Exploring the Relationship Between Nursing Specialty Certification and Surgical Site Infections.

OBJECTIVE: The aim of this study is to explore the relationship between nursing specialty certification and surgical site infections (SSIs) for colon (COLO) and abdominal hysterectomy (HYST) surgical procedures. BACKGROUND: SSI following COLO and HYST procedures is a preventable complication now included in the Centers for Medicare & Medicaid Services' Hospital Inpatient Quality Reporting Program. METHODS: Data from 69 hospitals, 346 units, and 6585 RNs participating in the National Database of Nursing Quality Indicators and SSI data on 22 188 patient COLO and HYST procedures from the National Healthcare Safety Network were examined in multivariate logistic regression analysis. RESULTS: Magnet® status was associated with lower SSI occurrence after adjusting for other variables. Higher American Society of Anesthesiologists scores, longer surgical procedure time, and wound class were associated with higher SSI occurrence. CONCLUSIONS: Future theory-based research should examine the association of nursing specialty certification with patient outcomes and investigate the effect of Magnet status on SSI.

Urinary catheterisation management after laparoscopic hysterectomy: a national overview and a nurse preference survey.

The aim of this study was to evaluate the catheterisation regimes after a laparoscopic hysterectomy (LH) in Dutch hospitals and to assess the nurses' opinion on this topic. This was particularly relevant as no consensus exists on the best moment to remove a urinary catheter after an LH. All 89 Dutch hospitals were successfully contacted and provided information on their catheterisation regime after LH: 69 (77.5%) hospitals reported removing the catheter the next morning after the LH, while nine hospitals (10.1%) removed it directly at the end of the procedure. The other 11 hospitals had different policies (four hours, up to two days). Additionally, all nurses working in the gynaecology departments of the hospitals affiliated to Leiden University were asked to fill in a self-developed questionnaire. Of the 111 nurses who completed the questionnaire (response rate 81%), 90% was convinced that a direct removal was feasible and 78% would recommend it to a family member or friend. Impact Statement What is already known on this subject? Although an indwelling catheter is routinely placed during a hysterectomy, it is unclear what the best moment is to remove it after an LH specifically. To fully benefit from the advantages associated with this minimally invasive approach, postoperative catheter management, should be, amongst others, optimal and LH-specific. A few studies have demonstrated that the direct removal of urinary catheter after an uncomplicated LH is feasible, but the evidence is limited. What the results of this study add? While waiting for the results of the randomised trials, this present study provides insight into the nationwide catheterisation management after an LH. Despite the lack of consensus on the topic, catheterisation management was quite uniform in the Netherlands: most Dutch hospitals removed the urinary catheter one day after an LH. Yet, this was not in line with the opinion of the surveyed nurses, as the majority would recommend a direct removal. This is interesting as nurses are closely involved in the patients' postoperative care. What are the implications of these findings for clinical practice and/or further research? Although randomised trials are necessary to determine an optimal catheterisation management, the findings of this present study are valuable if a new urinary catheter regime has to be implemented.

Performance and ease of use evaluation of a new surgical post-operative foam island dressing in 14 patients undergoing elective gynaecological surgery.

AIM: The aim of this evaluation was to investigate ease of use and clinical performance of a new post-operative foam island dressing in female patients undergoing elective gynaecological surgery. Women undergoing surgery have genuine concerns regarding the risk of a hospital acquired infection. METHODOLOGY: The new post-operative dressing was evaluated on 14 patients undergoing elective gynaecological surgery during two weeks in March 2011. Evaluators rated packaging and dressing ease of use, wear time, shower proof ability, skin blistering and ease of removal. Patients rated comfort of the dressing during wear time and removal. RESULTS: Nurses and Midwives rated blister prevention 100% (good), shower proof capabilities 86% (good) and ease of removal 79% (good). Patients rated comfort during wear time, skin integrity, and the importance of bathing (shower proof). No wound infections, peri wound maceration or adverse events were recorded. CONCLUSION: Ensuring best patient outcomes and meeting individual needs remains the cornerstone of nursing practice. Reducing the risk of surgical site infections (SSI) remains a focus for NHS Trust throughout the UK particularly as Gynaelogical procedures require mandatory surveillance by the Health Protection Agency 1(The importance of patient comfort and ability to tend to hygiene needs is fundamental). The evaluated dressing has a flexible island pad allowing further tensile stretch and conformability when in situ. This was demonstrated in this study by both clinicians and patients in blister prevention, conformability, and patient comfort outcomes of this evaluation.

Nursing educational intervention in hysterectomized women: a mixed method study protocol.

OBJECTIVES: To know the meaning of education in the perioperative period, in women undergoing hysterectomy for benign causes and to determine the effectiveness of educational nursing intervention in improving female sexual function, quality of life and self-esteem in women undergoing hysterectomy for benign causes. METHODS: Mixed design, exploratory sequential Qualitative phase semi-structured interviews and content analysis. Quasi-experimental study quantitative phase, non-equivalent control group. 26 women in 2 groups. Instruments: Biosociodemographic, Female Sexual Function Index, SF-36 Questionnaire, Rosenberg Scale. Both groups will receive traditional care and the experimental group will receive nursing educational intervention with web page support. Ethical requirements will be considered. EXPECTED RESULTS: The women in the experimental group will improve their sexual function, health-related quality of life and self-esteem in relation to the comparison group. CONCLUSIONS: Education in the perioperative period of hysterectomy is essential for the recovery of women who go through this experience.

Interviewing people about potentially sensitive topics.

AIM: This paper explores the challenges of interviewing people about sensitive topics. It uses existing literature and the first author's experience of interviewing women traumatised by having an emergency hysterectomy following a severe postpartum haemorrhage. It also highlights the strategies that can assist interviews. BACKGROUND: Interviewing participants about sensitive topics requires skill and special techniques. Certain research topics have the potential to cause participants and researchers distress and discomfort. Identifying ways to prevent vicarious traumatisation and researcher burnout is imperative to the integrity of the research. DATA SOURCES: Twenty one Australian women took part in in-depth, tape-recorded, face-to-face, email, internet and telephone interviews. REVIEW METHODS: This is a methodology paper on the first author's experience of interviewing women on potentially sensitive topics. CONCLUSION: Some participants may find telling their stories to be cathartic, providing them with a sense of relief. Implementing techniques that may be helpful in initiating the interview process can be challenging.

Perspectives on midwifery power: an exploration of the findings of the inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda, Ireland.

The Lourdes Hospital Inquiry: An inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda, Ireland, of 2006 recounts in detail the circumstances within which 188 peripartum hysterectomies were carried out at the hospital between 1974 and 1998. The findings of the inquiry have serious ramifications for Irish healthcare delivery and have implications for many professional groups, including midwives. The findings prompt clear questions about the relative position or power of midwives within maternity care. These questions are examined in this article, through the analysis and application of various theoretical perspectives on power. Critical views of power focus on the socio-political nature of oppressive structures within society and seek mechanisms to address these. Stemming from structure versus agency debates, Giddens's structuration theory examines the agency-structure interaction and stresses the centrality of agents' roles in the social reproduction of structures. Postmodernism, particularly drawing on the work of Michel Foucault, focuses on a fluid conception of power while also describing the nature of disciplinary power. It offers midwives a way of viewing power as productive and dispersed. Drawing on different aspects of these perspectives on power, helps us to understand midwives' relative positions and power relations and how to enhance these to prevent future tragic outcomes such as those reported in the inquiry report.

Training nurses to be teachers.

This article presents a research analysis using surveys administered to hospitalized patients who underwent a hysterectomy. Two categories of results are highlighted using the same survey tool. The initial survey was administered to assess patient satisfaction with discharge education. The follow-up survey was administered to the second group of participants following a training program created to assist the nurses in developing teaching tools and skills. That patient outcomes can be improved through nurses' enhanced teaching skills is borne out through these data.

The effects of reflexology on anxiety and pain in patients after abdominal hysterectomy: A randomised controlled trial.

OBJECTIVES: This study aimed at finding out the effects of reflexology on pain, anxiety levels after abdominal hysterectomy. DESING & METHODS: The study was performed on women hospitalized in the intensive care unit and gynecology services of Ege University Hospital in Izmir after abdominal hysterectomy between September 2013 and September 2014. This study was designed and conducted as a randomized controlled trial. The study sample consisted of 63 female patients: 32 in the experimental group and 31 in the control group. The postoperative daily monitoring sheet, Spielberger State Anxiety Inventory (SAI), was employed to collect research data and "visual analog scale" to evaluate pain levels. RESULTS: The female patients' average age was found to be 47.23 ±â€¯4.71. The three-day monitoring showed a significant difference between the experimental and control groups in terms of average pain levels and anxiety scores after reflexology (p < 0.05). CONCLUSION: Foot reflexology may serve as an effective nursing intervention to increase the well-being and decrease the pain of female patients after abdominal hysterectomy, and nurses should be aware of the benefits of reflexology.

Catheterization options following radical surgery for cervical cancer.

This trial assessed the potential benefits of intermittent self-catheterization (ISC) over standard care with suprapubic catheterization (SPC) in the postoperative bladder care of women with early-stage cervical cancer following radical hysterectomy. A prospective randomized controlled trial of 40 women was carried out. The urinary infection rate (catheter specimen of urine) was significantly higher in the ISC group at day 3 and day 5 (42% and 63%) compared to the SPC group (6% and 18%), p=0.05 and p=0.004, respectively. Forty-seven percent of patients randomized to SPC documented having problems arising from the SPC site, of which 23% were shown to have a positive wound swab. Despite a greater urinary tract infection rate, the technique of ISC was seen by women to be more acceptable, allowing fewer disturbances at night, greater freedom to live a normal life and less anxiety/embarrassment compared to SPC.

Symptom experience in women after hysterectomy.

OBJECTIVE: To review the literature addressing the symptom experience of women after hysterectomy. DATA SOURCES: Computerized searches in MEDLINE and CINAHL, as well as texts and references cited in articles. Key concepts in the searches included hysterectomy, sleep disturbance and pain, hysterectomy and fatigue, hysterectomy, depression, and depressed mood. STUDY SELECTION: Articles and comprehensive works relevant to key concepts and published after 1970, with an emphasis on new findings from 1990 to 2000. Sixty-four citations were identified as useful to this review. DATA EXTRACTION: Data were organized under the following headings: women and hysterectomy, biopsychosocial perspectives, common symptoms after hysterectomy (pain, disturbed sleep, fatigue, depressed mood, anxiety), and significance of review (implications). DATA SYNTHESIS: Literature suggests that after a hysterectomy, women experience complications during the postoperative recovery period that may vary with the type of surgical procedure. During this period, the quantity and quality of sleep as well as other symptoms (pain, fatigue, anxiety, and depression) are influenced by various physiologic, psychologic, and social factors. Despite limited evidence that sleep problems may occur frequently during the recovery period, only a few researchers have systematically examined sleep patterns in women after hysterectomy. None of these studies, however, used objective sleep measures or examined multiple dimensions of these women's lives. CONCLUSIONS: This review conceptualized the women's symptom experience as the experience of specific symptoms (pain, sleep disturbance, fatigue, depressed mood, and anxiety) that were influenced by biopsychosocial factors.

Sexuality after hysterectomy.

OBJECTIVE: To review the literature regarding sexuality after hysterectomy and identify areas for future research. DATA SOURCES: Articles published between 1970 and 2000 on sexuality and hysterectomy were located using MEDLINE, CINAHL, Psychlit, and Sociofile databases. STUDY SELECTION: English language research dealing with the topic was reviewed. DATA EXTRACTION: Study findings were categorized and include studies of the effect of hysterectomy on sexuality, women's perspectives on hysterectomy, and information sharing with women prior to surgery. DATA SYNTHESIS: A number of studies have explored sexuality after hysterectomy. Many of these studies have methodologic flaws, including vague measures of sexual satisfaction and potential for recall bias. A major source of bias is that the first measure of sexual satisfaction/functioning was performed in the immediate preoperative period when symptoms are more likely to affect sexual functioning. CONCLUSIONS: There are a number of gaps in the knowledge base pertaining to this topic. Future research in this area is needed to provide direction for nurses in the clinical area. Topics for future research include what women and their partners want to know about sexuality following hysterectomy and the most efficient methods to provide them with this information. In addition, sexuality in premorbid women needs to be more fully described.

Hysterectomy: what do women need and want to know?

OBJECTIVE: The purpose of this article is to describe women's experiences of hysterectomy and to identify their fears, concerns, and met as well as unmet health care needs. DESIGN: Narrative data of women's hysterectomy experiences were collected via a written survey. SETTING: Data were collected from women living in southeastern Wisconsin. PARTICIPANTS: Participants were 102 women who had undergone hysterectomy within the previous 2 years. The mean age of the women was 43 and mean time since hysterectomy was 13 months. Eighty percent of the women had undergone both hysterectomy and oophorectomy, and 78% were taking hormone replacement therapy. MAIN OUTCOME MEASURES: A questionnaire of women's hysterectomy needs and a demographic questionnaire were used to collect data via mail. The data from three open-ended questions were content analyzed. RESULTS: Seven themes about women's experiences of hysterectomy were identified: (a) positive aspects, (b) hormone replacement therapy, (c) insufficient information, (d) changes in sexual feelings and functioning, (e) emotional support, (f) psychologic sequelae, and (g) feelings of loss. CONCLUSIONS: Women wanted treatment choices, a part in decision-making, accurate and useful information at an appropriate time, provider support, and access to professional and lay support systems. The essentials for hysterectomy care are outlined and include the characteristics of care that women desire, the informational content that women want, health care systems that support patient satisfaction, and the outcomes women want.

A comprehensive education and support program for women experiencing hysterectomies.

Women undergoing hysterectomies require special education and emotional support. A new comprehensive program of nursing interventions helps assist women in coping with hysterectomies. Nurses, combining their skills in gynecologic and mental-health nursing, conduct presurgery classes, provide information and support during hospitalization, and offer a postdischarge support group to hysterectomy patients. This article includes descriptions of the program's development process, class content, and ways in which continuity of care is provided.

Changes in bladder function in the woman undergoing radical hysterectomy for cervical cancer.

Radical hysterectomy, a procedure used in the treatment of women with cervical cancer, is frequently a cause of either temporary or permanent bladder dysfunction in the postoperative period. Four major types of dysfunction are seen: hypertonus of the bladder muscle, loss of sensation of bladder fullness, difficulty initiating micturition, and bladder hypotonia. Nursing interventions can affect adaptation to some of these problems and prevention of others. A review of rehabilitative literature is used to develop a rationale for nursing care using Levine's Conservation Principles as a conceptual framework.

An evidence-based approach to managing women's decisional conflict.

Women who face difficult health decisions are likely to experience decisional conflict. To date, women have been supported in their decision making through informal counseling and client education. The Ottawa Decision Support Framework guides practitioners in assessing decision-making needs in clinical practice, providing support for client decision making, and evaluating the effectiveness of their interventions. Several evidence-based decision support tools were derived from this framework, including practitioner-administered and client self-administered decision guides, condition-specific decision aids, and the Decisional Conflict Scale.

Women's decision making regarding hysterectomy.

OBJECTIVE: To describe the decision-making process of women who choose hysterectomy for treatment of benign disease or distressing symptoms. DESIGN: Qualitative design based on grounded theory, using semistructured interviews. SETTING: Participants were interviewed in their homes or at their place of employment. PARTICIPANTS: Ten women who were premenopausal prior to hysterectomy. RESULTS: Decision making began when the women recognized abnormal body changes or bothersome symptoms. Four major processes were identified. "Seeking Solutions" was characterized by information seeking, information processing, and utilization of pharmacologic and nonpharmacologic treatments in an attempt to cure the disease and/or alleviate symptoms. "Holding On" included managing symptoms, rearranging activities of daily living to accommodate symptoms, and waiting. "Changing Course" was characterized by an abrupt change from Holding On to focusing on hysterectomy as the solution to the distressing symptoms. During "Taking Charge," the women displayed purposeful actions directed at arranging and preparing for surgery. CONCLUSIONS: Understanding the process of decision making will enable nurses to provide support for women who choose hysterectomy for treatment of benign gynecologic diseases and/or distressing gynecologic symptoms. Nurses' support of women's decision making should include referrals, education, and emotional support. In addition, nurses can help these women improve their quality of life by assisting them with symptom management.