When I first qualified as a nurse, after a year consolidating my training on a surgical ward, I accepted a position on a gynaecology ward. I’m afraid I did not enjoy it at all and so, when years later I decided to become a General Practice Nurse (GPN), one of my main concerns was that I would find the women’s health part of the role a bit tricky. Five years later, I found myself as the Sexual Health and Contraception Lead and the trainer for new Cytology Sample Takers for the practice – I could not have predicted that!
Cytology sampling is generally one of the first skills new GPNs are trained in. At the beginning of my training I remember thinking I would never get the hang of it. Once I was deemed capable of consulting on my own it felt like I was asking my mentor to come and find an elusive cervix on every other patient, but with time, patience and great mentorship my confidence and competence grew. All of sudden, I realised colleagues were asking me to find their patient’s elusive cervixes. Now that’s a nice feeling!
But cytology sampling is so much more than being able to take the sample. Skilful communication is crucial to the consultation being successful. The conversation that surrounds the sample taking is just as important as the procedure itself. I take the view that the aim of the consultation is, obviously to obtain a cervical sample, but also for the woman to understand what we are testing for, what an ‘abnormal’ result means and most importantly that when her next screening letter arrives, she makes an appointment straight away because last time wasn’t that bad. It is also an opportunity to find out about menstrual cycles, abnormal, unacceptable bleeding patterns, contraception and sexual health, and it is a great opportunity for health promotion.
The NHS Cervical Screening Programme saves approximately 5,000 women every year in the UK. However, we know that 1 in 4 women do not attend their cervical screening appointments (Jo’s Cervical Cancer Trust 2018). There are many reasons why women choose not to attend, and a previous bad experience is high on the list. There are many simple measures that can be put in place to ensure a positive experience. The list below highlights some of these measures, although it is not exhaustive;
- Creating a warm, welcoming atmosphere. If it’s a particularly cold day turn the radiator up, it can be chilly lying on the couch especially if the procedure takes slightly longer than expected.
- Allowing plenty of time for explanation and opportunity to ask and answer any questions prior to the procedure, this is particularly important if this is a woman’s first time.
- Allowing plenty of time for the procedure and not appearing rushed is reassuring.
- Generating appropriate discussion or chat can be a welcome distraction for some women.
- Something as simple as locking the door can be hugely reassuring for a woman who may be worried about someone coming into the room during the procedure.
- Always offer a chaperone.
Undergoing cytology sampling is not the nicest medical procedure women have to undergo, it is thought of as embarrassing, undignified, uncomfortable and painful, but it is important. Making the experience as pleasant and acceptable as possible is essential to increasing the screening numbers. It is worth remembering that not only does a successful consultation have a positive effect on the patient and increase the likelihood of her reattending, it also has the potential to positively influence her friends and family members.
As a student nurse you will not be able to take a cervical sample, but during a primary care placement you would be encouraged to assist in cytology consultations. Patients are always asked if they consent to having a student in the room before the consultation and, in my experience, nearly all are very happy to. It is a wonderful teaching opportunity and whilst cytology sampling is only one skill a GPN performs, training is usually accessed early in your GPN career. This means that you feel, very quickly, that YOU make a difference. Why not request a primary care placement? Who knows – you could become the future Cytology Lead in your practice!
Kim Grimmer (@Kiml71) – Sexual Health and Contraception Lead GPN