Reasons for middle-aged women in Taiwan to choose hysterectomy: a qualitative study using the bounded rationality perspective.

AIMS AND OBJECTIVES: To explore women's perspectives on deciding to undergo hysterectomy for benign conditions based on physicians' recommendations and the women's own judgement. BACKGROUND: Hysterectomy is the second most common surgical procedure worldwide. Although most hysterectomies are elective, physicians may recommend treatment that involves a loss of sexuality or ovary removal, creating a difficult choice for women. DESIGN: Qualitative, in-depth interview METHODS: A purposive sample of 17 women was recruited. The women had decided to undergo hysterectomy after the diagnosis of uterine fibroids. All these women had already decided not to have more children. Data were collected by in-depth interviewing, and content analysis was used to analyse the data. RESULTS: Our study revealed five themes: release from stress, inescapable fate, positive support, hoping for peace of mind and sense of trust. CONCLUSIONS: The participants felt that mental and physical health were the most important considerations, noting that when women no longer want children, a uterus is useless. The women believed that they retained their womanhood, even without a uterus, and were satisfied with the outcomes of their hysterectomy decisions. RELEVANCE TO CLINICAL PRACTICE: Our findings might serve as educational and counselling reference materials for healthcare providers, ensuring that women receive appropriate care quality and have their needs met. Healthcare providers can then maximise women's empowerment, deepen their awareness of body image and their concept of self-care and help them to clearly perceive their own concerns and needs so that they can make suitable decisions.

'Being a Part of Treatment': the meaning of self-monitoring for rural cancer patients.

BACKGROUND: The diagnosis and treatment of cancer entail managing vast amounts of information in order for patients to participate effectively in disease self-management. Information management includes patients' responses to acquire, manage, and use external and internal information, such as through self-monitoring practices. OBJECTIVE: The study objective was to examine the meaning of self-monitoring practices within the context of rural patients' responses to internal and external information. METHODS: An empirical phenomenological approach was used. Participants were adults 18 years or older, who were once diagnosed with cancer, who agreed to discuss health monitoring behavior in relation to their cancer experience, and who used services at a small, rural cancer center. Data were collected using semistructured interviews. RESULTS: Findings revealed a self-directed pursuit of self-monitoring that was shaped by 4 factors, that is, cognitive, affective, interpersonal, and symptomatic. Quotations from participants illustrate these factors. "I'd ask the questions …" represents the cognitive factor. "Are the horse stories about cancer treatments true?" represents the affective factor. The interpersonal factor is represented as "My nurse was there for me!" The symptomatic factor is represented as "Chemotherapy blocks out your memory." Informed by these factors, participants' self-monitoring practices fostered participants' sense of control and self-advocacy efforts. CONCLUSION: Nurses are in a strategic position to engage in supportive care practices through the facilitation of self-monitoring. IMPLICATIONS FOR PRACTICE: Assessment questions grounded in study findings are suggested for use by nurses to develop patient-centered education that facilitates self-monitoring practices.

Understanding hydatidiform mole.

Hydatidiform mole (often referred to as molar pregnancy) is the most common disorder in a category of pathologies known as Gestational Trophoblastic Diseases that are associated with abnormal fertilization in pregnancy. Current practices in screening and monitoring during early pregnancy allow for better identification of hydatidiform mole, sometimes prior to the onset of significant symptoms.Once a diagnosis is established, a thorough physical examination and laboratory testing are necessary. Initial treatment includes uterine evacuation. Serial monitoring of serum human chorionic gonadotropin levels is warranted until levels become nondetectable and continues for another 6 months. Reliable contraception is necessary until it has been determined that no trophoblastic tissue persists.Pregnancy is usually a joyful time, with maternal attachment to the developing fetus beginning early in the pregnancy. The woman who experiences hydatiform mole, however, must face the inability to maintain this pregnancy, the possible health consequences of the mole, and then be allowed the time to grieve. Nurses can be the first-line in providing compassionate, empathetic care for women in these circumstances.

[Choriocarcinoma: a case study]. / Coriocarcinoma: um estudo de caso.

The present study aimed at describing the case of a client bearer for gestational choriocarcinoma and the nursing assistance needed for this condition. From information contained in the medical history and of anamnesis and physical examination made in a home visit, made up diagnoses and inteventions of nursing based in literature. Diagnoses have been identified related to the periods perioperative and chemotherapy treatment. In addition to these diagnoses, it was possible to identify others on the post-treatment period of client. The process of nursing proved to be effective for the qualified assistance for the client with choriocarcinoma.

Coriocarcinoma: um estudo de caso / Choriocarcinoma: a case study / Coriocarcinoma: un estudio de caso

O presente estudo objetivou descrever o caso de uma cliente portadora de coriocarcinoma gestacional e a assistência de enfermagem necessária a esta condição. A partir de informações constantes do prontuário médico e de anamnese e exame físico realizados em visita domiciliária, formularam-se diagnósticos e intervenções de enfermagem embasados na literatura. Foram identificados diagnósticos referentes aos períodos perioperatório e de tratamento quimioterápico. Além dos diagnósticos referidos, foi possível identificar outros relativos ao período pós-tratamento da cliente. O processo de enfermagem mostrou-se efetivo para a assistência qualificada à cliente com coriocarcinoma.

The present study aimed at describing the case of a client bearer for gestational choriocarcinoma and the nursing assistance needed for this condition. From information contained in the medical history and of anamnesis and physical examination made in a home visit, made up diagnoses and inteventions of nursing based in literature. Diagnoses have been identified related to the periods perioperative and chemotherapy treatment. In addition to these diagnoses, it was possible to identify others on the post-treatment period of client. The process of nursing proved to be effective for the qualified assistance for the client with choriocarcinoma.

El presente estudio objetivó describir el caso de una cliente portadora de coriocarcinoma gestacional y la asistencia de enfermería necesaria a esta condición. A partir de informaciones constantes del prontuario médico y de anamnese y examen físico realizados en visita domiciliaria, se formularon diagnósticos e intervenciones de enfermería embasados en la literatura. Fueron identificados diagnósticos referentes a los períodos periquirúrgico y de tratamiento quimioterápico. Además de los diagnósticos referidos, fue posible identificar otros relativos al período pos-tratamiento de la cliente. El proceso de enfermeria se mostro efectivo para la asistencia calificada a la cliente con coriocarcinoma.

Representações sociais de mulheres portadoras de lesões precursoras do câncer cérvico-uterino: um novo olhar pela enfermagem ginecológica / Social representation of the women carriers of cervico-uterine cancer precursor lesions: a new look for the gynecologist nursing

Esta pesquisa trata das representações sociais acerca das lesões precursoras do câncer cérvico-uterino (LPCCU) e teve como referencial teórico para alicerçar este estudo a Teoria das Representações Sociais, segundo Serge Moscovici e Denise Jodelet. Foram entrevistadas 60 mulheres atendidas em um Serviço de Referência em Patologia Cervical no Município do Rio de Janeiro. Os sujeitos do estudo foram divididos em dois grupos: Grupo Idade Reprodutiva (GIR) e Grupo de Idade não Reprodutiva (GINR). Os dados foram coletados mediante o teste de Associação Livre de Ideias (ALI) e entrevista semi-estruturada. Os conteúdos das entrevistas foram processados pelo programa informatizado ALCESTE e posteriormente analisados, segundo a análise de conteúdo de Bardin. A categoria “órgão/corpo feminino” referente à representação do útero emergiu como representação hegemônica em ambos os grupos A categoria “filho/gerar vida/ fertilidade” foi mais relevante no GIR e ancora o útero na maternidade e no processo histórico-cultural mulher/ mãe/ reprodutora. A LPCCU foi objetivada como câncer/doença ruim em ambos os grupos, porém o GIR referiu o sexo como fator causador da sua doença tendo o homem, o maior transmissor. O GINR referiu ao seu próprio descuido, e não ter se prevenido como causador. O GIR apresentou como uma das dimensões da representação social, a atitude de mudança de hábitos de vida e ao tratamento convencional, evitando, assim, que a LPCCU tenha interferência na sua maternidade e sexualidade...

Representações sociais de mulheres amazônidas sobre o exame de papanicolau: implicações para a saúde da mulher / Social Representations of women amazônidas on examination papanicolau: implications for the health of the woman / Representaciones Sociales de mujeres amazônidas sobre el examen papanicolau: implicaciones para la salud de la mujer

Esta pesquisa tem como objetivos descrever as representações sociais de mulheres amazônidas sobre o exame Papanicolau e analisar as implicações desta para o cuidado de si mesmas. Trata-se de um estudo qualitativo-exploratório com o uso da Teoriadas representações sociais. A coleta de dados foi realizada no período de janeiro a dezembro de 2007, com o emprego de duas técnicas: a entrevista semi-estruturada com perguntas abertas e a observação livre. Para a interpretação desses dados foiutilizada a técnica de análise de conteúdo temático. A pesquisa teve como resultado três unidades temáticas, assim denominadas: O exame Papanicolau - um cuidado com a saúde da mulher; Tabus e crenças sobre o exame Papanicolau; e Uma prática de cuidado de si mesma: o exame Papanicolau. No estudo observamos que as mulheres temem muito ter câncer cérvico-uterino e, por esse motivo, representam o exame Papanicolau como uma prática de cuidado de si mesma.

This research has as objective to describe the social representations of women amazônidas on the Papanicolauexamination and to analyze the implications of this for the samecare of itself. One is about a qualitative-exploratório study with the use of the Theory of the social representations. The collection of data was carried through in the period from January through December of 2007, with the use of two techniques: the interviewhalf-structuralized with open questions and the free comment. For the interpretation of these data the technique of analysis of thematic content was used. The research had as a result, three thematic units, thus called: The Papanicolau examination - a carewith the health of the woman; Taboos and beliefs on the Papanicolau examination; and practical One of same care of itself: the Papanicolau examination. In the study we observe that the women are afraid of having uterine neoplasm for this reason, the Papanicolau examination represents a practical care of itself.

Esta investigación tiene como objetivos describir las representaciones sociales de mujeres amazônidas sobre elexamen Papanicolau y analizar las implicaciones de esta para el cuidado de sí misma. Se trata de un estudio cualitativoexploratorio con el uso de la Teoría de las representaciones sociales. La colecta de dados fue realizada en el periodo de enero a diciembre de 2007, con el empleo de dos técnicas: laentrevista semi-estructurada con preguntas abiertas y la observación libre. Para la interpretación de esos dados fue utilizada la técnica de análisis de contenido temático. La investigación tuvo como resultado tres unidades temáticas, así denominadas: El examen Papanicolau - un cuidado con la salud de la mujer; Tabúes y creencias sobre el examen Papanicolau; y el Una práctica de cuidado de sí misma: el examen Papanicolau. En el estudio observamos que las mujeres temen mucho tener cáncer cérvico-uterino y, por ese motivo,representan el examen Papanicolau como una práctica de cuidado de sí misma.

Potentialities in integral care: uterine cervical cancer prevention according to the users of the family health strategy

This study aimed to analyze the integral care in the uterine cervical cancer prevention practices in the conception of users of the Family Health Strategy through an exploratory and descriptive research with a qualitative approach. A total of 14 users who performed the Pap smear in December 2002 in four Family Health Units affiliated to Higher Education institutions were selected for the study. Data were collected between April and June 2003. We found that the users analyze and assess the praxis by issuing a value judgment about the care they receive, mainly in terms of light (relational) technologies. Concluding, humanized practices provided by professional/team favor integral care, strengthening the bond between users and health services, as well as health promotion.

El objetivo de este estudio fue analizar la atención integral dentro de las prácticas de prevención de cáncer de cuello uterino bajo la concepción de las usuarias de la Estrategia Salud de la Familia. Investigación de tipo exploratorio y descriptivo con enfoque cualitativo. Fueron seleccionadas catorce usuarias quienes realizaron el examen de Papanicolao durante el mes de diciembre de 2002, en cuatro Servicios de Salud de la Familia vinculados a Instituciones de Enseñanza Superior. La recolección de datos fue realizados entre abril y junio de 2003. Los resultados demuestran que las usuarias analizan y evalúan la atención recibida formando su opinión, en especial, con relación a las tecnologías leves (de relación). Se concluye que las prácticas humanizadas con responsabilidad profesional/equipo favorecen al cuidado integral, fortaleciendo el vínculo entre las usuarias con los servicios y la promoción de la salud.

O objetivo deste estudo foi analisar o atendimento integral nas práticas de prevenção do câncer do colo do útero na concepção de usuárias da Estratégia Saúde da Família. Foi realizada pesquisa exploratória e descritiva com abordagem qualitativa dos dados. Foram selecionadas quatorze usuárias que realizaram o exame Papanicolaou no mês de dezembro de 2002 em quatro Unidades de Saúde da Família, vinculadas a instituições de nível superior. Os dados foram coletados no período de abril a junho de 2003. Como resultado foi observado que as usuárias analisam e avaliam a práxis emitindo juízo de valor à assistência recebida, principalmente, no que se refere às tecnologias leves (relacionais). Conclui-se que práticas humanizadas com responsabilização profissional/equipe favorecem cuidado integral fortalecendo o vínculo das usuárias com os serviços de saúde e a promoção da saúde.

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.

Factores pronóstico en el carcinoma endometrial / Prognosis factors in endometrial carcinoma

Se analizan los diversos factores pronóstico en el carcinoma de endometrio y su valor predictivo en la progresión de esta enfermedad (AU)

[Palliative treatment in gynecologic cancer]. / Palliativ behandling ved gynekologisk kreft.

BACKGROUND: Data on the need for palliative care related to disease groups are very limited. MATERIAL AND METHODS: A retrospective analysis was performed on the hospital records of 228 patients who died from gynaecologic cancer during the 1988-1997 period. RESULTS: 76% of deaths took place in hospital; 12% at home. Median terminal hospital stay was 13 days. Symptoms from intestinal obstruction were dominating in 30% of cases and most frequently seen in patients with ovarian cancer. Palliative intestinal surgery was performed in 38% of patients with ovarian cancer, median survival being 5 months (range 10 days-7 years), perioperative mortality (within 30 days) 13%. Cachexia dominated in 27% and was more often present when death occurred at home. Assistance from a gastroenterologic surgeon, urologist, haematologist or anaesthesiologist was needed in 32% of cases. One in two patients received parenteral pain relief in the terminal phase, for a median period of five days. Palliative radiotherapy was given 21% of the patients, most often in cervical and endometrial cancer, and chemotherapy or hormonal therapy was used in 36%. Minor interventions like laparocentesis, pleurocentesis, tumour resections, and various forms of urinary deviations were frequent. INTERPRETATION: Hospital deaths are more common among patients suffering from gynaecologic cancer than among cancer patients in general (55% in Norway), and the need for multimodal hospital service is large. We see substantial benefits in the Norwegian model in which a gynaecologist experienced in oncology has comprehensive responsibility for the treatment, supported by other specialists and the primary health service.

[Ethical decision models in nursing and medicine]. / Ethische Entscheidungsmodelle in Pflege und Medizin.

A literature review on ethical decision making models shows that there is a great number of monodisciplinary ethical models in nursing and in medicine and new ones are constantly being developed. It is, however, to be questioned if by using these models divergent possibilities and consequences arise for practice. To answer this question this article deals with two selected models in ethical decision making. The model by Illhardt (1998) derives from a physician's viewpoint and understanding. The procedure from Tschudin (1996) was developed on the background of nursing. The practical application of these two models in this case study shows common ground as well as differences and interrelated effects on the decision making process. In relation to this case study the development of specific ethical decision making models for nursing is therefore questionable, most of all if an interdisciplinary implementation is the actual aim.

Uterine myomas: treatment options.

Myomas (also called fibroids) are the most common solid pelvic tumors. Treatment options for myomas include medical and surgical management. The goals of medical management are to shrink the myoma and reduce its blood supply. Surgical interventions include therapies for women who wish to preserve fertility or retain their uterus. Newer treatment options include myomectomy achieved through an abdominal, laparoscopic, or hysteroscopic approach. Nurses assess and counsel women regarding treatment options.

Intraoperative molar pregnancy crisis.

Molar pregnancy is a gestation in which the ovum is transformed into a fleshy tumor mass or mole. Of all gynecologic tumors, it is one of the most feared. It is characterized by first trimester bleeding, hyperemesis, and toxemia and can be diagnosed using pelvic ultrasound. Suction currettage is the treatment of choice for molar pregnancy when a patient desires to have more children; however, hysterectomy may be necessary. Abdominal hysterectomy reduces the risk of malignant sequelae. Complications associated with molar pregnancy usually are a result of suction curettage and include pulmonary insufficiency syndrome, choriocarcinoma, hyperthyroidism, theca lutein cysts, and disseminated intravascular coagulation. The perioperative nurse can be instrumental in assessing, planning, organizing, and directing intervention for potential complications associated with the management of a molar pregnancy crisis. The perioperative nurse is encouraged to review all aspects of molar pregnancy to understand the ramifications of the surgical procedures.