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A Killer Brewing Down There

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When a woman reaches puberty, her body not only changes hormonally and physically, but her cells within a specific area where her uterus and cervix meet together will interact with each other and begin to form what is called the transformation zone. This process will continue for the rest of this woman’s life while she has a reproductive cycle. Once this cycle begins, and a woman becomes sexually active, her genitalia area can become a brewing ground for what is known as cervical cancer (Lewis, Bucher, Heitkemper, Harding, Kwong, & Roberts, 2018, p.1256).

Cervical cancer is ranked as the fourth leading cause of deaths among woman with cancer and is the third most common cancer that a woman is diagnosed with in the world (Julinawati, Cawley, Domegan, Brenner, & Rowan, 2013). Approximately 530,000 women throughout the world will be diagnosed with cervical cancer each year, and about 275,000 of those women will die (McGraw & Ferrante, 2014). Most cervical cancers are caused by the human papillomavirus also known as HPV (Gersten, 2017). HPV is transmitted from one partner to the other through sexual intercourse. When the genitals of a woman come into contact with the genitals of her partner who has HPV, the skin and bodily fluid that contact between the woman and her partner will then place that woman at a higher her risk of contracting HPV. When this happens, the woman could end up with cervical cancer later on in her life (McGraw & Ferrante, 2014). There are many other contributing factors that can increase a woman’s risk in developing cervical cancer throughout her life. Many of these risks include smoking, or having multiple births, the use of oral contraceptives for a long period of time, or even from having a weakened immune system (“HPV and Cancer,” 2015).

One possible way the woman’s immune system could be weakened would be due to having the human immunodeficiency virus (HIV). A person with HIV is at a higher risk of contracting HPV from sexual intercourse because of their weakened immune system. When this happens, that person is then susceptible for their HIV to then become the acquired immunodeficiency (AIDS). A person who has HIV and ends up having cervical cancer is then known to have AIDS. Other risk factors could include being of a younger age when that woman became sexually active or even from having a previous sexually transmitted infection such as chlamydia or herpes simplex 2 (McGraw & Ferrante, 2014).

Prevention is the most important action to take when trying to prevent cervical cancer because cervical cancer is known as a slow progressing cancer that usually does not have any symptoms until it has progressed to the point where the cancer has left the cervix and has moved into other places within the body. Early symptoms before this happens could include bleeding that is not normal that occurs in between periods, after the woman has sex, or after she has gone through menopause, a vaginal discharge that starts out watery and progresses with color and odor as the cancer progresses, to having periods that are lasting longer and heavier than usual. The most common places that cervical cancer could spread to include the bladder, the intestines, the lungs, and the liver. When this happens, the woman may begin to have symptoms of back pain, bone pain or bone fractures, extreme tiredness and weakness, loss of appetite, pain in the legs or swelling in one leg, weight loss, pain in her pelvic, and even leaking of urine or stool from the vagina (Gersten, 2017).

The first most important way to prevent the possible chance of having cervical cancer would be to not have sex, but if and when a woman chooses to have sexual intercourse with someone, she needs to make sure to use a condom for protection. The use of a condom decreases the contact of the two person’s genitalia areas. Even though, the use of condoms helps to prevent the woman and her partner from giving HPV from one to the other, condom use is considered to be only 70% effective. Another way to help prevent cervical cancer is for the woman to have the HPV vaccination administered. The HPV vaccination can be given to a female as young as nine years of age all the way up to 26 years of age and there are two different types of HPV vaccines that have been approved by The Food and Drug Administration (FDA) by the names of Gardasil and Cervarix (McGraw & Ferrante, 2014).

The woman can help protect herself by having either a HPV test done or by having cervical cancer screenings performed once she becomes sexually active (Lewis et al., 2018). This is done by having the Papanicolaoi cytological test (Pap smear) performed (Gersten, 2017). There are currently two different types of Papanicolaoi cytological tests that can be performed to detect pre-cancerous cervical lesions before they turn into cancerous tumors along with cancerous tumors themselves. The two types of Pap smears are called “conventional cytology test” and “liquid-based cytology test”. Both are performed by removal of cells from the woman’s neck of her cervix, but are tested differently in the lab. The conventional cytology test places the cells on a glass slide and are looked at under a microscope, whereas the liquid-base test, the cells are placed in a glass vial with an added fluid that preserves the cells (McGraw & Ferrante, 2014, p. 749).

Even though these tests are available, there are still many barriers that are stopping these women from getting tested. These barriers include embarrassment, fear of pain from the procedure, inadequate knowledge and awareness about the procedure, the woman’s attitude towards the Pap smear test itself, the accessibility to have the test done, the woman does not have the support system that she needs, along with the time and the cost of the test to be performed (Julinawati et al., 2013). Due to these barriers, there are still many women all over the world who are not having the proper screening done to help prevent cervical cancer or to detect cervical cancer early enough for proper treatment for the best chance of survival.

Bharel, Santiago, Forgione, Leon, and Weinreb (2015) were all a part of the Boston Health Care for Homeless Program (BHCHP) that performed the study, Eliminating health disparities: Innovative methods to improve cervical cancer screening in a medically underserved population, over a period of five years from 2008 to 2013 in the Boston, MA area. Bharel et al. (2015) designed a method called the “Boston Health Care for the Homeless Program (BHCHP) 6-Part Cervical Cancer Screening Intervention” that was used to prove their hypothesis that by changing the approach to having cervical cancer screenings available to homeless women will increase the number of screenings that will be performed on these women. This study was done to show that by changing the standard of care on ways provided to these women would improve the number of homeless woman who are receiving proper cervical cancer screenings. By doing this would also decrease both the number of homeless women who are being diagnosed with cervical cancer and deaths that are occurring in these women. The findings of this study were proven to be true. the six step approach of interventions that were used during this process showed that there was a very large increase of homeless woman who were having cervical cancer screenings performed that went from nineteen percent in 2008 to fifty percent in 2013.

Bharel et al. noted that women who are homeless are at a higher risk of ending up with cervical cancer due to having many different types of barriers that otherwise may not be barriers for women who are not homeless. Some of these barriers that were included were about these women’s priorities of having food and shelter every day over having a medical examination done. Another barrier that was included was the possibility of the woman having a substance abuse problem. Homeless women are at a higher risk of being physically and sexually abused, which also places these women at a higher chance of having cervical cancer at some point in their lives due to not having the proper cervical cancer screenings for prevention. There were six parts to this intervention that were incorporated into woman’s health care that were used during this study to improve the outcome of homeless woman of the BHCHP population in receiving cervical cancer screenings. These included point-of-care service, multidisciplinary screening, health maintenance form in the electronic health record (EHR), process improvement, population management, and provider and patient education (Bharel et al., 2015).

Each step was very important to the success of this study. The data that was collected for the BHCHP population was broken down by age which included twenty-one to twenty-nine years of age, thirty to thirty-nine, forty to forty-nine, fifty to fifty-nine, and the greater or equal to sixty years of age. The data was also broken down by patient’s reported race that included black or African American, white, or other, and finally by behavioral health diagnosis commonness.

The information that was collected was then charted for the total BHCHP population of homeless women and the up-to-date cervical screenings that were current for both the 2008 percentage rates and the 2013 percentage rates for comparison to show the increase percentage rate from 2008 and 2013. Once this information was charted, then the data was charted based on the year along with the percentage of women who received one or more cervical cancer screenings in the past three years to compare. The results were then compared to those of the Boston Hospital that had started at eighty-one percent in 2008 and dropped to sixty-six percent in 2013, Uniform Data System (UDS) Massachusetts that had started at sixty-eight percent in 2008 and had dropped also to sixty-six percent, UDS National that had started at fifty-seven percent in 2008 and stayed at fifty-seven percent in 2013. This information that was collected had shown that the interventions that were performed during this study were the only group that showed a positive trend in improving the number of woman who were having cervical cancer screening performed for prevention and/or early detection of cervical cancer for prompt treatment (Bharel et al., 2015).

Using any and all medical visits as an opportunity to teach the patient about proper screening of cervical cancer and how it was done showed a positive increase in the number of screenings that were performed. Using this method allowed more homeless women to receive the proper cervical cancer screenings to help with prevention of cervical cancer, or to detect cervical cancer at an early stage (Bharel et al., 2015). Taking these interventions that were used with homeless women have shown a positive outcome and using those interventions with all women when attempting to increase the number of up-to-date cervical cancer screenings could also have a positive outcome.

Asgary, Alcabes, Feldman, Garland, Naderi, Ogedegbe, and Sckell (2015) noted in their study HPV knowledge and attitude among homeless women of New York City shelters, that the purpose of their study was to determine what homeless women’s attitudes and knowledge were about the HPV infection and the HPV vaccine in correlation to cervical cancer. This study was done to show that an improvement on educating these women about HPV infection and the HPV vaccine is necessary to help with the prevention of cervical cancer among homeless women in New York. Findings from this study showed that overall, homeless women in New York City shelters have a knowledge deficient when knowing about the HPV infection and that HPV causes cervical cancer along with knowledge about the HPV vaccine to help prevent this.

Three hundred homeless women partook in this study from 2012 to 2014. Asgary et al. (2015) used a national survey to collect the data that they needed for HPV. The three hundred women were divided into age ranges from twenty-one years of age to sixty-five years of age. These women were asked questions about how long they had been homeless, whether they smoke or not, their marital status, level of education, what race they identify themselves with, along with whether the woman spoke English or Spanish, and their sexual orientation. Each woman was also asked questions about HPV. These questions included if that woman knew that HPV causes cancer, if HPV causes an abnormal Pap smear test, if that woman has ever been treated for Genital Warts before, if she has ever been told that she has a HPV infection, to whether the woman knew if HPV infection is contacted through sex, if she thought that HPV is rare, and if she thought that HPV is “self-limiting” (Asgary et al., 2015). Each of the three hundred women were asked these questions and based on their answers is how Asgary et al. were able to take that data and chart the information to come to a conclusion.

This is a study that has never been done before, but Asgary et al. wanted to show that there is a knowledge deficient about the HPV infection and how HPV causes cervical cancer along with the HPV vaccine to help with prevention for women who are homeless. This study proved to be true with the data that was collected. Asgary et al. concluded that increasing the education by providing counseling and written materials that can be placed in shelters for these women to learn about HPV and cervical cancer and how to help prevent them.

The nurse will be an important role when care is being implemented in a woman’s health status. The nurse will be the one to not only educate the woman or the parents of a child about what steps that will be needed to be taken to help prevent cervical cancer, but the nurse will also be the person that will find the resources that are needed to ensure the best possible outcome. One of the “Healthy People 2020” overarching goals is to “attain high quality, longer lives free of preventable disease, disability, injury, and premature death” (“Healthy People 2020,” 2019, p. 1). One way that the nurse can accomplish this is to use evidence-based practice when educating the patient or the parents about what the human papillomavirus (HPV) is for including the different types of the HPV vaccines that are available. The nurse will include the importance of administering the vaccine before sexual activity has begun (Lewis et al., 2018).

Educating the patient or the parents that the HPV vaccine should be given when the child is between the ages of eleven and twelve years old, but that the vaccine can be given as early as age nine up until twenty-six years of age. This is done so that the patient or the parents have the proper knowledge to make the best decision about when to vaccinate themselves or when to vaccinate their child. The nurse can set up the appointment and will also provide the patient or the parents with information that can help with costs if the patient or the family does not have insurance or if the insurance does not cover the cost of the vaccine (“Cervical Cancer Awareness,” 2018).

Another overarching goal of the “Healthy People 2020” is to create “social and physical environments that promote good health for all” (“Healthy People 2020,” 2019, p. 1). The nurse will need to teach the woman about what she will need to do for prevention and also early detection of cervical cancer. The nurse will instruct the patient that once she becomes twenty-one years of age, she will need to begin having cervical cancer screenings performed (“Cervical Cancer Awareness,” 2018). There are many reasons as to why women do not have cervical cancer screenings done, and it is the nurse’s job to find out what that barrier is and find the ways that are necessary for these women to receive the proper care that is needed to maintain a healthy environment.

Many women do not have cervical cancer screenings done whether it be due to lack of funds from not making enough money or not having health insurance to the woman is homeless and food and shelter are her priority (Bharel et al., 2015). The nurse needs to use unique interventions such taking any and all medical appointments as an opportunity to not only teach the patient about cervical cancer screenings, but having the standard Pap smear trays ready and available in all clinical rooms will allow for these women to have these cervical cancer screenings performed as needed. Making sure that the nurse has access to the proper pamphlets for patients that meet each one of the women’s cultural needs is extremely important when caring for any woman including homeless women of different cultures. When the nurse gains the trust of any woman and creates a safe environment for that woman, she will be more likely to have a cervical cancer screening done for prevention and early detection than if the nurse did not educate and provide that safe environment. The nurse must be the advocate for all of his/her patients, including women who are homeless who may not have the money or the means to receive these much needed cervical cancer screenings (Bharel, 2015). Cervical cancer screening is key to both prevention and survival when detected early (Lewis et al., 2018).

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