Hysterectomy: What Do Women Need And Want To Know? - Brief Article

AORN Journal, Dec, 2000 by Rosie Lee Calvin, P. Renee Williams

HYSTERECTOMY: WHAT DO WOMEN NEED AND WANT TO KNOW? J Wade et al Journal of Obstetric, Gynecologic, and Neonatal Nursing Vol 29 (January/February 2000) 33-42

Hysterectomies are one of the most common surgical procedures women undergo in the United States, so the nursing community should explore both the physiological and psychosocial effects of this procedure using a variety of methodologies (ie, qualitative, quantitative, delphi). This qualitative study examined women's personal hysterectomy experiences to discover possible fears, concerns, or education needs they believe were not addressed adequately.

Design and sample. The study design was a written survey used to collect narrative data of women's hysterectomy experiences. Of 200 women from southeastern Wisconsin that received the survey, 181 (91%) returned it. The women's mean age was 43, heritage was 90% European-American, and 63% were married or living with a partner. More than 80% were college prepared, and 94% were employed.

Method. Researchers conducted a thematic content analysis of demographic data and written responses from 102 women. Women were asked three open-ended questions.

* Overall, how would you describe your hysterectomy experience?

* What fears, concerns, or questions related to your hysterectomy do you still have?

* How could your educational needs regarding your hysterectomy have been better met or served?

Researchers recognized that collecting cross-sectional data in one community from a homogenous sample and the fact that women's experiential descriptions required recall were limitations of the study.

Results. Researchers discovered seven themes demonstrating similarities and differences among the participants. One theme, positive aspects, demonstrated that 61 women received relief from troublesome symptoms, received good information and support from their providers, and actively participated in decision making.

Another theme, hormone replacement therapy (HRT), showed that 45 of 77 women receiving HRT were fearful and concerned due to a lack of information and participation in decision making. Some also thought their health care provider did not conduct adequate follow-up care or monitoring after prescribing HRT.

A third theme, insufficient information, showed that 38 of participants thought they received insufficient information about hysterectomy, their own anatomy and physiology, and menopause. These women wanted current literature, books, articles, or videotapes.

Sexual concerns, yet another theme, showed that 20 participants thought the health care system lacked a structure for providing emotional support throughout the hysterectomy experience. These women wanted prehysterectomy and posthysterectomy support groups, a hotline for questions, and opportunities for interpersonal female discussion.

Psychologic sequelae and feelings of loss, another theme, demonstrated that 17 women experienced psychological distress associated with hysterectomy, ranging from mood swings to one instance of clinical depression. A small number of women of childbearing age reported feelings of grief and loss. Changes in femininity, body image, and issues related to infertility also were mentioned by respondents.

Discussion. Researchers reported the most common themes among participants included a need for accurate and realistic information before and after surgery; provider support; and access to adequate resource systems related to positive aspects of hysterectomy. Many women experienced difficulty obtaining information and support, although the demographic characteristics suggested that they were positioned to obtain the information and services needed.

Future research should include women from diverse ethnic groups and socially disadvantaged women living in remote areas. Women's health care delivery systems and organizational structures also should be researched in depth.

Based on the results of this study, perioperative nurses practicing in surgical suites, delivery suites, and women's centers need to provide adequate preoperative and postoperative surgical information, as well as organized support systems for women undergoing hysterectomies or other major life-changing surgeries. Providing open and accessible relationships that encourage inclusive decision-making with patients will contribute to an uneventful intraoperative experience and an overall positive patient outcome.

ROSIE LEE CALVIN RN, DNS NURSING RESEARCH COMMITTEE 1998-2000

P. RENEE WILLIAMS RN, MSN, CCE DIRECTOR OF CONTINUING EDUCATION UNIVERSITY OF MISSISSIPPI MEDICAL CENTER SCHOOL OF NURSING JACKSON, MISS