Metastatic bone pain. Meanings associated with self-report and self-management decision making.

Patients with cancer and bone metastases are vulnerable to severe pain, especially when changing their body position, and many such persons die with unrelieved pain. One step in obtaining acceptable pain control is communicating one's pain to health care providers. This descriptive study aimed to depict possible gender differences in the meaning of pain in the context of pain self-report and self-management decision making for 10 men and 10 women with cancer and bone metastasis. No clear gender differences were found in the narrative data obtained during semistructured interviews. Both men and women equated pain with cancer recurrence. Pain interfered with work, social activities, and relationships. Most participants preferred not to tell others, even health care providers, about their pain. More than one half of the 20 participants did not take pain medications on schedules recommended by physicians. The study findings provide oncology nurses with direction for education related to pain management for persons with metastatic bone pain and their family members. Further research with a larger sample is needed to clarify how to overcome barriers to better pain management in this population.

Lymphedema prevention and management knowledge in women treated for breast cancer.

PURPOSE/OBJECTIVES: To describe what women treated for breast cancer know about upper extremity lymphedema, what they recall being told to help prevent lymphedema, what preventive strategies they used, and, if lymphedema occurred, factors related to its occurrence and strategies they used to manage it. DESIGN: Descriptive, correlational survey. SETTING: Survivor-established Breast Cancer Resource Center. SAMPLE: 72 women with breast cancer who returned a mailed questionnaire that was enclosed with a quarterly newsletter. METHODS: A survey instrument, the Lymphedema Knowledge Scale, developed from National-Lymphedema Network guidelines to prevent upper extremity lymphedema. Data that was analyzed using descriptive statistics, chi square, and t-tests. MAIN RESEARCH VARIABLES: Lymphedema knowledge, lymphedema occurrence, and lymphedema prevention and management strategies. FINDINGS: Although many respondents were aware of their risk for lymphedema, their knowledge and use of prevention strategies were poor. Most knowledge was obtained from surgeons, reading materials, and breast cancer survivors. Occurrence of lymphedema was significantly associated only with radiation therapy to breast and axilla and use of any prevention strategy. The 27 women experiencing lymphedema used several management strategies to control the condition. CONCLUSIONS: The few women who had knowledge of most of the recommended guidelines for lymphedema prevention and management did not recall nurses as resources. Research in a larger sample is needed to better examine the association between preventive practices and lymphedema occurrence. IMPLICATIONS FOR NURSING PRACTICE: Nurses could do more to inform patients before and during breast cancer treatment about their risk for lymphedema and the need for prompt diagnosis and treatment of the condition. Until strategies for lymphedema prevention are researched further, nurses should be cautious in counseling about lymphedema prevention.

Facilitation of self-transcendence in a breast cancer support group.

PURPOSE/OBJECTIVES: To examine the feasibility and patterns of effectiveness of a breast cancer support group intervention specifically designed to facilitate self-transcendence views and perspectives that would enhance emotional and physical well-being. DESIGN: Pre-experimental design pilot intervention study with a quantitative approach to data analysis. SETTING: Survivor-established breast cancer resource center in Austin, TX. SAMPLE: Women with recently diagnosed breast cancer (N = 16) participating in 90-minute support group sessions that met weekly for eight weeks. METHODS: Theory-driven support group intervention facilitated by an oncology clinical nurse specialist, a psychotherapist, and a breast cancer survivor. Activities planned for individual sessions were based on self-transcendence theory, cancer support group literature, and the facilitators' extensive previous support group experience. MAIN RESEARCH VARIABLES: Self-transcendence, emotional well-being, physical well-being. FINDINGS: Good networking, coordination, and follow-up were essential for participant recruitment and retention throughout the intervention period. Although specific theory-driven activities were planned for group sessions, facilitators maintained flexibility in meeting immediate concerns of the participants. Relationships among participants' scores on study variables indicated an association between self-transcendence and emotional well-being. Scores on self-transcendence and well-being variables at the end of the intervention increased from baseline, but only functional performance status, mood state, and satisfaction with life reached statistical significance. CONCLUSIONS: The pilot study was invaluable in providing direction for the conduct of future experimental studies. IMPLICATIONS FOR NURSING PRACTICE: Provides preliminary support for the use of theory-driven activities for promotion of self-transcendence views and behaviors within a cancer support group setting.

Constructing meaning from the experience of cancer.

OBJECTIVES: To describe how people with cancer create new sources of meaning at significant times in the illness trajectory. DATA SOURCES: Nursing research, including that of the author; documented observations and theories of psychiatrists and psychologists. CONCLUSION: There are turning points within the cancer trajectory when choices made by persons with cancer and their families may have far reaching consequences in terms of new goals to pursue and new sources of meaning to create. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can assist by carefully listening to what is important to patients, assisting to clarify values when necessary, and encouraging patients to seek connections with similar others that facilitate finding meaning and healing.

Self-transcendence: a resource for healing at the end of life.

An emerging body of theoretical and empirical knowledge links the concepts of self-transcendence and healing in persons facing end-of-life issues related to aging or life-threatening illness. Self-transcendence is postulated to be a resource for healing in that reaching beyond self-boundaries may lead to a sense of well-being derived from an intensified awareness of wholeness and integration among all dimensions of one's being. This paper proposes a link between self-transcendence and healing, based on clinical and empirical literature. Suggestions for approaches nurses may use to facilitate self-transcendence are included.

Self-transcendence and correlates in a healthy population.

The purpose of this study was to document the presence of self-transcendence perspectives in a healthy population and to compare self-transcendence and related concepts with previous findings in elderly well persons and in those with life-threatening illness. Levels of self-transcendence, as assessed by the Self-Transcendence Scale and the Purpose-in-Life Test in a sample of 152 persons (mean age = 46 years), were similar to those found in other populations. Moderate correlations with self-transcendence and female gender; older age, and higher self-report of health status were found. Self-transcendence was strongly correlated with sense of coherence, self-esteem, hope, and variables assessing emotional well-being.

The lived experience of self-transcendence in women with AIDS.

OBJECTIVE: To describe the lived experience of self-transcendence in women with AIDS, associated with increased sense of meaning and purpose, well-being, self-esteem, and connectedness with self and/or others. DESIGN: Exploratory-descriptive, using phenomenological research methods for the study approach, data collection, and data analysis. SETTING: One written description and nine audiotaped interviews of self-transcendence experiences were provided by women with class IV HIV infection (AIDS). PARTICIPANTS: Ten women recruited by nurses at an AIDS family clinic and through a flyer at the AIDS Support Group House in Seattle. OUTCOMES: Participant descriptions indicated that women with AIDS continue to find meaning and purpose in their lives through experiences of receiving from others, giving to others, and maintaining hope. RESULTS: The findings support the theory that self-transcendence views and behaviors are a source of mental health at the end of life. CONCLUSIONS: The findings suggest several ways nurses may help women with AIDS discover or make meaning and purpose in their lives.

Meaning and purpose in the lives of persons with AIDS.

Little research has been reported that explores meaning-discovery and meaning-making in persons with AIDS. Self-transcendence experiences, as proposed by Reed (1991), may lead to maintenance or restoration of mental health in persons facing end-of-life issues. Nurses who work with persons with life-threatening illness, such as men and women with AIDS, have opportunities to facilitate choices that lead to experiences from which meaning and emotional well-being may be obtained. This study used a phenomenological approach to describe experiences of 10 men and 10 women with AIDS that led to feelings of increased self-worth, purpose, and meaning in their lives. Participants provided oral or written descriptions of experiences associated with feelings of increased connectedness with others, sense of well-being, and hope for longer life. Data were analyzed using Colaizzi's phenomenological technique (1978). Although men and women with AIDS faced some of the same issues, their responses were different. By incorporating gender and individual differences, nurses may be better able to create therapeutic exchanges in which self-transcendence views and behaviors are fostered in both men and women with AIDS.

The lived experience of self-transcendence in gay men with AIDS.

This phenomenologic study described the structure of self-transcendence in eight gay men with AIDS. The men provided oral or written descriptions of experiences associated with feelings of increased interconnectedness with others, sense of well-being, and meaning and purpose in life. The data were analyzed using Colaizzi's phenomenologic technique. The men experienced self-transcendence in the three ways described by Frankl. Reaching out for help and helping others alleviated the men's sense of aloneness and isolation. Their acceptance of the closeness of death led to a sense of urgency to create a legacy and to participate only in activities that had meaning for them. Knowledge of these views and behaviors may help nurses to create a therapeutic exchange in which self-transcendent views are fostered in other gay men with AIDS.

Simultaneous concept analysis of spiritual perspective, hope, acceptance and self-transcendence.

This paper seeks to clarify four previously elusive concepts of concern to nurses: spiritual perspective, hope, acceptance and self-transcendence. Simultaneous concept analysis (SCA), a method developed by the authors, was used to generate a process model of antecedents, critical attributes and outcomes of all four concepts. This resulted in refined theoretical definitions for each concept. Interrelationships that became apparent among the concepts are discussed and implications of these interrelationships for theory and measurement are presented.

Self-transcendence and emotional well-being in women with advanced breast cancer.

Self-transcendence has been associated, in previous studies, with stressful life events and emotional well-being. This study examined the relationships among self-transcendence, emotional well-being, and illness-related distress in women with advanced breast cancer. The study employed a cross-sectional correlational design in a convenience sample (n = 107) of women with Stage IIIb and Stage IV breast cancer. Subjects completed a questionnaire that included Reed's Self-Transcendence Scale; Bradburn's Affect Balance Scale (ABS); a Cognitive Well-Being (CWB) Scale based on work by Campbell, Converse, and Rogers; McCorkle and Young's Symptom Distress Scale (SDS); and the Karnofsky Performance Scale (KPS). Data were analyzed using factor analytic structural equations modeling. Self-transcendence decreased illness distress (assessed by the SDS and the KPS) through the mediating effect of emotional well-being (assessed by the ABS and the CWB Scale). Self-transcendence directly affected emotional well-being (beta = 0.69), and emotional well-being had a strong negative effect on illness distress (beta = -0.84). A direct path from self-transcendence to illness distress (beta = -0.31) became nonsignificant (beta = -0.08) when controlling for emotional well-being. Further research using longitudinal data will seek to validate these relationships and to explain how nurses can promote self-transcendence in women with advanced breast cancer, as well as in others with life-threatening illnesses.

Critical multiplism: a research strategy for nursing science.

This paper describes critical multiplism from the perspective of the world views and models of scientific inquiry that frequently guide the work of nurse scientists. Nurse scientists may wish to consider critical multiplism as a research strategy within a dialectical model of scientific inquiry to study the multiple realities of interest to nurses. This approach to nursing knowledge development may enhance the usefulness of nursing research findings in nursing practice.

The lived experience of self-transcendence in women with advanced breast cancer.

The purpose of this exploratory study was to describe the lived-experience of self-transcendence in women with Stage IV breast cancer. A phenomenological approach was chosen for the research design and analysis. Five women who had lived with metastatic disease from 2 to 7 years described experiences from which they derived an increased sense of self-worth, purpose in life, and interconnectedness with others. The self-transcendent experiences involved an effort on the part of the participants to reach out beyond themselves to help other women, to permit others to help them, or to "just accept" unchangeable situations. The results indicated that participants found meaning in their lives in the face of life-threatening illness. Although nurses can not be expected to create self-transcendent experiences for their patients, they may be able to establish and maintain conditions in which the phenomenon occurs.