Nursing Care

Nursing Care

Care strategies aim to assist care delivery, by providing guidance, milestones and expected outcomes over a set time period (Herring, 1999). Throughout this assignment, the care pathway for women undergoing a full abdominal hysterectomy will be discussed. To do this the term hysterectomy will be defined, and some common conditions resulting in the procedure will be identified. As will recent trends relating to hysterectomies in the United Kingdom. Care strategies will then be discussed, in relation to the nurses' role at each stage. The short comings and advantages of using such frameworks will also be identified. In doing this legal and ethical considerations, along with the principals of holistic care in a surgical environment, to meet the needs patients from a diverse society will be addressed. Within this the focus will turn to post operative pain, and the tools used in its assessment. Some common tools used in the assessment of pain will be identified, compared and critically analysed.

Hysterectomy refers to the surgical removal of the uterus; this may or may not involve the removal of the ovaries, fallopian tubes and cervix depending on the nature of the patients condition (Castledine & Close, 2006). This is a major operation and is usually carried out as an elective procedure. The procedure may be carried out abdominally, using a horizontal incision on the lower abdomen, or vaginally, where the uterus is reached by making an incision around the top of the cervix (Santoso & Coleman, 2001). Less common are laparoscopic hysterectomies, which involve smaller abdominal incisions and the uses of a small telescopes, this approach is often referred to as keyhole surgery (Walsgrove, 2001). The type of hysterectomy a patient receives is often determined by the condition. There are a number of conditions that may result in a patient requiring a hysterectomy including, gynaecological cancers, fibroids which are benign tumours, endometriosis an inflammatory condition, painful and heavy bleeding, uterine prolapse caused by weakening of the muscle and ligaments, allowing the uterus to move into the vaginal canal and pelvic inflammatory disease a long lasting chronic infection (Tortora & Derrickson, 2006). Surgery is normally only carried out as a final resort, after other treatments options have been explored. However, in the case of malignancy a hysterectomy may be a critical aspect of treatment (Walsgrove, 2001).

Dysfunctional or heavy uterine bleeding is the most frequent indicator for a hysterectomy, accounting for forty-six percent of hysterectomies (Donaldson, 2006). 31898, women were admitted to hospital in 2005/6 for an abdominal hysterectomy, using 184907 bed days. 182 of these took place at a local hospital (Hospital Episode Statistics 2007). Ninety percent of all hysterectomies that were performed nationally where performed for benign conditions (Edozien, 2005). The Chief Medical Officers Report highlighted hysterectomies as an extremely common procedure, with one in five women having a hysterectomy by the age of sixty (Donaldson, 2006).

Care strategies are most suited to routine elected procedures such as hysterectomies, as common responses to interventions may be accounted for (Guezo, ...