The Intersection Of Subjectivism And Patient Centered Nursing For Breast Cancer Care And Pain Management.

Abstract

ABSTRACT Qualitative research offers diverse opportunities for gaining in-depth understanding into unique situations of human experiences. This research approach generates data in a co-constructed manner considering multiple realities in particular contexts of individuals and communities. Globally, many nursing and midwifery scholars carry out research within the qualitative paradigm because it allows in-depth understanding of their clients and context. The nurse or midwife is expected to provide individualised care and these demands implementing care that fit the needs of the client. The provision of such patient-centred care takes into consideration the nurses’ skills in reflexivity in client assessment, planning, implementing and evaluation of care. In this lecture, I discuss my experience as a qualitative researcher using ethnographic and phenomenological approaches to explore breast cancer and pain experiences. I used interviews, focus group discussions and observations as my main data collection strategies. These qualitative approaches have helped me gain in-depth understanding of cancer and pain experiences. I have employed Hildegard Peplau’s (1952) Interpersonal Relations Theory and Madeleine Leininger’s Transcultural Nursing Theory (1991) to guide my nursing and research career and these are consistent with the qualitative approaches. I note that nursing and midwifery care considerations draw from a plethora of theories that are available to guide care decisions and practices. Thus, I emphasize that nurses and midwives should endeavour to apply the appropriate theories in their practice. The lecture discusses some critical findings on breast cancer and pain management. Breast cancer has a high mortality rate in Ghana because women report late to the hospital. It is emphasized that early detection, diagnosis, and treatment promotes cure. Some women sought alternative treatment and went to prayer camps for healing which contributed to the late reporting. We found that women had strong emotional reactions to breast cancer diagnosis and were afraid of death. Women who lost their breast had heightened issues of body image because silicon breast prosthesis were not accessible, and some could not afford it. The loss of hair and the debilitating effect of chemotherapy hindered activity level and work. It was realized that some women were stigmatized by their family and friends. Also, support from the National Health Insurance Scheme was inadequate. However, most women received support in diverse ways to cope with breast cancer diagnosis and treatment. The lecture also discusses pain management experiences and issues within the clinical environment that hinders pain management. Pain is the most common reason why people seek healthcare and literature continue to report inadequate pain management across the globe. Our findings support the subjective nature of pain and the influence of socialization on pain expression and management. We explored different types of pain such as post-operative, menstrual, labour, low back, and cancer pain. Pain expression included grimace, crying and shouting. Pain was managed non-pharmacologically using positioning, massage, warm compress, and diversional therapy. Pain medications included tablets, suppositories, and injections. It was found that patients did not ask questions about their pain management because they thought the health professionals ‘knew best’. Three pain intensity assessment tools were validated including one we developed (Colour-Circle Pain Scale). The lecture highlights four main principles that could enhance pain management in a resource limited clinical context including client education, teamwork, supervision, and use of evidence. Some recommendations were made to improve breast cancer and pain management such as the need to support and improve funding for breast cancer treatment and use of validated tools to assess pain.

PROFILE Professor Lydia Aziato is the first Ghanaian Professor of Nursing and is affectionately referred to as Prof.1 by the nursing and midwifery fraternity in Ghana. She attended Ghana Senior High School in Koforidua from 1985-1992 and graduated as a professional nurse in 1997 from the Korle-Bu Nursing and Midwifery Training College. She obtained her first degree in Nursing and Psychology in 2001 and a Master of Philosophy (MPhil) in Nursing in 2005 both from the University of Ghana. She graduated with the highest cumulative grade point average (CGPA) of her class in 2001 and won a scholarship from Unilever Ghana Ltd for her MPhil programme. She also pursued her specialty training in Oncology Nursing from the Cross Cancer Institute in Edmonton, Canada and completed in 2006. Subsequently, she graduated with a Doctor of Philosophy (PhD) in Nursing from the University of the Western Cape (UWC), South Africa in 2013 where she developed a clinical guideline for post-operative pain management applicable to a resource-limited clinical environment. Prof. Aziato worked as a Staff nurse at the Mamprobi Polyclinic before she joined the University of Ghana in 2001 after her first degree. She rose through the ranks from a Senior Nurse Technician (2001-2006), Assistant Lecturer (2006-2008), Lecturer (2008-2014) Senior Lecturer (2014-2017), Associate Professor (2017-2020) and Professor (2020). TEACHING Prof. Lydia Aziato has taught in several nursing and midwifery training institutions including 37 Nursing and Midwifery Training College, Pantang Nursing Training College, Central University, Ghana College of Nurses and Midwives (GCNM), and at the University of Ghana School of Nursing and Midwifery, Centre for Social Policy Studies (CSPS) and the University of Ghana Pan African Doctoral Academy (PADA). She has taught many courses that span across diploma, undergraduate, postgraduate, specialist, and doctoral levels. She has also delivered several short-courses and facilitated many workshops. RESEARCH Prof. Aziato’s research work has a heavy orientation in qualitative approaches. Her research explores breast cancer, pain, surgical nursing care, women’s health, herbal medicine, and spirituality. She has over 80 publications including peer-reviewed journal articles, books, and book chapters. She has been the lead or co-investigator for many local and international projects funded with grants from USAID, WHO, Global Challenges Research Fund (GCRF), Global Health Fund, National Research Fund of South Africa, Nursing and Midwifery Council of Ghana, and the Ghana AIDS Commission. Prof. Aziato is currently the lead for a book project on the history of the Ghana Registered Nurses and Midwives Association, 1960-2020: Changes and continuities. MENTORING Prof. Lydia Aziato has provided mentorship for nurses and midwifes throughout her years of nursing practice, teaching, research, and administration. She has supervised 9 PhD students from universities in Ghana (UG), South Africa (Witwatersrand), Finland (Eastern Finland) and United Kingdom (Sheffield). She has also mentored over 40 post-graduate nursing and specialist nurses as well as over 40 undergraduate students. She is the Founder of Research Mentorship Alliance, an NGO that provides her the forum and platform to develop the research skills of nurses and midwives in Ghana and elsewhere. CONSULTANCY Prof. Aziato provides consultancy services for national and international organizations. She is a consultant assessor of national nursing and midwifery examinations for all categories of nurses and midwives since 2018. She has also provided consultancy services for the establishment of the Bachelor of Science in Nursing programme for Wisconsin International University College in 2015. Other consultancy services include assessing and accrediting nursing and midwifery programmes for the Ghana Tertiary Education Commission (GTEC) as well as developing the nursing and midwifery training curricula for many Universities and colleges locally and internationally. BOARDS AND COMMITTEES Prof. Aziato has served on 15 statutory, 15 ad-hoc and 8 international committees/boards in various capacities. She is the current chair for the College of Health Sciences Quality Assurance Committee. She is a board member of Narbitha College, and the Centre for Gender Studies and Advocacy (CEGENSA). She was a board member of the Ghana College of Nurses and Midwives and Nightingale School of Nursing. She was an Advisory Council Member of International Academic Nursing Alliance. Prof. Aziato currently chairs the Chi Omicron Board of Sigma Theta Tau International (STTI) and she serves on International Organization for Standardization through Ghana Standard Authority. INSTITUTIONAL BUILDING Institutional building has been an integral aspect of Prof. Aziato’s service over the years. She has been a member and faculty counsellor of the Honour Society of Nursing (STTI, Tau Lambda-at-Large Chapter, Ghana) from August, 2005 to July, 2017. Her work as the president of the Honour Society of Nursing, Chi Omicron Chapter) since July 2017 has also advanced nursing scholarship within Ghana. Prof. Aziato collaborated with other global scholars to establish international partnerships for the University of Ghana School of Nursing and Midwifery. Some of the partner institutions include the University of Alberta (Canada), New York University (US), John Hopkins University (US), Dicle University (Turkey), Sheffield University (UK), Stellenbosch University (South Africa), University of the Western Cape (South Africa), Jonkoping University (Sweden), University of Eastern Finland (Finland), Oslo Metropolitan University (Norway), and the Norwegian University of Science and Technology (Norway). FAMILY Prof. Lydia Aziato is married to Zangu-Rana Ibrahim D. Yakubu. She is blessed with three children (Manzoaya, Suguru-Veila, and Wunpini) and she fellowships with Temple of Grace Baptist Church in Madina, Accra.