The emotional work of caring, with a focus on gynaecological nursing

In this paper the author briefly reviews the concept of caring. Emphasis is given to the emotional component and its management in caring relationships. This is illustrated with reference to a study of gynaecological nursing. Analysis of nurses' perceptions and experiences revealed situations particularly relevant to empathy and emotional work in caring for gynaecological patients.

[Testing a screening strategy for identifying psychosomatic patients in gynecologic practice]

In a pilot-study 103 gynecological outpatients answered a gynecological questionnaire (FGB) including items of the (non-gynecological) complaints questionnaire (GBB) and a mood questionnaire (BSF). Cluster analyses of the FGB- and BSF-scores identify four groups. One group, consisting of 26 outpatients (= 25%), has as high GBB- and BSF-scores as a group of 256 psychosomatic in-patients answering these questionnaires at the beginning of their psychosomatic therapy. These 26 outpatients are labeled as high risk patients. Further results show high correlations between all FGB- and GBB-scores among the gynecological outpatients. A significant connection between the four group classification and ten biopsychosocial variables is found only for the variable professional state. The results are seen as a first confirmation of the tested screening-strategy. Moreover they give evidence that further investigations should pay more attention to the connection between job strain and gynecological complaints or disorders.

[Report of experiences in psychological consultation in a gynecologic clinic]

Potential and limits of psychotherapeutic practice in a general hospital. It is a known fact that psychological care of women in general hospitals is limited. The limits are defined by the way hospitals are run and the way people interact. In fact, psychological and medical treatment should be considered equally effective tools for achieving optimum results. However, the old boundaries are falling and the system is changing. Whenever people come together, with their different views of reality and different ideas of how best to cope with it, there is a potential for discussion. In the hospital context, these different viewpoints often clash. In spite of these limitations, psychological practice in a hospital is often not only feasible, but necessary. It is often effective in crisis intervention as well. Even in relatively brief psychotherapeutic encounters, proper methods used in a sensitive manner can bring about changes at deeper emotional levels. Women need this additional therapy. In the context under study here, psychotherapy should not be limited to either behaviour therapy or longer-term procedures. Another cooperative model involving both physician and psychotherapist is discussed, a model our laws, and society at large, have not yet given due support.

Social support and adherence behavior among women with abnormal Pap smears

BACKGROUND

Studies of hypertension, diabetes, and diet have indicated a relationship between social support and adherence to treatment regimens. Estimates of nonadherence following abnormal Pap test results range as high as 40%. In this study, the relationship between social support and adherence behavior was examined in a population of low-income, public-health-department patients with abnormal Pap smears.

METHODS

Medical record reviews ascertained adherence behavior and interviews determined receipt of social support for 498 women.

RESULTS

Related to adherence were: receipt of any social support; receipt of each of three types of support (informational, emotional, and tangible support); amount of support received; satisfaction with support; and source of support. Reported need for support was not related to adherence behavior. Receipt of social support was more strongly related to adherence when the woman's emotional response to the notification of the abnormal Pap smear was greater, and when acculturation was higher (among Latinas). Knowledge of the results of the Pap test was found to be an intervening variable between receipt of informational support and adherence. Knowledge of the purpose of the Pap smear was found to be independently related to adherence. Among black women, emotional support was most strongly related to adherence, while among Latinas, tangible support was most strongly related to adherence. In a multivariate model, Pap-test knowledge and the interaction between emotional response and receipt of any social support were significantly related to adherence.

CONCLUSIONS

Findings suggest that supportive interventions, including provision of medical information, emotional support, child care, and transportation, could help to reduce nonadherence.

Psychosexual gynecology

The psychosexual health of the female patient not only is affected by her overall gynecologic well-being but also may be greatly influenced by cultural myths and attitudes, psychological health, and social support. For primary care physicians to incorporate the psychosexual issues of a woman into her overall medical care, there must exist a sensitivity to the patient's needs, an atmosphere for open discussion regarding sexual and psychological concerns, an office staff to provide appropriate medical support, and the availability of experienced specialists in cases in which referral is necessary. The quality of the physician-patient interaction as well as the degree of empathy shown to women with gynecologic problems may exacerbate or improve psychosexual outcomes.

[Gynecological-obstetrical psychosomatics (theoretical and practical considerations on education)]

Theoretical concepts of psychosomatics are presented in the first section with special emphasis on psychosomatics in gynecology and obstetrics. In the second part, some examples are presented to demonstrate the realization of psychosomatic thinking in the setting of a university clinic. Arising difficulties are discussed.

[The emotive and cognitive reactions in temporary pharmacological menopause]

The authors have attempted to evaluate the extent to which menopausal crisis is linked to hypoestrogenism and the extent to which it is linked to the socioenvironmental context in which it takes place. The study analyses emotional and cognitive aspects in a group of women in temporary menopause which was pharmacologically induced for therapeutic purposes. The study was carried out in 30 patients suffering from benign gynecological pathologies receiving ovarian steroidogenesis-blocking treatment. Treatment consisted of a subcutaneous administration of a Gn-Rh analog every 28 days for 6 months. After having collected information regarding the symptoms that appeared following the administration of therapy, the authors evaluated the emotive (anxiety and depression) and cognitive (short-term memory and concentration) conditions of patients using psychometric reactives performed during the first check-up, and then repeated at the 3rd, 5th and 7th control visit: the State-Trait-Anxiety-Inventory to assess trait anxiety and state anxiety; scale D of the Minnesota Multiphasic Personality Inventory to assess depression; the sub-test for memory of figures from Wechsler-Bellevue Intelligence Scale to evaluate short-term memory; the Toulouse-Pieron reactive to evaluate attention and concentration. The results obtained were analysed statistically using Student's t-test and Pearson's coefficient. An analysis of the data shows that, after the first doses of the drug stress trends to diminish from the high levels recorded at the first visit, stabilising at normal values throughout treatment. Like anxiety and depression, concentration and memory do not show marked variations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Psychological consultation at a gynecologic clinic--a luxury or a necessity?]

The necessity for an integrated psychological care is proven by the example of the Psychological Ambulance in the University of Freiburg Women's Hospital. In 1993 387 out- or inpatients contacted the psychologist, mainly out of their own initiative. 819 consultations, each lasting for at least 45 minutes, were registered. Parameters influencing acceptance and implementation were as follows: formal qualification as well as medical and psychological competence of the staff; cooperation with the hospital physicians and other institutions providing psychosocial care. We found that further important is the integration within the hospital facilitated by the consultation-model plus the longterm perspective of the ambulance and its staff. Additional promotion of acceptance was generated by the informal recommendations among patients.

[Expert assessment of gynecologic diseases]

Medical reports in Gynecology have to consider the evaluation of organic diagnosis as well as connected psychical disorders. It has to be examined if psychical insults have led to dysfunction in the genital system. A typical example is hypothalamic amenorrhea as a sequel of extreme stress or chance of surroundings. Frequent lesions in the urinary system due to endometriosis, change of site, tumours and chronic inflammation of the female genital system often require a urological as well as a gynecological examination. Severity and duration of complaint, tendency to recur and the necessity of clinical treatment are essential factors in the assessment of the degree of disability. Examples of medical reports are shown and the limits of modified professional discretion are pointed out.

[An consultation concept for integrating psychosomatic medicine in gynecology]

This paper is meant to survey the results of an interdisciplinary concept of psychosomatic patient treatment carried out for two years at the Department of Gynaecology and Obstetrics of the University of Cologne. This integral programme offers a psychosomatic consultation hour taking place once a week at the Department of Gynaecology and Obstetrics. Each first consultation is attended both by a psychosomatic specialist and a gynaecologist. The hypothesis underlying this new programme, which supposes that the integration of the psychosomatic treatment into the everyday routine of the clinic would make it easier for the patients to find access to psychological help, has proved right in view of the experience made so far. In comparison to the former counselling concept, the newly established gynaecologic-psychosomatical programme has increased the attendance by 300%. Thanks to the integrated consultation hour the way of seeing gynaecological problems in a psychosomatic context has increased considerably within the clinic itself so that these problems can now often be solved directly between gynaecologist and patient without making use of the offered consultation hour. Experiences made so far prove that the psychosomatic consultation hours are a valuable contribution to the diagnostic and therapeutic spectrum of the Department of Gynaecology and Obstetrics.

Correlates of alcohol-related problems in African-American and white gynecologic patients

The purpose of this study was to assess racial differences in the risk of alcohol-related problems associated with alcohol consumption, regular psychoactive drug use, a family history of alcohol-related problems, sociodemographic factors (age and education), and social roles (work, marital, and parental) among nonabstaining African-American and White gynecologic outpatients. In addition, work, marital, and parental roles were investigated to determine whether they mediated or explained racial differences observed in relationships between these factors and alcohol-related problems. Respondents were 630 African-American women and 769 White women aged 13-77 who were systematically sampled from three obstetric/gynecologic clinics and two private practices in Erie County, New York. Hierarchical multiple regression analysis was used to test the significance of main effects of these factors on alcohol-related problems, to test the interactive effects of race with each factor, and to test the interactive effects of social roles with alcohol consumption, the only factor for which a racial difference was observed in its relationship with alcohol-related problems. Overall, results indicated that correlates of alcohol-related problems were similar for African-American and White women. Higher risk of alcohol-related problems was associated with lower levels of education and lack of work and parental roles. In addition, married women who drank heavily were at higher risk of alcohol-related women who drank heavily were at higher risk of alcohol-related problems than unmarried women who drank heavily.(ABSTRACT TRUNCATED AT 250 WORDS)

Reproductive health, use of estrogen and experience of symptoms in perimenopausal women: a population-based study

OBJECTIVE

The aim of the study was to examine reproductive health, use of estrogen, lifestyle, experience of menopausal symptoms and work-role related issues in a population-based sample of perimenopausal women.

METHODS

All women aged 48 years and residing in the catchment area of the Karolinska Hospital were recruited through the Swedish population register. They received a questionnaire covering sociodemographic background, reproductive health and gynaecological characteristics, social and work role related issues as well as a symptom rating scale.

RESULTS

Seventy percent of the women returned the questionnaire. Of these, 73% were premenopausal, 21% were postmenopausal and 6% were perimenopausal. Hormone replacement therapy was used by 7.5% of the respondents and the rate of hysterectomy was 8.6%. Regular exercise was reported by 44.4%. Factor analysis of the symptom ratings yielded four independent dimensions: Negative Moods, Vasomotor symptoms, Decreased Sexual Desire and Well-being. Multiple regression analyses showed that only vasomotor symptoms were significantly related to menopausal status. Negative Mood and Reduced Sexual Interest were better explained by the presence of vasomotor symptoms and by reproductive health and lifestyle variables such as current or previous PMS, dysmenorrhea, smoking and lack of exercise.

CONCLUSIONS

Only vasomotor symptoms were significantly related to menopausal status. Psychosocial and lifestyle variables as well as past or current reproductive health are more important determinants of women's psychological well-being during transition to menopause than menopausal status.