or young adult and their family. Being able to recognize the disease and seek support was challenging with often limited physical, emotional or social support resulting in feelings of fear and isolation. Four super-ordinate themes were identified: (a) ‘Is it Serious’, (b) ‘Too Much too Young’, (c) ‘Not the Same’ and (d) ‘Time to Live’.ConclusionsWith the rising incidence of MM in the adolescents and young adults population globally, there are demands to improve healthcare professionals and nurse's knowledge and understanding of MM. As young people with MM experience their journey outside specialist cancer services, the care delivery for this patient group and their families require stronger links between services.ImpactThis study will inform the improvement of care delivery for MM in order that this patient group is provided with the same access to service delivery as other adolescents and young adults with cancer

Trust as a mediator in the relationship between childhood sexual abuse and IL-6 level in adulthood

Childhood sexual abuse (CSA) has been shown to predict the coupling of depression and inflammation in adulthood. Trust within intimate relationships, a core element in marital relations, has been shown to predict positive physical and mental health outcomes, but the mediating role of trust in partners in the association between CSA and inflammation in adulthood requires further study. The present study aimed to examine the impact of CSA on inflammatory biomarkers (IL-6 and IL-1β) in adults with depression and the mediating role of trust. A cross-sectional survey data set of adults presenting with mood and sleep disturbance was used in the analysis. CSA demonstrated a significant negative correlation with IL-6 level (r = -0.28, p<0. 01) in adults with clinically significant depression, while trust showed a significant positive correlation with IL-6 level (r = 0.36, p < .01). Sobel test and bootstrapping revealed a significant mediating role for trust between CSA and IL-6 level. CSA and trust in partners were revealed to have significant associations with IL-6 level in adulthood. Counterintuitively, the directions of association were not those expected. Trust played a mediating role between CSA and adulthood levels of IL-6. Plausible explanations for these counterintuitive findings are discussed

Mirror, mirror on the wall...: Appearance Distress in Dermatology – An overlooked parameter?

No abstract available. Editorial

Transitions from child to adult health care for young people with intellectual disabilities: A systematic review:Health transitions and young people with intellectual disabilities

AimsTo examine the experiences of health transitions for young people with intellectual disabilities and their carers and identify the implications for nursing practice.DesignA systematic review and critical appraisal of qualitative, quantitative, and mixed methods studies.Data sourcesA search of the relevant literature published 2007–2017 was carried out in AMED, ASSIA, CINAHL, MEDLINE, PsycINFO, PubMed, and Science Direct Sociological Abstracts databases.Review methodsA total of 12 of 637 papers identified in the search met the inclusion criteria for this review. A narrative review of the papers was undertaken by synthesizing the key findings and grouping them into concepts and emergent themes.ResultsFour main themes were identified: (a) becoming an adult; (b) fragmented transition process and care; (c) parents as advocates in emotional turmoil; and (d) making transitions happen.ConclusionThe range of issues that have an impact on the transition from child to adult health services for young people with intellectual disabilities and their carers raise important implications for policy development, nursing practice, and education