Education and counselling group intervention for women treated for gynaecological cancer: does it help?

BACKGROUND: Women who have been through gynaecological cancer, experience challenges on many levels after diagnosis and treatment. Studies show that, in order to help women in their rehabilitation process, there is a need for holistic care and follow-up. AIM: The aim of this qualitative study is to provide insight into women's own lived experiences of participating in an education and counselling group intervention after curative treatment for gynaecological cancer. METHOD: A qualitative study based on data from three focus groups with 17 women who had participated in a nurse-led education and counselling group intervention after treatment for gynaecological cancer. RESULTS: The main findings show that participation in the rehabilitation group was described as a special community of mutual understanding and belonging. Education and the sharing of knowledge provided a clearer vocabulary for, and understanding of, the women's own lived experiences. The presence of dedicated and professional care workers was reported to be essential for the outcome of the group intervention. CONCLUSION: Attending a nurse-led education and counselling group intervention had a positive impact on various aspects of the women's lived experiences. The programme also provided professionals with important insights into the patients' views and feelings regarding cancer treatment, trajectories and rehabilitation. This knowledge has already proven itself useful in clinical practice for improving staff communication skills and psycho-social support related to gynaecological cancer care.

Children in an adult world: a phenomenological study of adults and their childhood experiences of being hospitalised with newly diagnosed type 1 diabetes.

Hospital conditions for children have changed dramatically over the last decades. Until recently, hospitalised children were left without their parents in an environment that was not adapted to children. In the period 1950-1980, hospitalised children did not have a voice. The aim of this Norwegian study was to use adult memories of childhood hospitalisation to investigate the influences of the hospital environment on the experiences of children. The study had a qualitative design and used a hermeneutic phenomenological approach. Twelve adults who were 5½ to 12 years old when they were first hospitalised with type 1 diabetes were interviewed. The participants described their hospital stays as representing a life in an adult world. They encountered an unfamiliar place where it was challenging to be abandoned in an adult hospital community with a serious and exhausting illness. The results underscore the need to incorporate children's perspectives to achieve a 'child friendly' environment in the hospital. Thirty years later there still may be a tension between the adults' responsibility to protect children and the children's own right to participation in decision-making. To understand current practices, it is important to know our historical past.

'Stay home for as long as possible': midwives' priorities and strategies in communicating with first-time mothers in early labour.

PURPOSE: To explore the priorities and strategies midwives in a labour ward use in their communication with primiparous women who seek contact in the early phase of labour. DESIGN: A qualitative study using focus groups. SETTING: Norway. PARTICIPANTS: 18 Midwives. FINDINGS: Five themes that seemed to constitute the key elements in the communication were identified. The themes were designated 'Getting the picture', 'Normalising the situation', 'Giving concrete advice', 'Letting the woman make the decision', and 'Staying at home for as long as possible'. CONCLUSIONS AND IMPLICATIONS: The findings of this study indicate that the midwives' overall strategy was to encourage women to remain out of hospital for as long as possible 'for their own good'. This strategy seems to rely on knowledge derived from non-contextual science within the dominant medical childbirth paradigm, and might not meet women's needs in early labour. When women are admitted in early labour, midwives should be able to 'protect' these women from unnecessary interventions and do so in partnership with the women themselves rather than accepting that women's mere presence in the labour ward yields complications and increases the likelihood of caesarean section. From the findings of this study, it is reasonable to ask whether an obstacle to this course might be the midwives' subordination to the medical paradigm. This causes midwives to function as 'gatekeepers' to the medical system instead of working in accordance with the philosophy of midwifery: 'for women's own good'.

'The waiting mode': first-time mothers' experiences of waiting for labour onset.

PURPOSE: To explore first-time mothers' experiences of waiting for labour onset, and to contribute to the discussion of existing practices surrounding perinatal care. METHODS: A qualitative study of 17 women in Norway. Diaries written by the informants and in-depth interviews were analysed in a tradition of life-world phenomenology. RESULTS: The participants entered a state of active waiting, "the waiting mode", in the days around the estimated date of delivery. When the women entered the mode there was a marked change in the way they interpreted bodily sensations. The women experienced being in a state of constant bodily alertness, their bodies felt all-consuming and they experienced themselves as being "more and more body". This generated a sense of being enclosed in the body, intensely trying to identify the signs of labour. Being in the waiting mode seemed to draw labour closer in a manner that opened up for the birthing process and helped the women to prepare for labour. CONCLUSIONS: The findings indicate that the estimated date of delivery is pivotal in shaping women's experiences of waiting. It raises concerns related to how women who are giving birth for the first time are prepared for labour, and a worry that too much weight is put on the exact date. A stronger emphasis on the diversity of women's experiences might be in place. Pregnant women could be encouraged to explore and interpret bodily experiences on their own terms, not merely in relation to the estimated date of delivery.

Life beyond cancer: women's experiences 5 years after treatment for gynaecological cancer.

The number of long-term survivors after cancer is increasing, mainly as a consequence of more efficient treatment. This creates a need for knowledge about experiences of life after cancer. The aim of this study is to gain a deeper understanding of lived experience of long-term cancer survivors and how they experienced cancer care. A qualitative study was performed, based on 32 in-depth interviews with 16 women declared as long-term survivors, aged 39-66. The first interview was made 5 years after treatment and the second a year later. The study has a phenomenological-hermeneutical approach in which the women's own experiences are the basis for understanding their life-world. The long-term surviving women experienced profound changes in their lives and had to adapt to new ways of living. Three core themes were identified: living with tension between personal growth and fear of recurrence: the women spoke of a deep gratitude for being alive and of basic values that had become revitalized. They also lived with a preparedness for recurrence of cancer. Living in a changed female body: the removal of reproductive organs raised questions about sexual life and difficulties related to menopause. Feeling left alone - not receiving enough information and guidance after treatment: the process of sorting things out, handling anxiety, bodily changes and menopause were described as a lonesome journey, existentially and psycho-socially. The findings are discussed in relation to Heidegger's perspective of anxiety towards death, existential loneliness and humans as self-interpreting beings. Surviving cancer entails living with profound life-changes, demanding as well as enriching. Existing follow-up regimes need to sharpen focus on psycho-social aspects, information and guidance. Additional follow-up programmes, focusing solely on the individual woman and her specific needs, are necessary.

Negotiating credibility: first-time mothers' experiences of contact with the labour ward before hospitalisation.

OBJECTIVE: to explore Norwegian nulliparous women's experiences of communication and contact with midwives at the labour ward in the early phase of labour. DESIGN: a qualitative study based on in-depth interviews. PARTICIPANTS: 17 women expecting their first baby. FINDINGS: four themes that emerged in the collected material seem to be central to how the labouring women decided to make contact with the labour ward and how they experienced this contact with the staff: (a) negotiating on two fronts, (b) avoiding being sent home, (c) searching for regularity, and (d) experiencing vulnerability. CONCLUSIONS: the study shows how women in labour for the first time negotiate their credibility with midwives through the requisite pattern of regularity, and also shows their vulnerability in attempting to avoid being sent home from hospital because it is 'too soon' to be admitted. It also argues that the midwifery profession is ambivalent about the paradigm to which it conforms in its contact with women in early labour. IMPLICATIONS FOR PRACTICE: the findings of this study show that the way in which questions are asked in this phase is very important. Midwives should be aware that if they only ask the 'standard question' related to the pattern of contraction regularity, they might lose vital information and also deprive the woman of the chance to verbalise her experiences and her needs as she perceives them. If the focus is shifted from the rigid instructions that women are given to an emphasis on the women's actual experiences, the need for negotiation will probably diminish. The task of assessing and evaluating women in early labour need not necessarily be performed inside the ordinary labour ward, but may be done in a more home-like environment outside the hospital or in the woman's home.

Doing midwifery between different belief systems.

Childbirth has been increasingly concentrated in large centralised hospitals, with a parallel trend toward more birth interventions in Norway. These changes have resulted in new ways of framing birth from: a normal woman's life experience to a medical event. Caring for the birthing mother in a modern centralised ward, take place between two different belief- systems: a biomedical and a phenomenological. A phenomenological account of seven midwives' descriptions of skilled midwifery in a Norwegian high-technology labour ward was carried out. The focus was on how skilled midwives experience their daily work between a biomedical and a phenomenological belief system. Three themes were identified: (1) sensing where the woman is in labour, (2) being available for but not overbearing to the women and (3) being in a room of struggle. The findings are discussed from the perspective of being between these two belief-systems, with special focus on wise midwifery judgement as a way of managing the struggle.