Symptom experience in women after hysterectomy

Reasons for middle-aged women in Taiwan to choose hysterectomy: a qualitative study using the bounded rationality perspective

AIMS AND OBJECTIVES

To explore women's perspectives on deciding to undergo hysterectomy for benign conditions based on physicians' recommendations and the women's own judgement.

BACKGROUND

Hysterectomy is the second most common surgical procedure worldwide. Although most hysterectomies are elective, physicians may recommend treatment that involves a loss of sexuality or ovary removal, creating a difficult choice for women.

DESIGN

Qualitative, in-depth interview

METHODS

A purposive sample of 17 women was recruited. The women had decided to undergo hysterectomy after the diagnosis of uterine fibroids. All these women had already decided not to have more children. Data were collected by in-depth interviewing, and content analysis was used to analyse the data.

RESULTS

Our study revealed five themes: release from stress, inescapable fate, positive support, hoping for peace of mind and sense of trust.

CONCLUSIONS

The participants felt that mental and physical health were the most important considerations, noting that when women no longer want children, a uterus is useless. The women believed that they retained their womanhood, even without a uterus, and were satisfied with the outcomes of their hysterectomy decisions.

RELEVANCE TO CLINICAL PRACTICE

Our findings might serve as educational and counselling reference materials for healthcare providers, ensuring that women receive appropriate care quality and have their needs met. Healthcare providers can then maximise women's empowerment, deepen their awareness of body image and their concept of self-care and help them to clearly perceive their own concerns and needs so that they can make suitable decisions.

The efficacy of preopoerative instruction in reducing anxiety following gyneoncological surgery: a case control study

Background

This is a quasi-experimental case control research focusing on the impact of systematic preoperative instruction on the level of postoperative anxiety in gyneoncologic patients. The population studied consists of the gyneoncologic surgery patients admitted to the Gynecologic Oncology Service at Zekai Tahir Burak Gynecology Training and Research Hospital from May to September 2010.

Patients and methods

Through a random sampling, 60 patients were recruited in each group. The study group was given a systematic preoperative instruction while the control group was given routine nursing care. Patients were interviewed in the postoperative period and anxiety was measured. The data-collecting tool consisted of the Individual Information Form and the State-Trait Anxiety Inventory. The collected data were analyzed by using the SPSS Program to find the frequency, the percentage, the mean and the standard variables, and the hypothesis was tested with Chi-square, variance, and t-independent test.

Results

It was found that the incidence rates from the post-operative anxiety score of the study group were lower than those of the control group (p < .05). The results of this research demonstrated that gyneoncologic surgery patients who were given systematic preoperative instruction felt less anxious than the ones who were given merely a routine nursing care.

Conclusions

Results of this study suggest that preoperative instruction programs aiming at informing gyneoncologic surgery patients at the preoperative stage should be organized in hospitals and have an essential role.

Sleep and fatigue symptoms in women before and 6 weeks after hysterectomy

OBJECTIVE

To compare sleep and fatigue experiences of women before hysterectomy and at 3 and 6 weeks after surgery, to compare symptoms by type of surgical procedure, and to examine the biopsychosocial contextual factors related to symptoms.

DESIGN

A descriptive repeated measures study assessed sleep and fatigue using questionnaires and objective wrist actigraphy monitoring for sleep.

SETTING

Data were collected in women's homes at least 2 days before surgery, and at 3 and 6 weeks postoperatively.

PARTICIPANTS

A convenience sample of 25 women scheduled for hysterectomy.

RESULTS

There was significantly higher self-reported sleep disturbance 3 weeks after surgery compared with baseline. Women who had vaginal hysterectomy continued to experience sleep disturbance and fatigue 6 weeks after surgery, while those who had abdominal hysterectomy reported better sleep and less fatigue at 6 weeks compared with baseline. The number of awakenings recorded with actigraphy increased postoperatively for both groups, and younger women experienced more wake time during the night than older women. Level of education was positively related to preoperative fatigue severity.

CONCLUSIONS

Findings suggested poor sleep and fatigue during the postoperative period should be evaluated in light of women's ages, level of education, and type of surgical procedure.

Anxiety, depression and coping strategies in post-hysterectomy Chinese women prior to discharge

OBJECTIVE

This survey investigated the relationships among anxiety, depression, coping strategies and demographic characteristics of post-hysterectomy Chinese women before discharge and further determined the best predictors of anxiety and depression among this group.

METHODS

The sample consisted of 105 women who were administered, 1-2 days prior to discharge, via one-to-one interview, the Zung Self-rating Anxiety Scale, the Zung Self-rating Depression Scale, the Brief COPE Scale and a demographic questionnaire.

RESULTS

Only 1.9% of the participants experienced anxiety, while 4.8% experienced depression after having a hysterectomy. Active coping, positive reframing, planning, emotional support and venting were the most frequently used coping strategies. Significant positive and negative correlations were found among anxiety, depression, coping strategies and the demographic characteristics of the subjects. The best predictors of anxiety were self-blame, venting and medical payment. The best predictors of depression were self-blame and employment status.

CONCLUSION

Self-blame was the predictor of both anxiety and depression. It implied that a patient's negative self-evaluation may influence both psychological status and mental health. The ways of medical payment and employment status were predictors of anxiety and depression respectively, both of which reflected the economic stress that affected the psychological status and quality of life of the Chinese women, post-hysterectomy, before discharge. The findings of this study indicate that care for Chinese women post-hysterectomy, before discharge, should address their physical, psychological, social and economic well-being.

Patterns of symptom distress in older women after surgical treatment for breast cancer

PURPOSE/OBJECTIVES

To describe patterns of symptom distress over time in older women receiving surgical treatment for breast cancer and to examine the relationship of selected patient and clinical characteristics to symptom distress.

DESIGN

Secondary analysis of breast cancer data from a prospective, longitudinal study of older patients with several types of cancer.

SETTING

Large mid-Atlantic teaching hospital.

SAMPLE

57 patients with breast cancer participated. Subjects had a mean age of 68 and were predominantly white, not Hispanic, married, Protestant, retired, and in stage I or II. A total of 55 subjects completed the study.

METHODS

The Symptom Distress Scale was used. Data were collected on discharge and at three and six months postdischarge. Descriptive statistics, t test, analysis of variance, correlation coefficients, and stepwise multiple regression were analyzed.

MAIN RESEARCH VARIABLES

Total symptom distress and 13 individual symptom scores.

FINDINGS

Fatigue, frequency of pain, outlook, and insomnia consistently were most prevalent and severe. Symptoms decreased gradually. Younger, more educated, and married women experienced more distress.

CONCLUSIONS

Interactions among symptoms are complex. Later symptom distress may be predicted by early experience and demographic characteristics.

IMPLICATIONS FOR NURSING

Clinicians should inquire about symptom distress at each encounter, expect multiple symptoms, and anticipate greater symptom distress in patients who are younger, more educated, or married or living with a partner. In women with more severe, earlier symptom distress, nurses should intervene promptly. Research should determine interrelationships of symptoms and how they might be affected by contextual variables, describe critical attributes of the nurse-patient interaction that might mitigate symptom distress, characterize the relationship of symptom intensity and distress, clarify the mechanism of the relationship between marital status and symptom distress, and identify the effect of symptoms, individually and collectively, on survival and quality of life.