After Mastectomy – Inpatient Experience of Women in New Zealand: A Qualitative Study.

Abstract

This qualitative descriptive study explored the experiences of 10 women post-operatively following mastectomy surgery for breast cancer. The setting was an acute surgical ward in a large tertiary hospital in a New Zealand where women are generally hospitalised for one to two nights post mastectomy.

The purpose of this research was to: i) contribute to a greater understanding of the in-hospital experience of New Zealand women immediately following mastectomy for breast cancer, ii) identify women’s expectations of care and service delivery from healthcare professionals, iii) generate data to inform the development of evidence-based interventions and models of care for the breast cancer care team that are tailored to meet the holistic needs of women post-mastectomy in the inpatient setting, and iv) identify possible areas for future research.

Data collection was through face-to-face, semi-structured, individual interviews which were audio-recorded and transcribed verbatim. The majority of participants were interviewed within two weeks following surgery, although up to six weeks was allocated for the interview period. The interview transcripts were analysed using a thematic analysis. Three main themes emerged:

(i) It’s not just physical (ii) Healing environment (iii) Task-focused care versus therapeutic care.

These findings suggest that a mastectomy is a momentous event in any woman’s life. Physically, the removal of the breast(s) leaves a scar which visually announces the disfigurement; however, unseen are the psychological ramifications of a cancer diagnosis, altered body form and loss of feminine identity. In the initial post-operative phase, the physical intrusion of the surgery and consequent inpatient environment influence the healing process. Environmental factors include room allocation; mixed-gender facilities; contact with other breast cancer patients; and aesthetics of the ward atmosphere and environment. Post-operative inpatient care requires not only professional competency with clinical and technical tasks, but additional therapeutic nursing skills. Some members of the breast cancer care team are skilled in interactive communication and can provide support to some psychological needs.

These findings provide insight into the experiences of inpatient stay of post-mastectomy patients in the New Zealand context; an area not previously explored. While focussed on the experiences of individual women, there are commonalities and aspects which may be relevant to nurses caring for other women, in other settings.