Conceptual models for women's health research: reclaiming menopause as an exemplar of nursing's contributions to feminist scholarship.

An examination of women's transition through menopause provides a remarkable example of nursing's contributions to feminist scholarship. The predominant biomedical model perpetuates the idea that menopause is a deficiency disease, whereas feminist and nurse scholars have deconstructed this paradigm and have reclaimed menopause as a part of midlife women's developmental stage. We begin this chapter with a review of the birth of women's health scholarship as it is the foundation for theory that undergirds feminist nursing research. We then discuss the tenets of feminist scholarship. The historical context of menopause is reviewed briefly to highlight the ways in which menopause was transformed from a normal physiological event to a disease. Using this as a backdrop, we reviewed nursing studies in two emerging bodies of knowledge. We reviewed 10 studies in the area of "women reclaiming menopause" and found that over all women believe the menopausal transition is a normal developmental stage. The second area of new research looks at "menopause across cultures." The studies of Korean, Indian, and Thai women reviewed demonstrate that similar to other health issues, the experience of Western women cannot be universalized, and most important, researchers must take into consideration the social, political, economic, and cultural forces that impact women's experience of the menopause transition.

Vaginal health and infections.

Vaginal infections are one of the most common reasons women seek health care. Nurses play an important role not only in the assessment and management of vaginal infections but also in educating women about vaginal health. Understanding the ecology of the vagina, performing a proper microscopy, and recognizing risk factors associated with infections are key to vaginal health.

The next step for emergency contraception: over-the-counter availability.

Emergency contraception to prevent pregnancy after episodes of unprotected sexual intercourse has existed since ancient times. Modern medicine began to use hormonal methods in the 1960s, and today emergency contraception is used regularly in many countries. In the United States, providers do not routinely prescribe it, nor do they adequately inform their patients that it is available. This occurs even though sufficient information exists on the safety and efficacy of this method. Because the effectiveness of emergency contraceptive pills relies heavily on prompt administration, better access for patients is essential. Recently, proponents of emergency contraception have attempted to better inform the public of this resource. In addition, two oral contraceptive products are now available and marketed specifically for emergency contraception. The purpose of this article is to discuss the safety and efficacy of emergency contraceptive pills and the potential for them to become available without a prescription.

The impact of media attention, family history, politics and maturation on women's decisions regarding hormone replacement therapy.

A purposeful sample of 21 well-educated European American women (42-53 years) were interviewed to explore how women make decisions about hormone replacement therapy (HRT) for natural menopause. Menopausal status included women who were premenopausal (n = 1), perimenopausal (n = 11), menopausal (n = 4), and postmenopausal (n = 5). Participants were grouped into 3 categories: taking or in favor of taking HRT (n = 6), undecided (n = 10) and stopped taking or opposed to taking HRT (n = 5). The impact of media attention was an important influence on women's thoughts and decisions-whether in favor, undecided, or opposed--particularly in conjunction with risk factors based on family history and what other family members were doing. Women in favor of taking HRT were interested in short-term symptomatic relief as well as prevention of disease in old age. Women who were undecided cited the scientific confusion in the media as contributing to their reticence about making a decision. The unprecedented number of magazine, book, and newspaper coverage of HRT during the study undoubtably influenced women's thoughts and decisions.

Women's health: where are nurse practitioner programs headed?

Until quite recently, the discipline of women's health has been restricted to reproductive health. While graduate nurse practitioner (NP) programs have included issues across the life cycle and health promotion in their curricula, there is growing emphasis on primary care of women. Graduate nursing programs that offer women's health and obstetric/gynecologic NP tracks were surveyed in 1996 to elicit content in the curriculum and to ascertain whether changes in requirements for certification were impacting programs. Programs listed in the 1994 National Organization of Nurse Practitioner Faculties directory (NONPF) were surveyed. Twenty-eight of 31 programs responded; results were tallied by frequency distribution. Results documented differences in programs, suggesting that a clear definition of women's health advanced practice is needed. The author recommends a national dialog to explore advanced practice in women's health and asks if there should be two types of NP programs--primary care of women (a generalist NP) and reproductive health (a specialist NP)--and how NP programs and credentialing bodies should differentiate graduate programs as well as content for certification exams.

Vulvovaginal conditions: social, psychological, and sexual considerations.

Women experiencing vulvovaginal conditions are affected socially, psychologically, and sexually. Although vulvovaginitis is a common women's health problem, these considerations are overlooked in the literature and, unfortunately, often in practice, as well. This article presents a discussion of the social, psychological, and sexual issues to be considered when treating women with vulvovaginal conditions, including implications for practice.

Taking a sexual history and educating clients about safe sex.

The importance for taking a sexual history cannot be overstated. In the general patient population, the goal of the history is to assess the impact of illness on a client's sexual health. This information provides the nurse with a baseline for educating the client about his or her sexual adaptation to illness or surgery. Further, the sexual history is a part of the holistic nursing framework for patient care. Nurses working in settings in which they routinely care for clients with STDs have the additional responsibility of utilizing data from the history to educate clients regarding risk factors, re-evaluation of lifestyle behaviors, and preventative measures. Education of clients is crucial to decreasing the incidence of STDs. Nurses need to confront their own values and attitudes regarding sexuality as the first step to overcoming barriers in discussing sexuality with their clients. Additionally, education regarding human sexual behavior is important in expanding nurses' knowledge in this area. I have outlined interview techniques that can be helpful in eliciting the sexual history, emphasizing open-ended questions and ubiquitous statements. These techniques can be useful in both ambulatory and in-patient settings. The format for taking a sexual history has been addressed, with specific questions relevant to clients exposed to STDs. I have pointed to the need for considering the sexual history within the context of the client's life situation and suggested that information regarding sexuality be thoughtfully gathered, taking into account variables such as culture and sexual preference. Finally, this article addresses educating clients for safe sexual practices and emphasizes the need for nurses to counsel all sexually active clients concerning the risk factors for STDs. As the incidence of STDs continue to increase, and particularly as AIDS becomes increasingly widespread, nurses must be in the forefront of educating the public. As a health care profession advocating caring and commitment to holistic care, nursing can contribute to health promotion activities through addressing clients' sexual health.

A feminist framework for graduate education in women's health.

Graduate programs in the area of women's health have focused primarily on childbearing issues. Titles of programs such as Parent-Child Nursing, Maternal-Newborn Nursing, and Maternal-Child Nursing suggest a focus on reproduction and reproductive organs. It cannot be assumed that programs presume a feminist framework or produce graduates who are women-centered and look beyond reproductive issues. It is essential that graduate education in women's health encompasses the values of feminism and women-centered philosophy. Feminist theory, as a world view of women, brings to nursing the underpinnings for a conceptual framework in women's health. Women's health is committed to health promotion, maintenance, and restoration of the whole person through women-centered practice. The graduate curriculum provides students with the philosophy and tools for advanced nursing practice; therefore graduate curricula in women's health must include two important purposes. The first purpose is refocusing the curriculum on the whole person-woman, not solely on obstetrics and gynecology. The second purpose is socialization of students towards feminist practice, in the profession, in clinical practice, and in research.