Holistic Understanding of Concerns of Women with Breast Cancer in Oncology Nursing: Carper‑Guided Narrative Conceptual Analysis Holistic nursing in breast cancer
Abstract
Background: Women diagnosed with breast cancer face various mental, emotional, psychological, and physical challenges. This study seeks to identify different ways of knowing to better understand the concerns of women with breast cancer, as well as the significance of implementing these insights in nursing, especially within the field of oncology care.
Methods: This Carper-guided narrative conceptual analysis used Carper’s 4 patterns of knowledge to explore the issues faced by women diagnosed with breast cancer. The 4 kinds of knowing described are personal, empirical, aesthetic, and ethical.
Results: Personal knowledge empowers nurses to enhance their emotional intelligence and cultivate a deeper understanding of their patients’ needs. The integration of aesthetic knowing in nursing practice is essential for those dedicated to providing compassionate and holistic care within the oncology field. Empirical knowing involves conducting research, developing measurement scales, and formulating compassion-focused therapies. Additionally, ethical dilemmas frequently arise during nurse–patient interactions in oncology settings.
Conclusion: Applying Carper’s 4 ways of knowing is essential for understanding the needs of women with breast cancer throughout their care. However, oncology nurses may also use their own judgment in certain circumstances. This study is poised to substantially influence the landscape of breast cancer care, with direct implications for nursing research, clinical practice, and the holistic management of patients.
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References
WHO. Breast Cancer. 2024. Breast cancer. Available from: https://www.who.int/news-room/fact-sheets/detail/breast-cancer
Fortune S. Psychological Concerns in the Aftermath of a Breast Cancer Diagnosis and Treatment for Young Adults. Oncology Nursing News. 2023 Oct 23; Available from: https://www.oncnursingnews.com/view/psychological-concerns-in-the-aftermath-of-a-breast-cancer-diagnosis-and-treatment-for-young-adults
Iddrisu M, Aziato L, Desey F. Psychological and physical effects of breast cancer diagnosis and treatment on young Ghanaian women: a qualitative study. BMC Psychiatry; Available from: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02760-4
Chinn P, Kramer M. Knowledge Development in Nursing Theory and Process. 9th ed. Elsevier; 2015. Available from: https://www.scirp.org/reference/referencespapers?referenceid=2776118
Neff K. The Development and Validation of a Scale to Measure Self-Compassion. Self and Identity. 2003;1;2(3):223–50. doi:10.1080/15298860309027. DOI: https://doi.org/10.1080/15298860309027
Al-Ghareeb S, Asiri MY, Aboshaiqah A. The relationship between perceived stress, mindfulness, and sociodemographics among breast cancer patients in Saudi Arabia: a cross-sectional study. Discov Psychol. 2025 7; doi:10.1007/s44202-025-00552-z. DOI: https://doi.org/10.21203/rs.3.rs-7371670/v1
AlGhareeb SA, Aboshaiqah A. National Policy Recommendation for Early Cancer Prediction Using Artificial Intelligence in Saudi Arabia: A Review. Journal of Medical Artificial Intelligence. 2025 30;0(0). Available from: https://jmai.amegroups.org/article/view/10499
Al-Ghareeb S, Asiri MY. Self-Compassion in Women After Breast Cancer Surgery: A Concept Analysis Based on Walker and Avant’s Method: Self-compassion in breast cancer surgery. Arch Breast Cancer. 2025 22;12(4):368–78. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/1127 DOI: https://doi.org/10.32768/abc.9152073846-129
Chen Y, Liu R, Xiao J, Wang Y, Yang Y, Fan H, et al. Effects of online mindful self-compassion intervention on negative body image in breast cancer patients: A randomized controlled trail. European Journal of Oncology Nursing. 2024 1;72:102664. Available from: https://www.sciencedirect.com/science/article/pii/S1462388924001625 DOI: https://doi.org/10.1016/j.ejon.2024.102664
Carper B. Fundamental patterns of knowing in nursing. ANS Adv Nurs Sci. 1978 Oct;1(1):13–23. DOI: https://doi.org/10.1097/00012272-197810000-00004
Fetaini M, Hawari A, Kaki F, Ujaimi R, Tashkandi H, AbuSanad A. Impact of breast cancer treatments on body image and quality of life in survivors. IJMDC. 2020;635–44. Available from: https://www.ejmanager.com/fulltextpdf.php?mno=76023 DOI: https://doi.org/10.24911/IJMDC.51-1575122675
Chinn PL. Personal knowing in cancer nursing - PubMed. Journal of Advanced Nursing. 1999;29(2):288–93. Available from: https://pubmed.ncbi.nlm.nih.gov/10205486/
Fookolaee SP, Hadadian F, Feizi A, Jouybari L. Nurses’ experiences of providing emotional intelligence-based nursing care: a hermeneutic phenomenological study. BMC Nurs. 2025 4;24:1013. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12323113/ DOI: https://doi.org/10.1186/s12912-025-03361-w
Zarrin L, Ghafourifard M, Sheikhalipour Z. Relationship between Nurses Reflection, Self-efficacy and Work Engagement: A Multicenter Study. J Caring Sci. 2023;27;12(3):155–62. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10663437/ DOI: https://doi.org/10.34172/jcs.2023.31920
Tavakol M, Sandars J. Twelve tips for using phenomenology as a qualitative research approach in health professions education. Medical Teacher. 2025;2;47(9):1441–6. doi:10.1080/0142159X.2025.2478871. DOI: https://doi.org/10.1080/0142159X.2025.2478871
Hasan S, Chew KS, Balang RV, Wong SSL. Beyond the scars: a qualitative study on the experiences of mastectomy among young women with breast cancer in a country with crisis. BMC Womens Health. 2023;13;23:596. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10641941/ DOI: https://doi.org/10.1186/s12905-023-02734-0
Wulandari SM, Yunitasari E, Kusumaningrum T, Myint NMM, Subu MA. Body image perception among breast cancer patients after mastectomy: A phenomenology study. The Journal of Palembang Nursing Studies. 2023;6;2(3):151–64. Available from: https://jpns-journal.com/index.php/jpns/article/view/87 DOI: https://doi.org/10.55048/jpns87
Hunter LP. Poetry as an aesthetic expression for nursing: a review. PubMed. 2000;40(2). Available from: https://pubmed.ncbi.nlm.nih.gov/12366643/
Molina J, Gallo J. Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making. International Journal of Environmental Research and Public Health. 2020;17(3):835. Available from: https://pubmed.ncbi.nlm.nih.gov/32013108/ DOI: https://doi.org/10.3390/ijerph17030835
Shahmohammadi S, Mangolian shahrbabaki P, Radmehr M, Shahraki SK. The effectiveness of aesthetic care training on nurses’ perceptions of end-of-life care in patients with cancer: a quasi-experimental study. BMC Palliat Care. 2024 8;23(1):34. doi:10.1186/s12904-024-01343-4. DOI: https://doi.org/10.1186/s12904-024-01343-4
Monge Moreno JT. Aesthetic Leadership in Nursing: A Theoretical Proposal for Rehumanizing Care Delivery. Nurs Inq. 2025;32(3):e70034. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12105069/ DOI: https://doi.org/10.1111/nin.70034
Swift A, Twycross A. Using ways of knowing in nursing to develop educational strategies that support knowledge mobilization. Paediatr Neonatal Pain. 2020 Sept 7;2(4):139–47. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8975233/ DOI: https://doi.org/10.1002/pne2.12037
Zhu F, Zhang W, Liu C, Qiang W, Lu Q. Association of self-compassion and body image disturbance among young breast cancer patients: Mediating effect of body surveillance and body shame. Asia Pac J Oncol Nurs. 2023;10(4):100199. DOI: https://doi.org/10.1016/j.apjon.2023.100199
Neff KD. The Role of Self-Compassion in Development: A Healthier Way to Relate to Oneself. Hum Dev. 2009;52(4):211–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2790748/ DOI: https://doi.org/10.1159/000215071
Gilbert P. The origins and nature of compassion focused therapy. Br J Clin Psychol. 2014 Mar;53(1):6–41. doi: 10.1111/bjc.12043 DOI: https://doi.org/10.1111/bjc.12043
Mehrabi N, Amiri H, Omidi A, Sarvizadeh M. The Effectiveness of Group Compassion-Focused Therapy on Body Image and Interpersonal Stress among Women with Breast Cancer: A Randomized Controlled Trial. IJ Psychiatry and Behavioral Sciences; 2023; p. e139764. Report No.: 18. Available from: https://brieflands.com/journals/ijpbs/articles/139764#abstract DOI: https://doi.org/10.5812/ijpbs-139764
Hemberg J, Hemberg H. Ethical competence in a profession: Healthcare professionals’ views. Nurs Open. 2020;18;7(4):1249–59. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7308671/ DOI: https://doi.org/10.1002/nop2.501
Kidayi PL, Manhica H, Nakazzi S, Mtuya CC, Aune RE, Serventi F, et al. Caring for Breast Cancer Patients Is a Work That Brings Sorrow”: A Qualitative Interview Study with Nurses in Tanzania. SAGE Open Nurs. 2023;10;9:23779608231187241. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10333987/ DOI: https://doi.org/10.1177/23779608231187241
Gastmans C, Mertens E, Palese A, Keogh B, Apolloni F, Wiisak J, et al. Perspectives of nurses and patient representatives on the morally competent nurse: An international focus group study. International Journal of Nursing Studies Advances. 2025;1;8:100296. Available from: https://www.sciencedirect.com/science/article/pii/S2666142X25000062 DOI: https://doi.org/10.1016/j.ijnsa.2025.100296
Bafandeh Zendeh M, Hemmati Maslakpak M, Jasemi M. Nurses’ perceptions of their supportive role for cancer patients: A qualitative study. Nurs Open. 2021;3;9(1):646–54. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8685772/ DOI: https://doi.org/10.1002/nop2.1112
Baysal E, Sari D, Erdem H. Ethical decision-making levels of oncology nurses. Nurs Ethics. 2019;1;26(7–8):2204–12. doi:10.1177/0969733018803662. DOI: https://doi.org/10.1177/0969733018803662
Rafii F, Nasrabadi AN, Tehrani FJ. How Nurses Apply Patterns of Knowing in Clinical Practice: A Grounded Theory Study. Ethiop J Health Sci. 2021;31(1):139–46. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8188100/ DOI: https://doi.org/10.4314/ejhs.v31i1.16
Atta MHR, Hammad HAH, Elzohairy NW. The role of Empathy in the relationship between emotional support and caring behavior towards patients among intern nursing students. BMC Nurs. 2024;28;23:443. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11212155/ DOI: https://doi.org/10.1186/s12912-024-02074-w
Fereidouni Z, Dehghan Abnavi S, Ghanbari Z, Gashmard R, Zarepour F, Khalili Samani N, et al. The Impact of Cancer on Mental Health and the Importance of Supportive Services. Galen Med J. 2024;26;13:e3327. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11368479/ DOI: https://doi.org/10.31661/gmj.v13i.3327
Kwame A, Petrucka PM. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nurs. 2021;3;20:158. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414690/ DOI: https://doi.org/10.1186/s12912-021-00684-2
Paiva ICS, Ventura FIQS, Vilela ACL, Moreira IMPB. Influence of oncology nurses’ decision-making and personality traits on missed nursing care and related factors: A correlational study. European Journal of Oncology Nursing. 2025;1;74:102749. Available from: https://www.sciencedirect.com/science/article/pii/S1462388924002473 DOI: https://doi.org/10.1016/j.ejon.2024.102749
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