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.

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.

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.

Repair of the threatened feminine identity: experience of women with cervical cancer undergoing fertility preservation surgery.

BACKGROUND: Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed. OBJECTIVE: The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer. METHODS: We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism. RESULTS: Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women's feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery. CONCLUSIONS: Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation. IMPLICATIONS FOR PRACTICE: Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients' needs and provide appropriate individual care.

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.

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.

Sexualidad en mujeres histerectomizadas / Sexuality in hysterectomized women

La Histerectomía es la segunda cirugía ginecológica más frecuente en el mundo. Su principal indicación es por patología benigna. Este procedimiento quirúrgico produce impacto en la sexualidad de la mujer, que necesitan ser evaluadas. Se propone realizar revisión sistemática de evidencia con el objetivo de conocer la sexualidad de las mujeres histerectomizadas por patología benigna Se consultan bases de datos científicas, seleccionándose investigaciones cuantitativas y cualitativas publicadas en los últimos años. Los resultados muestran que tanto el tipo como e/ abordaje de la histerectomía, parecen no repercutir de forma directa en la sexualidad. Las mujeres que se someten al procedimiento refieren experimentar mayoritariamente cambios positivos. Sin embargo, la ooferectomía, independiente del tipo o abordaje utilizados, resulta perjudicial posterior a la cirugía. La pareja juega un rol determinante en el proceso de toma de decisión, así como en la sexualidad posterior al procedimiento. Es necesario elaborar estudios chilenos respecto a/ tema, de modo de acercar los resultados a la realidad del país. Por otro lado, es fundamental capacitar al personal de salud respecto a la relevancia de la histerectomía y sus repercusiones, así como estimular al profesional de enfermería a desarrollar programas psicoeducativos para estas mujeres y sus parejas.

Hysterectomy is the second most common gynecological surgery in the world. Its main use is for benign disease. The impact associated with this surgical procedure in the sexuality of women, determined to be necessary to assess the impact in this area. OBJECTIVE: to determine the sexuality of women undergoing hysterectomy for benign disease, identify the various factors that influence in decision making and the role attributed to the couple. METHODOLOGY: was consulted scientific databases, selecting studies published in the last years. RESULTS: both type and the approach to hysterectomy appear to have a direct effect on sexuality. Women who undergo the procedure referred mostly positive experience. However, oophorectomy, regardless of the type or approach used, is detrimental after surgery. The pair plays a decisive role in the decision making process as well as in sexuality after the procedure. CONCLUSIONS: it is necessary to promote the development of Chilean studies on the subject, so as to bring the results to the reality of the country. On the other hand, it is essential to train health personnel regarding the relevance of hysterectomy and its impact and to encourage nursing professionals to develop psychoeducational programs for these women and their partners.

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.

Sexualidade e histerectomia: mitos e realidade / Sexuality and hysterectomy: myths and reality

A histerectomia é um evento cirúrgico que pode resultar em interferências na sensação e expressão da sexualidadefeminina. A sexualidade, por sua vez, pode ser concebida sob aspectos diversificados. A mulher, aovivenciar tal processo, pode experimentar situações que alterem o equilíbrio da identidade feminina. Nessecontexto torna-se oportuna uma reflexão sobre tais influências no exercício da sexualidade. Utilizam-seidéias sobre gênero e sexualidade para explicitar conceitos e relacioná-los a possibilidades de uma assistência(de enfermagem) construída com base na busca de paradigma que permita a ruptura com o modelo dominante.

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.

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.

Buscando estratégias para viver melhor sendo histerectomizada: o significado da remoção do útero e suas repercussões para o cuidado de enfermagem / Looking for strategies to live better after hysterectomy: the meaning of uters remotion and its repercussions to nursing care

A presente pesquisa pretendeu investigar as conseqüências da histerectomia para a vida da mulher, estabelecendo como rumo para a seqüência do trabalho as respostas às seguintes questões norteadoras: o que significa para as mulheres histerectomizadas a remoção do seu útero? Qual a repercussão desse significado em suas vidas? Como objetivos do estudo foram estabelecidos: a) identificar os significados da remoção do útero para mulheres histerectomizadas; b) descrever a repercussão da histerectomia na vida das mulheres histerectomizadas; c) analisar o processo de interação das mulheres histerectomizadas com o significado atribuído à histerectomia, à luz da perspectiva interacionista; d) discutir os resultados encontrados à luz de outras perspectivas. A metodologia empregada foi a abordagem qualitativa e descritiva, utilizando como método de coleta de dados a Grounded Theory, ou Teoria Fundamentada em Dados. As técnicas de coleta de dados aplicadas foram a entrevista semi-estruturada e a observação de campo. O referencial teórico de análise dos dados foi o Interacionismo Simbólico. Os resultados apontaram para a existência de dois fenômenos: o significado de histerectomia como cura e o significado de histerectomia como mutilação. Observou-se que a mulher interage com múltiplos atores de seu ambiente e a partir dessa interação, entra na situação de ter que viver sendo histerectomizada. Ao entrar na situação, define para si o significado da histerectomia como cura ou como mutilação. Toma, então, uma decisão, passando a aceitar o evento cirúrgico como uma mudança positiva ou negativa em sua vida. Essa decisão a faz ir em busca de estratégias para viver melhor sendo histerectomizada. O estudo conclui que a mulher histerectomizada permanece cheia de dúvidas quanto a sua integridade física, sexual e psíquica durante todo o processo de enfrentar a cirurgia e que não encontra o apoio esperado nos profissionais de saúde. O fornecimento de informações sobre o corpo feminino...

Total abdominal hysterectomy: development of a patient-centred care pathway.

This article describes how one organisation developed an integrated care pathway for women undergoing the procedure total abdominal hysterectomy. The efficacy of care pathways to provide patient-centred care is also discussed.