As I sit down and open my computer on a Monday morning, I have 4 smears booked in for that day, sadly by mid morning two have cancelled and one hasn’t attended. For the woman that has attended it is my chance to make this consultation a positive experience. 1 in 3 women do not attend for their cervical smear (NHS 2018). This statistic makes it vital for us health care professionals to remove the embarrassment and stigma that is involved with women having their smear test taken. This is where it can feel daunting for the practice nurse!
Providing a seamless consultation with cervical smears can be difficult especially with it being such an intimate procedure but it is important that we cover all areas. There are five vital things we must do before we obtain a sample from the patient:
1. Make the patient feel comfortable
We are about to perform an intimate procedure, so make sure to ask how your patient is and if she has any anxieties about the procedure. This is a great moment to empower your patient, she has made the daunting decision not to turn around in the practice car park, instead is prepared to put her trust in you! That’s pretty amazing.
2. Gain the information you need for the lab
When was your last smear? (If ever)
What was the first day of your last menstrual period?
Are you taking any form of contraception, including the IUD/Implant?
Are you taking any hormone replacement therapy?
Would you like a chaperone?
3.Has the patient had any history of gynaecological problems?
This question can indicate how the patient may react when you do begin the procedure. I also ask the patient her expectations of the cervical smear. It can also provide a little insight into whether the patient has any history of sexual/physical violence.
4.Explain what the procedure is, what we are testing for and gain informed consent
To explain the procedure I always show the patient the leaflet that they received through the post with their smear letter. This takes us to what we are testing for, a virus called HPV. By explaining what HPV is and how it can change the cells of the cervix, we can ensure that the patient has an understanding of what we are screening for and can give informed consent.
5.Offer the patient a chance to ask questions
This is her health and her body, and you have been given the privilege to provide this screening programme. We need to ensure we answer questions to the best of our ability and act as an advocate for our patients.
After you have gained this information we need to change the direction of the consultation. It seems obvious for us as nurses that women need to take their lower half of clothes off, but if you have never had a smear taken or had an intimate examination, this might not be as obvious! Lets make sure we guide our patients without making them feel foolish.
Show them where to put their clothes, where to sit and where to put their legs! (If you have stirrups this makes the leg thing a lot easier). Talk them through what you are doing, but also try to slip some normal conversation in to ease some of the tension there may be.
It can be hard to find the cervix at first, have confidence that you can find it! Use the techniques that you were taught! Fists underneath the bum, a big cough, stand up and have a jump- the patient that is! If it works it works – just ensure that you are keeping it dignified.
After obtaining the sample ask how the patient is, give her some privacy and let her get changed in peace and quiet. Usually the patient does not want to hang around long after the smear, so I explain what happens now with the sample and when she will hear the results.
So, Bobs your uncle! Fanny’s your aunt! You have just taken a great smear, that was informed, dignified and hopefully your patient will walk away feeling empowered and will give her the reassurance that smears don’t have to be a bad experience.
Warm the speculum – In the past nurses would use Pellijelly on the speculum but this jams the machines at the labs. Warm water can help on insertion and makes the speculum feel a little more pleasant for the patient. I keep the speculum in a cup of warm water just before taking a sample.
If the bed is motorised, bring the bed up to standing level so you don’t have to strain your back and peer over the patient.
Ensure you gain all the history you need from the patient before taking the sample, this means you aren’t asking any questions when the patient needs to relax during the procedure.
Written by Annie Winstanley, a Practice Nurse (@AnnieWinstanle1)