8.11 Applying the Nursing Process and Clinical Judgment Model

Nurses assist health care providers in performing reproductive exams, typically in an outpatient setting. This section will focus on using the nursing process to obtain a gynecological history and apply the nursing process to a reproductive problem.

Assessment (Recognizing Cues)

After introducing oneself, providing privacy, asking about preferred pronouns, and establishing rapport, a nurse completes a focused gynecological history that includes the following questions^[1]:

• Menstrual History
  • When did menstruation first start?
  • What was the first day of the last menstrual period?
  • What is the length of menstrual bleeding (days)?
  • What are the frequency and regularity of menstrual cycles?
  • Is menstrual bleeding heavy or does it contain clots?
  • Is there bleeding between periods?
  • If sexually active, is there any bleeding after intercourse?
  • If menopausal, has there been any menopausal bleeding?
• Gynecological History
  • Previous gynecological diagnoses or surgery
  • Date & results of previous PAP smear
  • Current contraception method(s)
• Past Obstetric History
  • Gravidity (Number of pregnancies)
  • Parity (Number of deliveries)
  • Dates of deliveries, length of pregnancies, and mode of deliveries (spontaneous vaginal delivery or cesarean section)
  • Weight and gender of newborns
  • Complications before, during, and after delivery

Diagnosis (Analyzing Cues)

A NANDA nursing diagnosis related to client concerns about their sexuality is “Impaired Sexual Function.” Table 8.6 provides the definition and selected defining characteristics. At-risk populations for this diagnosis include, but are not limited to, individuals experiencing infertility, individuals with a history of being abused, postmenopausal individuals, and older adults. As always, refer to a current, evidence-based nursing care planning resource when providing client care.^[2]

Table 8.6. NANDA Nursing Diagnosis Related to Sexuality

Identification of Outcome Criteria  (Generate Solutions)

Nurses collaboratively set goals and identify outcome criteria with clients and their families based on the client’s and families’ values, cultural beliefs, and preferences. Sample outcome criteria related to the “Ineffective Sexuality Pattern” diagnosis are the following:

• After the teaching session, the client will state accurate knowledge of sexual anatomy and functions.

• After the teaching session, the client will describe safe sex practices regarding avoidance of sexually transmitted infections.

• After the teaching session, the client will select their preferred and effective method of contraception.

• After the teaching session, the client will describe the purpose of reproductive screening.

Planning (Generate Solutions)

Nurses plan interventions based on identified outcome criteria for clients. Sample interventions include the following^[3]:

• After establishing rapport and therapeutic communication, give the client permission to discuss issues with sexuality. For example, “Do you have any concerns about your sexual functioning because of your health status?”
• Assess the influence of cultural beliefs, norms, and values on client’s perception of sexual behavior.
• Assess the client’s use of safer sex practices to prevent sexually transmitted infections.
• Assess the client’s use of contraceptives and discuss effectiveness.
• Initiate discussions about sexual health with adolescents, including attitudes and knowledge about sexual behavior and abstinence, providing age-appropriate, accurate information regarding sexual activity and risky sexual behaviors.
• Provide age-appropriate information regarding sexually transmitted infections and contraceptive methods.
• For couples who are planning pregnancy or experiencing early pregnancy, assess their knowledge about reproductive screening and provide accurate information while encouraging verbalization of their questions, concerns, and emotions regarding screening.

Implementation (Take Action)

During the implementation stage, the nurse provides teaching on reproductive topics, assists with reproductive assessment visits, and administers contraceptive injections. The nurse also considers if the planned interventions and teaching topics are still safe and appropriate to implement based on the client’s status. For example, if the nurse plans on providing health teaching about contraceptive methods but discovers the client thinks they may be pregnant, the topics and the goals of the discussion change.

Evaluation

After implementing nursing interventions, the nurse analyzes the effectiveness of the interventions and modifies the nursing care plan accordingly.