| Summary: | 博士 === 國立臺灣大學 === 護理學研究所 === 97 === 【Background and purpose】
The pelvic examination (PE) is a common experience facing with the majority of women. Women patients’ positive and negative experiences in connection with the PE are, to a large extent, connected to the physicians’ and nurses’ behaviors and attitudes. Nowadays, few studies focus on exploring this area. In addition, Taiwanese medical system is primarily dominated with paternalistic physician-patient relationships, indicating that the physician has centrality, superiority and authority. Thus, this study was divided into two parts. The first part of the study was to understand their experiences concerning physicians’/nurses’ behavior in the situation of the PE from women patients’ perspective ; the second part of the study was to improve physician-nurse-patient interaction and increase quality of care in PE through action research based on women patients’ negative experiences,
【Subjects and methods】
The qualitative approach was used in the first part of the study. Thirty-two women were asked to describe their positive and negative experiences while receiving the PE and what they perceived as critical for the PE procedures. Data were analyzed with the critical incident technique (CIT).
The second part of the study used the four phases of this action research project, including fact-finding, planning, action, and evaluation. According to the fact-finding about women patients’ negative experiences, the researcher, physicians and nurses discuss the action objective together, leading to the consensus objectives. Also, an action research group was established in the local, the region hospital. Then an action research was formed with participants and collaborative physicians and nurses. Research adopted 3 cyclical processes and revised action aimed to improve physician-nurses-woman patient interaction and meet women patients’ need. Questionnaire data was analyzed using SPSS 10.0 and descriptive interviews were transcribed verbatim for analysis.
【Results】
The results of the first part of the study consisted of 44 categories of behaviors, four subcategories, two categories [acknowledged as a person and created confidence], and one main theme [a helping relationship]. Women patients perceived positive experiences, including being respected, being in control, being engaged, and being supported. On the contrary, women patients also described negative experiences, including not being respected, feeling uncertain, needs being neglected, and not being supported. Through understanding the meaning behind women patients’ experiences indicated that the women were to expect physicians/nurses hold a helping relationship of connotation and principle.
The result of the second part of the action research emphases the involvement of the researcher and participants [physicians and nurses] in the process of involvement, collaboration, and reflection in action. Through 3 cyclical processes to evaluate changes or adjust in physicians’ and nurses’ behaviors, and change environment in the obstetric and gynecological outpatient department. First, the physicians’ behaviors were changed or adjusted, including (1) physicians were willing to once again ask for permission by saying, “Are you ready?” This made women patients feel respected, relaxed their body, and increased interaction with physicians. (2) Physicians also could choose not using a curtain, and (3) ask whether to permit the other physicians to come into the examination room to learn PE skills. Second, concerning the nurses’ behaviors was changed, including, nurses assessed whether a woman understood a PE procedure and asked whether to she preferred a curtain or not; Nurse needed to clean examination table right
now when woman patient finish a pelvis exam; If the physician was used to utilize a curtain, a nurse told “I will utilize the curtain for you.” and interacted with the woman patient; If women patient was waiting for the physician for a long time, the nurse needed to put her legs on the examination table or sit on the side of examination table; Nurses also designed a PE procedure protocol to increase women patients’ awareness of the procedure. Third, an examination room was changed to increase privacy and added a cover so that speculums would not be seen in the garbage can in order to decrease women patients’ tension.
【Conclusions】
The conclusion of the first part of the study showed that these women patients had positive experiences when their physicians acknowledged them as persons and facilitated the procedure to create confidence. When physicians/nurses hold a helping relationship with women patients, women patients were more likely to be acknowledged as a person and created their confidence. If physicians and nurses followed the above suggestions, then they could create women-friendly clinics. The conclusion of the second part of the study was to promote physician-nurse-woman patient interaction and to decrease women patients’ discomfort in the PE procedure. These findings can be incorporated into medical and nursing education and used as a valuable reference for those training to become obstetric and gynecological physicians or nurse. The results were also regarded as best practice guidelines in an obstetric and gynecological outpatient department. We also suggested nurses or physicians to expand action research to practice, enhancing the focus of woman patient-oriented practice
Keywords: pelvic examination, women patients, experience, physician-nurse-patient interaction, qualitative study, action research, a helping relationship
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