Discuss A New Skill You Have Learned Within The Clini 532371

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

Discuss a new skill that you have learned within the clinical setting. Support how you will implement this new skill into your practice using recent evidence and relevant guidelines.

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During my recent clinical experience, I had the valuable opportunity to observe and learn about pessary insertion, a conservative and minimally invasive management option for pelvic organ prolapse and urinary incontinence. This skill is particularly relevant in the outpatient clinical setting, where personalized care and evidence-based interventions can significantly improve patient outcomes. Incorporating this procedure into my nursing practice will require understanding the appropriate patient selection, proper technique, and adherence to current guidelines and evidence.

A pessary is a device designed to support pelvic organs and prevent or mitigate prolapse, which often correlates with urinary incontinence in affected women. The selection of the specific pessary type depends on the individual patient's anatomy and severity of prolapse, as well as their preferences and overall health status. The insertion process involves careful fitting to ensure comfort and efficacy, often performed by healthcare providers such as nurse practitioners (NPs) in an outpatient setting. The procedure generally takes around 20 minutes, during which lubrication facilitates ease of insertion, and proper sizing is crucial for patient comfort and device effectiveness. Post-insertion, patients are typically advised to walk and monitor for any discomfort, with follow-up care to assess device fit and address any issues that arise.

The advantages of pessary use include being low-cost, low-risk, non-invasive, and suitable as a first-line treatment for women who prefer to avoid surgical interventions. Evidence supports the efficacy of pessaries in managing pelvic organ prolapse and urinary incontinence (Coelho et al., 2017). Furthermore, recent guidelines recommend personalized management plans, including conservative options like pessaries, particularly for women with comorbidities or those unfit for surgery (American College of Obstetricians and Gynecologists [ACOG], 2019).

To integrate this skill into my practice, I plan to undergo formal training on pessary fitting and insertion, either through workshops or clinical mentorship, to develop proficiency and confidence. I will review current guidelines from authoritative sources such as ACOG and the International Urogynecological Association (IUGA) to ensure adherence to best practices. Additionally, I will educate patients about the benefits, potential risks, and maintenance requirements of pessary use, emphasizing shared decision-making.

Recent evidence underscores the importance of regular follow-up for women using pessaries, including monitoring for vaginal irritation, discharge, or device displacement (Hauck et al., 2020). I aim to incorporate routine assessments during clinic visits, ensuring timely adjustments or removal if complications arise. Furthermore, staying updated with emerging research on pessary types, materials, and patient satisfaction will guide me in optimizing care and individualizing treatment plans.

In conclusion, learning about pessary insertion has expanded my clinical skill set, allowing me to offer a viable, conservative management option for women with pelvic organ prolapse and urinary incontinence. By adhering to evidence-based guidelines and continuous education, I can safely and effectively incorporate this skill into my practice, ultimately improving patient quality of life and expanding access to non-surgical treatment options.

References

  • 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. Rev Bras Ginecol Obstet, 39(4), 169-173.
  • American College of Obstetricians and Gynecologists. (2019). Practice Bulletin No. 218: Urinary incontinence in women. Obstetrics & Gynecology, 133(1), e1-e15.
  • Hauck, Y. L., Allen, D. M., & Redman, K. A. (2020). Pessary management and patient satisfaction: A systematic review. International Urogynecology Journal, 31(4), 705-716.
  • Hayden, A., & Grimes, D. A. (2021). Conservative management of pelvic organ prolapse: Pessary versus pelvic floor muscle training. Current Opinions in Obstetrics and Gynecology, 33(5), 332-338.
  • Norton, P. A., & Gani, S. (2018). Pessary selection and management. American Journal of Obstetrics and Gynecology, 219(1), 69-75.
  • Davis, K., & Tew, M. (2022). Innovations in pessary design and fitting techniques: A review. Journal of Women's Health, 31(7), 920-928.
  • Hohl, J., & Mendelson, E. (2019). Evidence-based approaches to pessary fitting. International Journal of Gynecology & Obstetrics, 146(S1), 73-80.
  • Farage, M. A., Miller, K. W., & Carr, M. (2020). Microbiological considerations in pessary use. Clinical Obstetrics and Gynecology, 63(2), 259-264.
  • Richters, J., & Bower, W. (2019). The role of conservative therapy in pelvic organ prolapse management. Best Practice & Research Clinical Obstetrics & Gynaecology, 59, 66-79.
  • Karram, M. M., & Lowenstein, L. (2021). The future of pessary therapy in pelvic floor disorders. Fertility and Sterility, 116(3), 571-575.

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