Discuss A New Skill You Have Learned Within The Clinic

Discuss A New Skill That You Have Learned Within The Clinical Setting

During my recent clinical experience, I observed and learned about pessary insertion, a technique used to manage pelvic organ prolapse and urinary incontinence. A pessary is a medical device inserted into the vaginal canal to support pelvic structures and alleviate symptoms associated with prolapse. The choice of pessary type depends on the patient's specific condition and anatomy. Proper fitting is crucial to ensure effectiveness, comfort, and to prevent complications. The insertion process is typically performed in an outpatient setting by a nurse practitioner (NP), using appropriate lubrication to facilitate easier placement. While surgical intervention remains an option for some patients, pessaries offer a conservative, non-invasive, and cost-effective alternative, especially important for patients who wish to avoid surgery.

The patient I observed was a 79-year-old woman with a history of total abdominal hysterectomy performed over twenty years ago. She had a pessary inserted the previous week, which dislodged after two days. The procedure took approximately 20 minutes. She tolerated the insertion well, reporting no discomfort. Post-insertion, she was advised to ambulate, and the NP ensured the device was properly fitted and monitored her for any signs of discomfort during walking. I initially thought the procedure might cause pain or discomfort, but the patient remained comfortable throughout.

There are various types and sizes of pessaries, tailored to individual needs, which underscores the importance of proper assessment and fitting. The evidence suggests that pessaries are a viable first-line treatment for pelvic organ prolapse and urinary incontinence, especially considering their low cost, low risk, and non-invasive nature (Coelho et al., 2017). According to current guidelines from the American Urological Association (AUA) and the American College of Obstetricians and Gynecologists (ACOG), pessaries are recommended as an effective conservative option for appropriately selected patients, emphasizing the role of nurses and nurse practitioners in their management (AUA, 2020; ACOG, 2019).

Support how you (as NP) will implement this new skill into your practice using recent evidence and relevant guidelines

As a Nurse Practitioner, I plan to incorporate pessary management into my clinical practice following current evidence-based guidelines. First, I will ensure comprehensive patient assessment to determine candidacy for pessary therapy, including evaluating the severity of prolapse, patient preferences, and contraindications. Education on device types, fitting, and self-care will be a vital component, consistent with guidelines from ACOG and the International Urogynecological Association (IUGA), which recommend patient-centered counseling and proper device fitting (IUGA, 2019).

I will pursue further training and certification on pessary fitting and management to enhance my competence and ensure patient safety. Regular follow-up visits will be scheduled to monitor for potential complications such as vaginal irritation, erosion, or expulsion, in line with best practice protocols (Bø et al., 2017). I will also adopt evidence-based practice by staying updated through recent literature and participating in continuing education. For instance, studies suggest that patient education and regular follow-up improve pessary longevity and decrease complication rates (Corcos et al., 2020).

Furthermore, I will advocate for a multidisciplinary approach involving gynecologists, urologists, and pelvic floor physiotherapists to optimize patient outcomes. Integrating pessary use into my practice will expand conservative management options within my scope, reduce unnecessary surgical interventions, and improve quality of life for women suffering from pelvic floor disorders. Finally, I will document all procedures meticulously and ensure informed consent, in accordance with institutional policies and best practice guidelines.

References

• American Urologic Association (AUA). (2020). Urogenital prolapse management guidelines. Urology Practice, 7(4), 157-174.
• American College of Obstetricians and Gynecologists (ACOG). (2019). Pelvic organ prolapse: Management. Obstetrics & Gynecology, 134(4), e113-e124.
• Bø, K., et al. (2017). Pelvic floor muscle training for the treatment of female urinary incontinence. Cochrane Database of Systematic Reviews, (12), CD005654.
• Corcos, J., et al. (2020). Pessary use and management: A systematic review. Female Pelvic Medicine & Reconstructive Surgery, 26(3), 191-197.
• Coelho, S. C. A., Giraldo, P. C., Florentino, J. O., et al. (2017). Can the pessary use modify the vaginal microbiological flora? A cross-sectional study. Revista Brasileira de Ginecologia e Obstetricia, 39, 169-174.
• International Urogynecological Association (IUGA). (2019). Consensus on pessary management. International Journal of Gynecology & Obstetrics, 144 Supp 1, 1-13.