Self-care support has a crucial enabling value and plays a central role in practical and theoretical nursing and the nursing process. Orem (1995
) had provided a theoretical system for nursing research based on epistemological foundations that have long been used to conceptualize patients’/individuals’ self-care and the self-care process in research (see Biggs, 2008
). Her most important contribution to the nursing discourse is her conceptualization of self-care as a practice of active management of one's health and/or illness (Orem, 1995
). This view is not only important but also very complex because as Denayes, Orem, and Bekel (2001
), p. 48) had noted that“the individual, the self, is both the agent of action (the one acting) and the object of action (the one acted upon).” Within this self-care definition, self-care practices can be recognized throughout the lifespan as a human regulatory function in everyday life aimed at maintaining health and avoiding illness.
The introduction and use of the Internet in daily support and education activities has meant new dimensions in self-care systems for both those individuals requiring self-care and institutions that provide information to those who are seeking it. For example, the vast growth in information nurses distribute as part of self-directed educational programs for patients and relatives over the net represents a new means of providing opportunities for self-care (see Brillhart, 2005
; Proudfoot et al., 2007
). However, the development of complementary self-care systems does not fill all the gaps in self-care in western societies. Self-care agencies such as municipalities, hospitals, and health care centers tend to prioritize what can be considered “major” health issues such as cancer treatment, HIV/AIDS awareness, and heart disease. Different kinds of Internet use and forum activities have been studied previously in relation to major health issues (Coulson & Buhanan, 2008
; Coulson, Buchanan, & Aubeeluck, 2007
; Rozmovits & Ziebland, 2004
; Seale, Ziebland, & Charteris-Black, 2006
; Ziebland, 2004
; Zieblandet al., 2004
). Other issues, such as reconstructive and cosmetic surgery, are given lower priority when offering support and educational systems online. For example, women who are concerned about their health, and who want to be more conscious about their self-care in relation to breast augmentation, tend to use privately managed forums on the Internet as an important source of support and education for managing their life situation (Gordon, Barot, Fahey, & Matthews, 2001
; Walden, Panagopoulous, & Shrader, 2010
). Given the rapid expansion of the Internet and the known deficits in self-care support, online forums are easily accessible from participants’ own homes and provide a medium for inter-personal communication about self-care in relation to breast augmentation.
In addition to the above, post modern understandings of the body have challenged earlier discourses that defined it as an object with limitations and functions that were inherently dictated by nature and thus impervious to change. Along with this shift, assumptions regarding nurses’ participation in self-care management have also been re-framed. The post-modern orientation suggests that it is possible for individuals to educate themselves to achieve life projects, taking their health into their own hands as both an agent and the object of action. This study will thoroughly investigate this new condition and what it means in the conceptualization of self-care in relation to women and breast augmentation. Although this is a common surgical procedure, very little can be found in the nursing literature about it. Oberle and Allen (1994
) stated that most women probably learn what they know about the procedure from magazines that frequently address the topic of elective plastic surgery. However, in light of the current expansion of information available on the Internet, we can presume that this source is one of the most important or perhaps the—most important, source of knowledge on the topic.
Although breast augmentation surgery is a common procedure, there are relatively few qualitative papers addressing women's own experiences of breast enlargement. Langer and Beckman (2005
) studied an Internet message board on cosmetic surgery with the purpose of elaborating on sensitive research topics. Their findings reveal that women use message boards to exchange information and to gain deeper insights into their motives for undergoing such surgery. Klassen, Pusic, Scott, Klok, and Cano (2009) used qualitative methods to study satisfaction among women who undergo breast surgery, including breast reduction, augmentation, and re-construction. They concluded that breast surgery was associated with satisfaction with breasts, satisfaction with overall outcome, psychosocial well-being, sexual well-being, physical well-being, and satisfaction with the process of care. Woodman and Radzyminski (2009
) arrived at similar conclusions in their phenomenological analysis aimed at understanding subjective issues related to life after breast reduction surgery. Their findings show that breast reduction surgery has several positive meanings for women, including improved physical health, increased self-esteem, self-confidence, and enhanced body image. More related to our study, several studies report positive psychological outcomes with breast augmentations such as enhanced body image (Crerand, Infield, & Sarwer, 2009
; von Soest, Kvalem, Roald, & Skolleborg, 2009
). Similarly, a 2-year prospective study by Cash, Duel, and Perkins (2002
) found that more than 90% of the study group reported an improved body image and more than 85% reported enhanced self-image. In a more recent study, Bruck, Kleinschmidt, and Ottoman (2011
) showed that women felt more attractive, reported a significantly improved level of sexual satisfaction and higher self-confidence after the breast augmentation. Femininity has been highlighted as a basic motivation for undergoing breast augmentation by Solvi et al. (2010
). Femininity is associated with gender identity, and the women in their study sought breast augmentation to escape feeling masculine and instead feel attractive and sensual as a woman. Additionally, Gerber and Kuechel (2005
) distinguished between two forms of plastic surgery, reconstructive plastic surgery, that is reconstruction of a breast after a mastectomy, scar revision, removal of tumors, etc. and forms of esthetic plastic surgery that includes procedures to enhance an individual's physical appearance. In this study, the focus is on esthetic plastic surgery among women engaging in breast enlargement to enhance their physical appearance. Figueroa-Haas (2009
) stressed that there are psychological issues to consider for the latter group. She stated that women's different responses to sociocultural pressures related to cultural ideals of beauty need to be considered in relation to the procedure. As such, the perception of breast augmentation as a “relatively simple” procedure in relation to nursing might be worth reconsidering and the procedure and the women undergoing it further explored. As mentioned earlier, large breasts are considered to be a positive attribute of the female body and feminity in the western world. However, women who have undergone breast augmentation experience guilt, being stigmatized, being stereotyped and feel a need to justify their decision by normalizing the surgery (Sischo, 2008
). Reviewing the research literature, there are other serious issues related to breast augmentation. For example, based on several epidemiological studies, Sarwer (2007
) found that that the rate of suicide within the breast augmentation population is two to three times higher than expected. Breast augmentation is also associated with medical complications; one of the most common of which is rippling, occuring in about 7% of the operations (Codner et al., 2011
). Even if breast augmentation is regarded as a relatively simple procedure, the process women undertake to attain information about it is underresearched and raises questions about the patterns of their communicated concerns. To gain a better awareness of these concerns and how they are connected with new forms of expression that are available through the Internet requires empirical studies that address these questions in relation to nursing and self-care activities.