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Dr Bridie McCarthy Supervisor : Dr Tom Andrews Co-supervisor : Professor Josephine Hegarty

Emotional Resistance Building: A grounded theory of how family members of loved ones undergoing chemotherapy deal with fear of emotional collapse. Dr Bridie McCarthy Supervisor : Dr Tom Andrews Co-supervisor : Professor Josephine Hegarty. Outline of Presentation. Background to study

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Dr Bridie McCarthy Supervisor : Dr Tom Andrews Co-supervisor : Professor Josephine Hegarty

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  1. Emotional Resistance Building: A grounded theory of how family members of loved ones undergoing chemotherapy deal with fear of emotional collapse Dr Bridie McCarthy Supervisor: Dr Tom Andrews Co-supervisor: Professor Josephine Hegarty

  2. Outline of Presentation • Background to study • Research methodology • The emergent substantive theory

  3. Background • Interest in family members • Clinical experience • Teaching experience • Personal experience • Chemotherapy units • Colo-rectal cancer • Literature on communication

  4. Aim of Study • To explore family members’ experienceswhen their loved ones were undergoing chemotherapy treatment for colo-rectal cancer.

  5. Methodology • Grounded theory (classical) • Data collection – Interviews (n=35) • Analysis: • Constant comparative analysis • Field notes and memoing • Ethical approval

  6. Core Category • Main concern: • Fear of emotional collapse • Core category: • “Emotional Resistance Building” (ERB)

  7. PHASES OF ERB Phase 1 Figuring out Emotional reflecting Information seeking Advanced planning Emotional shielding Phase 3 Uncertainty adjustment Pragmatic adjusting Reality adjusting Reconciliatory adjusting Phase 2 Getting on with it Burden relieving Emotional releasing Emotional holding

  8. Phase 1: Figuring out • Emotional reflecting • Time taking • Explanation seeking • Comparison making I couldn't believe it. I had to take time to think, was it real or just a bad dream. How could it be real, she is too young.

  9. Phase 1 – continued • Information seeking • Attending medical appointments • Active listening/questioning • Establishing trust in HCPs I never knew he was so lonely until he told the doctor why he couldn’t sleep at night. I was just thinking it was depression and at him to pick himself up. It was a real wake-up call for me

  10. Phase 1: Continued • Advance planning • Action planning • Disclosing the diagnosis • Re-normalising We are in this together and we will get through it together

  11. Phase 1 continued • Emotional shielding • Emotional hiding • Physical hiding • Emotional containing It was terrible at the start. I didn’t leave the house, I just didn’t want to meet or see anyone. I just wanted to be by myself and have a good cry

  12. Phase 2: Getting on with it • Burden relieving • Responsibility taking • Openly communicating • Illness fighting We have to fight this. We are getting the best treatment and I believe my wife will come through this We are both very positive and I have to believe it. We have small children, my wife is not even 40 yet and we have our whole lives ahead of us.

  13. Phase 2 continued • Emotional releasing • Externalising emotional displays • Externalised burden sharing • Spiritualised burden sharing God has spared me my husband for which I am most grateful. Now if He will save him for me and my family I will do whatever it takes , anything he wants me to do to save my husband, I will do it

  14. Phase 2: Continued • Emotional holding • Emotional postponing • Maintaining hope • Illness detachment No matter how bad the news I would never cry in front of my partner or HCPs. I would hold back until I get to the first loo or until I got home

  15. Phase 3: Uncertainty adjustment • Pragmatic adjusting • Planning • Negotiating support • Illness disclosure I work shift hours so I had to arrange my dad’s chemo around times that suited me. If I couldn’t do that I really don’t know how we’d manage

  16. Phase 3 – continued • Reality adjusting • Getting through each day • Letting go • Confidence layering My wife got so sick with the chemo that I had to do everything. It was hard going at the beginning with young children as well, but I just took one day at a time

  17. Phase 3: Continued • Reconciliatory adjusting • Valuing time • Balancing • Accommodating disruption You never know from day to day or week to week what is gong to happen. Even if they will have the chemo. So you have to be ready for setbacks

  18. Conclusion • Policies and reports highlight the need to include and support family members (FMs) of patients with cancer (WHO 2006 & DoH&C 2012). • That nurses should have an awareness of the emotional impact of cancer on FMs (DoH&C 2012). • This explanatory theory highlights the many concerns that FMs experience and how they process them to avoid emotional collapse. • Future - Need to intervene at an earlier stage, to reassure, support and guide FMs during this process

  19. Thank you for listening Bridie

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