The Device That Changed The Practice Of Medicine: The Stethoscope

Imagine for a moment the year 1800. A doctor is meeting with a patient – most likely in the patient’s home. The patient is complaining about shortness of breath. A cough, a fever. The doctor might check the patient’s pulse or feel their belly, but unlike today, what’s happening inside of the patient’s body is basically unknowable. There’s no MRI. No X-rays. The living body is like a black box that can’t be opened.

The only way for a doctor to figure out what was wrong with a patient was to ask them, and as a result patients’ accounts of their symptoms were seen as diseases in themselves. While today a fever is seen as a symptom of some underlying disease like the flu, back then the fever was essentially regarded as the disease itself.

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But in the early 1800s, an invention came along that changed everything. Suddenly the doctor could clearly hear what was happening inside the body. The heart, the lungs, the breath. This revolutionary device was the stethoscope.

The inventor of the stethoscope was a French doctor named René Laennec. In medical school, he had learned to practice percussion – a technique in which doctors tap their fingers against a patient’s chest and listen to the sound to try and hear what’s going on inside.

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One day, he tried percussing a patient but had trouble hearing. So he rolled up his notebook into a little cylinder and put one end on the patient’s chest and one end in his ear. He was so impressed by the quality of the sound that he decided to construct a device for listening to the internal sounds of the body.

The result was the original stethoscope. Laennec had invented a way to hear the inner workings of the human body. Now he needed to connect the sounds he was hearing with what was happening anatomically inside the patient’s body.

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To do this, Laennec listened to people right before they died, and then connected these sounds to discoveries made during the autopsy. Soon, Laennec made some key discoveries using his stethoscope. For example, he found that when a person has fluid beneath their lungs, they make a bleating sound, kind of like a goat. A sound he called egophony. He also discovered sounds that tracked with the different stages of tuberculosis.

Laennec published his results, and soon doctors were making other important discoveries that changed the way people thought about disease. Little by little our entire understanding of disease shifted from one centered around symptoms to one centered around objective observation of the body. Medical language completely changed, as doctors invented new anatomical words for diseases, like Bronchitis, which means the inflammation of the bronchial tubes.

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In parallel, the device evolved as well. In the 1840s, doctors began experimenting with flexible tubing and soon an Irish physician invented the binaural stethoscope design with two earpieces that we still use.

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This evolving device got doctors thinking about disease in new ways, changing their dynamic with patients and giving doctors a lot more power. Before the stethoscope, to be sick, the patient had to feel sick. After the stethoscope, it didn’t matter what patients thought was wrong with them, it mattered more what the doctor found.

René Laennec actually felt that patient’s accounts of their own disease were still important, but the quest for objective information about disease was underway, and the stethoscope was just the beginning. Now we have X-rays, CT scanners and MRI and PET scans. All of these devices are basically trading upon the same paradigm that the stethoscope created: that doctors should be able to detect abnormalities inside the body to reach a diagnosis, regardless of how the patient is feeling.

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These new technologies have led to so many important discoveries about the human body and disease. Today, we can spot tumors before they become life threatening and diagnose problems like high blood pressure before they causes heart disease. But this new way of thinking has also pushed doctors and patients farther apart. The doctor is no longer in your bedroom interviewing you about every detail of your experience.

René Laennec died in 1826 at the age of 45, mostly likely of tuberculosis, a disease he and his stethoscope helped us understand. It’s been 200 years since he first rolled up his note book and pressed it to that patient’s chest. Medicine looks completely different than it did back then, but somehow the stethoscope has endured.

It’s no longer a wooden cylinder, but to this day, when you walk into a doctor’s office for a routine exam, you can expect to feel the familiar stethoscope on your back.

But that could be changing. Powerful imaging technologies like ultrasound have made the stethoscope exam less critical to the diagnostic process. Medical students aren’t as good as using stethoscopes as they used to be, and across the board doctors today rely less on the stethoscope to make diagnoses. The rise of portable ultrasound has some doctors arguing that we don’t need the stethoscope anymore. They say that if you have that technology right at the bedside, why not use it right away? Ultrasound is an incredible tool, but it still isn’t widely available in many developing countries, and even in the United States it’s expensive. Right now the stethoscope functions as a screening tool so that patients don’t need to go get an expensive ultrasound unless they need one.

Dr. Andrew Bomback is a nephrologist and an assistant professor at Columbia. He still uses his stethoscope, but he says that in general doctors aren’t as good at listening to the body as they once were, and they rely on the stethoscope exam less and less to make a diagnosis. “It’s become almost a ritual more than an actual tool in terms of making diagnosis,” Bomback explains.

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Regardless of how it’s used, the stethoscope remains omnipresent in our culture. Do a Google image search for doctor, and you will see what a physician is supposed to look like. The plurality of the doctors pictured on the first page of results are white men in white coats. Some of them are peering inside patient’s ears, others are writing something down on a clipboard. But all of them have stethoscopes.

And they are wearing the stethoscope in the exact same way–which is like a shawl around the back of the neck. Andrew Bomback says this way of wearing the stethoscope is a relatively recent fashion trend, probably borrowed from TV shows like ER and Scrubs. Doctors used to wear their stethoscopes dangling down the front of the shirt like a tie, which was practical. If you needed to use it quickly you could just pop it into your ears. Bomback observes that “it’s almost like this new version of wearing it like a scarf or a shawl is almost a concession that it’s more a fashion accessory than actually a tool that we’re using.”

But even if it’s become a fashion accessory, Dr. Bomback isn’t ready to give up his stethoscope. He says it’s an important conduit to connecting with his patients. Physical contact between a doctor and a patient has become increasingly rare. Doctors visits are short and physicians often spend much of time staring at a computer screen. Bomback says the stethoscope provides an important opportunity for intimacy.

“The stethoscope is still a part of the exam” he says, “aligned with the laying on of hands” associated with healers. “When we go to do the physical exam, we move away from our desk, we move away from the computer, and we stand right next to the patient and it’s a much more intimate conversation.”

Bomback says he thinks the stethoscope lives on in part to keep doctors and patients from drifting too far apart. To make sure doctors keep close to their patients, and keep listening.


This article originally appeared on 99pi.org. 99 Percent Invisible is a podcast on the design of things we never stop to think twice about. If you enjoyed this article, head over to their website and listen to their playlists.



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  Photo cr: Unsplash  

 Mental Health 

 Mental health is a level of psychological well-being, or an absence of mental illness. It is the “ psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment” . From the perspective of positive psychology or holism, mental health may include an individual’s ability to enjoy life, and create a balance between life activities and efforts to achieve  psychological resilience . 

 According to the World Health Organization (WHO), mental health includes “ subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one’s intellectual and emotional potential, among others.”  Cultural differences, subjective assessments, and competing professional theories all affect how mental health is defined. 

 Mental health nurses play and important part in helping patients lead a positive life. It is not uncommon for physical disorders to arise from mental issues. It is a field that is growing in awareness. It is estimated that  40% of Malaysians will suffer from mental health issues in their lifetime . 

 Specialization tasks 

 Maintaining good mental health is crucial to living a long and healthy life. Mental health nurses are required to show a considerable amount of empathy towards their patients in assisting them to make a full recovery. Research has shown that there is stigma attached to mental illness. Therefore, it is extremely important that mental health nurses develop excellent observational skills in the treatment of the patient. 

 Activity therapies 

 Activity therapies, also called recreation therapy and occupational therapy, promote healing through active engagement. Making crafts can be a part of occupational therapy. It is very common for nurses to take patients on walks as part of this type of therapy. 

 Psychotherapy 

 Psychotherapy is the general term for scientific based treatment of mental health issues based on modern medicine. It includes a number of schools, such as  gestalt therapy ,  psychoanalysis ,  cognitive behavioral therapy  and  dialectical behavior therapy . 

 Legal requirements 

 Mental health nurses assist in the legal requirements for the patient. Requirements encompass the setting of the patient or a group of patients. 

 Progress monitoring 

 Mental health nurses may have roles that include visiting patients in their home to monitor their progress and carry out risk assessments. While carrying out this task, nurses assess the risks involved to the patients’ safety, health, and welfare. 

 Pathway 

 In order to specialize as a mental health nurse, you must be a registered nurse, practicing for a minimum of three years. A Bachelor’s of Science in Nursing is an advantage. You must take up a psychiatry-based training course with practical hands-on experience. For those courses, you may be able to get accreditation if you have a degree in psychology, or social work. 

 Required skills 

 You will need to display: 

 
	 
	 Exceptional observational skills. You will be required to assess patients and look out for signs of tension or anxiety, which sometimes are not that obvious. 
	 
	 
	 Physical fitness, especially when working in a hospital. Increased stamina and strength is an added bonus. 
	 
	 
	 Emotionally and spiritually resilient to work in a challenging environment. 
	 
 

 Job prospects 

 While a lot of work for mental health nurses is done in the hospital, the majority is community-based in a wide variety of settings. Some of them include community mental health centers, nursing homes for the elderly, rehab units, and private clinics. 

 Working conditions 

 Salaries for mental health nurses will depend on the level of education that they possess. Those with a BSN or MSN will earn more. The type of institution and experience that you have will also factor in your earnings. 

 It is important to have a calm demeanor and able to handle stress well as you will be working with many difficult patients with psychotic episodes. It can be rather jarring to those who are not used to it. However, when approaching these situations without judgement, many mental health nurses manage to overcome these issues and help the patients with their treatment. 

 Career opportunities 

 Search for high-paying mental health nursing jobs on  MIMS Career . Browse, save, and apply for nursing jobs, all in one-click. Take the opportunity for higher pay and better work locations. Our pages are all mobile-responsive, allowing you to take that leap for a better job whenever, wherever you are. All our job postings are heavily screened to  prevent scams and mistrustful behavior . 

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Photo cr: Unsplash Mental Health Mental health is a level of psychological well-being, or an absence of mental illness. It is the “ psychological state of someone who is functioning at a satisfactory level of emotional and...

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 A close relative of mine is a young nurse. Two years ago she started taking care of this nice lady who was partially paralysed; her breathing muscles would no longer function autonomously, hence a tracheostomy was done so she could breathe. The condition left her bed-ridden on bad days, and wheel-chair bound on good ones. 

 She cared for the lady to the best of her abilities, for about 18 months. One day the lady started feeling cold. She was sweating and shivering at the same time. She went unconscious, and had five cardiac arrests within 36 hours. 

 After unsuccessfully trying to stabilize her blood pressure, she died of heart failure. The young nurse was devastated. It wasn’t her own mother, but it might as well seemed like it. It was her first patient death while working as a nurse. It affected her so much she found it difficult to work for the next week. 

 This experience is shared by many nurses in the country. How nurses bond with their patients depends on circumstances and the length of time they provided care to them. A strong bond between patient and nurse is essential to effective nursing, but when death happens, it can deal a very significant blow. 

 The first death of your patient can massively impact you as a nurse. So will subsequent ones. 

 It is extremely important that this doesn’t mentally compromise your ability to do your work. 

 How can you, as a nurse, deal with it? 

 1. It’s okay to feel emotions. Embrace it fully. 

 You are human. You are in a compassionate profession: the very basis of nursing started on the principle to relieve pain, assuage suffering, and provide help to those of ailing health. 

 It is okay to feel overwhelmed at first, especially when you have cared for the patient for so long. 

 Empathy is good for your job, it makes you a better nurse, but it makes loss more painful. 

 Allow yourself some time to feel, and understand your emotions. 

 Your line of work is to care for people, the noblest of all human traits. Your grief on the death of your patient means that you have done your job. 

 2. Try to accept the death happened. 

 Some wards have it harder than others for this. 

 A geriatric ward would have the oldest, most needy patients. Conducting CPR on these patients can be cruel, especially if you or your team are not willing to “let go” of the patient. 

 However, death in these parts of the hospital would be a routine part of the day. It is wise to accept it, so you can continue giving out the best care to the other still-living patients without letting it affect the quality of your work. 

 Accept their deaths, and the fact that you have done all you could to alleviate their suffering. Know that you have done your best to keep them comfortable and retain their dignity. 

 3. Remain in control and neutral if breaking the news to the family. Don’t add to the problem. 

 It is okay to share your emotions with the patient’s loved ones. 

 Respect the family; if they do not wish you to partake in their grief, then kindly leave them alone. They have also gone through much, just like you. 

 Some relatives will blame the doctor/nurse for causing the death. Don’t take this to heart. The Kubler-Ross model of grief lays out five stages, and anger is one of them. 
Find your own ways to vent, either through support groups, family, or colleagues. 

 4. Talk about it. Don’t bottle it in. 

 One of the best things about being in the nursing workforce is that you’re surrounded by people who have gone through similar experiences too. 

 Death is prevalent amongst healthcare professions, and sometimes just talking to a senior can help a lot. 

 Find someone you’re comfortable with. It can be a senior nurse, a matron, or even your other colleagues in the ward. 

 Ask them how they managed to overcome such periods of distress. Pour out whatever you’re feeling to them; it is very likely that they have felt everything you are feeling right now. 

 Talking about it helps you make sense of what you’re feeling. By articulating it into words, you can pinpoint exactly what’s bothering you, and help you to come to terms. 

 5. Realize that these things happen. 

 Things happen. Death is part and parcel of the life in a hospital. Some areas will be more prone to dealing with death than others, like the ER, surgical ward, the ICU. 
You might find yourself poring over the moments that led up to the death in your mind, going over what you could have done better, what you could have done differently. 

 This leads to a general feeling of guilt. This can be very destructive to your well-being, and can affect the performance of your work to other patient who also need your care. This is not a good coping mechanism if it jeopardizes the health of your other patients. 

 6. Believe that you are making a difference. 

 The death of a patient does not equal to failure. 

 How you deal with the patient’s relatives is an extension of how you treated their late relative. 

 For all the grief that you may be feeling right now, the patient’s family has it harder. 

 Showing that you cared provides a monumental difference, and leads the family to a safer path of acceptance. 

 Conclusion 

 The trait that sets humans apart from other species is our ability to empathize for our fellow brethren. 

 Other fauna have demonstrated this to a certain degree, but only humans have been able to take it to their very core, make it into their reason to live, and deliver it back to their community. 

 Nursing is more than just facts or skills or the amount of certifications that you can obtain to move your career. It is founded on empathy; the ability to understand others’ suffering and pain. 

 During times when you feel overwhelmed or devastated by the loss of your patient, stand firm and be proud of who you are, because nurses do things that not many will have the capacity to accomplish. 

 You will find your way to deal with it as you become more experienced, and become better at learning what is the best way to help families cope with grief over time. 

 Steel your heart, adjust that uniform, and carry on providing the best that you can give to your other patients.

How to Cope with Death and Loss, as A Nurse

A close relative of mine is a young nurse. Two years ago she started taking care of this nice lady who was partially paralysed; her breathing muscles would no longer function autonomously, hence a tracheostomy was done so she could breathe. The...

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 Nephrology/Renal Nursing 

 Nephrology is a specialty of medicine and pediatrics that concerns itself with the kidneys:  the study of normal kidney function, kidney problems, kidney health, and the treatment of kidney problems.  It encompasses dietary and medication to replacement forms of treatments. Systemic conditions that affect the kidneys and systemic problems that occur as a result of kidney problems are also studied in nephrology. A physician who has undertaken additional training to become an expert in nephrology may call themselves a nephrologist or a renal physician. 

 A nephrology nurse (or renal nurse - those two terms are used interchangeably) is a nursing practitioner that focuses on kidney health. They treat and care for patients that are suffering from those suffering from kidney problems as well as those that are at risk of developing them. 

 As a renal nurse, one must be prepared to stay on top of current developments, as treatments in this field are accelerating their development at a very rapid pace. This is possible to be done by regular consumption of renal-related literary content such as medical journals. Attending seminars and conference is also a possible method. 
   

 Scope 

 Renal nursing concerns the  diagnosis and treatment of kidney diseases , including electrolyte disturbances and hypertension, and the care of those needing replacement therapy, including dialysis and transplant patients. 

 Many diseases affecting the kidney are systemic disorders not limited to the organ itself. Examples include acquired conditions such as systemic vasculitides and autoimmune diseases, as well as congenital or generic conditions such as polycystic kidney disease. 

 Methodology of nursing 

  History and physical examinations are central to the diagnostic workup in nephrology or renal nursing.   

 This may include inquires regarding family history, general medical history, diet, medication use, drug use and occupation. Examination typically includes an assessment of volume state, blood pressure, skin, joints, abdomen, and flank. 

 Urinary analysis (urinalysis) is an instrumental method in assessing possible kidney problems. Nurses in this specialization are trained to notice the appearance of blood in the urine, protein, pus cells or cancer cells in the urine, often with the help of a urologist or nephrology physician. 

 Basic blood tests can be used to check the concentration of hemoglobin, platelets, sodium, potassium, chloride, or phosphate in the blood. All of these may be affected by kidney problems, and renal nurses are supposed to be well-versed in this area. 

 Under certain circumstances, an invasive test is required for diagnosis. A biopsy of the kidney may be performed. This typically involves the insertion, under local anesthetic and ultrasound or CT guidance, of a core biopsy needle into the kidney to obtain a small sample of kidney tissue. Kidney biopsy is also used to monitor response to treatment and identify early relapse. 

 Training 

 The process differs across countries, but the outcome is indefinitely similar. Nephrology is a subspecialty of general medicine. A nephrology/renal nurse will have to complete nursing school, a minimum of three years of practice as a general nurse, and a BSN (Bachelor’s of Science in Nursing) or post-basic course in renal subjects. Typically this training lasts 1-2 years. 

 Nurses in training for renal nursing often continue in the world of academia to obtain research degrees, putting a temporary halt to their clinical practice. Some also sub-specialize in dialysis, kidney transplantation, CKD, cancer-related kidney diseases, procedural nephrology or other non-nephrology areas. 

 However, only pediatric-trained nurses are allowed to train in pediatric nephrology, due to differences in physiology. 

 Work environment 

 A major task and responsibility for renal nurses are  administering treatments to patients.  Treatments can include medications, blood products, surgical interventions, renal replacement therapy and plasma exchange. Kidney problems can have a significant impact on quality and length of life, and so psychological support, health education and advanced care planning play key roles in nephrology. 

 Renal nurses often find themselves having a better work setting compared to their non-specialized counterparts. Schedules are less erratic, especially for nurses working in dialysis support roles. 

 On average, renal nurses with post basic certification get  about 10% more pay.  

 Career opportunities 

 
	 Dialysis centers (out- and in-patient) 
	 Nephrology wards 
	 Transplant units 
	 Home care 
	 Medical device industry 
	 Pharmaceutical industry 
	 Government and nonprofit healthcare settings (eg:  NKF ) 
	 Community clinics 
 

 There is a severe shortage of nephrology nurses in Malaysia. 

 Search for high-paying job in renal nursing at  MIMS Career . MIMS Career is a premier, healthcare-focused job portal site for Malaysia, Singapore, the Philippines and Indonesia. Our simple sign-up process allows you to easily apply for jobs you might be interested in with a single click. Job locations include hospitals, nursing homes, and private practices. It’s free, easy to use, and safe. 

 Can’t find what you’re looking for? Set up a job alert and we’ll notify you by email whenever positions that suit your preferences are available. All of our pages are mobile-responsive, so you can take your applications with you on the go. 
   

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 As incidences of chronic kidney disease and other related renal issues continue to rise, the need for adequately trained nurses in those fields continue to grow. Similar conditions are seen in various parts of the world. In 1999, the incidence of patients with kidney conditions requiring long-term care is 340,261. In 2010 it is over 600,000. 

 The diagnosis of renal conditions can be done with a primary care doctor. However, treatment and care of those patients require an understanding of risks, comorbid conditions, complications, and probabilities for loss of kidneys by both physicians and nurses. 

 For nurses, a post-basic renal course can open the doors to working in this area which is sorely lacking in manpower. Here are the reasons why you should consider pursuing a renal post-basic certification. 

 From bedside to business 

 There are a lot of CKD (chronic kidney disease) clinics opening up. Having a renal certification enables you to work at these clinics as your training is aligned with what they have to offer their patients. 

  Pusat Hemodialisis Mawar  is one of them. They are the largest private charity haemodialysis organization in the country. They have 13 centres spread throughout the country. 

 A short search on Google Maps also reveals a lot of haemodialysis centres in Klang Valley. 

 Being a nurse at institutions like those will train your patient management skills as you run the day-to-day administrative tasks in parallel with your nursing duties. 

 Better work setting 

 You’ll have a less erratic schedule than your peers. Dialysis patients require a regular timing on their treatment. Your shifts would be on more regular hours. A more fixed routine can be better for your health and well-being. 

 Better pay 

  On average, renal nurses with post basic certification get about 10% more pay.  

 Hospital dialysis nurses may be offered more pay, but they may also be required for emergency dialysis treatments, making their schedule less average than others in their field of focus. 

 Adjustable pace 

 You can choose to work in smaller dialysis centres for slower pace, or larger nephrology units in hospitals if you wish for a faster paced working environment. Unlike other specialties, you have a choice to work in the kind of environment that suits your working style. 

 Rapid changes in the field 

 Technological advances in the renal treatment field progresses at a rapid pace. Previously, it was slow. Kidney diseases were complex and difficult to study. Therefore treatments were vaguely ineffective. 

 The 21st century brought in upgraded transplantation technologies with breakthroughs in biocompatible materials. 

 As a renal nurse, you will handle the care of post-transplant patients. The tasks and how you perform your duties to these patients have a high probability of changing with the frenetic pace of research. 

 High Demand 

 Renal nurses have good experience in interpreting telemetric data. This makes them efficient at being support units in surgical wards to ensure successful procedures. 

 Dialysis is expensive, costly, and there’re not enough facilities and manpower in public and private hospitals. 

 Conclusion 

 Pursuing a renal post-basic certification is a solid pathway to consider. Nurses with this certification are more in demand, have better pay, and all the listed advantages above. For people who like clinical challenges, treading this path is for you. 

 Already have a post-basic in renal care? Head over to MIMS Career to search and apply for renal care jobs in your area. Just signup and experience our convenient 1-click application process. It’s fast, safe, and easy. MIMS Career also allows you to search in our huge database of employers seeking new staff. You can also save potential jobs for later viewing, and create your own personalized job alert.

Renal Post-Basic, a certification to consider

As incidences of chronic kidney disease and other related renal issues continue to rise, the need for adequately trained nurses in those fields continue to grow. Similar conditions are seen in various parts of the world. In 1999, the incidence...

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 Gynaecology is the medical practice of dealing with the health of the female reproductive system and the breasts. Literally the term gynaecology means “the study of women.” The opposite of gynaecology is andrology, which deals in male-specific medical issues. 

  Almost all modern gynaecologists are obstetricians : physicians who deal in the branch of medicine and surgery of childbirth and labor. These two fields overlap in many areas, therefore in many institutions Obstetrics and Gynaecology are lumped together as O&G. 

 Gynaecology is concerned with the health of the female reproductive organs and the ability to reproduce. It also encompasses paediatric and adolescent problems to post-menopausal ages. 

 History 

 From ancient Egypt circa 1800 BC, the Kahun Gynaecological Papyrus is the oldest known medical text of any kind. It writes about women’s complaints; gynaecological diseases, fertility, pregnancy, contraception, etc. In the 4th century BC Hippocrates wrote texts about gynaecological diseases that were common afflictions to Greek women at the time. 

 J Marion Sims is widely considered to be the father of gynaecology. He operated during the 19th century at Jefferson Medical College, New York. However the title is now being scrutinized due to his unethical development of his surgical techniques. He operated a lot on slaves, many of whom were not given anaesthesia. 

 Training 

 Post-basic courses on midwifery, gynaecology, and obstetrics are considered to be part of gynaecological training. If desired, a nurse can opt to pursue a Masters in order to carry out research work in the field, and proceed to doctorate studies. 

 Training is given out to encourage the study and advancement of the practice of gynaecology. It is also done by the publication of clinical guidelines and reports on aspects of the specialty and service provision. 

 Gynaecology is a vast field. Nurses who work in this area have sub-specialties in high-risk obstetrics, fertility care, or minimal access surgery. The job most deals with healthy women, where unexpected challenges can present themselves on a daily basis. Work includes a large number of hands-on procedures, and training reflects that. 

 Common Cases 

 Patients range from those who have chronic disorders which are not life threatening, to those who require immediate acute emergency treatment. 

 Nurses in this field are often required to provide assistance during operative procedures. Some of the common procedures a gynaecological nurse with oversee include: 

 
	 dilation and curettage 
	 Oophorectomy 
	 Exploratory laparotomy 
	 Treatments for urinary incontinence 
	 Cervical excision procedures 
	 treatment of polyps 
	 surgery for cancers 
 

 A major part of a gynaecology nurse is the delivery of infants. Their work includes: 

 
	 assist delivery using instruments (forceps or vacuum) 
	 C-sections 
	 Foetal health 
 

 Career Opportunities 

 
	 Independent Nurse Consultant 
	 Educator 
	 Training programme director for gynaecology nursing 
	 
	 Research in public and private sectors 
	 
	 - 
 
   

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