Fluent Essays

Discussion RubricThe student will be asked to critically analyze a topic or concept discussed in class and submits your comments on a threaded discussion board. The student will be responsible for submitting a weekly, two-part assignment:Part 1: The first part will be a summary of the topic in the student’s own words (200- 250 words) to demonstrate their understanding of the topic. The student is required to cite the book using APA format. For some forum discussions there will also be supplemental material that the student may use to develop the summary; if supplemental content is provided, the student will need to cite at least one of those sources in the summary to demonstrate their application of the knowledge that the student have gained from the lecture and the text. Within the summary the student is also allowed to convey real life experiences, when appropriate, to further develop their point. ActivitiesAssuming a role of a consumer of research, you will need to be savvy at conducting an electronic database search of your identified clinical problem. You will then appraise the studies identified to answer a clinical question. 1. For this weeks discussion you will choose one research article (one of the four that have been provided on the attachments and identify the theoretical framework. 2. Next you will identify at least one primary source and one secondary source in the reference section which pertains to the theoretical framework. 3. Conduct an electronic database search to locate those articles using Gale-Infotract on LIRN, CINAHL, or ProQuest. Briefly review the abstracts of the articles. 4. Last, conduct an Internet search of the theoretical framework. Identify possible benefits and concerns that you uncovered with using this theoretical framework instead of another. wk_2_article_1.pdf wk_2_article_2.pdf wk_2_article_3.pdf wk_2_article_4.pdf Unformatted Attachment Preview Available online at www.sciencedirect.com Applied Nursing Research 20 (2007) 181 – 187 www.elsevier.com/locate/apnr The needs of men with prostate cancer: results of a focus group study Meredith Wallace, PhD, APRN-BC a,⁎, Sherri Storms, BSN, RN b b Abstract a Yale University School of Nursing in New Haven, CT 06536, USA Health Care Management at Fairfield University School of Nursing in Fairfield, CT 06524, USA Received 3 March 2005; revised 26 June 2006; accepted 24 August 2006 Prostate cancer is the most common type of cancer diagnosed in men in the United States and accounts for 43\% of all newly diagnosed malignancies. This year, approximately 218,890 men were diagnosed with prostate cancer (American Cancer Society, 2007). Of all men diagnosed with cancer each year, more than 30\% will be diagnosed with prostate cancer. Receiving a diagnosis of cancer can be very difficult and emotionally challenging for patients and their families. There is limited research surrounding the psychosocial and educational needs of men diagnosed with prostate cancer and the effectiveness of existing support services for this population. The purpose of this qualitative and grounded theory study was to explore the psychosocial needs of men with prostate cancer using a previously developed cancer model. Demographic questionnaires and focus groups were used with a sample of 16 men aged between 49 and 81 years. The results of the qualitative analysis revealed consistency with a previously tested breast cancer model and identified unique concerns of men within three stages of the prostate cancer experience. Implications for nursing research and practice are presented. © 2007 Elsevier Inc. All rights reserved. Prostate cancer is the most common type of cancer diagnosed in men in the United States and accounts for 43\% of all newly diagnosed malignancies. This year, approximately 218,890 men were diagnosed with prostate cancer (American Cancer Society, 2007). Of all men diagnosed with cancer each year, approximately one in six men will get process cancer over a lifetime. However, only 1 in 34 will from the disease. Prostate cancer deaths are second only to lung cancer deaths in the United States (American Cancer Society, 2007). Moreover, prostate cancer is nearly 100\% survivable, if detected early (Us Too! International, 2004). Receiving a diagnosis of prostate cancer can be very difficult and emotionally trying for patients and their families. The diagnosis of cancer brings about many emotions for which men may turn to others for education and support. The myriad of treatment decisions presents great challenges to men diagnosed with this disease. In addition, the aftermath of prostate cancer also brings about the need for psychosocial support surrounding the management of side effects and the reality of cancer as a chronic ⁎ Corresponding author. E-mail address: mwallace@mail.fairfield.edu (M. Wallace). illness. The Oncology Nurse Society 2005–2009 research priorities underscore the need to describe the physiological, psychosocial, existential, and economic impact of cancer diagnosis and treatment, as well as their impact on quality of life. The purpose of this qualitative and grounded theory study was to explore the psychosocial needs of men with prostate cancer using a previously developed cancer model. 1. Background A study by Harden et al. (2002) was designed to explore the experiences of 22 couples living with prostate cancer. The focus group research found that the diagnosis of prostate cancer brought about special concerns for men and spouses living with the disease, including uncertainty, and concerns about living with the effects of treatment, difficulty with coping, and the need for help. Another study, that by Lintz et al. (2002), was designed to determine the support and psychological care needs of a group of 249 prostate cancer patients. The researchers used standardized quality-of-life and support instruments, including the Support Care Needs Survey, the Support Care Preferences Questionnaire, the 30-item European Organization for Research and Treatment 0897-1897/$ – see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.apnr.2006.08.008 Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 182 M. Wallace, S. Storms / Applied Nursing Research 20 (2007) 181–187 of Cancer Core Quality-of-Life Questionnaire and Prostate Module, and the Hospital Anxiety and Depression Scale. The results revealed that men diagnosed with prostate cancer feared that the disease would spread, resulting in death (44\%). Men also feared changes in sexual feelings associated with prostate cancer (41\%). The authors also reported that men diagnosed with prostate cancer sought information through brochures, the Internet, and friends who might have gone through a similar experience. The researchers concluded that men were given inadequate psychological support and health information at the time of their prostate cancer diagnosis. Coreil and Behal (1999) described the characteristics and functioning of 38 man-to-man prostate cancer support groups to determine ways to strengthen the program. The number of participants in each group ranged from 20 to 60, and the instruments were designed by the researchers to collect information on meeting practices and the perceived needs of the groups. The programs generally received high ratings of satisfaction for education, but it was felt that more attention should be devoted to psychosocial issues. Other areas of desired improvement were improving access to support services, attracting a more diverse membership, and having an improved outreach to newly diagnosed patients. Katz et al. (2002) conducted a descriptive study comparing 94 men who had attended 1 of 10 prostate cancer support groups in the San Francisco area over the 6-month study period with those in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) national prostate cancer registry. Using the RAND 36-Item ShortForm Health Survey and the University of California at Los Angeles Prostate Cancer Inventory, they found that after adjusting for ethnicity, age, and type of treatment, men attending support groups reported significantly better physical function (p = .0017), physical role function (p = .0015), vitality (p = .0001), pain (p = .0028), mental health (p = .04), general health (p = .0007), sexual function (p = .001), and bowel function (p = .0025) as well as less sexual bother (p b .0001) as compared with the CaPSURE registry group. A total of 41.8\% of the support group reported having an annual income of $50,000 or higher, versus 16.1\% of the CaPSURE registry group. The support group members reported higher educational levels than did those in the registry, with 36.6\% of support group members attending graduate school as opposed to 17.4\% of the CaPSURE registry group. The researchers concluded that men who attended support groups have a better health-related quality of life as compared with other men with prostate cancer. Nicola, McPhail, Eastwood, and James (2005) developed and evaluated a new prostate cancer support group facilitated by clinical nurse specialists in England. The authors reported the process of developing the support group, including reviewing the literature, visiting other support groups, and receiving expert consultation. Participants in the support group included patients and their partners who had expressed interest through urology clinical nurse specialists. Posters were also distributed within area hospitals and medical practices. After 1 year, the investigators evaluated the effectiveness of the support groups. A total of 92\% (n = 23) of the respondents reported that the support group met their expectations, 96\% requested more one-on-one consultations, and 92\% found the group to be excellent. These studies present critical and important information to help nurses understand and manage the concerns of men diagnosed with prostate cancer. However, their small sample sizes and lack of objective measures limit the generalizability of their findings. Moreover, studies supporting psychosocial support groups have been small and lack diversity in sampling. Consequently, evidence to support the role of nursing support to meet the informational and support needs of men with prostate cancer is limited. Manne (2002), in her review of the literature on prostate cancer and support programs, reported that there is a critical lack of information on the use of support groups despite the fact that competing treatment options and critical lack of psychosocial information cause many men to turn toward them for education, coping strategies, and peer support. Current data suggest that men are given inadequate support at the time of receiving their diagnosis of prostate cancer and that they usually turn to support through other men who have gone through prostate cancer. Moreover, they often research through the Web if they have access to a computer or use support groups for education, coping strategies, and peer support. Limited research supports some of the benefits of psychosocial support groups for men with prostate cancer. However, the success of support groups is auspicious and not grounded in sufficient research because there is limited information on the needs of men attending these support groups. Moreover, there is limited information regarding the effectiveness of such support on other ethnic groups (Barg & Gullatte, 2001). In addition, it has been demonstrated that men are less likely than women to join support groups (Krizek, Roberts, Ragan, Ferrara, & Lord, 1999). One-onone programs have not been the target of research to determine if they are more effective in meeting the needs of men with prostate cancer as compared with traditional support groups. In fact, the literature remains deficient of studies in which men are questioned about their informational and support needs and how they could best be filled. 2. Conceptual model The conceptual model for this study was based on the work of Wilmoth (2001) in her study exploring the aftermath of breast cancer. In her qualitative study, designed specifically to address the sexuality of women with breast cancer, 18 women aged between 35 and 68 years were interviewed individually. Based on the results of the qualitative and grounded theory analysis, a process of adjustment from disease was identified as women processed losses such as missing parts, loss of bleeding and sexual sensations, becoming old, and loss of womanhood. These Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. M. Wallace, S. Storms / Applied Nursing Research 20 (2007) 181–187 losses were influenced in the study sample by relationships and informational control. Through the identification of losses and influencing factors, three stages were identified and a model that transcended the three stages of cancer from diagnosis through survival—taking in, taking hold, and taking on—was developed. Although the model has not been adapted from breast cancer to prostate cancer, the common factors between the two diseases make the theory derivation logical (Walker & Avant, 2004). Because both types of cancer involve reproductive functions tied closely with sexual identity, the losses experienced by women with breast cancer, such as loss of bleeding and that of sexual sensations, may be seen as parallel to the losses of erectile function and sexual sensations among men with prostate cancer (Incrocci, 2005). The feeling of becoming old and loss of womanhood in individuals with breast cancer may also be seen in men with prostate cancer. Moreover, the influencing factors of relationships and informational control that influenced the stages of disease adjustment in women with breast cancer provided the purpose for this study of men with prostate cancer. Consequently, the model shows consistency with the experience of men with prostate cancer. Within each stage, unique experiences shape the ability to transcend toward the next stage and have the potential to predict outcomes. At the center of the model is the self. It is theorized that positive experiences within the three stages will enhance the health of self. Effective nursing support services theoretically positively impact the experience within each stage, promote positive transitions between stages, and enhance the health, well-being, and quality of life of the self. 3. Methods A qualitative and grounded theory method (Strauss & Corbin, 1994) and a convenience sampling design were implemented to ascertain the needs of men diagnosed with prostate cancer and their views on how these needs could best be met. The grounded theory method (Strauss & Corbin, 1998) was chosen because it seeks to explore how people define reality and how their beliefs are related to their actions. Once the study was approved by the respective institutional review board, open enrollment was held until each focus group was filled with a minimum of 10 participants. Participants for this study were recruited through newspaper advertisements, direct mailing to former and current support program users, and flyers distributed via affiliated urology practices. The flyer and newspaper advertisements explained the study and encouraged participants to contact the researcher if they had questions or were interested in participating in the study. Men were included in the study if they had a diagnosis of prostate cancer. Inability to communicate in English and give informed consent excluded men from this study. Focus group meetings were held off the hospital campus to prevent mens 183 associations of the hospital with their prostate cancer experiences. Moreover, a male focus group consultant was obtained to conduct the focus group to prevent men from limiting their comments owing to embarrassment with female investigators. When a potential participant contacted the investigator, the purpose and description of the study were discussed and the participant was told that he would be expected to participate in a focus group that will last for at least 1 hour. The participant was given the opportunity to either decline participation or be scheduled to participate. Most participants who called agreed to participate and were scheduled for a focus group. Demographic questionnaires and open-ended questions (Table 1) were used to collect data regarding the needs of the participants in relation to prostate cancer and the effectiveness of current support systems in meeting these needs. 4. Results Two focus group discussions were held with men who were in various stages of treatment for prostate cancer. The first panel consisted of 10 men, whereas the second panel consisted of 7 men, a number of whom had participated in the hospitals one-on-one support network. The ages of the participants ranged from 49 to 81 years (M = 66.75 years). Prostate cancer in the sample had been diagnosed between 6 months and 12 years earlier, with the average time since diagnosis being 4.3 years. Eight men in the sample had a high school education, 5 had gone to college, and 3 had attended graduate school. Fifteen of the men in the sample were married and 1 was divorced. In addition, 15 of the men in the sample were Caucasians, 1 was African American (in the first focus group), and 1 reported “other” as his ethnic background. The annual income of the sample ranged from $20,000 to $100,000. The focus group sessions were audiotaped. The primary investigator listened to all audio tapes, taking field notes as appropriate. Field notes were compared with the report completed by the focus group facilitator using the constant comparison method. Results were organized using the model of Wilmoth (2001): taking in (diagnosis), taking hold (experience), and taking on (survival). In addition, participants perspectives on current support services and suggestions for services that would facilitate the healthiest possible transition between stages were noted. 4.1. Taking in (the diagnosis) The data revealed that participants experienced an assortment of emotions upon receiving the diagnosis of prostate cancer. Words such as “shock,” “blindsided,” “body blow,” “fear,” “anger,” and “roller coaster” were used to describe their feelings upon receiving the diagnosis. Some participants linked the diagnosis with death, as demonstrated by the following statement: “The word cancer is followed closely in my mind with death.” Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 184 M. Wallace, S. Storms / Applied Nursing Research 20 (2007) 181–187 Others disengaged; as one participant stated: “I had to stay away from the world.” Other participants stated that they were surprised; for example: “It was the last thing in the world I thought I would have.” Other participants demonstrated lack of knowledge; for example: “I didnt even know what a prostate was.” 4.2. Taking hold (the experience) After the initial array of emotions, the diagnosis commonly led men to an information-seeking period that seemed to provide relief from early fears and anxieties. Sources of information during this period included the physician, the Internet, family members, and acquaintances who had prostate cancer. Interestingly, the physician was not consistently considered to be the best source of information. One participant said: “My doctor was great. He said that I was not going to leave his office until every question was answered.” On the other hand, another participant said: “I didnt get any help at all from the doctor.” As a group, participants would have liked to know more about prostate cancer before receiving the diagnosis. They Table 1 Focus group discussion questions • What kinds of emotions and feelings did you have when first diagnosed with prostate cancer? What psychological impact did the diagnosis have on you? • How did you deal with these emotions? What kinds of assistance, if any, did you seek to better deal with your feelings? What services were most helpful? • Looking back, what would you have done differently? What kinds of assistance would you have liked to be available? • What about the information you obtained about prostate cancer? Where did you go for information? What were the most helpful sources? What kind of information would you wish was available or more easily available? • What kinds of emotions and feelings did you have when you were deciding on the kind of treatment to have for your prostate cancer? • How did you deal with these emotions? What kinds of assistance, if any, did you seek to better deal with your feelings? What services were most helpful in assisting you to decide on the treatment to have? • Looking back, what would you have wished that you had done differently? What kinds of assistance would you have liked to be available? • What about the information you obtained about the treatments for prostate cancer? Where did you go for this information? What were the most helpful sources? What kind of information would you wish was available or more easily available? • How has the experience of dealing with prostate cancer affected your life? What do you do now that you didnt do before? How has it changed you? • What are some of the issues you are dealing with, emotionally, clinically, and financially since you completed your treatment regimen? • What kind of help are you getting to assist you in dealing with these issues? • Specifically, what support services have you used? What has been your experience with these services? • What would you like to have available in the way of support services that are not available now? • What other kinds of services or assistance should be mad ... Purchase answer to see full attachment