Using health psychology techniques to manage chronic physical symptoms.

Chest pain and palpitations, non-malignant pain, breathlessness and fatigue often endure despite the receipt of appropriate nursing and medical care. This is distressing for patients, impacts on their quality of life and ability to function and is associated with high healthcare usage and costs. The cognitive behavioural approach offers nurses a model to understand how people's perceptions and beliefs and their emotional, behavioural and physiological reactions are linked. Common 'thinking errors' which can exacerbate symptom severity and impact are highlighted. Understanding of this model may help nurses to help patients cope better with their symptoms by helping them to come up with alternative more helpful beliefs and practices. Many Improving Access to Psychological Therapy services offer support to people with chronic physical symptoms and nurses are encouraged to sign post patients to them.

Self-efficacy, pain-related fear, and disability in a heterogeneous pain sample.

The fear avoidance model of chronic pain is well established for specific chronic pain groups and of considerable clinical utility, but it suffers from poor generalizability. Therefore, in this study we examined the role of self-efficacy (SE) in the relationship between pain-related fear (PRF) and three pain-related outcomes-pain severity, disability, and depression-in a more heterogeneous chronic pain sample. Sixty-eight participants between the ages of 18 and 75 years experiencing chronic pain were recruited from the general public. Participants completed a questionnaire that measured catastrophizing, SE, fear of movement, avoidance behavior, PRF, pain severity, disability, and depression. In support of our first hypotheses, higher SE was associated with: (1) less catastrophizing, fear of movement, avoidance of pain, and PRF; and (2) less pain severity, disability, and depression. And higher catastrophizing, fear of movement, avoidance of pain, and PRF were associated with higher pain severity, disability, and depression. Although complete mediation was not found, post hoc examination of partial correlations revealed that the relationship between PRF and disability was partially mediated by SE; however, SE had no mediatory effect on the relationship between PRF and either pain severity or depression. Within the constraints of a relatively small sample size, we concluded that within a heterogeneous pain population, PRF remains the most integral component of the fear avoidance model.

The relationships among coping strategies, religious coping, and spirituality in African American women with breast cancer receiving chemotherapy.

PURPOSE/OBJECTIVES: To (a) examine coping capacity, psychological distress, spiritual well-being, positive and negative religious coping, and coping strategies among African American (AA) women with breast cancer, and (b) explore relationships among these variables to enhance an already tested comprehensive coping strategy program (CCSP) intervention for AA women with breast cancer (CCSP-AA). DESIGN: Descriptive-correlational. SETTING: Comprehensive cancer center in Maryland. SAMPLE: 17 AA women with breast cancer. METHODS: Women completed the Hospital Anxiety and Depression Scale, Sense of Coherence scale, Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Brief Religious Coping Inventory, and Coping Strategies Questionnaire. MAIN RESEARCH VARIABLES: Psychological distress, coping capacity, coping strategies, religious coping, and spiritual well-being. FINDINGS: A higher coping capacity was beneficial, as it was related to less psychological distress, negative religious coping, and catastrophizing. Women using less negative religious coping had greater spiritual well-being and less distress. Using more coping self-statements was associated with higher spiritual well-being and less negative religious coping. Catastrophizing had a negative effect on psychological distress and spiritual well-being. CONCLUSIONS: The development of a CCSP-AA that incorporates aspects of spirituality and components in a coping intervention needs to be tested in a clinical trial. The intervention will teach patients to recognize and restructure their thinking to avoid catastrophizing and negative religious coping. IMPLICATIONS FOR NURSING: Nurses need to work collaboratively with AA women to reinforce beneficial coping patterns and approaches. A tailored CCSP-AA for women with breast cancer administered by a nurse can be taught to assist AA patients in coping more effectively. KNOWLEDGE TRANSLATION: AA women with breast cancer use more positive religious coping and experience less distress and greater spiritual well-being, but catastrophizing has a negative effect on spiritual well-being. Nurses need to reinforce positive coping patterns for AA women with cancer.