Infertility management in primary care.

Infertility is a growing issue for couples. Primary care NPs can manage initial treatment as well as address the emotional and financial burdens of patients experiencing infertility. NPs can provide timely access to investigations and treatment, helping patients achieve their goal of pregnancy sooner.

The Human Responses and Nursing Diagnoses of Those Living With Infertility: A Qualitative Systematic Review.

OBJECTIVE: To systematically retrieve, critique, and synthesize patients' human responses about living with infertility and identify possible related nursing diagnoses according to NANDA-I. METHODS: Systematic review of qualitative nursing studies. FINDINGS: A total of 39 papers were included, 49 human responses, and 77 potential infertility-related nursing diagnoses were identified across three themes. Main foci matching nursing diagnosis were related to spiritual well-being, spiritual distress, and resilience. CONCLUSIONS: Patients respond to infertility in a variety of ways and this raises the need for a more effective, holistic, and accurate nursing diagnosis. IMPLICATIONS FOR PRACTICE: The accuracy of the nursing diagnosis is critical in raising the quality of the nursing process and in meeting infertile patients' circumstances and care expectations.

Preconception care for infertile couples: Nurses' and midwives' roles in promoting better maternal and birth outcomes.

INTRODUCTION: Preconception care promotes better maternal outcomes, may assist in preventing birth defects and improves fertility awareness among healthy childbearing couples. Yet, the significance of preconception care for infertile couples is undeveloped area of practice in Europe. AIMS AND OBJECTIVES: To discuss the importance of nurses and midwives in providing preconception care to infertile couples in the United Kingdom and Spain. DESIGN: Discursive paper. METHOD: A comparison of different midwifery and nursing approaches to preconception care for infertile couples in two European countries. FINDINGS: At present, infertile couples' needs for preconception care are not routinely identified or understood. There is an opportunity for these needs to be considered and identified by nurses at the time of investigation for infertility or when planning pregnancy with assisted conception. CONCLUSIONS: We argue that, by providing preconception care, nurses and midwives have an opportunity to deliver important advice to infertile couples in both primary care and specialist infertility services.

Nursing Care of Women Veterans of the Iraq and Afghanistan Wars.

The Iraq and Afghanistan wars are unlike earlier wars, and the women veterans who have served in them are unlike veterans of earlier wars. Now these veterans are presenting with distinctive general, genitourinary, reproductive, and behavioral health issues. When seeking health care after deployment, they may be accessing multiple health care providers across numerous sites, including the Veterans Health Administration and civilian facilities. Enhanced levels of understanding, respect, and concern for the many combat-related health challenges experienced by these veterans will help civilian nurses and other clinicians provide optimum care. Provision of health care to women veterans should be multidisciplinary and effectively coordinated among various health care providers and facilities to ensure that their post-deployment health and wellness needs are met.

[Benefits of nursing care service in the assisted reproduction clinic to self-cycle-management and self-efficiency of infertility patients].

OBJECTIVE: To investigate the benefits of nursing care service in the assisted reproduction clinic to self-cycle-management and self-efficiency of the outpatients with infertility. METHODS: We randomly divided 600 females preliminarily diagnosed with infertility into a control and an experimental group, 288 in the former and 285 in the latter group excluding those whose husbands had azoospermia. For the women patients of the experimental group, we conducted nursing care intervention concerning related knowledge, skills, diet, excise, medication, and psychology, by one-to-one consultation, individualized or group communication, establishing files, telephone follow-up, and wechat guidance. After 3 months of intervention, we compared the compliance of medical visits, effectiveness of cycle management, sense of self-efficiency, satisfaction, and anxiety score between the two groups of patients. RESULTS: In comparison with the controls, the patients of the experimental group showed significantly better knowledge about assisted reproduction and higher effectiveness of self-cycle-management, self-efficiency, and satisfaction (P <0.05), but a markedly lower degree of anxiety (P <0.05). CONCLUSIONS: Nursing care service in the assisted reproduction clinic can improve the compliance of medical visits, effectiveness of self-cycle-management, self-efficiency, and satisfaction and reduce the anxiety of the patients.

Experiences of Spanish women undergoing hysterosalpingography as part of the infertility process: a phenomenological study.

AIMS AND OBJECTIVES: To describe and understand the experiences and perceptions of women who undergo hysterosalpingography as part of the infertility process. BACKGROUND: Nurses and midwives should conduct research into the emotional aspects of caring for patients undergoing infertility treatment. The hysterosalpingography is considered to be the most feared test in the infertility process and the one about which very little is known. DESIGN: A phenomenological qualitative study. METHODS: Ten Spanish women who had undergone hysterosalpingography participated in this study. In-depth interviews were carried out between October 2012-May 2013. Data analysis was performed with the help of atlas.ti software to identify emerging themes. RESULTS: The experience of the participants who underwent hysterosalpingography during the infertility process is represented by the following three themes: (1) becoming a mother to feel complete as a person and as a woman, with the subthemes 'maternity as a life objective' and 'maternity in terms of gender identity'; (2) infertility--an intimate experience which provokes negative feelings, with the subthemes 'negative feelings regarding own infertility' and 'infertility as an experience that is little shared with others'; (3) Undergoing hysterosalpingography, with the subthemes 'feelings regarding hysterosalpingography', 'treatment by medical providers' and 'areas for improvement regarding the service given by the providers'. CONCLUSION: For women who undergo hysterosalpingography, maternity may be seen as a life objective that could identify them as women. Results suggest that although infertility is experienced with negative feelings such as anxiety, frustration and sadness, hysterosalpingography seems to be related with both hope and fear when facing the test. RELEVANCE TO CLINICAL PRACTICE: Knowing the experiences of these women could help nurses, midwives and physicians to provide better patient-centred care.

[When the unconscious is not infertile]. / Quand l'inconscient n'est pas stérile.

Among infertile couples who are undergoing the process of medically assisted reproduction, those for whom no biological cause for their infertility has been detected are offered a meeting with a liaison psychiatry team. They can then continue consultations with a psychiatrist in private practice. These consultations confront the couples with the various conflicts, injuries and impulses, buried in their unconscious which can cause symptoms of infertility. What is at play for these men and women and for the structure of each couple in its singularity?

Factores relacionados con el incremento de la infertilidad / Factors associated with an increase in infertility

OBJETIVOS: conocer los factores relacionados con el incremento de la infertilidad, así como las causas y criterios de derivación delas parejas estériles y revisar el proceso de las diferentes alternativas terapéuticas que se pueden proponer fruto de las nuevas tecnologías. MÉTODO: revisión narrativa en la que se realiza una búsqueda bibliográfica en las bases de datos Cochrane, Medline y Cuiden y consulta en páginas de sociedades científicas. El criterio de selección se limitó a artículos originales y revisiones en los últimos 15años, con texto disponible en abstracto a texto completo, en español y en inglés. RESULTADOS Y CONCLUSIONES: se recuperaron un total 56 referencias, de las cuales se seleccionaron 19. Del análisis de los 19artículos y documentos seleccionados se generaron tres categorías principales: factores relacionados con la infertilidad, causas de infertilidad y tratamientos de la misma. El retraso del deseo reproductivo y el estilo de vida explican un posible incremento delos problemas de infertilidad, siendo la causa única o múltiple. Para su tratamiento, la elección de una técnica u otra (inseminación artificial, fecundación in vitro y donación de ovocitos) varía en función de la etiología de la esterilidad. En España se estima que casi un 15% de las parejas tienen problemas de esterilidad. La velocidad a la que evolucionan las técnicas de reproducción humana asistida y los tratamientos de infertilidad ponen en relieve la necesidad de formación constante de los profesionales relacionados con la reproducción

OBJECTIVES: to understand those factors associated with an increase in infertility, as well as the causes and referral criteria for infertile couples and to review the process of different therapeutic alternatives which can be offered, as a result of new technologies. METHOD: narrative review involving a bibliographic research in the Cochrane, Medline and Cuiden databases, and a search in webpages by scientific societies. The selection criteria was limited to original articles and reviews within the past 15 years, with text available as abstract or full text, in Spanish and in English. RESULTS AND CONCLUSIONS: in total, 56 references were collected,and 19 of these were selected. From the analysis of these selected19 articles and documents, three main categories were generated: factors associated with infertility, causes of infertility, and treatments for this condition. The delay of the reproductive desire, as well as lifestyle, can explain a possible increase in infertility problems, which may have a single cause, or multiple causes. For treatment, the selection of a technique over another (artificial insemination, in vitro fecundation, and ovocyte donation) varies according to the etiology of sterility. It is estimated that almost15% of couples in Spain have sterility problems. The fast rate of evolution of assisted human reproduction and infertility treatments highlight the need for constant training targeting those professionals associated with reproduction

[Educational strategy addressed to nurses in primary care for infertility: an intervention study]. / Estratégia educativa voltada para enfermeiros sobre atençao básica à infertilidade: estudo de intervenção.

The objective was to assess the impact of an educational strategy approaching infertility assistance; and verify practices introduced into the daily work of the participants after this intervention. Research-action developed with 11 nurses from the Family Health Strategy, in Fortaleza-CE, through the reading of a brochure in a "circle of conversation." Data were collected in August and October 2010, before, immediately after and 60 days after the intervention. An increase in the levels of knowledge was noted immediately after the intervention, when all participants had a "more than good" or "very good" level of knowledge, leaving behind the "little" and "good" levels rated before the intervention; at 60 days, a "good" level of knowledge was noted again, showing a relative decrease in knowledge. There was self-recognition of the ability to introduce practices into the daily work after the intervention, confirming the positive impact thereof

Evaluation of the training course for a nursing intervention programme to promote maternal role attainment in pregnant Japanese women who have undergone assisted reproductive technology.

This study evaluated the effectiveness of a 2 day training course for a nursing intervention programme to promote maternal role attainment in pregnant Japanese women who have undergone assisted reproductive technology. Participants were 12 Japanese nurses with more than 3 years of clinical experience at reproductive institutions. The effectiveness of the training course was evaluated by assessing the following: (i) understanding of the nursing intervention programme; (ii) attitudes of nurses towards women who are pregnant following assisted reproductive technology; and (iii) self-efficacy for implementing the programme. The training course was effective in increasing basic understanding of the programme and in assisting self-evaluation of the attitudes of participants towards pregnant women. However, acquisition of effective interview skills and changes to make the programme clinically feasible are still needed. Findings suggest that researchers who use this training programme may need to evaluate and include training of nurses in interview skills suitable for their working environments.

Estratégia educativa voltada para enfermeiros sobre atenção básica à infertilidade: estudo de intervenção / Educational strategy addressed to nurses in primary care for infertility: an intervention study / Estrategia educativa para enfermeros en atención primaria a la infertilidad: estudio de intervención

Objetivou-se avaliar o impacto de estratégia educativa abordando assistência à infertilidade e verificar práticas introduzidas no cotidiano laboral dos participantes após intervenção. Pesquisa-ação, desenvolvida com 11 enfermeiras da Estratégia Saúde da Família de Fortaleza-CE, por meio da leitura de fôlder em "roda de conversa". Os dados foram coletados em agosto e outubro de 2010, anteriormente, imediatamente após e decorridos 60 dias da intervenção. Constatou-se aumento do nível de conhecimento imediatamente após a intervenção, quando todas as participantes obtiveram nível de conhecimento "mais que bom" ou "muito bom", deixando de se enquadrarem nos níveis "pouco" e "bom", como ocorreu antes da intervenção; com 60 dias, registrou-se nível de conhecimento "bom", constatando relativo declínio no conhecimento. Houve autorreconhecimento com relação à capacidade de introduzir práticas no cotidiano laboral após a intervenção, confirmando impacto positivo da intervenção.

The objective was to assess the impact of an educational strategy approaching infertility assistance; and verify practices introduced into the daily work of the participants after this intervention. Research-action developed with 11 nurses from the Family Health Strategy, in Fortaleza-CE, through the reading of a brochure in a "circle of conversation." Data were collected in August and October 2010, before, immediately after and 60 days after the intervention. An increase in the levels of knowledge was noted immediately after the intervention, when all participants had a "more than good" or "very good" level of knowledge, leaving behind the "little" and "good" levels rated before the intervention; at 60 days, a "good" level of knowledge was noted again, showing a relative decrease in knowledge. There was self-recognition of the ability to introduce practices into the daily work after the intervention, confirming the positive impact thereof.

El objetivo fue evaluar impacto de estrategia educativa dirigida a la asistencia a la infertilidad y verificar prácticas en el trabajo diario de los participantes después de esta intervención. Investigación-acción, desarrollada con 11 enfermeros de la Estrategia de Salud Familiar en Fortaleza-CE, mediante lectura del folleto en "rueda de conversación." Los datos fueron recolectados en agosto y octubre de 2010, antes, inmediatamente después, y transcurridos 60 días de la intervención. Se comprobó aumento del nivel de conocimiento inmediatamente después de la intervención, cuando todos las participantes obtuvieron nivel de conocimiento "más que bueno" o "muy bueno", dejando los niveles de ajuste "poco" y "bueno" como antes de la intervención; con 60 días fue recolectado nivel de conocimiento "bueno", con disminución relativa en el conocimiento. Hubo autorreconocimiento de la capacidad de iniciar prácticas en la rutina laboral después de la intervención, lo que confirma el impacto positivo de esta.

Helping patients through the pain of infertility.

While males and combined couple factors play a large part in infertility cases, women often carry the physical, social, and emotional burden of these diagnoses. Nurse practitioners are in a prime position to assess women at risk for infertility, initiate an investigation to identify potential etiologies, refer women to specialized centers, and provide them with ongoing care and support through this difficult period in their lives.

Toward developing a training pathway for fertility nurses: report of the 2010 training and educational survey.

Fertility nursing and its role extension has increasingly been referred to as 'specialist' or 'advanced nursing practice'. Nevertheless, Government initiatives have prompted a review of 'Advanced Nursing Practice' and the Nursing & Midwifery Council (NMC) has taken steps to address the disparity of roles, job titles, training and competence of nurse practitioners, concluding that advanced nursing practice should be subject to revalidation in the same way as professional registration. Fertility nurses form an integral part of the multidisciplinary team. Yet no formal or nationally recognised framework or training pathway exists. In this paper, we present the findings of a recent online survey of training and educational needs of fertility nurses; its aim being to work toward developing a national training pathway. Our findings identify the relationship between fertility nurse competencies, advanced nursing practice and medical sub-specialist training, at the same time, highlighting the difference in accessibility, funding and levels of training, as well as assessment and expertise within clinical practice. We conclude that it is essential to protect role extension through regonised Higher Educational Institution (HEI) accreditation, by appropriate, role-focussed training. Notwithstanding a national review, the diverse list of job titles also needs to be addressed adequately to encompass and respect role extension.

Supporting the couple with conception challenges.

Current literature indicates a lack of direction for NPs managing the psychosocial needs of couples who are having difficulty with conception but have not yet been diagnosed as infertile. A protocol is presented for NPs in the primary care setting to assist them in providing psychosocial support for these couples.

Phthalate exposures and human health concerns: A review and implications for practice.

High levels of exposure to phthalates have been associated with an increased risk for adverse male fetal reproductive development. Although animal studies have consistently demonstrated reproductive health effects, additional human epidemiological studies are needed to fully understand the potential harm to humans. Recent findings reported for humans have demonstrated endocrine-disrupting action similar to that associated with phthalate exposures in animals. As a result, phthalate exposure is an emerging public health concern that warrants further review. This article explores the state of the science on phthalate exposure, reviews the literature, and provides recommendations occupational health nurses can use to optimize the health of susceptible populations.

Ethical considerations for genetic testing, infertility, and balancing maternal-fetal needs.

Among the ethical issues confronting maternal-child nurses are questions surrounding genetic testing, contraception and sterilization, infertility/assisted reproductive technology, and equality in balancing maternal-fetal needs. This article explores these issues, reviews the literature currently available, and discusses nursing clinical implications for each as well as representative case studies. The types of support needed by childbearing families who are facing ethical issues requires emotional and physical support, informational support, and advocacy support. The role of the nurse in educating women about the ethical implications of their choices cannot be overestimated. When women have been educated about the implications of their decisions and are therefore empowered to make informed decisions about their lives and their pregnancies, clinical nurses who practice ethically respect those decisions and support the women in their choices.