The significance of motherhood for adolescents whose mothers have breast cancer.

PURPOSE/OBJECTIVES: To describe adolescents' experiences of living with mothers with breast cancer. RESEARCH APPROACH: Qualitative. SETTING: Northeastern United States. PARTICIPANTS: 11 adolescents aged 13-19 years whose mothers were diagnosed with breast cancer within a year prior to the study. METHODOLOGIC APPROACH: With Van Manen's phenomenologic interpretive paradigm, multiple levels of analysis of transcribed semistructured interviews yielded common themes and a unique account and understanding of adolescents' lives when their mothers have breast cancer. MAIN RESEARCH VARIABLES: Adolescent coping and maternal breast cancer. FINDINGS: Five distinct themes were identified: life changed, turning to self, learning to be with my mother, needing to normalize, and speaking openly--the importance of communication. Study findings uncovered the powerful role mothers held in the adolescents' lives. CONCLUSIONS: The depth of the feelings and conflicts expressed by the adolescent participants, who appeared to be coping with their mothers' breast cancer, emphasizes the need to explore coping responses used in adolescent adjustment to maternal breast cancer. Given that all the adolescents reported some level of anxiety and conflict in their lives, further research should address factors that underlie their coping mechanisms. INTERPRETATION: Study findings and insights underscore the significance of the maternal-adolescent relationship. Healthcare professionals need to ask more directed questions and develop interviewing and counseling skills to support mothers through this difficult illness. Adolescent children require support and guidance in coping with their mothers' breast cancer journey.

Cervical cancer: patterns of long-term survival.

PURPOSE/OBJECTIVES: To describe the quality of life (QOL) experienced by long-term survivors of cervical cancer and the factors that promoted their adaptation. DESIGN: Qualitative. SETTING: Homes and offices in the northeastern United States. SAMPLE: 19 women diagnosed with cervical cancer from 1975-1995. METHODS: Semistructured interviews were tape recorded. Interviewers asked the participants questions regarding their cancer experience, recovery, and long-term survival. Qualitative content analysis was used to identify themes that characterized participants' accounts. Participants varied in regard to how the themes were manifested in their accounts. MAIN RESEARCH VARIABLES: Meaning, impact on identity, impact on QOL, coping strategies, and future expectations. FINDINGS: Three distinct patterns of response emerged from participants' accounts of long-term survivorship with cervical cancer. Women categorized in the "moving on" pattern described their cancer as a difficult period taking place in the past, women in the "renewed appreciation of life" pattern focused on the positive outcomes of their cancer experience, and women in the "ongoing struggles" pattern emphasized the continuing negative outcomes of their cancer experience. Despite their overall distinctness, some common qualities in the patterns emerged, including the shock of the diagnosis, the pivotal role of healthcare providers, and the importance of support from family and friends. CONCLUSIONS: Cervical cancer survival, for most of the study participants, brought with it some degree of long-term complications, with differences in reported QOL attributed to an ability or choice to reframe the cervical cancer experience. IMPLICATIONS FOR NURSING: QOL and depression measures alone do not uncover embedded meanings of women's experiences with longterm survivorship. Clinicians can use a variety of interview probes and evidence-based psychosocial and educational approaches to assist the target population in the journey. Findings suggest that nurses play a key role in responding to cervical cancer survivors' unique experiences with illness and recovery.

Improving oral health in women: nurses' call to action.

The purpose of this article is to discuss the most significant oral health and related problems experienced by women, and to provide a Nurse's Plan of Action to respond to these largely preventable diseases. Oral health is integral to women's overall health and well-being, with poor oral health being associated with cancer, heart disease, diabetes, depression, and the birth of preterm, low-birthweight babies. Poor nutrition and lifestyle, principally tobacco and heavy alcohol use, can further increase the risk for oral diseases. Disparities are evident in women's reported poor access of regular dental care related to lack of dental insurance and low income. These facts are disturbing because most oral diseases are preventable. The Surgeon General's report on oral health in America (U.S. Department of Health and Human Services, 2000) and, more recently, the "National Call to Action to Promote Oral Health" (U.S. Department of Health and Human Services, 2003) emphasized the need for partnerships of key stakeholders, including nurses, to get involved in oral disease prevention. Nurses are in an ideal position to provide health promotion education and screening across the multitude of settings in which they work regarding oral health and risk factors for oral disease. Nursing interventions aimed at promoting healthy outcomes and preventing disease should include a focus on oral health.

Promising outcomes in teen mothers enrolled in a school-based parent support program and child care center.

BACKGROUND: This study described a cohort of teen mothers and their children attending an urban high school with a parent support program and school-based child care center. Specific aims of the study were to describe maternal characteristics and outcomes, and child developmental and health outcomes. METHODS: A volunteer sample of 65 adolescent mothers enrolled in the parent support program and their children were interviewed, surveyed, and assessed. Fifty-three mothers had children enrolled in the school-based child care center and 12 mothers had their children cared for by family members. Maternal characteristics assessed included self-esteem and depressive symptoms, social stressors and support, self-perceived parental competence, parent-child teaching interactions, and subsequent childbearing and maternal educational outcomes. Child outcomes included child developmental assessments and health outcomes. RESULTS: About 33% of teen mothers were mildly to moderately depressed and 39% of the sample had experienced transitional homelessness. Social support networks were small; in the past 12 months, mothers experienced a mean number of 13.2 +/- 11.9 negative life events. Maternal self-report measures and mother-child observation measures indicated positive levels of parental competence. Maternal educational outcomes were positive, and only 6% of mothers had subsequent childbirths within 2 years. The mean scores on developmental assessments of children fell within the normal range, although there were 7 children identified with developmental delays. CONCLUSIONS: For at-risk teen mothers, this parent support program and school-based child care setting appears to offer promising opportunities to help young mothers with parenting, avoid rapid subsequent pregnancies, and stay engaged with school, while their children are cared for in a close and safe environment.

Adolescent mothers' depression after the birth of their babies: weathering the storm.

This phenomenological study explored the experiences of adolescent mothers with depression following the birth of their babies. A sample of 20 English-speaking participants, between the ages of 16 and 18, were asked to reflect upon and describe their thoughts, feelings, and perceptions about being depressed after the birth of their babies. Significant statements were extracted from each of the transcribed interviews and meanings formulated that reflected the intent of the statements. The meanings were organized into six theme clusters. A written, exhaustive description was reviewed by study participants for credibility and trustworthiness of the findings. The metaphor of being hit by a nor'easter storm emerged from the participants' descriptions of their experiences and was threaded throughout the description of the themes. Implications for practice and directions for future research are presented.