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.

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.

Preoperative teaching and hysterectomy outcomes

This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

Beliefs and perceptions of African American women who have had hysterectomy

This study used a qualitative, ethno-nursing, ethnographic design to identify cultural beliefs within the African American community related to hysterectomy. Three themes were derived from interviews with 30 women: African American cultural myths, fears, and sexual symbolism related to hysterectomy; benefits of hysterectomy that included freedom from pain and public embarrassment and freedom from risk of pregnancy; and improved self-esteem and sexuality. Results of this study indicate that there are negative connotations of hysterectomy in the African American community, which may cause some African American women to delay the procedure until they have no choice. Education and knowledge of cultural beliefs will enable health care providers to provide culturally sensitive and comprehensive care to African American women; it also will enable health care providers to instruct African American women to avoid unnecessary delay of hysterectomy.

An evidence-based approach to managing women's decisional conflict

Women who face difficult health decisions are likely to experience decisional conflict. To date, women have been supported in their decision making through informal counseling and client education. The Ottawa Decision Support Framework guides practitioners in assessing decision-making needs in clinical practice, providing support for client decision making, and evaluating the effectiveness of their interventions. Several evidence-based decision support tools were derived from this framework, including practitioner-administered and client self-administered decision guides, condition-specific decision aids, and the Decisional Conflict Scale.

Sexuality after hysterectomy

OBJECTIVE

To review the literature regarding sexuality after hysterectomy and identify areas for future research.

DATA SOURCES

Articles published between 1970 and 2000 on sexuality and hysterectomy were located using MEDLINE, CINAHL, Psychlit, and Sociofile databases.

STUDY SELECTION

English language research dealing with the topic was reviewed.

DATA EXTRACTION

Study findings were categorized and include studies of the effect of hysterectomy on sexuality, women's perspectives on hysterectomy, and information sharing with women prior to surgery.

DATA SYNTHESIS

A number of studies have explored sexuality after hysterectomy. Many of these studies have methodologic flaws, including vague measures of sexual satisfaction and potential for recall bias. A major source of bias is that the first measure of sexual satisfaction/functioning was performed in the immediate preoperative period when symptoms are more likely to affect sexual functioning.

CONCLUSIONS

There are a number of gaps in the knowledge base pertaining to this topic. Future research in this area is needed to provide direction for nurses in the clinical area. Topics for future research include what women and their partners want to know about sexuality following hysterectomy and the most efficient methods to provide them with this information. In addition, sexuality in premorbid women needs to be more fully described.

Women's decision making regarding hysterectomy

OBJECTIVE

To describe the decision-making process of women who choose hysterectomy for treatment of benign disease or distressing symptoms.

DESIGN

Qualitative design based on grounded theory, using semistructured interviews.

SETTING

Participants were interviewed in their homes or at their place of employment.

PARTICIPANTS

Ten women who were premenopausal prior to hysterectomy.

RESULTS

Decision making began when the women recognized abnormal body changes or bothersome symptoms. Four major processes were identified. "Seeking Solutions" was characterized by information seeking, information processing, and utilization of pharmacologic and nonpharmacologic treatments in an attempt to cure the disease and/or alleviate symptoms. "Holding On" included managing symptoms, rearranging activities of daily living to accommodate symptoms, and waiting. "Changing Course" was characterized by an abrupt change from Holding On to focusing on hysterectomy as the solution to the distressing symptoms. During "Taking Charge," the women displayed purposeful actions directed at arranging and preparing for surgery.

CONCLUSIONS

Understanding the process of decision making will enable nurses to provide support for women who choose hysterectomy for treatment of benign gynecologic diseases and/or distressing gynecologic symptoms. Nurses' support of women's decision making should include referrals, education, and emotional support. In addition, nurses can help these women improve their quality of life by assisting them with symptom management.

Symptom experience in women after hysterectomy

OBJECTIVE

To review the literature addressing the symptom experience of women after hysterectomy.

DATA SOURCES

Computerized searches in MEDLINE and CINAHL, as well as texts and references cited in articles. Key concepts in the searches included hysterectomy, sleep disturbance and pain, hysterectomy and fatigue, hysterectomy, depression, and depressed mood.

STUDY SELECTION

Articles and comprehensive works relevant to key concepts and published after 1970, with an emphasis on new findings from 1990 to 2000. Sixty-four citations were identified as useful to this review.

DATA EXTRACTION

Data were organized under the following headings: women and hysterectomy, biopsychosocial perspectives, common symptoms after hysterectomy (pain, disturbed sleep, fatigue, depressed mood, anxiety), and significance of review (implications).

DATA SYNTHESIS

Literature suggests that after a hysterectomy, women experience complications during the postoperative recovery period that may vary with the type of surgical procedure. During this period, the quantity and quality of sleep as well as other symptoms (pain, fatigue, anxiety, and depression) are influenced by various physiologic, psychologic, and social factors. Despite limited evidence that sleep problems may occur frequently during the recovery period, only a few researchers have systematically examined sleep patterns in women after hysterectomy. None of these studies, however, used objective sleep measures or examined multiple dimensions of these women's lives.

CONCLUSIONS

This review conceptualized the women's symptom experience as the experience of specific symptoms (pain, sleep disturbance, fatigue, depressed mood, and anxiety) that were influenced by biopsychosocial factors.

An analysis of perioperative care

Perioperative nursing requires an appreciation of patients' needs throughout the episode of care. This article presents a critical analysis and examination of the perioperative care of a patient undergoing total abdominal hysterectomy. In addition to analysing the efficacy of care delivery in the perioperative setting, we will explore the application of nursing theory and research to everyday practice and the degree to which a hospital's infrastructure facilitates quality care.

Hysterectomy

Hysterectomy is often thought of as a last resort, but it is a common operation and there are many reasons why it is carried out. The author looks at these and discusses the different surgical procedures and nursing care for patients undergoing hysterectomy.

Hysterectomy: what do women need and want to know?

OBJECTIVE

The purpose of this article is to describe women's experiences of hysterectomy and to identify their fears, concerns, and met as well as unmet health care needs.

DESIGN

Narrative data of women's hysterectomy experiences were collected via a written survey.

SETTING

Data were collected from women living in southeastern Wisconsin.

PARTICIPANTS

Participants were 102 women who had undergone hysterectomy within the previous 2 years. The mean age of the women was 43 and mean time since hysterectomy was 13 months. Eighty percent of the women had undergone both hysterectomy and oophorectomy, and 78% were taking hormone replacement therapy.

MAIN OUTCOME MEASURES

A questionnaire of women's hysterectomy needs and a demographic questionnaire were used to collect data via mail. The data from three open-ended questions were content analyzed.

RESULTS

Seven themes about women's experiences of hysterectomy were identified: (a) positive aspects, (b) hormone replacement therapy, (c) insufficient information, (d) changes in sexual feelings and functioning, (e) emotional support, (f) psychologic sequelae, and (g) feelings of loss.

CONCLUSIONS

Women wanted treatment choices, a part in decision-making, accurate and useful information at an appropriate time, provider support, and access to professional and lay support systems. The essentials for hysterectomy care are outlined and include the characteristics of care that women desire, the informational content that women want, health care systems that support patient satisfaction, and the outcomes women want.

The healing process, the road to recovery and positive mental health

This paper is designed to explore and examine the experience of loss following a hysterectomy. The painful aftermath of the ordeal and the work involved in the healing process are outlined and discussed from both a personal and professional perspective. The manuscript highlights a number of inner struggles that had to negotiated before an equilibrium in mental health and wellbeing was successfully achieved. The forces that move the dialogue forward from one theme to the other are complex in their simplicity. The enigmatic dimensions of physical pain and emotional torment are expressed and worked through in a sensitive and intimate manner. The mysteries of internalized, conflicting messages on socialization issues, such as gender roles and living in and identifying with only one culture are discussed and debated. In addition, the disharmony between spiritual ideals, the meaning and purpose of life, the process of self-actualizing and the physical realities involved in living are identified and elaborated upon. Embroidered within the tapestry of the text is the need to revisit the curriculum for the education and training of mental health nurses to enhance the quality and provision of effective, humane and therapeutic nursing care.

The quality and management of written information presented to women undergoing hysterectomy

A study of a random sample of hospitals in England that provide information leaflets for women undergoing hysterectomy indicates a large variation in quality. In general, the findings reveal that written information for patients is given a relatively low priority. Production and dissemination of information for hysterectomy patients is somewhat ad hoc. It is not clear that any evaluation of the leaflets has been conducted to prove the efficacy of the available literature. While the majority of leaflets include information deemed essential by past hysterectomy patients, the presentation of the recovery process often implies no control for the patient, and conceives normality with a narrow perspective about what healthy behaviour means for women. The provision of a specific timetable for resumption of housework duties in 65% of the leaflets is a case in point. On the basis of the results of the survey, recommendations are made concerning the improvement of the standard of patient information leaflets.

Early discharge schemes for hysterectomy patients

This review looks at the needs of hysterectomy patients discharged early from hospital. The author explores the concept of early discharge schemes and evaluates whether they can be safe, cost effective and provide quality care. Reflection on these factors suggests that an early discharge scheme could be a way to provide choice, and fulfill expectations of quality, holistic care and cost effectiveness, while allowing the nurse to work as an expert practitioner.

The hysterectomy experience: an ethnographic study

Women who undergo a hysterectomy typically experience preoperative symptoms that severely affect quality of life. The purpose of this study was to understand the hysterectomy experience from the informants' perspective. The research design chosen was ethnography. Research aims included (a) describing the quality of life before hysterectomy, (b) understanding the decision-making process involved in having a hysterectomy, (c) describing the knowledge base women have about hysterectomies, (d) describing concerns and fears about hysterectomies, (e) making comparisons before and 3 months after the hysterectomy, and (f) discovering what advice women give each other about hysterectomies. Ethnographic interviews were conducted and analyzed according to the Spradley method. The informants provided researchers with valuable advice for professionals caring for women who elect to undergo a hysterectomy.

Attitudes and knowledge about hysterectomy: a study of women in Mmabtho

Thirty women aged 18 to 50 years (mean age = 28) completed a questionnaire measuring attitudes and knowledge about hysterectomy. The results showed that almost 60 percent of the respondents lacked knowledge about the procedure and that educational level made no significant difference to knowledge about hysterectomy. The data also indicated that many respondents were uncertain about hysterectomy. Analysis of the reasons given for their attitudes showed that many women held unfounded fears about the procedure. It is recommended that efforts be made to change the negative perception of hysterectomy.

Using Orem's Model

My actual knowledge of care plans and nursing models was non-existent until my conversion course to RGN in 1989. I found it difficult to grasp and at times a paper exercise. A care plan should be used as a link between the outpatient's nurse and ward nurses involved with the patient's primary care and the personnel in theatre responsible for the patient. The purpose of nursing documentation is to show that care has been planned for each individual patient; to inform nursing staff and others involved in delivering care; to record changes in the patient's condition or care; to maintain continuity of care.

Home visiting for a posthysterectomy population

There are many valid indications for providing home visits to posthysterectomy clients. In-home assessment of the client's status permits immediate care or referrals and saves unnecessary acute care visits to emergency rooms and physicians' offices. Nursing interventions have identified holistic healthcare needs and prevented other problems from developing. Assisting the clients in developing their problem-solving abilities enhances the goal of return to self-care during the immediate postoperative follow-up and afterward. Finally, the vital role the clinical nurse specialists can play in the healthcare system is more clearly established for these consumers of care.

Development of a postoperative self-assessment form

This paper describes a patient self-assessment form developed for use in a research study examining early discharge and transitional nursing follow-up care for women with abdominal hysterectomy. Transitional care nursing involves preparation for an early discharge from the hospital and nursing follow-up for convalescence at home through an 8-week recovery period. The goal of transitional care is to assist the client in regaining her preoperative level of self-care. This article will include a brief overview of the ongoing research study, a description of the role of the clinical nurse specialist (CNS) in transitional care, and the use of the self-assessment form. The form is applicable to numerous clinical settings.

Laparoscopic hysterectomy

1. Laparoscopic hysterectomy obviates the need to create a traditional large abdominal incision. Through the laparoscope, surgical steps similar to those of a traditional abdominal hysterectomy are done prior to removal of the uterus via the vagina. 2. The dramatic improvement in postoperative recuperation in laparoscopic hysterectomy is the result of several factors: avoidance of laparotomy incision; minimal degree of traumatized and devitalized tissue as finer instrumentation is used; minimal use of suture material, reducing the chance of tissue reaction; and avoidance of postoperative bowel function compromise. 3. In the long run, laparoscopic hysterectomy will not replace all traditional abdominal and vaginal hysterectomies. Not all hysterectomies are candidates for laparoscopic surgery, such as patients with large pelvic masses or marked distortion of the anatomy due to various disease processes (ie, cancer).

A comprehensive education and support program for women experiencing hysterectomies

Women undergoing hysterectomies require special education and emotional support. A new comprehensive program of nursing interventions helps assist women in coping with hysterectomies. Nurses, combining their skills in gynecologic and mental-health nursing, conduct presurgery classes, provide information and support during hospitalization, and offer a postdischarge support group to hysterectomy patients. This article includes descriptions of the program's development process, class content, and ways in which continuity of care is provided.