Gynaecological assessment and history taking

Nurse practitioners (NPs) rarely undertake gynaecological histories or female genital examinations yet, by doing so, they can broaden their scope of practice. This article discusses what NPs should ask women about their gynaecological histories and how to undertake pelvic examinations, and reviews common gynaecological symptoms. Further articles will cover different aspects of the pelvic examination and potential differential diagnoses.

[Causes of pain in obstetrics]

For women, the childbearing period is a source of pain related to dysmenorrhoea, childbirth, abortion, gynaecological diseases, etc. Physiologically, female sex hormones influence pain modulation. Whatever its cause, appropriate evaluation and treatment should be offered to relieve these women.

Sexual health innovators

Much of the care that patients attending the sexual health clinic at London's St. Mary's Hospital receive is nurse led. Improvements to the service have been boosted by training programmes.

Cross-mapping ICNP terms with Taiwanese gynecological nursing records

Cross-mapping the terms of International Classification for Nursing Practice (ICNP) with the handwritten nursing records of gynecological patients at one district of private teaching hospital in the south of Taiwan was conducted in July and August, 2004. The purpose of this study was to validate the applicability of ICNP for electronic nursing records in a gynecological setting. A Chinese version of the ICNP beta 2 browser was used to code nursing record sentences. Medical charts were reviewed until data were saturated. A total of sixty-two patient records were analyzed, producing 6,327 sentences, this included 1,918 sentences on nursing phenomena (30.3%) and 4,409 sentences on nursing action (69.7%). The ratio between the two was about 1:2.3. Coded sentences were compared according to the four levels of applicability with the original records, each was identified as a "perfect fit", "conceptual fit", "partial fit", or "unable to fit". Of the 6,327 sentences, 2,041 (32.3%) were designated as "perfect fit", 2,457 (38.8%) as "conceptual fit", 1,663 (26.3%) as "partial fit", and 166 (2.6%) as "unable to fit". The top ten most described nursing phenomena included: acute pain, high temperature, conscious change, potential infection risk, state of mind change, potential risk patient's mobility change endurance level, gastrointestinal function obstacles, changes in urination, anxiety, and diarrhea. The top ten most described nursing actions included: observe surgical wounds, monitor vital signs, changes of mentality, instruction on medication, arranging clinical check ups, wound infection prevention, urinary drainage tube and urine nature observation, checking for vaginal drainage, pre/post-operative healthcare, and discharge planning. Study results indicated that 71.1% of sentences could be cross-mapped. Further validation is suggested to validate ICNP in other gynecological hospitals.

[Effects of pain control education on pain control barrier, postoperative pain and pain control satisfaction in gynecological patients]

PURPOSE

The purpose of this study was to evaluate the effects of preoperative pain control education on the pain control barrier, postoperative pain and pain control satisfaction in gynecological patients.

METHOD

The study was a quasi-experimental research design. There were 58 subjects who were admitted for gynecological surgery to D University Hospital in B city. Pain control education was provided individually to the experimental group one day before their operation day for 20 minutes with the 'Pain Control Guide Book' in the patient's admission room. The education book was made by researchers based on pain management references and patient interviews. For assessing the pain control barrier, a simplified version of Barriers Questionnaire was used, postoperative pain was assessed on a numeric scale(0-10) and satisfaction of pain control was assessed by one question.

RESULTS

The pain control barrier(F=15.828, p<.001) and the post pain score of the experimental group was lower than that of the control group. In addition, pain control satisfaction of the experimental group(t=3.612, p<.001) was higher than the control group's.

CONCLUSION

With the above results, preoperative pain control education could be an effective nursing intervention for pain control of surgical patients.

The experience of physical symptoms among women living with HIV

As the number of women living with HIV and AIDS increases, so does survival time for individuals living with this chronic condition. Symptom existence, intensity, and bothersomeness greatly affect quality of life in women living with HIV and AIDS. Symptoms experienced by women living with HIV include symptoms related to HIV infection itself, those related to opportunistic infections, and those related to medications and treatments. Symptoms experienced by women include those common to both genders and those specific to females. The presence and intensity of symptoms varies with progression of the disease and with deteriorating status of HIV disease indicators. While research is limited on this topic, some research on the general symptom experience of women and on symptoms specific to or common among women has been done. Extended life expectancy among women with HIV increases the importance of nursing care focused on symptom assessment and symptom management. This article reviews research on symptoms commonly experienced by women living with HIV and presents implications for the care of women experiencing distressing symptoms.

Advancing the clinical perspective: a practice development project to develop the nurse practitioner role in an acute hospital trust

AIMS

The aims of this project were to investigate awareness and foster understanding of the concept of the nurse practitioner and to facilitate and support the development of nurse practitioner roles within an acute hospital trust.

BACKGROUND

A limited understanding of and minimal support for the development of the nurse practitioner (NP) role were identified within an acute hospital trust in the south of England. This was the impetus for pursuing the project outlined in this paper. THEORETICAL PERSPECTIVE: The project used practice development theory synonymously with action research methodology comprising of four action research cycles.

METHOD

Data were collected in a variety of ways within the four overlapping cycles using formal and informal methods, which were analysed concurrently during the project. Techniques included questionnaires, semi-structured interviews, meetings, discussions and the project leader's field notes' diary.

OUTCOMES

A better understanding of the concept and support for NP posts were enhanced across the trust. A Nurse Practitioner Development Group (NPDG) was established, which helped to facilitate the development of NP posts. An example of such a post was established within a NP-led gynaecology pre-operative assessment clinic, which was a pilot project and constituted Action Research cycle 3.

CONCLUSION

It is concluded that the development of NP roles, with the support of a NPDG, within an agreed strategy offers a robust process for NP development within an acute hospital setting.

RELEVANCE TO CLINICAL PRACTICE

This project demonstrated how practice development and action research might be used together as a systematic process for developing and supporting professional roles that aim to improve the quality of patient care and the effectiveness of health care services.

Coping Style and Women's Participation in Breast and Gynecological Screening

The purpose of this project was to determine the role of coping style in women's practice of breast and gynecological screening behaviors. Women were classified into one of four coping groups based on measures of vigilance and screening distress. Data were analyzed from a subset of 85 U.S. women who participated in a larger longitudinal study designed to examine self-reported screening participation. Results indicate frequency of screening participation and importance of obtaining immediate mammography feedback differed across coping style groups. Women characterized as high in vigilance and screening distress were most at risk for nonparticipation in screening.

Catheter-associated UTIs in patients after major gynaecological surgery

A group of nurses undertook an audit across two hospitals comparing the incidence of catheter-related urinary tract infections in patients who had catheters inserted during major gynaecological surgery. The data suggests that using an anaesthetic lubricating gel for catheterisation reduces urinary tract infection rates for these patients.

Improving cancer screening among lesbians over 50: results of a pilot study

PURPOSE/OBJECTIVES

To explore the impact of two one-hour lesbian-specific educational interventions by a lesbian physician on the cancer screening behaviors of lesbians.

DESIGN

A pilot pre- and post-test intervention study.

SETTING

Two lesbian, gay, bisexual, and transgendered senior organizations in the San Francisco Bay Area (one urban, one suburban).

SAMPLE

36 participants aged 50-81 (meanX = 60.2, SD = 6.48). The majority were Caucasian (86%), single (61%), living in urban areas (67%), employed (56%), and educated beyond high school (meanX = 15.47 years, SD = 2.90, range 9-21). Eleven percent (n = 4) did not have any health insurance and were not on Medicaid or Medicare.

METHODS

A lesbian physician led a one-hour, didactic, lesbian- specific educational program on cancer screening, including a review of current research findings with regard to lesbians' risk for cancer and 45 minutes of information on recommended cancer screening, followed by a 15-minute question-and-answer period. Participants completed a pre- and postintervention survey.

FINDINGS

Follow-up data were available for 22 women. Of the six women (27%) who had not focused their attention on breast screening behaviors for two years or more, one-third had obtained mammograms and half began performing monthly breast self-examinations. Of the four women (18%) who had not undergone a pelvic examination for three years or more, one obtained a pelvic examination. The women reported no changes in colorectal cancer screening behaviors.

CONCLUSIONS

Some of these difficult-to-reach women changed their behavior in a very short period of time, supporting the need for a larger study to confirm these findings.

IMPLICATIONS FOR NURSING

A need exists to develop appropriate interventions for the underserved population of lesbians older than 50.

Gynecologic care for women with HIV infection

The purpose of this article is to review the gynecologic conditions encountered among women with HIV and to outline elements of gynecologic care for these women. The most prevalent problems are vulvo-vaginal candidiasis and cervical dysplasia; however, other sexually transmitted diseases, pelvic inflammatory disease, genital ulcer disease, and menstrual abnormalities are also seen. Drug interactions may limit the effectiveness or increase the toxicities associated with hormonal contraception. Intrauterine devices are contraindicated.

Effects of recliner-chair versus traditional hospital bed on postsurgical diagnostic laparoscopic recovery time

Little has been documented regarding postoperative nursing interventions that are effective in decreasing postoperative recovery time, improving patient outcomes, or optimizing discharge readiness. A randomized study was conducted to evaluate 2 methods of recovery positioning and to examine factors that affect home readiness (eg, voiding, intake) for postsurgical laparoscopy patients. Participants were randomized into 2 groups. The control group was recovered in traditional hospital beds, while subjects in the experimental group recovered in a "recliner-chair," which was adjustable by the patient for comfort. The results showed that patients who recovered in adjustable recliner-chairs reached home readiness sooner and experienced greater comfort levels than patients who recovered in traditional hospital beds. Furthermore, patients in the recliner-chair group had fewer adverse symptoms such as nausea, severe pain, and delayed voiding. This is a U.S. government work. There are no restrictions on its use.

Who cares? Offering emotion work as a 'gift' in the nursing labour process

Who cares? Offering emotion work as a 'gift' in the nursing labour process The emotional elements of the nursing labour process are being recognized increasingly. Many commentators stress that nurses' 'emotional labour' is hard and productive work and should be valued in the same way as physical or technical labour. However, the term 'emotional labour' fails to conceptualize the many occasions when nurses not only work hard on their emotions in order to present the detached face of a professional carer, but also to offer authentic caring behaviour to patients in their care. Using qualitative data collected from a group of gynaecology nurses in an English National Health Service (NHS) Trust hospital, this paper argues that nursing work is emotionally complex and may be better understood by utilizing a combination of Hochschild's concepts: emotion work as a 'gift' in addition to 'emotional labour'. The gynaecology nurses in this study describe their work as 'emotionful' and therefore it could be said that this particular group of nurses represent a distinct example. Nevertheless, though it is impossible to generalize from limited data, the research presented in this paper does highlight the emotional complexity of the nursing labour process, expands the current conceptual analysis, and offers a path for future research. The examination further emphasizes the need to understand and value the motivations behind nurses' emotion work and their wish to maintain caring as a central value in professional nursing.

The evolution of advanced practice nursing in the United States: caring for women and newborns

The evolution of advanced practice nurses to care for women and newborns has its roots in public health nursing of the latter decades of the 19th century. As we consider the challenges of practicing as advanced practice nurses in the 21st century, it is instructive to look back on 100 years of creating new programs and systems for delivering care. Such reflection helps us to clear our vision to imagine the future.

[The most frequent nursing diagnoses in a gynecological admission unit]

Our objective was to identify the most frequent nursing diagnoses in a gynecological admission unit. The defining characteristics were surveyed from the data reported in the nursing case history and the patient files of 30 patients. The nursing diagnoses were found according to the revised NANDA Taxionomy I. The five most frequent nursing diagnoses were: risk for infection (30 cases); risk for pain (24 cases); health-seeking behaviors (11 cases); fear (10 cases) and stress incontinence (5 cases).

Selected hormonal agents in gynecology

Hormonal agents are used to treat many conditions, including endometriosis, amenorrhea, fibroids, and dysfunctional uterine bleeding. Because women visit their care provider for various gynecologic problems more than any other reason, application of therapeutic uses in this rapidly expanding field is essential for nurses working in endocrine gynecology. Strategies for hormone use are discussed in light of the goals of patient education and treatment in the areas of pain relief, fertility, and cycle regulation.

The emotional work of caring, with a focus on gynaecological nursing

In this paper the author briefly reviews the concept of caring. Emphasis is given to the emotional component and its management in caring relationships. This is illustrated with reference to a study of gynaecological nursing. Analysis of nurses' perceptions and experiences revealed situations particularly relevant to empathy and emotional work in caring for gynaecological patients.

Gynaecological nursing

This paper shows how gynaecological nursing is perceived by nurses working in this specialism. To gain an emic perspective a qualitative study was conducted with 12 qualified nurses working in a gynaecological unit. Data were obtained by means of in-depth interviews and the use of paradigmatic cases. Analysis showed the nurses to identify many aspects to their work that could be shared with nursing in general. However, the specific nature of gynaecological nursing indicated a special focus on interpersonal work related to the private and sensitive nature of gynaecological disorders, with social, psychological and emotional implications for sexuality, reproduction, future life and relationships.

Using 'a Vision for the Future' targets to change practice

This article reviews the progress of a gynaecology unit towards meeting the targets set by A Vision for the Future (DoH/NHSME 1992). The authors describe how the targets have helped change practice and detail the initiatives developed to facilitate such change.

Preliminary evaluation of the effectiveness of a preoperative clinic for gynaecological surgery

A preoperative clinic for gynaecological surgery was introduced primarily to provide counselling but with access to multidisciplinary support. Initial results showed a substantial reduction in the postoperative hospitalisation period and a significant improvement in attendance rates.

Developing an early pregnancy assessment unit

This paper describes the work of a nurse-run early pregnancy assessment service in Sheffield. The authors explain how the unit attempts to reduce the anxieties of women who may be prone to miscarriage by screening them early and offering same-day results.

Reviewing options to hysterectomy

The author reviews the options for women for whom hysterectomy has been advised. Nurses working in the community are identified as key personnel in offering such women skilled counselling and advice. This article provides nurses with information on the alternative treatment methods available.

Chlamydia infection in a nurse-midwifery caseload

The purpose of this study was to determine whether antepartum treatment of chlamydia infection resulted in a change in incidence of maternal infection in the intrapartum and postpartum periods as indicated by the incidence of maternal febrile morbidity or antibiotic therapy. In June of 1986, an inner-city tertiary-care center nurse-midwifery service began including diagnosis and treatment of chlamydia infection in routine antepartum care. In this retrospective chart review, the incidence of intrapartum and postpartum infection among women who delivered in this caseload between May 1985 and May 1986 (the last year prior to the routine chlamydia diagnosis and treatment) was compared with that of women who delivered between July 1986 and July 1987 (the first year after initiation of the testing). No significant differences were found. Implications for the development of research projects within nurse-midwifery clinical services are discussed, along with methodologic problems that may ensue when attempting to study changes in outcome in ones' own service.

Fundamental and situational components in a strategy for attaining a positive patient experience of the pelvic examination: a conceptual approach

Since 1983, researchers in medicine, behavior, and health care have been involved in collaborative work concerning attitudes toward the pelvic examination (PE). Important components of the analysis are social actions and conduct, which are conceptualized from role theory. The outcome of the PE is determined by both fundamental and situational components. The purpose is to discover optimal environmental conditions under which the PE should be performed. The medical profession has a long history, primarily established within hospitals. Professional performance has been directed toward diagnosis and cure; consequently, a particularistic view dominates. Throughout history the midwifery profession has had the primary task of supporting the woman in confinement. The dominant view of the midwifery profession is universalistic. The strategy we present is an approach for conceptualizing the bases determining the PE situation. It is a distinct step toward finding gynecological practices that may create positive patient experience of the PE.