Nursing interventions in radiation therapy : studies on women with breast cancer

University dissertation from Stockholm : Karolinska Institutet, Department of Oncology-Pathology

Abstract: The general aim of this thesis was to acquire knowledge to be used to improve the care of cancer patients during and after radiation therapy, in particular for women with breast cancer. The specific objectives were first to assess nursing care problems of importance for the development of nursing care in a radiation therapy department and secondly to evaluate possible effects on side-effects, coping ability, and subjective distress of a nursing intervention based on Orem's self-care theory. A structured communication process according to the Delphi technique in three phases was used to assess perceived nursing care problems in the care of the cancer patient and in work with other professionals from the nurse's perspective. The nurses reported; poor follow-up of patients after completion of treatment, lack of time to document nursing care given and lack of time to treat patients as the most problematic areas of importance for the development of nursing care. One hundred and thirty four patients participated in the randomized study. The experimental group consisted of 67 patients, as did the control group. No measurable effect of the nursing intervention was found for side effects or quality of life. However, the nursing intervention proved to have positive effects in minimizing stress reactions (p=< 0.05). Further, the results showed that the intervention provided patients older than 59 years with stronger motivation to be emotionally involved (df=2, F=3.463, p=<0.05). Side effects experienced the severity of the most commonly reported side effects, and quality of life during and up to three months after treatment, included analysis of the whole group (n=134). Experienced side effects and their severity increased as the treatment progressed. Fatigue, sleep disturbances, skin symptoms, dry mouth, sore throat, pain, nausea, cough and dyspnea were the most commonly reported side effects. Quality of life improved as treatment progressed. The women used several strategies to cope with the treatment, and these changed over time. Family and friends had a positive impact on the coping process at all points of measurement. In addition, work and contact with colleagues provided the women with a sense of normalcy. The women used a broad spectrum of own activities to aid recovery. In conclusion, there was a significant effect of the nursing intervention on the degree of emotional involvement for patients aged over 59 years. This type of intervention should be directed towards patients risking poor adjustment, such as older age groups. The persistent pattern of symptoms and side effects implies that the period from the second week during treatment up to two weeks following its completion is the critical time for targeting interventions for symptoms and side effects of treatment. Nursing care in radiation therapy should be organized in a way that provides nurses with sufficient time for the provision of nursing care. Social support such as family, friends and work outside the home seemed important to the women in order to cope with the treatment. The identification of patients risking poor adjustment such as single, widowed or unemployed women offers important challenges during and after completion of treatment, and interventions are required to meet their needs.

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