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A GROUP OF WOMEN PERCEPTION ABOUT VAGINAL SWAB COLLECTION BY NURSES

Solange Rodrigues da Costa; Camila de Jesus Rocha Marques; Nátia Henrique Cabral

Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória

Av. Nossa Senhora da Penha, 2190, Santa Luiza - Vitória/ES. Brasil

Received on 30 March 2015

Abstract

Objective: To know the perception of patients from a Health Strategy Unit of the city of Vitória Family / ES, regarding the collection of preventive performed by the nurse, with regard to satisfaction, trust and answer questions during the call. Methods: A descriptive qualitative study, performed in a unit of the Health Strategy city of Vitória Family – ES. The sample consisted of 29 women treated by nurses who perform the collection of screening test during the study period. Data collection was conducted through semi-structured interviews. For data analysis we used the thematic analysis of Minayo. Results: This study found that some women even demonstrating some degree of resistance to the collection of preventive performed by the nurse, to go through such an experience, realized the professionalism and the ability of it to exercise this practice competently, thus overcoming all negative perception the performance of this professional. The perception of the patients seen by nurses for preventive collection was positive since the degree of satisfaction, confidence and clarify doubts achieved results that classify the good performance of this professional in their field. Conclusion: hese results provide reflection on the role of nurses in the prevention of cervical cancer as well as in promoting the health of families in their area.

Keywords

Women’s Health; Community Health Nursing; Vaginal Smears

Introduction

Cervical cancer is considered to be a public health issue due to the continuous and sustained number of cases that annually increase because of late diagnosis and, consequently, to the high rate of female morbidity and mortality worldwide. Nurses’ participation on the changing of such scenario motivated the present study. [1]

Cervical cancer incidence is approximately two times higher in less developed countries in comparison to that in developed countries. Except for the non-melanoma skin cancers, this is the second most common tumor in the female population. It just loses position for breast cancer and is the fourth cause of death for cancer among women in Brazil. The country presents estimated risk of 17 cases per 100.000 women. This estimate attains to 340 new cases in the State of Espírito Santo, 40 cases only in Vitória [2].

Improved access to health services and information is fundamental for cervical cancer control and it requires expanding the coverage of and changing health work processes. The broad population access to clear information, consistent and culturally appropriate to each region, should be an initiative from health services at all levels of care. [3]

Cervical cancer has the highest potential for prevention and healing in comparison to other cancers. It may reach approximately 100% cure when early diagnosis is accomplished. The early screening of asymptomatic women through cytopathological analysis allows detecting the precursor lesions and the disease in its early stages, before the symptoms appear; besides, it is a low technological complexity and cost examination. [3]

Nurses’ role in health promotion as well as in cervical cancer primary and secondary prevention is of fundamental importance. The professional can answer patients’ questions at the Nursing consultation and create a friendly environment to the Pap smear test. They can also give orientation on prescribed medications, refer patients to medical consultation and / or colposcopy – when necessary – and it makes their performance an important means of cervical neoplasia prevention. [4]

Therefore, the importance of conducting a study on this topic was noticed. Thus, the current study assessed the perceptions of women assisted in a unit that offers Family Health Strategy (FHS) in Vitória (Espírito-Santo State). FHS concerns vaginal swab collection done by and test results delivered by the nurse as a result from satisfaction, trust and questions answered during attendance. It is believed that by having such perception, nurses can benefit from this information to improve their conduct in women care.

Method

A descriptive study was qualitative approach was developed in a Unit that offers Family Health Strategy (FHS) in Vitória. Such Unit holds five FHS multidisciplinary teams composed of nurses, doctors, nursing staff, Community Health Agents (CHA), dentists, dentist assistants, social workers and psychologists. All the professionals look forward to work in an interdisciplinary way in order to fulfill the needs of families living in the area. It is open from Monday through Friday, between 7 am and 6 pm with appointed consultations and spontaneous demand. They annually hold an average of 740 vaginal swab collections performed by doctors and nurses. There are no guidelines regarding group or individual examination collection; there is reduced spontaneous demand for Pap smear and it helps the active search by CHAs for expanding the access to the service.

The current study included 29 women treated by nurses during Pap smear collection at the Health Unit during the data collection period. The sample was completed when women’s responses became repetitive and did not add new information about the object of study. The following individuals were included in the sample: women treated by a nurse during vaginal swab collection; women older than18 years and who agreed to participate in the study after being informed about it. The participants signed the Informed Consent (IC) form. Individuals excluded from the sample were: women who were not assisted by a nurse during vaginal swab collection; women under 18 years old and those who refused to participate in the study after being informed about it. Data collection was performed by researchers through semi-structured interview. The answers were used for data analysis using the thematic analysis by Minayo (2004) and it met the following steps: ordering, classifying and finally analyzing the data analysis. Data were organized by the thematic content technique: pre-analysis, material exploration, result processing and interpretation. Such procedure is one of those that better match the qualitative health research. In the first stage, a sentence  had been defined as registration form. In the second stage, data were sorted and grouped according to specific categories for each theme established in the pre-analysis. As for the third step, data were analyzed according to the theoretical basis. The project was approved by the Research Ethics Committee “Comitê de Ética em Pesquisa – CEP” of School of Sciences of Santa Casa de Misericórdia,Vitoria – EMESCAM in 24th/09/2013, opinion n. 405.033.

Results

When asked about the level of satisfaction regarding vaginal swab collection by nurses, 25 women participating in the current study reported to be very pleased and 4, to be satisfied. There was no dissatisfaction with the service provided by nurses, women recognized and valued their work.

The following narrative excerpts show women’s reports on their satisfaction with the received care:

“… Because they are very sweet, thoughtful, delicate, it is very difficult for us to be exposed in such way” (Orchid).

“… I really liked her. She was very helpful to me. I’ve never done a Pap smear so easily” (Lily).

“… I was afraid before and I realized the exam was not the way I’ve imagined; I had never done it before” (Tulip).

“… She was very helpful and made us feel very comfortable” (Crane flower).

“… She reassured me and would not let me nervous; she was very comprehensive” (Acacia).

“… She is very attentive, takes questions, guides us” (Dahlia).

All interviewed patients felt confident about the nurse’s care during consultation for vaginal swab collection and it demonstrate nurses’ ability to conduct adequate assistance to cervical cancer prevention. It can be evidenced in the following narratives:

“… They gave me confidence so I could do the exam” (Daisy).

“… She is sweet, loving, very professional. We feel that she knows what she’s doing ” (Azucena).

“… They served us well; they know how to reassure the patient and make us understand what’s going on there” (Tulip).

“… I felt no difference between the nurse or gynecologist” (Dahlia).

“… She made me feel safe and cared” (Gerbera).

“… She was calm; she talked to me and made me feel safe” (Glorious).

All interviewed patients had their doubts answered and most of them thought that it was great. There was no bad scoring for nurse attendance, as it can be seen in the following reports:

“… She clarified my doubts, I had questions about the contraceptive” (Orchid).

“… I always thought I had something, and she told me that the changes after having a baby were normal” (Lavender).

“… I thought it was good because she clarified my doubts, took my concern” (Dahlia).

“… I liked it because it was one of the few places I had such clarity on receiving information  (Acacia).

“… The assistance she gave me was the best I ever had” (Tulip).

“… Because she explained me some things about breast cancer and self examination; as the correct way to do it, I did not know it was ten days after my period” (Chrysanthemum).

Most of the women interviewed about cervical cancer did not report any doubt concerning cervical cancer and vaginal swab collection. However, 6 women had one or more questions regarding the discussed topics, as it is evidenced in the following statements:

“… I do not know the reason for preventive collection” (Rose).

“… It’s more about the disease, how does cancer appears?” (Violet).

“… I had no doubts, only on breast examination” (Sunflower).

“… The breast exam. I actually did not know about it” (Orchid).

“… About cervical cancer and the reason why we need prevention” (Jasmine).

“… First of all it was regarding the appliance’s size, my friends told me it was big. Second, it was about breast palpation. (Daisy).

According to data in the current study, it is clear that most of the assessed patients (n = 15) underwent vaginal swab collection for the first time with a nurse and 13 of them had already done it with another nurse before, but they did not remember which one. The reason that led or would lead these women to undergo new vaginal swab collection by a nurse is described by them as it follows:

“… A health professional came over and handed me a piece of paper to come here. I have no preference “(Celosia).

“… Because of the Pink October” (Violet).

“… because the scheduled doctor is absent today” (Jasmine).

“… Because I prefer her” (Chrysanthemum).

“… Actually I prefer the nurse; I feel more comfortable with the nurse ” (Glorious).

“… Because I know that she is able to develop such test” (Iris).

Discussion

The current study’s cohort consisted of women (n = 21) aged 18 to 39 with complete or incomplete high school education (n = 16) and single (n = 16). It is worth mentioning that the current research contemplate only women over 18 years. According to the results, it was understood that the attention given to the patient during consultation for vaginal swab collection was one of the most important points from the perspective of these women. Such attention favors the bond between patient and the health professional at the time of the examination. Nurses should give total attention to each woman they attend as if she was unique. They should deal with healthcare in a particular way, since constructing this tight connection with the patient brings positive results. [5]

Respect and attention during consultation are essential to establish trust between user and provider. A relationship based on trust transmits easiness and safety, which are fundamental therapeutic supports. [3].

Welcoming and understanding the community where the nurse works in are important actions to strengthen the bond of trust between the professional and the patient, and to help preventing cancer. [1]

Thus, the nurse’s role in controlling cervical cancer concern the total attention given to women during nursing consultation to vaginal swab collection according to protocols or other technical regulations found in this profession’s legislation. [3]

During consultation to Pap smear test, the nurse also exercises its educational role by guiding the patient on how to take actions concerning their own health. During the consultation the nurses should guide the patient on breast self-examination and talk about the importance of such exam. The professional should make women feel free to talk and have their questions answered and have a broadening look over patients’ beliefs, values and thoughts about the procedure. [5]

Women feel more relaxed and comfortable for the examination when they receive guidance and attention during exam preparation. [6] Choosing a language that can be understood by the patient is as important as explaining her about the procedure. [7]

Results showed that the main questions about vaginal swab collection and cervical cancer refer to examination purposes, to the etiology and pathophysiology of the disease, to self-examination / clinical breast exam, and to the collection procedure itself.

It is believed that some women do not perform Pap smear test because they are unaware of the reason it is done and are not informed about its periodicity. Thus, health professionals are still challenged by the need to promote women’s admission in the cervical cancer prevention program. [8]

As for breasts self-examination, the Brazilian National Institute of Cancer (Instituto Nacional de Câncer –INCA) does not assign it as an isolated method of breast cancer early detection. It is recommended that breast self-examination must be part of the health education activities that help women to get to knowledge their bodies. Studies suggest that breast self-examination is not effective for early detection and does not help reducing mortality due to breast cancer. Therefore, the breast exam done by women themselves does not replace the physical examination performed by qualified health professionals. [3]

The nurses should advise patients about the Pap smear’s purpose, the risk factors of cervical cancer, the collection procedure and they should highlight the importance of often repeating the examination. From the moment women receive information about this subject, they are able to promote self-care and to spread this information within the community; they will also be motivated to return and get the test results.

Patients look for Pap smear test by nurses because of the health agents’ active work in the community, the prevention campaigns such as the “Pink October” and the impossibility of appointing a consultation with a doctor. On one hand, women do not care about who is collecting the vaginal swab, on the other, it is important to notice that some of them actually prefer to consult with the nurse at the time to collect the material.

It is believed that the good performance of the Family Health Strategy (Estratégia Saúde da Família) team is expressed by actions such as the active search of health workers which help women to learn about cervical cancer prevention methods. It is extremely important to search for women who have not attended the health unit for a long time. It was the awareness about campaigns such as the “Pink October” that have encouraged women to seek health services and to undergo this type of examination; fact that makes early detection and health promotion possible.

There are women who show resistance to perform the examination with nurses however, as it can be seen in the current study, many of those who undergo vaginal swab collection with a nurse for the first time have demonstrated satisfaction and confidence on the provided assistance. It shows the need for better community orientation on the nurses’ role within ESF.

Nursing professionals are committed to human and community health. It is up to this professional to work in the promotion, protection and recovery of health by exercising their profession with autonomy respecting the ethical and legal principles of nursing. Nurses must be prepared to act in the care dimension by preventing and detecting early cervical cancer. [10]

Conclusion

The present study aimed to assess patients’ perceptions within a Family Health Strategy Unit (FHS), in the city of Vitória (Espírito-Santo State), about vaginal swab collection performed by nurses as well as patients’ satisfaction and trust on the nurses and the answers given by them during the attendance. It also aimed to identify the reasons why interviewed women undergo new vaginal swab collection with a nurse as well as their main doubts about the collection procedure and – or about cervical cancer.

The patient’s perception about nurses’ assistance during the collection procedure was overall positive as the level of satisfaction, trust and answered questions achieved results that show good professional performance regarding cervical cancer prevention.

The nurses are responsible for strengthening the bonds with the patients through health education activities and by answering the patients’ questions to make them aware of the prevention practices to reduce morbidity and mortality caused by cancer and other diseases. Nursing consultation is the moment when the professional has the opportunity to create a link with the patient / client, thus enabling positive results from the provided assistance.

Women’s resistance to vaginal swab collection was overcome as nurses showed to be professional and capable of exerting such practice.

It was found that prevention and health promotion campaigns on topics related to women’s health, such as the “Pink October”, play a key role in the community, since it encourages women to seek health and self-care services.

Results in the current study provide reasoning on nurses’ role in cervical cancer prevention as well as in promoting family health. It is possible to believe that the nurses can act within a community, with autonomy, knowledge and dedication in order to promote health and prevent diseases.

References

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    2. BRASIL. Ministério da Saúde. Instituto Nacional do Câncer (INCA). Diretrizes brasileiras para o rastreamento do câncer do colo do útero. Rio de Janeiro: INCA, 2011.
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Authors

Solange Rodrigues da Costa: Master / UFES (Course Coordinator).

Camila de Jesus Rocha Marques: Hospital Santa Casa de Misericórdia de Vitoria. (Nurse)

Nátia Henrique Cabral. Enfermeira: América Dourada County, Bahia State. (Nurse)

 

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