Women's decision making regarding hysterectomy.

OBJECTIVE: To describe the decision-making process of women who choose hysterectomy for treatment of benign disease or distressing symptoms. DESIGN: Qualitative design based on grounded theory, using semistructured interviews. SETTING: Participants were interviewed in their homes or at their place of employment. PARTICIPANTS: Ten women who were premenopausal prior to hysterectomy. RESULTS: Decision making began when the women recognized abnormal body changes or bothersome symptoms. Four major processes were identified. "Seeking Solutions" was characterized by information seeking, information processing, and utilization of pharmacologic and nonpharmacologic treatments in an attempt to cure the disease and/or alleviate symptoms. "Holding On" included managing symptoms, rearranging activities of daily living to accommodate symptoms, and waiting. "Changing Course" was characterized by an abrupt change from Holding On to focusing on hysterectomy as the solution to the distressing symptoms. During "Taking Charge," the women displayed purposeful actions directed at arranging and preparing for surgery. CONCLUSIONS: Understanding the process of decision making will enable nurses to provide support for women who choose hysterectomy for treatment of benign gynecologic diseases and/or distressing gynecologic symptoms. Nurses' support of women's decision making should include referrals, education, and emotional support. In addition, nurses can help these women improve their quality of life by assisting them with symptom management.

Different levels of immunoreactivity for synaptosomal-associated protein of 25 kDa in vasoconstrictor and vasodilator axons of guinea-pigs.

Immunoreactivity (IR) for synaptosomal-associated protein of 25 kDa (SNAP-25) was examined in axons of autonomic vasoconstrictor and vasodilator neurons innervating the lingual and uterine arteries of guinea-pigs. Polyacrylamide gel electrophoresis and immunoblotting of protein extracts demonstrated a SNAP-25-IR band at 25 kDa in both arteries. Quantitative confocal microscopy demonstrated significantly higher levels of SNAP-25-IR in varicosities with IR for vasoactive intestinal peptide (VIP) than in adjacent axons with IR for tyrosine hydroxylase (TH). Levels of SNAP-25-IR in TH-IR axons, relative to adjacent VIP-IR axons, were significantly higher in the lingual artery than the uterine artery. These differences in IR for SNAP-25, a protein considered essential for calcium-dependent exocytosis of neurotransmitters, raise the possibility that mechanisms of transmitter release may vary between different classes of autonomic neurons.

Knowledge, self-efficacy, coping, and condom use among urban women.

In this study, path analysis was used to test a model of the relationships among condom use knowledge, self-efficacy for condom use, coping, and condom use in a sample of 100 urban women. In the final model, the paths between condom use knowledge and self-efficacy, between self-efficacy and condom use, and between self-efficacy and problem-focused coping were significant. In addition, condom use knowledge was indirectly related to condom use through self-efficacy. The final model accounted for 43% of the variance in condom use. Although the women engaged in risky behaviors including having multiple partners, high-risk sexual partners, and unprotected intercourse, they did not worry about or perceive themselves at risk for HIV. To assist women to decrease their risk for sexually transmitted HIV infection, clinicians should conduct individualized assessments of each client's sexual behaviors to identify women at risk. Individualized interventions are recommended to increase both knowledge of how to use condoms and self-efficacy for condom use among women at risk for HIV.

Sexual behavior and condom use among urban women attending a family planning clinic in the United States.

In this paper I present data on risky sexual behavior and condom use among a sample of 100 adult women who attended a family planning clinic in an urban area of the United States. Although the women in this study protected themselves from pregnancy by using contraception, they engaged in sexual behaviors that put them at risk for sexually transmitted human immunodeficiency virus (HIV), including unprotected oral, anal, and vaginal intercourse, and sex with risky partners. Alcohol and drug use were also common among the women in this sample. Almost half of the participants reported a history of sexually transmitted infections. Health assessment for women using contraception should include assessment of risk factors for sexually transmitted HIV infection. All women should be counseled regarding methods of reducing their risk for HIV.

Emergency contraception: the nurse's role in providing postcoital options.

Emergency contraception refers to pregnancy prevention methods initiated after unprotected sexual intercourse. Research has shown that 75% of the 3.5 million unintended pregnancies that occur in the United States every year could be prevented through use of emergency contraception. Hormonal methods and postcoital insertion of intrauterine devices have been shown to be safe and effective. Nurses play an essential role in the distribution of emergency contraception as patient educators, advocates, and support persons.

PIP: An estimated 75% of the 3.5 million unintended pregnancies that occur in the US each year could be averted through use of emergency contraception. Nurses can play central roles in emergency contraceptive distribution as patient educators, advocates, and support persons. Nurses who work in emergency departments and outpatient settings are in an ideal position to participate in the development and implementation of emergency contraceptive programs. In the US, oral contraceptives and copper-containing IUDs are the two methods used for emergency contraception; RU-486, widely used in other countries for this purpose, is not yet available in the US. Lack of knowledge of the availability of emergency contraception is a major barrier to its effective use. Information about this option should be integrated into the health care of all women of reproductive age. Some health care providers will provide a woman with an emergency dose of oral contraceptives and detailed instructions for their use to avoid delays in access when postcoital contraception is needed. Women who take doses at home must be instructed about the prevention of vomiting and what to do if vomiting occurs. It should be emphasized, however, that this method should not replace routine contraceptive use and does not confer protection against sexually transmitted diseases. In cases of rape or sexual assault, women should be offered options for psychological counseling and emotional support.

The grief response to mid-trimester fetal loss.

This descriptive study examines the grief response of mothers who experienced a fetal loss in the middle trimester of pregnancy. Twenty mothers who lost a baby through spontaneous abortion or perinatal death within 1 year participated in this study. Data were collected by mailed questionnaires. All characteristics typical of the grief response were identified, including despair, anger or hostility, guilt, loss of control, rumination, depersonalization, somatization, and death anxiety. Comparison of the study population to a group of parents who suffered the loss of a child and to a group of women who had suffered the death of a close relative demonstrated that the study group presented a grief response similar in nature and intensity to the two normative groups. This study supports previous studies that indicated the existence of grief after mid-trimester fetal loss. Replication of this study with a larger sample is recommended to further support these findings.