Clinical nurses' awareness and caring experiences for patients with cervical cancer: A qualitative study

To determine the degree to which nurses are aware of cervical cancer and to describe nurses' experiences of caring for patients with cervical cancer. To promote quality of nursing care of cervical cancer, we need to explore their perceptions and nursing experience in doing cervical-cancer care. This study was a qualitative descriptive design. Interviews were conducted with 14 registered nurses. The interviews were audiotaped, transcribed and analyzed. Content analysis was performed. Fourteen nurses who had been working at wards and cancer education centers were recruited in this study. Nine key themes emerged from three categories such as nurses' awareness of cervical cancer, awareness of cervical cancer patient and caring experience. Nurses expressed fear of cervical cancer and helplessness in the face of a life-threatening prognosis. Nurses stated that they might have prejudice about cervical cancer, since it is caused by a sexually transmitted disease. They also recalled that patients with cervical cancer were more sensitive and demanding. Our findings provide a comprehensive and in-depth perspective in understanding the experience of caring for cervical cancer patients. Clinical nurses showed complex emotional reactions to cervical cancer, and expressed prejudice against the sex life of cervical-cancer patients. More education is required to ensure that clinical nurses can provide a nurse-led intervention with patients by managing nurses' fear, prejudice, and the care burden.

A nurse-led cervical screening clinic in primary care

Eliza is a practice nurse in a large general practice in England. She is trained in cancer screening and health promotion as well as chronic disease management. Today patients are consulting with her for their cervical smear test.

Emelda’s Story: Applying Ethnographic Insights to Cultural Assessment and Cervical Cancer Control

This article builds a bridge between cultural research and clinical practice by applying insights from an ethnographic study of cervical cancer in Iquitos, Peru, to a cervical cancer focused cultural assessment tool and teaching guide for use with immigrant patients. This application is grounded in Campinha-Bacote’s model of cultural competency. Ethnographic research is recommended as a source of knowledge from which insights can be drawn to build assessment skill in cross-cultural clinical encounters—insights into asking the right questions.

A home-based, nurse-led health program for postoperative patients with early-stage cervical cancer: A randomized controlled trial

PURPOSE

To investigate the effect of a home-based, nurse-led health program on quality of life and family function for postoperative patients with early-stage cervical cancer.

METHOD

226 cervical cancer patients, from two hospitals between December 2012 and April 2014, were randomly divided into intervention and control groups. Patients in the intervention group received an individual home-based, nurse-led health program (family-care team provision, physiological rehabilitation, emotion-release management, informal social support system, and follow-up monitoring), in addition to conventional nursing education. Patients in the control group only received conventional nursing education. The Functional Assessment Cancer Therapy-Cervix, Female Sexual Function Index, and the Family Adaptability and Cohesion Scale were used for assessment before and after the intervention.

RESULTS

After the intervention, significant improvements were found for the quality of life total scores (t=-7.650, p=0.000), sexual function scores (t=-6.465, p=0.000), cohesion scores (t=-8.417, p=0.001) and adaptability scores (t=-10.735, p=0.000) in the intervention group. Moreover, proportions of family types were also improved (χ2 = 17.77, p=0.000). However, for the control group, no significant differences were found except for a decrease in sexual function scores (t = -4.035, p=0.000). Significant differences in change scores between groups were also found for quality of life (F=41.980, p=0.000), Sexual function (F=37.380, p=0.000), cohesion (F=15.268, p=0.000) and adaptability (F=16.998, p=0.000).

CONCLUSION

A home-based, nurse-led health promotion program improves the quality of life, sexual function and family function in postoperative patients with early-stage cervical cancer.

Effect of structured teaching programme on VIA test for early detection and diagnosis of cervical cancer

The conceptual framework of the study, undertaken in select health centres of New Delhi, was based on General System Model. The research approach was evaluative with one group pre-test and post-test design. The study population comprised of Community Health Workers working in selected centres in Najafgarh, Delhi. Purposive sampling technique was used to select a sample of 30 Community Health Workers. A structured knowledge questionnaire was developed to assess the knowledge of subjects. A Structured Teaching Programme was developed to enhance the knowledge of Community Health Workers. Pre-test was given on day 1 and Structured Teaching Programme administered on same day. Post-test was conducted on day 7. Most of the Community Health Workers were in the age group of 21-30 years with academic qualification up to Higher Secondary level. Maximum Community Health Workers had professional qualification as ANM/MPHW (female). Majority of the Community Health Workers had experience up to 5 years. Initially there was deficit in scores of knowledge of Community Health Workers regarding Visual Inspection with Acetic Acid (VIA) test. Mean post-test knowledge scores of Community Health Workers were found to be signifi- cantly higher than their mean pre-test knowledge score. The Community Health Workers after expo- sure to Structured Teaching Programme gained a significant positive relationship between post-test knowledge scores. The study reveals the efficacy of Structured Teaching Programme in enhancing the knowledge of Community Health Workers regarding VIA test and a need for conducting a regular and well planned health teaching programme on VIA test for improving their knowledge on VIA test for the early detection and diagnosis of cervical cancer.

Developing a hand-held Pap test card to improve cervical cancer screening

We identified an educational deficit among clients at a community health clinic regarding the latest cervical cancer screening recommendations. A literature search on Pap testing and problems with compliance or screening indicated multiple barriers to cervical cancer screening. Education, health promotion and the use of a hand-held health card/record were identified as methods to educate women regarding cervical cancer prevention. We developed a hand-held Pap test card to be similar to an immunization card. The card was designed to fulfill the needs of both clients and practitioners.

Colleen's story: reflections on the concept of "patient and family centered care"

As a patient who has also been a family caregiver, I would like to offer my reflections on the concept of "patient and family centered care." How is it defined from a patient perspective? Why is it important? In what circumstances is it evident? And where is it lacking? I would like to leave the reader with a list of relatively small but, in my experience, powerful things that health care workers can do today to improve the patient and family experience.

Cervical cancer screening in the Vietnamese American population

The Surveillance, Epidemiology, and End Results program reported that Vietnamese women have higher rates of invasive cervical cancer than any other racial or ethnic group. Practitioners must be aware of the unique qualities of this population and implement strategies that promote early screening and detection.

Role of the nurse immuniser in implementing and maintaining the National Human Papillomavirus 'Cervical Cancer' Vaccine rollout through a school-based program in Victoria

In an effort to understand the strengths and limitations of current approaches to human papillomavirus vaccine (HPV) delivery in schools, we conducted an audit of nurse immunisers (NI). In this survey of 159 Victorian NI, the NI perceived that knowledge, safety and side effects were among the most important issues raised by parents, schoolgirls, and teachers in the school setting. The most common concern identified by NIs was the physical layout of the vaccination setting (41%), followed by safety, then knowledge of the vaccine. There is a need for ongoing assessment of factors that improve or impede the delivery of HPV vaccines.

Cervical cancer: prevention, diagnosis, treatment and nursing care

This article provides an update on cervical cancer, broadly covering aspects of the disease ranging from epidemiology to aetiology and prevention to treatment.

[An experience nursing an uncertain patient with recurrent cervical cancer]

This article describes an experience nursing a patient with recurrent cervical cancer. As a result of urinary leakage after radical surgery, the patient underwent a second anterior exenteration and ileo-conduit operation while experiencing emotional uncertainty. The nursing care involved a combination of direct care, home visits, telephone and OPD follow-up. Data collection and analysis followed via observation, conversation and the recording of behavioral processes. Nursing measures were taken to address the sense of threat induced by uncertainty and anticipatory grieving. We found the same sense of uncertainty that research has found to affect breast cancer patients, and found that it is similarly significantly higher pre-operation than post-operation. Besides providing information and supportive encouragement, nursing staff should evaluate the degree of uncertainty and the sources of support available to the patient, as well as improving nursing guidance for self-care. The support of family members, especially the spouse, is a form of positive feedback which may significantly reduce the degree of uncertainty.

"Inside and outside": Sikh women's perspectives on cervical cancer screening

Cervical cancer can be detected at an early stage through regular screening. The literature suggests that cervical cancer in immigrant women, a growing population in Canada, is less likely to be detected early than it is in the general population, as immigrant women tend not to take advantage of screening. Culturally appropriate screening services for immigrant women are few. A qualitative descriptive study was conducted with female members of an urban Sikh community in Canada to explore perspectives on cervical cancer screening. In-depth interviews (13) and focus groups (3) were carried out to uncover challenges to cervical cancer screening. The researchers identified a prevailing theme of "inside/outside" whereby the women felt confined to their community, finding it difficult to move "outside" into Canadian society in order to participate in screening. Lack of knowledge about the importance of prevention, influence of family and community, and health-provider issues affected the women's access to screening. The results will be helpful for nurses planning and delivering screening services to Sikh women.

The Effects of Concrete Objective Information and Relaxation on Maintaining Usual Activity During Radiation Therapy

PURPOSE/OBJECTIVES

To examine the effects of concrete objective information (COI) and relaxation instruction (RI) on patients undergoing radiation therapy, as well as the contribution of symptom uncertainty and body awareness to the intervention effects.

DESIGN

Three-group randomized trial. Assignment was stratified by cancer site. Data collectors were blinded to group assignments.

SETTING

University medical center radiation therapy department serving both urban and rural communities in the southeastern United States.

SAMPLE

76 adults having radiation with curative intent for gynecologic, head and neck, or lung cancer. Most were Caucasian and had in situ to stage II disease. Mean age was 55 years.

METHODS

COI and RI were delivered by tape recordings. Outcome measures were indicators of usual activities and emotions at treatment week 3 and two and four weeks post-treatment.

MAIN RESEARCH VARIABLES

Intervention group; social, household, and recreational activities; anxiety, depression, and anger; body awareness; and symptom uncertainty.

FINDINGS

Participants receiving either intervention reported more social activity during treatment. Those given RI who were high in body awareness reported more household activity during treatment. No effects were found regarding emotion. Symptom uncertainty partially explained COI effects.

CONCLUSIONS

The findings provide additional support for the effectiveness of COI in helping patients to maintain more of their usual activities during radiation therapy. Instruction in progressive muscle relaxation also may help in maintaining activities.

IMPLICATIONS FOR NURSING

COI helps patients to cope with treatment by reducing their uncertainty about symptoms. RI effects may vary by activity type and awareness of usual body sensations.

Factors related to depressive symptoms among long-term survivors of cervical cancer

In this article we describe depressive symptoms among survivors of cervical cancer. Study participants were previously diagnosed and treated with cervical cancer 5 to 25 years prior to the completion of a telephone survey. Through a population-based survey of women identified via a state tumor registry in southern New England, the investigators learned that depressive symptoms are prevalent among a subgroup of long-term survivors long after diagnosis and treatment. The at-risk participants included those who were at a lower economic status and whose marital status and ability to work had changed, and who continued to experience pain and diarrhea caused by radiotherapy. Findings from this study warrant additional research with this potentially vulnerable group of women.

A multicultural and multilingual outreach program for cervical and breast cancer screening

Partners in Health: The Breast and Cervical Health Cooperative is a New Orleans-based community health intervention program designed to increase the access of underserved multicultural, multiethnic, and multilingual women to cervical and breast cancer health education and screening. This article describes innovative approaches used over the past 4 years to successfully link the services of a university cancer center to women in the community through a culturally sensitive outreach program. In addition to cancer screening, health referrals were made for many other diverse medical/social complications such as hypertension, obesity, and violence. The program initially targeted African American women but during the past year has successfully integrated Latinas. Key to the program's success was the collaboration of community lay health educators, community churches, advanced practice nurses, and public health programs. This article provides an overview of program strategies and outcomes and discusses multicultural and multilingual issues.

Cervical cancer in Hispanic/Latino women

Cervical cancer is largely preventable if detected early. Minority populations and people of low socioeconomic status are affected disproportionately by cervical cancer. When compared to non-Hispanic white women, Hispanic/Latino women residing in the United States have twice the incidence rate of and 1.4 times the mortality from cervical cancer. Contributing factors include lack of awareness about cancer prevention and available services; lack of access to quality health care; feelings of embarrassment, fear, and fatalism; and limited linguistically and ethnically sensitive information about cervical cancer prevention and detection. Education and screening programs targeted at this population have the potential to decrease the morbidity and mortality associated with cervical cancer, and nurses play an important role in educating Hispanic/Latino women about cervical cancer.

Evaluation of a cervical cancer screening intervention for prison inmates

BACKGROUND

Female prison inmates are underscreened and are at higher risk of cervical cancer. The impact of a nurse-led Pap screening intervention was examined, which included information sessions and Pap testing clinics.

METHOD

Pap screening rates for 650 inmates at the Burnaby Correctional Centre for Women were compared both before and during the 20-week intervention period. These rates were determined by record linkage of Correction Branch inmate records and Cervical Cancer Screening Program patient records. Associations between socio-demographic factors and Pap screening rates were also examined.

RESULTS

A higher proportion of inmates was screened during the intervention period (26.9%) than during the preintervention period (21.0%) (although the difference was not statistically significant (p=0.06)). Very short-stay inmates were less frequently screened in the preceding two years before the intervention. Inmates with no high school education and longer lengths of incarceration were significantly more likely to receive Pap testing during the intervention period as compared to the preintervention period.

CONCLUSION

The nurse-led intervention resulted in a modest improvement in the proportion of inmates receiving Pap screening. Unfortunately, the benefit of the nurse clinician did not reach, to a greater extent, inmates who had not been previously screened or who were inadequately screened. There is need for further work to target this hardest-to-reach group.

Quality in colposcopy

This article analyses the colposcopy service, which is a crucial part of the National Health Service Cervical Screening Programme (NHSCSP), to assess how quality is measured and delivered. It highlights the role of the nurse colposcopist and discusses where improvements to the service could be made.

Evaluating the WEB training program for cancer screening in Native American women

The Native Women Enjoying the Benefit (WEB) program trains nurses to perform breast and cervical cancer screening examinations for Native American women. Several evaluations have shown that the program improves nurses' knowledge and skills, and nurses value its positive impact on clinic, nurse, and patient behaviors. Beyond effectiveness, program longevity often rests upon equilibrium that results from alignment between a program's values and principles with those of its sponsoring organization and pertinent surrounding environments. We examined how Native WEB values align with those of its 2 most relevant environments-the medical institution (immediate environment) that sponsors it and the broader health care context (distal environment). We found that social justice views articulated in Catholic social teaching served as a convenient synthesis of the 2 environments' values and principles. We used this conception of social justice to determine whether the Native WEB program reflected the perspectives of its immediate and distal environments.

Mammograms and Pap Smears for Australian Deaf Women

This study aimed to assess baseline knowledge about mammograms and Pap smears among Australian Deaf women, to investigate their participation in breast and cervical cancer screening services, and to explore, where relevant, their perceptions about their access to breast and cervical screening services. An interview schedule was developed, and a convenience sample of 13 Deaf women was interviewed face-to-face by the first researcher with an accredited Auslan interpreter. The Deaf women's knowledge about mammograms and Pap smears often was incomplete. However, most of the eligible women had undergone a mammogram and had been rescreened within the recommended time frame. Although most had received a Pap smear, some were not attending as recommended by the Cancer Council of Australia. This exploration into the experiences of Deaf women can prompt all nurses to consider the needs of particular minorities and the barriers they may face to participate fully in health services.

[Assessment of the midwives preparation to take care of patients with cervical cancer]

INTRODUCTION

The success of the cervical cancer treatment depends not the only on the early diagnosis, but also on the immediate initiation of the appropriate treatment and proper nursing care, which should be adequate with the present knowledge.

OBJECTIVE

The objective of the research was the assessment of the theoretical preparation of nurses taking care of patients with cervical cancer.

MATERIALS AND METHOD

50 nurses, working in the departments of gynecological diseases, have been interviewed. All the nurses graduated from College of Nursing, 3 of them additionally studied in the Pedagogical Graduate School. 60% of the nurses had 10-20 years of professional experience. We used special questionnaire made of 3 parts: describing the objective of the research/test, characteristics of the patient, specific questions. There were 18 questions: 5-closed, 1-open, 12-semiopen. They were checking the knowledge about the diagnostics, preparation of the patient to the operation using Wertheim-Meigs-Valle method, postoperative care until the discharge from the hospital and then oncological care.

RESULTS

Almost all of them (88%-92%) have known the sequence of the diagnosis and treatment of the cervical cancer. 90% of them have been knowledgeable what kind of diagnostic and nursing procedures were required before the surgery using Wertheim-Meigs-Valle method. Almost all of the tested nurses (96%-100%) have known the procedure of postoperative care. They had a practical knowledge how to assess the patient condition and components of care that the patients require during the first few days after the surgery. According to the tested nurses, 90% of the patients operated because of cervical cancer, should follow up in oncological centers.

CONCLUSION

1. The nurses' preparation to take care of patients with cervical cancer is sufficient and it affects the effectiveness of the treatment. 2. The nurses have knowledge about pre- and postoperative procedures that the patients require, as well as assessment of general condition and patients' care, which are so important in the first few days after the surgery.

Cervical cancer prevention and early detection--the role of nurses and midwives

Worldwide 31% of cancers in women are in the breast or uterine cervix. Cancer of the uterine cervix is one of the leading causes of cancer death among women. The estimated new cancer cervix cases per year is 500.000 of which 79% occur in the developing countries, where it is consistently the leading cancer and there are in excess of 233.000 deaths from the disease. The major risk factors for cervical cancer include early age at first intercourse, multiple sexual partners, low socioeconomic status, HSV, HPV infection, cigarette smoking and extended use of oral contraceptives. Well organized and applied public education and mass screening programmes can substantially reduce the mortality from cervical cancer and the incidence of invasive disease in the population. Women who are health conscious are more likely to have used screening services (mammogram, pap-smear test) and performed breast-self examination and genital hygiene. There are both opportunities and burdens for nurses and midwives working in primary health care settings. This is a prime example of a role of public education in cancer prevention with reference to population-based cancer screening programs.

Determinants of participation of women in a cervical cancer visual screening trial in rural south India

The efficacy of a single round of screening of visual inspection with acetic acid (VIA) on cervical cancer incidence and mortality is investigated in a cluster randomized controlled trial in south India. Women aged 30-59 years in 113 clusters in Dindigul District were randomized to VIA screening by nurses (57 clusters, 48,225 eligible women) and to a control group (56 clusters, 30,167 women). 30,577 (63.4%) eligible women participated in screening. Younger, educated, married, multiparous, low-income women and those who have had tubal sterilization had a higher compliance with screening. Of the 2069 women diagnosed with CIN and invasive cancer, 1498 (72.4%) received treatment. Young women, those who practiced contraception and women with high-grade precursor lesions and invasive cancers were more likely to comply with treatment. In summary, our study indicates that women accept screening with VIA by nurses and a moderate level of compliance with screening and treatment can be reached through appropriate service delivery systems including health education activities, personal invitations, clinics in proximity to the target women, and testing and treatment in the same session. Our results imply that integration of screening activities with primary health services seems to have the potential to replicate most of these service delivery conditions in routine programs.

Effect of nurse colposcopists on a hospital-based service

The number of colposcopies performed annually in the UK is increasing. Nurse colposcopists have been introduced by many units to cope with this workload. The small amount of evidence to support the introduction of nurse colposcopists suggests that nurses are viable alternative providers of colposcopy. This study compares the performance of nurse colposcopists with that of doctors.

Outcomes of training nurses to conduct breast and cervical cancer screening of Native American women

Native WEB (Women Enjoying the Benefit) is a unique training program for nurses employed by the Indian Health Service (IHS), tribal clinics, and other clinics with large, underserved populations. It teaches nurses breast and cervix cancer screening techniques and trains them to administer and maintain high-quality screening programs that include patient outreach, education, and training. We review American Indian (AI)/Alaska Native (AN) women's need for screening services, identify some of the obstacles to screening, and present our evaluation of the Native WEB's impact on clinics, nurses, and patients. Findings show that Native WEB training is associated with increased screening activity at all three levels.

When to suspect squamous cancer at colposcopy

Advanced practice nurses are increasingly using colposcopy to investigate abnormal cervical cytology. Specific colposcopic features can lead the clinician to suspect squamous cancer. This article discusses vascular pattern study, examination evaluation, lesion grading, and correlating colposcopy with histology and cytology to aid in identifying squamous cancer.

Screening and early detection among racial and ethnic minority women

OBJECTIVES

To highlight sociocultural factors reported to influence and strategies to promote breast and cervical cancer screening and early detection behaviors of racial and ethnic minority women.

DATA SOURCES

Published articles, book chapters, and reports.

CONCLUSIONS

The most successful strategies for promoting screening and early detection among racial and ethnic minority women are collaborative and include approaches that are culturally sensitive and appropriate.

NURSING IMPLICATIONS

Intercultural and intracultural differences in racial and ethnic minority women challenge nurses to explore strategies that focus on the health care provider, the health care delivery system, and the individual woman within the context of the woman's culture.

Evolution of the evidence-based Papanicolaou smear

Cervical cancer rates have decreased over the past century, but rates have remained relatively constant during the last decade. Evidence-based management of the abnormal Papanicolaou (Pap) smear and the use of additional testing at the time of the Pap smear are discussed in light of the current evidence. Also explored in-depth is the evidence base for Papanicolaou smear collection and retrieval methods, especially as it relates to their influence on the validity of the smear results. In addition, issues that need to be considered by the clinician, including the use of colposcopy, especially in light of health service implications such as the need for adequately trained personnel, increased clinical visit time, and increased cost are presented.

The experience of women receiving brachytherapy for gynecologic cancer

PURPOSE/OBJECTIVES

To explore and document the lived experience of receiving low-dose rate brachytherapy for gynecologic cancer.

DESIGN

Qualitative method based on phenomenology.

SETTING

Radiation treatment facility in a cancer-care setting in Toronto, Ontario, Canada.

SAMPLE

Ten women between the ages of 36 and 75 (x = 59.2) receiving low-dose rate brachytherapy for cancer of the cervix or endometrium.

METHODS

Verbatim data were analyzed manually using Giorgi's method of analyzing qualitative data.

FINDINGS

Three themes emerged from the data: (a) women's experiences with brachytherapy were embedded within the complete context in which treatment was given, shaped by personal, environmental, and treatment-related factors, (b) the discomfort that women experienced during brachytherapy was perceived as a totality of symptoms including but not limited to pain, and (c) the brachytherapy experience was characterized by an intense focus on time and tensions embedded in issues related to time.

CONCLUSIONS

When dealing with the brachytherapy treatment, women are concerned with the context in which the treatment is provided and the care that is associated with the treatment. Different and unique strategies assist women to get through treatment. Supportive nursing interventions can be implemented easily in the nursing care plan for women undergoing brachytherapy.

IMPLICATIONS FOR NURSING PRACTICE

The aspects of nursing care that women perceive as positive, such as competence level of the nurse, symptom management, and providing information in sensory terms, should be strengthened. Alternatively, aspects of nursing care that are perceived negatively by women should be changed. Nurses have to avoid situations that will prolong the time of brachytherapy treatment. Nurses should support women in using coping strategies that assist them in getting through the brachytherapy treatment.

The role of human papillomavirus in screening for cervical cancer

PURPOSE

To review the options for effectively screening for cervical cancer, including human papilloma virus (HPV) identification, cytologic screening, colposcopy, or a combination approach. Current pathophysiology, diagnostic criteria, treatment approaches, and patient preparation and education related to cervical cancer screening and prevention are also included.

DATA SOURCES

Comprehensive review of current literature, including research and review articles.

CONCLUSION

Because the Papanicolau (Pap) smear is a screening tool, not a diagnostic tool, further studies must be done to identify the actual nature of discovered abnormalities. Of particular concern is the classification of atypical squamous cells of undetermined significance (ASCUS), which may simply indicate inflammation, or may be the first indicator of serious pathology. Following ASCUS Pap smears with HPV screening will allow for a clarification of the best approach to treatment. A screening algorithm supported by a review of the literature is proposed.

IMPLICATIONS FOR PRACTICE

Cervical cancer is a preventable disease caused by certain forms of HPV. Current screening protocols are based on the use of the Pap smear; and in areas where this test is routine and available, morbidity and mortality rates have dropped dramatically. Many women throughout the world and in underserved regions of the U. S. do not have adequate access to routine screening with Pap smear technology. As long as women continue to die needlessly of cervical cancer, more comprehensive and accessible screening methods must be explored. (Cutting the unnecessary worldwide and in the U. S.).

Sexual implications of gynecologic cancer treatments

Gynecologic cancers affected 81,000 women in 1999. The disease and its associated treatment commonly pose a threat not only to the life of such patients, but also to their sexuality and fertility. These women and their partners require knowledgeable, compassionate care. Effective, holistic nursing care for women experiencing gynecologic cancers requires an understanding of basic concepts of female sexuality, the diagnosis and treatment of gynecologic malignancies, the impact of the disease and its treatment on a woman's sexuality, and ways the nurse can incorporate sexuality issues into practice.

Abnormal cervical cytology in pregnancy: a laboratory and clinical dermatologic perspective

The dermatologic examination of the pregnant woman with abnormal cervical cytology can be a challenge to the clinician. This article explores both the laboratory and clinical examinations and the special issues of each that are affected by pregnancy. The technique of obtaining an adequate Pap test as well as guidelines on managing the abnormal Pap result will be addressed. Normal and abnormal colposcopic findings are described with reasons why they may be more difficult to differentiate in pregnancy. As long as no invasive cancer is found, the pregnancy may proceed with continued surveillance. Postpartum regression rates of intraepithelial neoplasia are high.

Health promotion in cervical cancer prevention among the Yakama Indian women of the Wa'Shat Longhouse

The purpose of this 3-year study was to gain a greater understanding of the importance of the Wa'Shat Longhouse religion to the design of a culturally appropriate health promotion (cervical cancer prevention) program with the Yakama Indian people of eastern Washington. This descriptive study involved interviews with 10 Wa'Shat members, observations, and participant observations of 30 community ceremonial activities. The framework of health promotion planning guided the investigation. We found that (a) program goals needed to be holistic and wellness oriented, (b) teaching methods needed to include circular symbols, and (c) intervention strategies needed to be linked to the natural patterns of communication of the Wa'Shat Longhouse and to involve elders. Storytelling, talking circles, and use of role models were all found to be important teaching methods. We confirm previous perspectives on the importance of religion, provide greater depth in this understanding and outline implications for transcultural nursing practice.

Predicting intentions to obtain a Pap smear among African American and Latina women: testing the theory of planned behavior

OBJECTIVE

To determine the empirical adequacy of the theory of planned behavior (TPB) to explain Pap smear use intentions in African American and Latina women.

METHOD

A correlational design was used, and a convenience sample of 108 African American and 96 Latina adult women were recruited from urban community-based agencies located in a large mid-Atlantic metropolitan area. The Pap Smear Questionnaire (PSQ) was designed and used. The Demographic Assessment Survey collected demographic information (age and socioeconomic status for both groups; and level of acculturation for the Latinas).

RESULTS

Direct relationships between attitude and perceived behavioral control and intention to obtain an annual Pap smear were found for African American and Latina women. The subjective norm did not significantly predict intention. Attitude (beta = .58; p < .001) provided the best explanation of intention among African American women to obtain an annual Pap smear, followed by perceived behavioral control (beta = .30; p < .001). Among Latinas, the findings reflected those of the African American sample. However, attitude (beta = .40; p < .001) and perceived behavioral control (beta = .35; p < .001) were weighted similarly. The external variables of age and income had indirect effects on intention for African American and Latina women, respectively.

CONCLUSION

The study findings did not support the empirical adequacy of the TPB for either of the ethnic groups. Future studies should test a modified version of the TPB that includes measures of both social support and subjective norms. Direct measure items of subjective norm, group-specific measures of perceptions of control, and other measures of acculturation should be added to the PSQ and further tested.