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The instrument was analyzed by a psychologist and in research based on Lipp's recommendations. This inventory consists of two parts, with 20 affirmations each. The anxiety trait evaluates how often women perceived their own life, and the anxiety status evaluates anxiety in the moment of the interview. For statistical analysis, SPSS software, version We performed a descriptive analysis using frequency tables and graphics.
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To analyze the relationship between variables and stress, we applied the chi-square test. After the end of the study patients received a letter containing the results achieved. Patients who presented with stress in the exhaustion and near-exhaustion phases were referred to our institution's psychological service. Among all patients, Of the women who were experiencing stress, Among women in the exhaustion phase, more had developed psychological symptoms Fifty-eight percent of women in the resistance phase presented physical symptoms; the most frequent were lack of memory, constant physical fatigue, and constant tiredness.
Ages ranged from 31 to 80 years; the mean age was Women with family income was one to three times minimum wage, and of these women Of the 50 women who had a partner, Eighty-one percent of women underwent the surgery at the hospital where the study was conducted; The chi-square test showed no associations between stress and the following variables: Patients who have cancer or are facing the possibility of a malignant tumor become desperate, distressed, fearful, hopeless, sad, and nervous.
Moreover, the previous studies we identified included small samples. They also affirm that women with a psychiatric history and had low expectations of treatment benefits due to their lack of support or previous experience with family members have higher risk for developing psychological imbalance. The most frequent stress phase was exhaustion, followed by resistance.
Stress in mastectomized women
Among women in the exhaustion phase, psychological symptoms were prevalent, particularly the following symptoms: In this phase, people experience excess of activities and high consumption of energy, and are more susceptible to any organic diseases that might appear.
Women in this phase were trying to deal with stress, for which they were seeking homeostasis. Soon, these women could become vulnerable to infections and diseases as a result of cortical suprarenal hyperactivity and high consumption of energy. No patients were at the alarm or near-exhaustion phase. Almost all patients had psychological symptoms. The most common psychological symptoms of stress were self-doubt, thinking constantly about a specific subject, and excessive tiredness.
This population reported feeling constant physical fatigue, suffered from muscle tension, and experienced excessive irritability; these physical symptoms occurred more often than psychological symptoms, results that agree with our findings. Thus, it is reasonable to ask whether stress is related to intrinsic characteristics of the patients - not only aspects associated with the disease itself and its consequences but also history and life habits, because the study instrument determined how women normally felt about their life.
Stress situations that last for a long time result in body imbalance; for this reason, the defense mechanism against cancer become weak from exhaustion. Therefore, an important point is how to strengthen defense mechanisms against cancer and increase defense efficacy after appearance of a malignant tumor; the defense is necessary to improve life satisfaction, hopefulness about survival, and the ability to resist and self-heal from cancer.
This regular attendance might be explained by the patients' need for a place where they can speak freely about their doubts, uncertainty, and distress and the effects on their daily activities. Considering the age of women included in this study, we observed similar findings in a study of patients with breast cancer in London; the mean age in that study was Similar results were seen in other studies of mastectomized women conducted in Espirito Santo.
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The family income in our study was similar to that reported in other research22 among patients with breast cancer, which reported a total of no more than three times minimum wages. Most of the interviewed women were housewives, and a minority were retired.
Concerning Social Security, a study in post-mastectomy women agrees with results found in our study. In addition, a study of mastectomized women conducted in Campinas showed the importance of support to women with breast cancer; women who have a partner present better scores on psychological and social relations domains.
Presence of a partner may indicate that women have a greater chance of receiving social and psychological support and having better living conditions. This fact probably explains why women were referred to PREMMA after breast cancer diagnosis; this did not occur when treatment was carried out at different hospital. A previous study found that most women with breast cancer underwent conservative treatment, a finding that differs from the situation in our study.
We observed that the evaluation effects of PREMMA implementation, such as nursing intervention before surgery among women diagnosed with breast cancer, showed that those enrolled in PREMMA before surgery had a low level of anxiety compared with those who enrolled after the surgery. Although the program was initially created with the goal to perform postoperative interventions, the results of this study led the rearrangement of the referral flowchart for women just after diagnosis.
It is critical that nurses incorporate into their daily practice the use of instruments that allow them to identify normal stress behavior. Doing so could facilitate and support nursing interventions. Stress was not significantly related to most variables, but the association of stress with trait variables of anxiety was significant.
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