الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
According to Michael, (2022), the breast is a uniquely important part of the female body. A proportionately developed breast is a feminine feature and a sign of sexuality. Breasts are necessary for women’s self-confidence, when their role in society has expanded immensely. Also, breast cancer is the most commonly diagnosed cancer among women and the second leading cause of cancer mortality in women worldwide. Meanwhile, Abdalla, (2022) added that a diagnosis of breast cancer, regardless of the stage, can be stressful, influencing multiple spheres of life, disrupting physical status, emotional and spiritual well-being, and personal relationships for the patient and family. Breast cancer is a serious health and social problem. According to the National Cancer Institute, breast cancer is the most common type of cancer in women in Egypt as it accounts for about 44% of total malignancies among Egyptian females. It is an important cause of mortality among women that kills about forty thousand women each year. There are several treatment styles for breast cancer, depending on its type and stage, which include local treatments such as surgery, radiation therapy, and systemic treatments such as chemotherapy, hormonal therapy, and targeted therapy (Ibrahim etal., 2014; Mahmoud and Saleh, 2020).Mastectomy is a repercussion of the surgical process resulting from breast cancer. Breast removal represents one of the most significant bodily repercussions and involves the patient’s psycho-emotional state. Society values the body as essential to sexual attraction, which causes women to be afraid of not being more sexually attractive to their partners and to avoid sexual contact (Guex, 2021). In a woman’s life, breast removal carries a range of feelings, and many go through the denial of the disease process, the intense and prominent fear of death, and the belief that, besides the threat to 104 their physical integrity, there have been changes in their family and conjugal relationships (Arroyo and Lopez, 2016). Furthermore, Visser and Herbert (2019) reported that Egypt like many other rdeveloping countries, women after mastectomy may experience unique stressors related to loss of fertility, changes in various social roles, body image, sexual concerns, and altered relationships with significant others. Similarly, Johnson (2020) concluded that a mastectomy is a critical event that influences nearly all aspects of a woman’s and her family’s activities of daily living. Furthermore, women usually lose interest in the deterioration of their economic standards. Also, they may experience deterioration in their sexual adjustment. These problems for these specific groups of patients eventually alter their coping strategies and quality of life. Coping is a key factor in the transition from stressful events to adapted outcomes such as psychological symptoms and physical illness. Coping has two main functions: dealing with the problem that is causing the distress (problem-focused coping) and regulating stressful emotions (emotion-focused coping) (Folkman et al., 2018). Early identification of patients with poor compliance with treatment and control of distress is necessary. It is equally important to recognize and diagnose common psychiatric disorders, primarily anxiety and depression, which can occur and can affect the coping style. Referral for counseling to a mental health professional familiar with the care of patients with cancer may be indicated (Fredette, 2015). Nursing plays an essential role in preventing complications after surgery, providing qualified assistance, promoting physical, emotional, and psychological support, and assisting oncological patients in adapting to new situations and adopting positive health behaviors. It helps with a good prognosis, and interpersonal relationships, not only with the patient but also with the family. The nurse should be 105 familiar with the guidelines for screening preventive services for women after mastectomy (Çol & Kılıç, 2019) The purpose of the current study was to investigate the effect of nursing intervention on coping strategies of women after mastectomy. The study was conducted at the Female Surgical Department and Oncology Department of Menoufia University Hospital in Menoufia Governorate. A quasi-experimental design was used in carrying out the study. Non-probability (a purposive sample) sample, including (100) women with mastectomy, were selected. The women were divided randomly into two groups (study and control). Each of the 100 women was asked to pick a piece of paper containing a number; those who selected number 1 were assigned to the study group, and those who selected number 2 were assigned to the control group. 1. The study group, which included 50 women after mastectomy was instructed to follow the nursing intervention. 2. The control group, which included 50 women after mastectomy was left on routine hospital care. Inclusion criteria for the studied women: Both groups have the following criteria: - Women over 25 years old, as they are the highest age group associated with the occurrence of female breast cancer and mastectomy (Alves et al., 2012). Women who are undergoing mastectomy. - Women who can communicate clearly. - Women who agreed to participate in the research. 106 Throughout the present study, data was collected using these instruments. These instruments were as follows: Instrument I: A structured interviewing questionnaire included socio-demographic data, obstetrical, gynecological, medical, and surgical history, and assessment of women’s knowledge regarding breast cancer and mastectomy. Instrument II: An observational checklist of 10 items to assess women’s practice of breast self-examination (BSE). Instrument III: Adaptive Coping Strategies Questionnaire: It consisted of 31 items that are apply to all women with mastectomy, which included the following: (Conscious way of Living; Positive attitudes; Reappraisal; Trustin medical help; God’s help; Search for alternative help). All items were scored on a 3- point scale from (0= Never), (1= Sometimes) and (2= Often). An approval from the committee of Hearing and Ethics was obtained from the Faculty of Nursing, Menoufia University, on 8/6/2020. Approaches to ensure ethics were considered in the study regarding confidentiality and informed consent. The researcher introduced herself to the women and explained the purpose of the study to obtain their acceptance to be recruited in the study as well as to gain their cooperation Confidentiality was achieved by the use of locked sheets with the names of the >women replaced by numbers. All participants were informed that the information they provided during the study would be kept confidential and used only for statistical purposes. After finishing the study, the findings were presented as a group of data without any personal participant information remaining. Informed consent had been obtained from all women after explanation prior to enrollment in the study. Each woman had been informed that participation in the study 107 was voluntary, and each woman could withdraw from the study whenever she decided to do so. Each woman was allowed to freely refuse participation. They were free to ask any questions about the study details. Upon the completion of data collection, each answer was coded and scored. The researcher coded the data into a coding sheet so that the data could be prepared for computer use. Data were statistically analyzed using (Statistical Package for the Social Sciences, version 22, SPSS Inc. Chicago, IL, USA). The findings of this study supported the three study hypotheses and failed to accept the null hypothesis. The women with mastectomy would exhibit a higher score of total knowledge regarding breast cancer and mastectomy and a higher score of practice regarding breast self-examination after the implementation of the nursing intervention. Also, women with a mastectomy had higher scores on coping strategies after the implementation of the nursing intervention program. This indicates that the nursing intervention is the key element for improving the coping strategies of women after mastectomy. The findings of the present study showed that: ● There was no statistically significant difference among the studied women regarding their sociodemo graphic characteristics and previous obstetrical, gynecological,medical, and surgical history.● There was no statistically significant difference among the studied women regarding their level of knowledge regarding breast cancer and mastectomy before the intervention. 108 ● There was a highly statistically significant difference among the studied women regarding their level of knowledge regarding breast cancer and mastectomy after the intervention. ● There was no statistically significant difference among the studied women regarding their practice of breast self-examination (BSE) before the intervention. ● There was a highly statistically significant difference among the studied women regarding their practice of breast self-examination (BSE) after the intervention. ● There was an impairment in all aspects of adaptive coping strategies, which means that there was no statistically significant difference among studied women before the intervention. There was an improvement in all aspects of adaptive coping strategies, with a highly statistically significant difference among the studied women after the intervention.● There was a highly statistically significant difference between the studied women’s socio-demographic characteristics and their total coping strategies scores after the intervention.● There was a highly statistically significant difference between the studied women’s socio-demographic characteristics and the practice regarding BSE after the intervention ● There was a positive and highly significant correlation between total knowledge score and total coping strategies after the intervention among the study group. ● There was a positive and highly significant correlation between the total practice score and total coping strategies after the intervention among the study group There was a positive and highly significant correlation between women’s age and total coping strategy after the intervention among the study group. According to the findings of the present study, it can be concluded that there was a highly statistically significant increase in total knowledge scores in the study group regarding breast cancer and mastectomy than before. In addition, the implementation of the nursing intervention was effective, and there was a highly statistically significant increase in practice scores in the study group regarding breast self-examination. In addition, the women’s coping strategies in the study group are better than before. Based on the findings of the current study, the following recommendations are proposed: Women who have had a mastectomy are advised to receive ongoing knowledge and skills regarding adaptive coping strategies as a part of their nursing care from maternity nurses, and are encouraged to participate in psychological nursing interventions as part of their regular nursing care, and also further research needs to be conducted on a larger sample size in different hospital settings to attain more generalized results.