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Hysterectomy is a full or partial surgical removal of the uterus, is the
second most common surgery among women of reproductive age. Nurses play a key
role in assisting patients in the preoperative period and postoperative.
Objective: To analyze the
available evidence in the literature on nursing care for women undergoing
hysterectomy. Method: an integrative review, in order to answer the question:
What is the evidence on nursing care to women undergoing hysterectomy? For
this, databases were consulted Medline, PubMed, LILACS, BDENF, Scopus, CINAHL
and Cochrane. After the selection of studies, we proceeded with the reading in
full and then the data were extracted and organized for analysis. The final
sample consisted of 7 items.
Results: The predominant nursing
care: education and health.
Conclusion: the articles analyzed allowed to present that teaching in
effective health in nursing care to women undergoing hysterectomy.
Keywords: Women,
Hysterectomy, Nursing
INTRODUCTION
The hysterectomy is a total
or partial surgical removal of the uterus, it may be abdominal or vaginal, it
is the second most common surgery among women of reproductive age, preceded
only by surgical delivery [1]. Hysterectomy may be indicated in the treatment
of cancer, dysfunctional uterine bleeding, endometriosis, non-malignant
growths, persistent pain, relaxation, pelvic prolapse and previous uterine
injury [2]. In the United States of America, 600,000 hysterectomies are
performed annually, presenting the most frequent indication for the surgical
procedure: uterine fibroids [3]. According to the Department of Informatics of
the National Health System (DATASUS), 103,510 hysterectomies were performed in
Brazil in 2011 [4]. Research in Taiwan and Turkey has shown that the uterus
refers to femininity, sexuality, fertility and maternity, and the loss of this
organ implies the generation of new problems related to the social role and the
way the woman is inserted [5].
Nurses play a key role in assisting patients in the preoperative and
postoperative period. The factors that can be limiting to a good recovery are
the body image, lack of preparation, limited financial and social support.
Nurses should intervene responsibly, act as educators so that patients are
aware of the whole process in order to heal doubts, reduce anxiety, and address
important issues [3].
METHOD
This study deals with an integrative literature review, with a
qualitative-quantitative approach, whose purpose is to summarize the results of
researches on a specific subject, corroborating to a more accurate
understanding of the subject to be studied.
For the development of this study, the stages recommended by the
literature were carried out such as: delimitation of the theme and formulation
of the guiding question; establishment of criteria for selection of
publications; definition of the information extracted and categorization of the
selected studies; evaluation of selected studies; interpretation of the results
and dissemination of the knowledge obtained [6].
The first phase of the review consisted of the delimitation of the
topic and the elaboration of the guiding question of the research: What
evidence about nursing care for women undergoing hysterectomy?
Subsequently, the search for
articles indexed in the Bireme database using the Descriptors in Health
Sciences (DeCS) was carried out. The articles were collected through the DeCS:
“women”, “hysterectomy” and “nursing”, combined simultaneously.
By means of Bireme, it is possible to simultaneously consult the
databases selected for search of articles, namely: Medical Literature Analysis
and Retrieval System On-Line (Medline), Latin American and Caribbean Literature
in Health Sciences (LILACS) and Database Nursing Data (BDENF),
In the second phase, it was
established as inclusion criteria for the selection of publications: To
complete the research article could, be available electronically, be published
in Portuguese, English or Spanish languages, contain information pertinent to
the guiding question and be an article published between the periods from 1988
to 2013. The bibliographic survey took place from March to April 2016.
Before the application of the research
instrument, a rigorous reading of the articles was done to exclude the works
that did not approach the researched subject. In the third phase, an instrument
built for integrative review was used for data collection, in order to identify
the characteristics of the studies, such as: article title, authors, type of
research, database, year of publication, country and level of evidence [7].
Next, in the fourth phase, the studies were
evaluated for their representativeness, results found and relevance. In the
phase concerning the interpretation of the findings, the exploratory, selective
and interpretive reading was carried out. In the last step, related to the
dissemination of the knowledge synthesized and evaluated in the present review,
the results found were described in illustrative tables and discussed later.
RESULTS AND DISCUSSION
Analysis and interpretation of the data
corroborate the accomplishment of a synthesis of data recorded in the
instrument of data collection and discussion of the findings found from the
articles [6].
In
relation to the year of publication of the articles, there is an increasing
number of publications from the year 2000, culminating in a greater number 4
(57.14%) articles. When analyzing the research sites of the 7 selected
articles, it is noticed that 7 (100%) were published in other countries, with a
majority of them (71.42%) of American origin, showing absence of studies with
the focus on the Brazilian reality.
It was found in the integrative review reports
of five ways of providing nursing care for women undergoing hysterectomy showed
that education and health programs were the most prevalent in promoting care.
In the analysis of their articles evidence of absence of scientific production
in Brazil, with absence of intervention studies to corroborate with
evidence-based nursing practice.
The interventions that were evaluated in
nursing care for women submitted to hysterectomy were: teaching, management,
surveillance, modern dressings, alternative therapy and the use of musical
resources.
A study was carried out in India to evaluate
the knowledge of women (n=30) in the postoperative period of abdominal
hysterectomy before and after the implementation of a structured teaching
program. It was possible to conclude that the program was effective in
increasing the knowledge of women with a significant association between
variables such as age, schooling, abdominal surgery and previous information
[9].
Pre-operative education is an essential element
in health care. It is necessary to explain basic aspects in advance about the
surgical procedure and associated care in a language accessible to the public.
Nurses have the function of educating individuals in the various aspects
related to surgical procedures. Such professionals need to develop skills and
knowledge in teaching and counseling women undergoing hysterectomy, in order to
promote assistance in a rapid establishment of health. Therefore, the
curriculum should offer opportunities for academics to be trained in planning
and conducting, educating corroborating for better health and counseling to
individuals [9].
A quasi-experimental study conducted in the USA
aimed to compare the reports of pain and the level of anxiety in two groups of
women after abdominal hysterectomy. The experimental group (n=10) received
treatment with traditional nursing associated with 30 min of Reiki, while the
control group (n=12) received only the traditional nursing care. It was
concluded that the experimental group reported less pain, fever and the use of
analgesics compared to the control group. The experimental group reported a
lower level of anxiety during the 72 h after the surgical procedure [10].
A clinical study in the United Kingdom aimed at
evaluating the use of a new dressing for surgical incision in women (n=14)
submitted to elective gynecological surgery. The nurses considered it good
(100%), with good resistance to shower proof (86%) and easy to remove (79%). No
wound infections and adverse events were recorded. It allows greater comfort
and better nursing care for women [11].
Clinical trial conducted in the US in order to
describe the patient's problems and advanced interventions in nursing practice,
with analysis of 333 records, with patients undergoing hysterectomy (n=53)
concluded that the essential skills in providing care include actions well
developed in the assessment, teaching, counseling, communication,
collaboration, knowledge of health behaviors, trading systems and having
specific knowledge of the condition of different patient problems [12].
Randomized clinical trial conducted in the US
with the following to evaluate the effects of preparing for
mastectomy/hysterectomy in the behavior of self-care of women in the
postoperative period and one month after surgery. The sample consisted of 60
women, 30 of whom underwent mastectomy and the other 30 underwent hysterectomy.
A teaching program was provided by nurses before and after surgery, self-care
was observed during the immediate postoperative period. We conclude that the
groups performed self-care activities at home significantly better than uneducated
groups [14]. Women who perform hysterectomy need special education and
emotional support from the health team in particular of nursing care [15].
CONCLUSION
The findings of this review have drawn
attention to the low number or scarcity of Brazilian studies related to the
subject in question. The results promote a reflection of the importance of
nursing care to women undergoing hysterectomy. The articles evaluated reported
on nursing care for women submitted to hysterectomy in the literature. Thus, the
integrative review can be considered an effective tool, since it provides the
health professional with a scientific basis on the researched topic, basing its
practice and improving the care provided to the woman.
1. (2006) Brasil. Ministério da Saúde. Departamento de
Informática do SUS DATASUS. Sistema de informações hospitalares do SUS-sih.
SUS: banco de dados. Available in: http://www.datasus.gov.br
2. Smeltzer SC, Bare BG, Cheever KH, Hinkle JL, Brunner S
(2011) Tratado de enfermagem médico-cirúrgica. Rio de Janeiro: Guanabara
Koogan.
3. Hampton T (2014) Critics of fibroid removal procedure
question risks it may pose for women with undetected uterine cancer. JAMA 9:
891-893.
4. (2007) Brasil. Ministério da Saúde. Sistema de
Informações Hospitalares (SIH/SUS). Available in: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/qruf.def
5. Pinar G, Okdem S, Dogan N, Buyukgonenc L, Ayhan A (2012)
The effects of hysterectomy on body image, self-esteem and marital adjustment
in Turkish women with gynecologic cancer. Clin J Oncol Nurs 16: E99-104.
6. Mendes KDS, Silveira RCCP, Galvão CM (2008)
Integrative review: research method for the incorporation of evidence in health
and nursing. Texto contexto – enferm 4: 758-764.
7. Ursi ES, Galvão CM (2006) Prevention of skin injuries
in the perioperative: Integrating review of literature. Rev Latino-am Nursing
1: 124-131.
8. Stetler CB, Morsi D, Rucki S, Broughton S, Corrigan B,
et al. (1998) Utilization focused integrative reviews in a nursing service.
Appl Nurs Res 4: 195-206.
9. Mathew DA (2011) Structured teaching programme for
women undergoing abdominal hysterectomy. Nurs J India 6: 122-123.
10. Vitale AT, O’Connor PC (2006) The effect of Reiki on
pain and anxiety in women with abdominal hysterectomies: A quasi-experimental
pilot study. Holist Nurs Pract 6: 263-272.
11. Gibson E, Stephens C (2013) Performance and ease of
use evaluation of a new surgical post-operative foam island dressing in 14
patients undergoing elective gynecological surgery. J Tissue Viability 2:
37-41.
12. Brooten D, Youngblut JM, Deatrick J, Naylor M, York R
(2003) Patient problems, advanced practice nurse (APN) interventions, time and
contacts among five patient groups. J Nurs Scholarsh 1: 73-79.
13. Taylor LK, Kuttler KL, Parks TA, Milton D (1998) The
effect of music in the post anesthesia care unit on pain levels in women who
have had abdominal hysterectomies. J Perianesth Nurs 13: 88-94.
14. Williams PD, Valderrama DM, Gloria MD, Pascoguin LG,
Saavedra LD, et al. (1988) Effects of preparation for mastectomy/hysterectomy
on women’s post-operative self-care behaviors. Int J Nurs Stud 3: 191-206.
15. Dulaney PE, Crawford VC, Turner G (1990) Comprehensive
education and support program for women experiencing hysterectomies. J Obstet
Gynecol Neonatal Nurs 4: 319-325.
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Table 1 -
Table 2
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Table 3
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