Endometriosis: «Nivel de conocimiento y expectativas de formación específica entre profesionales especialistas en medicina de familia y comunitaria y matronas en atención primaria en la isla de Gran Canaria» / Endometriosis: “Level of knowledge and expectations of specific training among primary care doctors and midwives on the island of Gran Canaria, Spain”

Objetivo: Analizar el nivel de conocimiento entre profesionales sanitarios de atención primaria sobre endometriosis e identificar sus necesidades formativas en esta materia. Diseño: Estudio descriptivo realizado en atención primaria del Área de Salud de Gran Canaria, mediante cuestionario online anónimo. Resultados: Ciento diecinueve especialistas en medicina de familia y comunitaria y 37 matronas respondieron el cuestionario. El 54,6% de profesionales médicos y el 67,6% de matronas consideran escaso su conocimiento sobre endometriosis. Menos del 50% de profesionales conoce la guía de atención a las mujeres con endometriosis en el Sistema Nacional de Salud. Los síntomas más frecuentes relacionados con endometriosis son: dismenorrea moderada/severa, dolor pélvico crónico, esterilidad. Los menos relacionados son los digestivos y las alteraciones urinarias catameniales. Un 80% de profesionales médicos señalan como menor de 10 el número anual de pacientes en las que piensan que puedan tener endometriosis y menos de 20 para el 75% de matronas. El 40% de profesionales médicos trataría a una paciente con solo dismenorrea y sin planes de gestación con anticonceptivos orales; el 8% considera que el dolor con la menstruación es algo común. El 25% de profesionales especialistas en medicina de familia y comunitaria señalan la terapia de larga duración con antiinflamatorios no esteroideos como tratamiento de primera línea. Menos del 25% de ellos derivarían al especialista en Ginecología con solo sospechar endometriosis. Mayoritariamente los profesionales manifiestan interés en mejorar su formación en endometriosis. El 94,6% de las matronas consideran que tienen un papel estratégico en el manejo de pacientes con endometriosis. Conclusión: La demora en el diagnóstico de la endometriosis se debe en parte al desconocimiento de la enfermedad. Los profesionales de atención primaria constituyen la primera línea de atención sanitaria.(AU)

Objective: To analyze the level of knowledge of endometriosis in primary care doctors and midwives and to identify their training needs in this area. Design: Descriptive study conducted in the primary care services of the Health Area of Gran Canaria, through an anonymous online questionnaire. Results: One hundred and nineteen doctors and 37 midwives completed the questionnaire; 54.6% of doctors and 67.6% of midwives considered that their knowledge about endometriosis was poor. Less than 50% of healthcare professionals knew the National System of Health's guidelines for the management of women with endometriosis. Symptoms most frequently associated to endometriosis included: moderate/severe dysmenorrhea, chronic pelvic pain and sterility. Less frequently related ones included: digestive symptoms and catamenial urinary disorders; 80% of doctors suspected endometriosis in <10 women per year; 75% of midwives suspected this condition in <20 women per year; 40% of doctors would prescribe oral contraceptives to patients with dysmenorrhea who were not planning pregnancy; 8% of doctors considered that menstruation-associated pain was common. Medical therapy was the most frequently chosen first-line treatment; 25% of doctors would choose long-term NSAIDs therapy as a first-line treatment; less than 25% of them would refer a patient to the Gynecology service only for suspected endometriosis. Most health professionals expressed their interest in improving their knowledge about endometriosis; 94.6% of midwives considered that they played a strategic role in the identification and management of patients with endometriosis. Conclusion: Delays in the diagnosis of endometriosis are partially due to ignorance of the disease. Primary care professionals constitute the first line of health care. In this context, it is essential to develop specific training strategies, which would be welcome by health professionals.(AU)

Intervenções do enfermeiro obstetra no cuidado à mulher com endometriose / Obstetric nurse interventions in the care of women with endometriosis

No presente relatório estudam-se as intervenções do enfermeiro EESMO no cuidado à mulher com endometriose e realiza-se uma análise crítica das competências comuns e especificas do enfermeiro EESMO, assim como as competências do grau de Mestre. Aprofunda-se a endometriose na sua: caracterização, aspetos históricos, manifestações, tratamento, impacto na vida da mulher/família, relação com infertilidade, impacto na gravidez e feto e retrata-se o cuidado à mulher com endometriose por enfermeiros especialistas, no Reino Unido. Depois, refere-se a Teoria do Cuidar de Kristen Swanson (1991), mencionando o seu metaparadigma e adapta-se a teoria à mulher com endometriose. Em seguida, tratam-se as opções metodológicas visando o desenvolvimento do enfermeiro EESMO, assente na scoping review (segundo orientações do Joanna Briggs Institute, 2020), na prática baseada na evidência e na pesquisa empírica. Tem-se assim, como principal propósito integrar a melhor evidência científica relacionada com a mulher/família com endometriose, refletindo sobre os cuidados prestados pelo enfermeiro EESMO a estes indivíduos. Desta forma, pretende-se mapear o estado da arte relativamente a esta temática e define-se como questão de pesquisa: "Quais são as intervenções do enfermeiro EESMO, no cuidado à mulher com endometriose?". Durante a realização do Relatório de Estágio, elaborou-se e implementou-se um questionário a 10 enfermeiros EESMO, que prestam cuidados em serviços de ginecologia, há mais de um ano. Depois da análise de conteúdo dos registos, categorizaram-se as intervenções enunciadas segundo o modelo biopsicossociocultural e espiritual. Após a análise dos resultados obtidos (Bardin, 2011), foi claro que os enfermeiros EESMO prestam cuidados holísticos, no entanto, nem todas as intervenções propostas pela evidência científica são aplicadas na prática clínica. Conclui-se ainda que, é necessário formar enfermeiros EESMO, de modo a que este profissional seja expedito, na disseminação da temática na população mundial, encorajando a mulher/família com endometriose a procurar ajuda nas unidades de saúde de referência, contribuindo para o seu bem-estar e advogando a mulher/família no seio da equipa multidisciplinar. Por fim, surgem algumas questões que podem suscitar interesse à realização de futuras pesquisas.

This report studies the interventions of nurse midwives (EESMO) in the provision of care to women with endometriosis, conducting a critical analysis of the common and specific competencies of the nurse midwife, as well as the ones conferred by Master's degree. Endometriosis is addressed in terms of: characterization, historical aspects, manifestations, treatment, impact on woman and family's lives, correlation with infertility, impact on pregnancy and foetus and portrays the care of women with endometriosis by nurse midwives in the United Kingdom. The analysis of this pathology and its impact was studied within the metaparadigm of Kristen Swanson's Theory of Care (1991), adapting the theory to women with endometriosis. The methodological approach focuses on the nurse midwife's development, based on the scoping review (according Joanna Briggs Institute's guidelines, 2020), on practice-based medicine and empirical research. Thus, the main purpose is to integrate the best scientific evidence related to the woman with endometriosis and its family, reflecting on the nurse midwife's care to these people. The purpose of this analysis was to identify the state of the art in relation to this theme with a research question: "What are the interventions of nurse midwife's care to women with endometriosis?". During the clinical placement, a questionnaire was developed and implemented to 10 nurse midwives, who have been providing care to women in gynaecology services for more than one year. The answers analysis content, enunciated interventions which were categorized according to the biopsychosociocultural and spiritual model. The analysis of the results obtained (Bardin, 2011), revealed an adequate holistic care provided by nurse midwives, however, not all interventions proposed by scientific evidence are applied in clinical practice. It should also be noted that nurse midwives need continuous education and practice of nurse, so that these nurses are expeditious, disseminating this issue within the population, encouraging women and families with endometriosis to seek help at health units, contributing to their well-being and advocating for the women and their families within a multidisciplinary team. Finally, the study revealed some questions that may arouse interest in future research.

General practitioners and endometriosis: Level of knowledge and the impact of training.

OBJECTIVE: To assess general practitioners' (GPs') knowledge of and practice in the diagnosis and management of endometriosis following the publication of updated French national guidelines in 2017. MATERIALS AND METHODS: A descriptive, anonymous, epidemiological survey of 102 GPs in the Picardie region of France. RESULTS: Only 25% of the GPs considered that they knew enough about endometriosis for their routine clinical practice. This proportion was 58.9% amongst GPs with an university diploma in gynaecology and 31.4% amongst those participating in continuing medical education courses on gynaecology. Only 19.6% of the GPs were aware of the updated French national guidelines. With regard to five main suggestive, localizing signs of endometriosis, dyspareunia, dysmenorrhoea and infertility were mentioned as being of diagnostic value by 55.9%, 37.3% and 43.1% of the GPs, respectively; in contrast, functional urinary tract disorders and painful defecation were not mentioned very often. GPs with a qualification in gynaecology and those participating in continuing medical education in gynaecology knew more about treating endometriosis. CONCLUSION: In the Picardie region of France, GPs appear to be only moderately aware of how to manage endometriosis; this probably contributes to the diagnostic delay associated with this condition. GPs with a university diploma in gynaecology and those participating in continuing medical education in gynaecology appeared to have a better grasp of the subject. Continuing medical education on this topic should therefore be promoted and expanded.

Papel da enfermagem frente a portadoras de endometriose e depressão / Role of nursing in relation to endometriosis and depression carriers

Objetivo: analisar a importância do papel da Enfermagem em relação a mulheres portadoras de endometriose acometidas por depressão. Métodos: trata-se um estudo bibliográfico, tipo revisão integrativa, com busca nas bases de dados LILACS, BDENF, MEDLINE e IBECS. Selecionaram-se artigos trilíngues na íntegra, no período de 2008 a setembro de 2018. Coletaram-se as informações a partir de um instrumento, apresentaram-se os resultados por meio de figuras e os discutiram com a literatura. Resultados: selecionaram-se oito artigos para análise. Mostrou-se a importância do papel do enfermeiro no enfrentamento da endometriose associada aos distúrbios de depressão. Sabe-se que a endometriose afeta a vida cotidiana das mulheres, dificultando as suas atividades diárias, as suas relações pessoais e interferindo na sua capacidade reprodutiva. Compromete-se, ainda mais, a qualidade de vida à medida que os sintomas se tornam mais graves. Conclusão: conclui-se que, para melhorar a qualidade de vida da mulher portadora de endometriose, o enfermeiro deve garantir o conhecimento e o empoderamento das mulheres para que o sofrimento seja amenizado.(AU)

Objective: to analyze the importance of the role of nursing in relation to women with endometriosis affected by depression. Methods: this is a bibliographical study, type integrative, with search in the LILACS, BDENF, MEDLINE and IBECS databases. Trilingual articles were selected in full, from 2008 to September 2018. Information was collected from an instrument, the results were presented by figures and discussed with the literature. Results: eight papers were selected for analysis. The importance of the role of nurses in coping with endometriosis associated with disorders of depression has been shown. It is known that endometriosis affects the daily life of women, hindering their daily activities, their personal relationships and interfering in their reproductive capacity. It further compromises quality of life as symptoms become more severe. Conclusion: it is concluded that, in order to improve the quality of life of women with endometriosis, nurses must guarantee the knowledge and empowerment of women so that suffering is reduced.(AU)

Objetivo: analizar la importancia del papel de la enfermería en relación a mujeres portadoras de endometriosis acometidas por depresión. Métodos: se trata de un estudio bibliográfico, tipo revisión integrativa, con búsqueda en las bases de datos LILACS, BDENF, MEDLINE e IBECS. Se seleccionaron artículos trilingües en su totalidad, en el período de 2008 a septiembre de 2018. Se recogen las informaciones a partir de un instrumento, se presentaron los resultados por medio de figuras y los discutieron con la literatura. Resultados: se seleccionaron ocho artículos para análisis. Se mostró la importancia del papel del enfermero en el enfrentamiento de la endometriosis asociada a los disturbios de depresión. Se sabe que la endometriosis afecta la vida cotidiana de las mujeres, dificultando sus actividades diarias, sus relaciones personales e interfiriendo en su capacidad reproductiva. Se compromete, aún más, la calidad de vida a medida que los síntomas se vuelven más graves. Conclusión: se concluye que, para mejorar la calidad de vida de la mujer portadora de endometriosis, el enfermero debe garantizar el conocimiento y el empoderamiento de las mujeres para que el sufrimiento sea amenizado.(AU)

Arquétipos do conjunto de dados essenciais de enfermagem para atendimento de portadoras de endometriose / Arquetipos de datos clave para la atención de enfermería de pacientes con endometriosis / Essential data set's archetypes for nursing care of endometriosis patients

Objetivou-se elaborar um Conjunto de Dados Essenciais de Enfermagem para Atendimento às Portadoras de Endometriose (CDEEPE) e representá-lo por arquétipos. Pesquisa exploratória, aplicada com participação de especialistas, realizada no Laboratório de Informática em Saúde da PUCPR, entre fevereiro e novembro de 2010. Foi dividida em duas etapas: construção e avaliação do CDEEPE, que abordou as fases do Processo de Enfermagem e as Necessidades Humanas Básicas; e desenvolvimento dos arquétipos, a partir do conjunto definido. O CDEEPE foi avaliado, por médicos e enfermeiros, com média consensual de 95,9% e foi especificado contendo 51 dados. Para representá-lo, foi criado o arquétipo "Percepção dos Órgãos e Sentidos". Este estudo possibilitou identificar informações importantes para a prática de enfermagem, contribuindo para informatização e aplicação do Processo de Enfermagem no cuidado prestado. O CDEEPE foi base para criação do arquétipo, que possibilitará os registros de forma estruturada, organizada, eficiente, interoperável e semântica.

El objetivo era desarrollar un conjunto mínimo de datos esenciales para la atención de enfermería de pacientes con endometriosis (CDEEPE,) y lo representa por arquetipos. Investigación exploratoria aplicada con la participación de especialistas que se llevó a cabo en el Laboratorio de Informática de la Salud de PUCPR entre febrero y noviembre de 2010. Estaba dividido en dos etapas: construcción y evaluación del CDEEPE, incluyendo las fases del proceso de enfermería y las necesidades humanas básicas y el desarrollo de los arquetipos basados en del conjunto de datos definido. El CDEEPE fue evaluado por los médicos y enfermeras con un promedio de consenso del 95,9% y se especificó con 51 elementos de datos. El arquetipo de "Percepción de órganos y los sentidos" fue creado para representa este conjunto de datos. Este estudio permitió identificar la información importante para las prácticas de enfermería contribuyen a la informatización y la aplicación del proceso de enfermería durante la atención. El CDEEPE fue la base para la creación de arquetipo, que hará posibles los registros estructurado, organizado, eficiente, interoperable y semántico.

This study aimed to develop an Essential Data Set for Nursing Care of Patients with Endometriosis (CDEEPE), represented by archetypes. An exploratory applied research with specialists' participation that was carried out at Heath Informatics Laboratory of PUCPR, between February and November of 2010. It was divided in two stages: CDEEPE construction and evaluation including Nursing Process phases and Basic Human Needs, and archetypes development based on this data set. CDEEPE was evaluated by doctors and nurses with 95.9% of consensus and containing 51 data items. The archetype "Perception of Organs and Senses" was created to represents this data set. This study allowed identifying important information for nursing practices contributing to computerization and application of nursing process during care. The CDEEPE was the basis for archetype creation, that will make possible structured, organized, efficient, interoperable, and semantics records.

[Essential data set's archetypes for nursing care of endometriosis patients]. / Arquétipos do conjunto de dados essenciais de enfermagem para atendimento de portadoras de endometriose.

This study aimed to develop an Essential Data Set for Nursing Care of Patients with Endometriosis (CDEEPE), represented by archetypes. An exploratory applied research with specialists' participation that was carried out at Heath Informatics Laboratory of PUCPR, between February and November of 2010. It was divided in two stages: CDEEPE construction and evaluation including Nursing Process phases and Basic Human Needs, and archetypes development based on this data set. CDEEPE was evaluated by doctors and nurses with 95.9% of consensus and containing 51 data items. The archetype "Perception of Organs and Senses" was created to represents this data set. This study allowed identifying important information for nursing practices contributing to computerization and application of nursing process during care. The CDEEPE was the basis for archetype creation, that will make possible structured, organized, efficient, interoperable, and semantics records.

Learning to take charge: women's experiences of living with endometriosis.

This paper describes aspects of a study that was conducted to determine women's needs for information related to laparoscopy for endometriosis. Sixty-one women attended focus groups, during which they described endometriosis as a disease of multiple losses: of relationships, of career and of a sense of self-worth. The women indicated that the pathway to diagnosis and treatment had been long and unnecessarily difficult. Many women said that they had reached a point where they decided enough was enough: the medical merry-go-round had to finish. They had to become assertive, take control and decide for themselves how they were going to manage their disease and their quality of life. For all but one woman in the study, complementary therapies were vital. For some women, alternative therapies had replaced allopathic medicine completely. Complementary/alternative therapies were a mechanism for regaining control.

Endometriosis.

Endometriosis is a common condition that causes pain and distress to many women. A variety of medical and surgical treatment options exist, and the nursing role is mainly one of information-giving and support.

Endometriosis--a missed malady.

Endometriosis is a disease that affects approximately 5.5 million girls and women in their reproductive years in the United States and Canada. During the menstrual cycle, the endometrial lining of the uterus thickens in preparation to receive a fertilized egg. If fertilization does not occur, this lining sloughs off during menstruation. Endometrial tissue can migrate out of the fallopian tubes and grow outside of the uterus as endometrial implants. This can result in severe pain. Endometriosis is very difficult to detect because most women become accustomed to painful menstrual cycles at an early age. The disease often will go undiagnosed because even with extensive endometriosis it is possible to have minimal symptoms or none at all. Physicians have few diagnostic tools to detect the scars and growths of endometriosis. The only way to confirm the diagnosis and stage of endometriosis is by laparoscopy. Treatment options include hormone therapy and surgery. In the past, the most successful treatment was open laparotomy with excision of the endometrial implants. This article discusses the use of the ultrasonic scalpel to resect endometrial implants through the laparoscope. The patient's perioperative course also is discussed.

Focus group study of endometriosis: struggle, loss and the medical merry-go-round.

Women with endometriosis experience a range of problems for which they may or may not be adequately supported. This paper reports on one aspect of a study conducted at the Epworth Hospital, Melbourne, to identify the information needs of women facing laparoscopy for endometriosis. A number of focus groups were conducted that provided women with a forum for communicating their experiences of endometriosis and laparoscopy. The findings include the experiences of 61 women who described the lack of support, the struggles and the losses involved in living with endometriosis. By far the worst experience that these women described was the encounter with health professionals and the ways in which their symptoms were trivialised and dismissed. There is a great deal for nurses to learn about the experience of living with endometriosis if they are to support women with this chronic illness in their search for well-being.