Assignment: Research Project-Sharing

Assignment: Research Project-Sharing

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Overview

This assignment will allow you to share the evidence that you found in the Module Four Evidence Based Practice Project: Finding the Evidence.  You will create a visual aid as described below and share your findings with your peers on the discussion board.

Submitting your assignment

• This assignment will be posted on the DB.  The instructor will provide you with feedback and upload your grade to Blackboard.

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Grading Rubric

Use this rubric to guide your work the assignment.  Points are awarded for each section based on content and clarity of expression.

 Instructions for Completing Your Assignment

• Now that you’ve uploaded your EBP Project from Module Four into Blackboard to be graded, it’s time to do the second half of the project in Module Five.
• You see, it is good for you to have the correct knowledge about something…or to know the right way to practice.  However, it is even better if you share your new knowledge with others!
• To prepare for this week, I would like you to do two things.
  • Prepare a Visual aid that covers your EBP from Module Four:
    • Your PICO question
    • What you discovered in your search for information about your PICO question.   Make sure to include information from each of your resources (this means at least 4 facts).
    • What you would recommend for practice (or as a change in practice) based on your research.
  • Be creative and professional with your visual aid for your audience with facts from your presentation.   This is a visual aid of your choosing that should be professional in quality and content. It can be a power point or brochure, for example. Simply typing your information into the discussion board will not meet the criteria for this project, you must provide a creative visual aid with illustrations. Impress your instructor and classmates!  Please include your references for your project on your visual aid.   Remember your coach and peers must be able to open your submission to view and grade it or comment on it (for example, no .zip files or Keynote Presentations from Apple computers). 
• Your instructor will provide you with feedback regarding your presentation in Blackboard and post your grade in the gradebook.

Self-Perception of Breast Cancer Patients Post Treatment

In partial fulfillment of the requirements of

Body image can best be defined as the perception a person has of their physical self, including the thoughts and feelings that result from that perception. Treatments for women diagnosed with breast cancer usually involve either chemotherapy or mastectomy, the removal or one of both of the breasts, for treatment depending on whether the cancer has metastasized. Many physical changes occur to the body with either treatment. In regards to chemotherapy, changes include hair loss, burning, scarring, decreased physical function, weight loss and more (Bahrami, Hosseini & Mohamadirizi, 2017). After all of these changes to the body, the question is how do women 18 years and older diagnosed with breast cancer perceive themselves during the 6 months following a mastectomy or chemotherapy treatment? According to a study conducted by The Brazilian Journal of Gynecology and Obstetrics, there is a significant reduction in scores achieved for body image in women with breast cancer. In fact, these concerns regarding body image increased significantly in 41.5% of young patients with breast cancer (Prates, Ruffo, Prates, Veloso, & Barros, 2017).  Patients from the study described the cosmetic effects resulting from a mastectomy as a “terrible mutilation that is emotionally devastating” and in turn, leads these female patients to avoid social interactions due to a decreased body image. The study also reports that 67% of these breast cancer patients feel inadequate in regards to their femininity, finding it rather difficult to accept and embrace their new bodies (Prates, Ruffo, Prates, Veloso, & Barros, 2017).

Women with breast cancer over the age of 18, receiving chemotherapy, were studied before, during, and 1 month after receiving treatment at a university hospital in Bangkok. One of the objectives of this study was to investigate how distressing symptoms influence the quality of life in women with breast cancer and if there are symptom clusters (Phligbua, Pongthavornkamol, Knobf, Junda, Viwatwongkasem & Srimuninnimit, 2013, p. 251). Some interesting facts from the article is that out of 39 physiological and psychological symptoms that patients reported, “I don’t look like myself” as one of the top five symptom clusters before, during, and after chemotherapy treatment (Phligbua et al., 2013, p. 254). The “I don’t look like myself” symptom cluster, which includes worrying, difficulty concentration, hair loss, and skin changes, accounted for 45.2% of the variance regarding quality of life at Time 1, 60.7% at Time 2, and 39.0% at Time 3 (Phligbua et al., 2013, p. 260). In conclusion, the resulting side effects of breast cancer treatments encourage women’s negative attitudes and perceptions about themselves. This study also found that these symptoms that create a negative self-concept formed during treatments persist after receiving treatment for up to 6 months. Considering this decline in positive self-perception, determining how women are affected at exact times of treatment can better assist nurses to understand and care for the patients in therapeutic ways relating to body-image.

Reliability is related to how consistent the measurement method of a study is (Grove, Gray, & Burns, 2015, p. 287). In the Pligbua et al. (2013) study, +data was collected by using three questionnaires: A demographic and Medical Record form, including demographics and medical history of the patients; The Modified Memorial Symptom Assessment Scale (MSAS), in which evaluated if the patients had experienced each of the 39 symptoms associated with cancer and if so, rate the frequency, intensity, and level of distress; The Functional Assessment of Cancer Therapy-Breast (FACT-B) version 4 in which evaluated patients concerns more specific to breast cancer on a 5 point scale (Phligbua et al., 2013, p. 252-253). A pilot study was used to evaluate the reliability of the modified MSAS and FACT-B by using 20 women with breast cancer, currently completing chemotherapy treatment, which provided a Cronbach’s alpha range of 0.80 to 0.83 for the modified MSAS and 0.84 to 0.86 for the FACT-B (Phligbua et al., 2013, p. 253). Cronbach’s alpha coefficient, a way to determine the internal consistency and reliability of the clusters, was used for every factor at each of the three time frames. A coefficient higher than 0.60 identified a homogenous pattern among the symptom clusters and a coefficient lower than 0.60 identified areas in which caution should be taken in the study (Phligbua et al., 2013, p. 253). Self-image presented with a Cronbach alpha coefficient of (a=0.634) for time two occurring during chemotherapy and (a=0.603) for time three, occurring after treatment (Phligbua et al., 2013, p. 258-259). These two Cronbach coefficients show internal consistency reliability within the concept of decreased self-perception during and after breast cancer treatment. Evidence Based Practice Project-Sharing the Evidence

Validity determines whether the use of an instrument is appropriate of the specific group or purpose of what is to be examined (Groves, Gray, & Burns, 2015, p. 290). The researchers in the Phligbua et al. (2013) study article analyzed all of the data, which was generated by appropriate descriptive statistics, by using exploratory factor analysis and multiple regression by using SPSS (Phligbua et al., 2013, p. 253). The factor analysis was used to determine the exact amount of symptom clusters and the multiple regression analysis was used to determine the predicting ability of symptoms before, during, and after chemotherapy treatment upon the patient’s quality of life (Phligbua et al., 2013, p. 253). The exploratory factor analysis was conducted as the researchers selected the twenty most distressing symptoms reported by minimum 5% of study participants before the treatment and minimum 30% of study participants after treatment (Phligbua et al., 2013, p. 253). This study demonstrates construct validity in the research designs and data measurement methods. Assignment: Research Project-Sharing

In the evaluation of the Phligbua et al. (2013) research study, there are both strengths and weaknesses apparent. A weakness is all of the date collected is objective. The Modified Memorial Symptom Assessment Scale, or modified MSAS, as well as the Functional Assessment of Cancer Therapy-Breast (FACT-B) are both questionnaires completed by the women with breast cancer participating in the study. Objective studies often lead to biases, especially when considering this specific study as symptom experiences are dynamic and multidimensional (Phligbua et al., 2013, p. 263). A strength within this study is collecting data for all three questionnaires before treatment, during treatment, and after treatment. This is important because symptoms affect patients at different points in the treatment but also shows correlation as to if a symptom cluster is more common at a certain stage of the treatment. Knowing this information could be valuable to improving quality of care in relation to managing symptoms and also improving quality of life as medical professionals can assist these women cope as they conduct their chemotherapy treatment (Phligbua et al., 2013, p. 264). Evidence Based Practice Project-Sharing the Evidence Assignment: Research Project-Sharing

The Clinical Practice Recommendations for Quality of Life Assessment in Patients with Gynecological Cancer, found on the US National Library of Medicine National Institutes of Health website, focuses on clinical practices to enhance quality of life in regards to women with cancer. Quality of life, although it has not yet been formally defined, is composed of patient’s performance status, physical, emotional, and social functioning, body-image, as well as spiritual dimensions (Leppert, Gottwald & Forycka, 2015). Therefore, it is important for health care providers to assess the attitude of patients towards themselves, their disease, in addition to observing the patients mechanisms of coping with the disease (Leppert, Gottwald & Forycka, 2015). Performing a quality of life assessment has positive benefits for both the patients’ and families’ well-being, including improving the patients’ satisfaction with care and enhances the adaption process of coping with a disease (Leppert, Gottwald & Forycka, 2015). In addition to acknowledging the need for a quality of life assessment in women with breast cancer suffering from symptoms that result from treatment, this clinical practice guideline advises education sessions with the patient. It has shown that education sessions can improve adjustment, knowledge, and increase positive self-concept (Leppert, Gottwald & Forycka, 2015). There are many actions that healthcare providers, such as nurses, can perform to enhance quality of life such as conducting an assessment, providing education sessions, or as simple as listening to their worries and participating in therapeutic communication. Assignment: Research Project-Sharing

After receiving breast cancer treatments, it is proven that many women report that they do not like their bodies, leading to low self-esteem, depression, and a low quality of life. Researchers created a program called Restoring Body Image After Cancer (ReBIC), which is an organization developed with an objective of addressing body image alterations in women who have received treatment for breast cancer by using guided imagery (Esplen, Wong, Warner, & Toner, 2018). Guided imagery is a type of complementary medicine technique which involves a person imagining any of the five sensations that could be associated with reaching a goal, in turn producing a physical or psychological effect (Esplen et al., 2018). The study consisted of 131 women who performed guided imagery exercises expressing personal identity and group therapy to create a mutually supportive environment to learn from shared experiences of others, in addition to a control group of 63 women who did not receive any type of psychological therapy (Esplen et al., 2018). The results of the study reported women who participated in the ReBIC therapy expressed less distress about their body appearance, less body stigma, improved quality of life, and overall had lower amounts of breast cancer-related concerns compared to the control group. This study demonstrates why it is important for breast cancer patients to reach out or be assisted to find a ReBIC program or psychologist counselors who specialize in body image of cancer patients. Support groups are helpful and members of the healthcare team are the patient’s biggest advocate to locate this therapy. Evidence Based Practice Project-Sharing the Evidence Assignment: Research Project-Sharing

In conclusion, do women over the age of eighteen who have been diagnosed with breast cancer perceive themselves differently following treatment such as a mastectomy or chemotherapy? Physical changes to the body following breast cancer treatments have proven to result in a decreased body image, decreased quality of life, and depression. A recommendation for nurses providing care for women in the months after treatment is offer therapeutic communication to allow patients to express feelings, perform a quality of life assessment, as well as education the patient about options such as Restoring Body Image After Cancer (ReBIC) program. This would benefit the patient by giving the opportunity for these women to regain confidence and quality of life during the coping process. Evidence Based Practice Project-Sharing the Evidence In conclusion, do women over the age of eighteen who have been diagnosed with breast cancer perceive themselves differently Assignment: Research Project-Sharing