NSG 410 Stratford University Aronson Glynn & Squires Article Discussion Discussion Rubric The student will be asked to critically analyze a topic or conce

NSG 410 Stratford University Aronson Glynn & Squires Article Discussion Discussion Rubric

The 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.

Activities

Assuming 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 week’s 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. 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 men’s
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 hospital’s 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.
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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 didn’t
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 didn’t 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 didn’t 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…
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