NOVEMBER 2001, VOL 74, NO 5 R E V I E W S

RESEARCH REVIEWS

AFRICAN AMERICAN WOMEN AND BREAST CANCER: NOTES FROM A STUDY OF NARRATIVE R J Moore Cancer Nursing Vol24 (February 2001)

erioperative nurses care for people with breast cancer P from the time of diagnosis to

the end stage of the disease. Breast cancer affects both men and women, the young and the aged, and people with diverse cul- tural and racial backgrounds. Nursing care should be culturally sensitive, and perioperative nurses must learn how the disease affects patients from all walks of life. This research study reports find- ings from a narrative study of 23 African-American women who survived breast cancer.

leading cancer affecting women. Overall, the incidence of breast cancer is increasing, although mortality rates decreased from 1990 to 1995. This reduction has been attributed to better and earli- er detection through widespread use of mammography. Although the mortality rates for non- Hispanic Caucasian and Hispanic women with breast cancer are decreasing, rates for African- American women are increasing. Breast cancer remains a leading cancer killer of African-American women.

The literature suggests that can- cer prevention programs may fail in minority or underserved com- munities. A belief of cancer fatal- ism may exist in some communi- ties, and patients may believe that a diagnosis of cancer leads to uncontrollable pain, suffering, and

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Background. Breast cancer is a

death. This belief may be a bamer to screening, because patients have cognitive thoughts such as “cancer testing is looking for trouble.”

Methodology. This study used qualitative semistructured inter- views based on a methodology of narrative. Narrative was used to explore individual explanatory models of illness contextually embedded. The researcher states,

This study focused on the illness narratives of Afiican American breast cancer survivors as a means of retrospectively examining the impact that receiving messages about breast can- cer had on the women, and of evaluating how these images agected the women 5 perceived risk for this disease, including their experiences of illness.

Interviews were read and coded by categories, themes, and patterns. Although this was a pilot study, no mention of member checking or credibility indicators was identified in support of the thematic findings.

Sample. This article solely reports the findings of the African- American participants’ narratives, although Caucasian-American women participated in the study as well. The researcher sampled African-American women from 40 to 55 years of age who were recruited from two field sites- one in Menlo Park, Calif, and one in Houston. Although the article includes a table that summarizes participant characteristics, it is confusing, as the greater than and lesser than signs appear to be inaccurate. Further, although this study focuses on African- American women, the participant

characteristics are compared to the characteristics of “white American women.” Also, the comparison sample data for the two groups fail to increase readers’ knowledge, as the Caucasian women’s narratives were not reported. Comparing the two samples may have contributed to stereotyping African Americans rather than exploring the lives of these women in regard to their own standards and norms.

Findings. The researcher iden- tified three important themes that provide knowledge for periopera- tive nurses caring for African- American women. The first theme is “breast cancer is a white woman’s disease.” Of the 23 women interviewed, 22 (96%) reported that they initially thought of breast cancer as a white woman’s disease and that this belief was reinforced by the media. One participant cited the example of how a volunteer gave her a white prosthesis because she did not have one to match the par- ticipant’s skin tone. This theme reflects that many participants’ knowledge, gained via the media and health care providers, is cul- turally inadequate.

caused by the stress of heart- break.” This theme reflects that a cancer diagnosis is just one more stressor affecting participants’ lives. These women believe at some level that their “broken hearts” and life stressors, such as racism, contribute and are linked to their diagnosis of cancer.

The final theme, “African- American women receive less than adequate social support,” suggests that there is a perceived lack of social support and under- standing for African-American survivors of breast cancer. Many of these women believe that

The second theme is “cancer is

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Caucasian women are afforded more societal support for their survival.

Conclusion. The implications of this study suggest that nurses need to be sensitive to Ahcan- American perspectives of the ori- gins of breast cancer and to have culturally sensitive materials available. In addition, support groups by and for this cultural group may reduce the perception that breast cancer is a “white woman’s disease.”

MICHELLE BYRNE RN, MS, PHD, CNOR

NURSING RESEARCH COMMIITEE

FETAL AND UTERINE RESPONSE DURING MATERNAL SURGERY J M Kendrick American Journal of Maternal Child Nursing Vol19 (Mq/June 1994) 165-1 70

he incidence of nonobstetric surgery requiring anesthesia T during pregnancy is 0.2% to

2.2%, and approximately 50,000 women are affected in the United States per year. Perioperative monitoring of the fetus and uter- ine activity remains a matter of controversy. Few studies support the appropriateness and feasibility of fetal heart rate (FHR) monitor- ing during nonobstetric surgical procedures. In spite of improve- ments in surgical techniques and anesthesia, little has been written about fetal and uterine response during nonobstetric surgery. Fetal heart rate monitoring may allow rapid improvement of fetal status or uterine activity should early compromise or contractions be detected. The purpose of this study was to assess and describe FHR changes and uterine activity that occur during nonobstetric

surgery in women at 20 to 40 weeks gestation; to determine whether infant birth weights were lower when the mother under- went surgery during pregnancy; and to determine the value of fetal monitoring during nonob- stetric surgery.

Methodology. A multiple case descriptive design and a conven- ience, nonprobability sample was used. Ten pregnant women meet- ing inclusion criteria participated. Inclusion criteria consisted of women with a fetus at 20 to 40 weeks gestation, nonemergent but necessary surgery, regional or general anesthesia, physician’s order for fetal monitoring, and availability of the investigator. The study was conducted at a sin- gle site tertiary facility.

Data were collected using chart reviews, patient interviews, and participant-observer roles dur- ing the procedure. Fetal and uter- ine monitoring was performed using an external ultrasonic trans- ducer and tocodynamometer, which were initiated preoperative- ly to establish baseline. Moni- toring was continued during phase one recovery unless an extended time frame was indicated (eg, uterine contractions).

During abdominal surgery, a sterile aquasonic gel and sleeve were used and held in place by the investigator who was scrubbed. In procedures where more than one contraction occurred every 10 minutes, the obstetrician or pennatalogist was notified if IV hydration did not decrease activity. Prophylactic tocolytic medications were admin- istered before the development of cervical change because these subjects were at higher risk of preterm labor. To determine whether fetal birth weights were

affected, they were compared to fetal birth weights of infants delivered previously to the same subject.

Results. Subjects ranged in age from 19 to 36 years (M = 24.8) with a mean gestation of 23.9 weeks (20 to 35.6 weeks). Seven of the subjects were multi- gravidas. Six were in the second trimester, and four were in the third trimester. The length of sur- gery ranged from 15 minutes to 3 hours and 50 minutes (M = 103 minutes). There was a significant difference in the length of surgery and anesthesia (M = 27.13 min- utes, 10 to 50 minutes) because anesthesia was begun before an incision was made.

Contractions every two to three minutes (ie, uterine activity) were noted in one-half of the sub- jects. Four of those subjects underwent abdominal surgery. Intravenous tocolytic medications were required to resolve uterine activity in three subjects, and IV hydration was required to resolve uterine activity in one subject. Three subjects experienced preterm labor, but none delivered preterm.

Deceleration of FHR was noted during nine of the proce- dures, and variability from base- line was noted in all subjects. Decreases in FHR (eg, 10 to 25 beats per minute) were significant in eight of the procedures where subjects received general anesthe- sia. In one subject who underwent a cholecystectomy at 2 1 weeks gestation with general anesthesia, prolonged deceleration of FHR before detection of maternal hypotension was observed.

Fetal birth weights were com- pared to those of the subject’s other children. There was no sig- nificant difference at the 0.1 level

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