Rosemary T. Theroux

Graduate students' experiences with standardized patients as adjuncts for teaching pelvic examinations

Purpose: To explore graduate nurse practitioner students’ perceptions of their experiences when learning to perform pelvic examinations in the laboratory and performing them in subsequent clinical rotations. One group was taught by faculty with voluntary peer examination, and the other two groups were taught by standardized patients (SPs). Data sources: Surveys with open‐ and closed‐ended (responses on Likert scales) items administered twice during 3 consecutive years to students enrolled in an advanced health assessment course. Conclusions: All groups reported feeling anxious while learning pelvic exam techniques and in subsequent clinical experiences. SPs provided immediate feedback to students, decreased their feelings of anxiety, and increased their confidence in performing examinations. Students who were taught pelvic examination techniques by SPs rated their learning experiences more positively and reported a better understanding of exam techniques than students who learned to perform exams by voluntary examination of classmates. Implications for practice: Graduate nursing programs should consider locating and using SP programs for teaching pelvic examinations in advanced health assessment courses. Although more cost‐effective, voluntary peer examination was a less effective teaching method.

Women's Decision Making About the Use of Hormonal and Nonhormonal Remedies for the Menopausal Transition

OBJECTIVE To critically review qualitative research on womens decision making about the use of hormonal and nonhormonal remedies for the menopausal transition. DATA SOURCES Computerized searches in CINAHL, MEDLINE, Medscape, and PsychINFO databases, using the keywords decision making, hormone therapy, herbal remedies, attitude toward hormone therapy, and qualitative research; and ancestral bibliographies. STUDY SELECTION Articles from indexed journals from 1982 to 2001 in the English language relevant to the keywords were evaluated. Sixteen studies met inclusion criteria and were included in the analysis. DATA EXTRACTION Study findings were organized into several categories and compared and contrasted across publications and categories. DATA SYNTHESIS Half of the researchers described decision making as a weighing of benefits and risks. Womens considerations, beliefs, and values, as well as interaction with the environment, were primary influences on the process. CONCLUSIONS Major gaps in care for midlife women were identified. Women need information about the process of menopause and the range of available options for menopause management. Nurses can play a major role in providing information, counseling, and developing decision aids. Womens values and beliefs, cultures, life contexts, and desire for involvement in the decision should guide interventions.

Next-of-kin's perspectives of end-of-life care

The purpose of this article was to describe the next-of-kins perspective of the end-of-life (EOL) experiences associated with the death of a family member or close friend. The quality of EOL care from the next-of-kins perspective given to their loved one needs further study in the context of a community setting focus. A secondary analysis of data from a survey of a random sample of dying experiences in the community setting included qualitative descriptive analysis of open-ended survey data and content analysis used to count the number of positive, negative, mixed, and not applicable responses. Qualitative content analysis of 186 next-of-kin responses revealed two themes: (1) communication and (2) family values and preferences including three subthemes of having a supportive environment to secure a peaceful death with dignity and respect, the desire to be present at the time of death, and attending to the needs and wishes of the dying individual and family. The need for palliative care services in institutionalized settings, continuity of provider care (physician and nurse), family presence, and support for caregiver and financial concerns with hospice services was identified. Communication remains an essential component in all aspects of EOL care with further examination involving the loved ones perspectives.

Women's decision making during the menopausal transition

Purpose: To describe womens experiences during decision making about hormonal and nonhormonal therapies during the menopausal transition. Data Sources: Transcripts from 21 semi‐structured audio taped interviews with seven peri‐ and postmenopausal women who had a recently visited a nurse practitioner (NP) and were making a decision about menopausal management. Conclusions: Decision making was a nonlinear process in which women considered available options, weighed benefits and risks and likely outcomes. Reevaluation of the decision was ongoing. Both internal and external conditions influenced their decisions. Media reports of findings from the Womens Health Initiative study may have influenced some womens perceptions of the risk of using hormones for symptom relief. Implications for Practice: Women described caring and empowering consultations with the NPs. They appreciated provision of information, adequate time spent at the visit, and decision support. NPs have a critical role to play in providing women with current research findings about hormone therapy and alternatives for symptom relief, and assisting women with understanding risks and benefits of each possible choice. Both individual and group approaches for decision support should be available to women. The approach of a collaborative partnership in decision making is a model that is congruent with nursing practice.

The Hysteroscopic Approach to Sterilization

Permanent sterilization is the most common form of contraception in the United States today. Previously, this was accomplished via the laparoscopic method. A new less invasive method has been developed, in which the Essure microinsert is inserted through a hysteroscope into the fallopian tubes. A subsequent benign inflammatory process results in tubal occlusion within 3 months of insertion. Approved since 2002, this method offers high efficacy without incisions, general anesthesia, or a prolonged recovery period.

Working Hard: Women's Self-Care Practices in Ghana

Womens health care providers have noted an increased infant mortality rate among Ghanaian immigrants. We conducted focus groups with 17 women in Ghana. We asked them how they maintained their health both before and during pregnancy. When discussing their health, women repeatedly described the conditions or context of their daily lives and the traditional practices that they used to stay healthy. Knowledge of womens lives, the health care system that they previously used, and their cultural practices can be utilized by health care providers to more fully assess their patients and design more culturally appropriate care for this group of women.

Factors influencing women's decisions to self-treat vaginal symptoms

Purpose To review the research on womens self‐treatment of vaginal symptoms, describe factors influencing this phenomenon, identify evidence‐based interventions, and suggest strategies for nurse practitioners (NPs) to promote safe and effective self‐treatment decisions by women. Data sources Research articles identified through Medline and CINAHL databases. Conclusions The primary factors influencing womens decisions to self‐treat vaginal symptoms were personal (attitudes, beliefs, values, knowledge and experience, and emotions) and environmental (culture, social networks and norms, media, and life context). Implications for practice Womens self‐diagnostic skills and decision making for self‐treatment can be improved through education and support from NPs. The traditional office visit may not provide an opportunity to teach women appropriate self‐care because many women do not access providers for advice or information. Different methods of providing information to large numbers of women through consumer publications need to be developed and evaluated.

The HPV Vaccine: Rates, Attitudes and Acceptibility

An understanding of the link between HPV and cervical cancer has been found to be limited among the general public.

Caffeine during pregnancy: how much is safe?

Although multiple studies have found a link between caffeine and miscarriage, it has been thought that study fi ndings were skewed by the fact that women with nausea and vomiting would decrease their caffeine consumption as a The safety of caffeine use in pregnancy has been studied since the 1980s. Caffeine readily crosses the placenta; its clearance is prolonged in pregnant women and is metabolized slowly in the fetus as well. It has been thought that caffeine is harmful to the fetus because it stresses the fetus’s immature metabolic system and decreases blood fl ow to the placenta. Caffeine intake has been shown to increase the rate of miscarriage (Weng, Odouli, & Li, 2008). Recently, the question of what constitutes a safe level of caffeine use in pregnancy was examined by two teams of investigators (Savitz, Chan, Herring, Howards, & Hartman, 2008; Weng et al., 2008). Their fi ndings have been widely Recently, the

CommentaryNot Just Another Annual Exam: Thoughts on the Nurse-Patient Relationship

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