Use of Oral Contraceptives in Reproductive Health - Coursework Example

Title: Institution: Tutor: Date: Use of oral contraceptives in reproductive health. Contraception use in reproductive health has effectively helped to dramatically bring changes in the general structure of world population in the past 50 years Reproductive health is one of the set key millennium goals to be achieved through reduction of child mortality, improvement of maternal health, and eradication of poverty. Women must have access to effective and safe methods of controlling fertility for this projection to be attained (WILLIAMSON et al 2009). This aspect forms the key objectives of world health organization advocacy on family planning, to let women protect themselves against unwanted pregnancies (WORLD HEALTH ORGANISATION 2008). Medical practitioners and nurses have an upper hill task of offering necessary information and clinical intervention in reproductive health (WORLD HEALTH ORGANISATION 2008). Technological advancement and social development has placed demand on clinical nursing to impress timely responses to problem solving in health care system. Care for patient especially those attending reproductive health clinics require practitioners in clinical nursing to be observant during the delivery of services of any incidences that can lead to the patient developing unnecessary medical complications. This calls for expertise, knowledge and skills of effective problem solving practice while discharging duties (TAYLOR 1997, p.330). Generally, leaders in clinical nursing should be aware of factors that drive nurses to make certain decisions in the course of their practice. This promotes and improves career development of nurses (BRYER, JAYNE & DOMINI 2006, pp. 187-195). According to Dowie and Elstein in (TAYLOR 1997, p. 330), nurses have traditionally appreciated correct clinical judgment with high esteem. Nursing training should emphasize the need for problem solving through utilization of cognitive processes while practicing clinical nursing (TAYLOR 1997, p. 330). It is the duty and responsibility of a nurse to ensure safety of patient at all times, this requires application of appropriate approach in problem solving. Experimentation approach is a more safe process to be applied by a nurse since it is based on following logical criteria for diagnosis and implementation of treatment measures with a predictable result (TAYLOR 1997, p. 331). This approach was applied to asses a lady seeking prescription of a combined Microgynon 30.Through application of nursing cognitive process in solving problems, the lady patient was interviewed using in depth interview of semi-structured questions on the period she has been using a combined contraceptive pill. The diagnostic outcomes revealed possible risk of developing venous embolism complications because she had undergone orthopedic leg casting after fracturing her patella (TAYLOR 1997, p.329). The rationale of this paper is 1. To outline strategies to be used in nursing intervention to resolve problems, 2. To investigate patient compliance to advise by medical experts, and 3. Identify challenging or limiting factors that pose challenge to nursing practice. To achieve these goals, a methodological and qualitative framework was adopted (TAYLOR 1997, p.331). The clinical health condition chosen is that of a lady on repeated combined contraceptive pill yet she had undergone a recent leg orthopedic. The reason behind this choice is because it presents a unique scenario where the lady patient finds no problem continuing her usual contraceptive dose in disregard of eventual development of other medical complications. In contrast, the nurse has to change the prescription to cerazette as a prescription only dose based on cognitive observation and skills in preventing occurrence of medical complication (TAYLOR1997, p. 331). Reproductive health is a very important field in medicine that brings critical assessment of issues at primary level yet has intense repercussions on the national and international level. The impact of population growth trends and world economic dynamics may be of interest for economists and not medical practitioners. However economic policies geared on controlling the increase of population are basically a manifest of healthcare planning on reproductive health. This leads to controlled birth rates by controlling conception frequency among women (TAYLOR 1997, p. 331). Contraceptives play a major role in limiting pregnancy and ensuring that the method applied is safe. There are traditional methods of avoiding pregnancy, however in recent times modern and convenient methods have been developed and adopted. Examples include, use of condoms, injection and oral contraceptives. Contraception can simply be defined as a process that prevents either fertilization like in the case of use of condoms or inhibition of conception by use of oral or injectable contraceptives (TAYLOR 1997, p.331). The composition of oral contraceptives is mainly progestogen, oestrogen or a combined pill. Progestogen type in each pill defines whether it is third or second generation. However, there are other formulations that contain cyproterone for treating excess androgen hormone although it also has contraception ability. Table 1 bellow lists the various examples of contraceptives available on the market (CONTRACEPTIVE INFORMATION RESOURCE 2005-2009). Brand Name (labeling) Pharma Estrogen Progestin Leena Watson 0.035 mg ethinyl estradiol 0.5-1.0 mg norethindrone Levora Watson 0.03 mg ethinyl estradiol 0.15 mg levonorgestrel Low Ogestrel Watson 0.03 mg ethinyl estradiol 0.3 mg norgestrel Lutera Watson 0.02 mg ethinyl estradiol 0.1 mg levonorgestrel Microgestin Watson 0.02-0.03 mg ethinyl estradiol 1.0-1.5 mg norethindrone Nora-BE Watson none 0.35 mg norethindrone Nor-QD Watson none 0.35 mg norethindrone Ogestrel Watson 0.05 mg ethinyl estradiol 0.5 mg norgestrel Ortho-Novum Ortho 0.035 mg ethinyl estradiol 0.5-1.0 mg norethindrone Ortho-Cept) Ortho 0.03 mg ethinyl estradiol 0.15 mg desogestrel Micronor Ortho none 0.35 mg norethindrone Ortho Tricyclen Ortho 0.035 mg ethinyl estradiol 0.18-0.25 mg norgestimate Ortho Tricyclen Lo Ortho 0.025 mg ethinyl estradiol 0.18-0.25 mg norgestimate Modicon Ortho 0.035 mg ethinyl estradiol 0.5 mg norethindrone Reclipsen Watson 0.03 mg ethinyl estradiol 0.15 mg desogestrel Trivora Watson 0.03-0.04 mg ethinyl estradiol 0.125-0.5 mg levonorgestrel Tri-Norinyl Watson 0.035 mg ethinyl estradiol 0.5-1.0 mg norethindrone Yasmine Bayer 0.03 mg ethinyl estradiol 3.0 mg drospirenone Yaz Bayer 0.02 mg ethinyl estradiol 3.0 mg drospirenone Zovia 1/35E-28 Watson 0.035 mg ethinyl estradiol 1.0 mg ethynodiol diacetate Zovia 1/50E-28 Watson 0.05 mg ethinyl estradiol 1.0 mg ethynodiol diacetate (Source: Contraceptive Information Resource: Oral contraceptive pills). Studies reveal that second and third generation oral contraceptives display varying risk factors to the development of thromboembolism. There is similar display of the pattern in oral contraceptives containing gestodene or desogestrel. (KREMMENREN et al 2001, pp.131-134). According to world health organization survey of 1995, there is evidence that show lower risks association with third generation oral contraceptives which have less oestrogen levels to the incidence of thromoemboilism occurrence. This study opens discussion on why combined oral contraceptive like microgynon 30 with progestogen is associated to thromboembolism (KREMMENREN et al 2001, pp.131-134). Gestodene and desogestrel third generation oral contraceptives are less associated to thromboembolism than second generation levonorgestrel (Table. 2 and chart 1). Contraceptive % risk Population No Contraceptive use 5 100000 2nd generation OCP 15 100000 3rd generation OCP 25 100000 Pregnancy 60 100000 (Table 2: shows comparison of risks for contraceptive use in the population) (Chart1. Graphical representation of data comparing risks of contraceptive use). Combined oral contraception prevents pregnancy by inhibiting ovulation. The contraceptive action makes the cervical mucus membranes thick and the lining of uterus to be thin. However, there are major and minor side effects associated with oral contraceptives. The main side effects are associated with blood clot in brain that causes stroke, Veins, lungs and Heart attack. There is clear evidence on etiology of developing thromboembolism and consumption of oral contraceptives. It is argued that taking of combined oral contraceptive pill increase the patients odds of developing blot clot (KREMMENREN et al 2001, pp.131-134). In this case the nurse noticed the lady with a long casted leg, which prompted immediate interview session to ascertain information related to history of her current or previous contraceptive use and type of drug. Newell and Simon (Newel 1972) method of thinking loudly was applied to get cognitive access and conceptualize the medical predicament. Interview response answers were deeply thought of to allow for an insight into repercussions of subject (NEWEL 1972). A combined experimental and diagnostic reasoning were adopted as the process of solving the lady’s medical situation. Evidence was gathered from previous medical records, her medical history and nursing learning experiences. The data was then processed based on information theory and model (ELSTEIN et al in TAYLOR 1997, p.331), in this process the nurse used cognitive knowledge and skills to asses the veracity of the lady’s health condition. Leg cast, blood pressure, and lady’s long usage of Microgynon 30 combined dose were classified as cues that posed major risks for developing medical complications. External consultation by the nurse revealed that other medical professionals who have attended to her including the orthopaedic doctor never considered the high risk (NEWEL 1972). Due to complexity revolving around this lady medical background because she has been using microgynon 30 even after orthopaedic long leg casting and no pathological conditions has developed. The nurse applied intuitive- humanist model to diagnose and classify all information explicitly on the patient and the long leg cast. This model was preferred in order to get desired outcomes that would be beneficial to the young lady (BANNING 2008, p.187). During consultation and after the interview the patient was disappointed since the nurse could not prescribe her favorite contraceptive. The patient resistance prompted the nurse to give a detailed account on the dangers that could arise if she continued using her preferred method of combined contraceptive. The lady was given a reflective account on the literature of using oral contraceptives which is associated to occurrence of blood clots in leg veins. Consequently the blood clot can be detached and move up to the lungs. This condition may result to blockage of the veins and is commonly referred to as thromboembolism. Occurrence of thromboembolism is rare but also very dangerous to health, although some women recover successfully, a small number have succumbed to it (MEDSAFE 2002). Predisposing factors for development of blood clot increases with age and also depends on the type of contraceptive pill used. Studies show that blood clot occur in women not taking oral contraceptives on small scale but this situation is aggravated further through combination contraception pills. However, progestogen only pill has low or little risk of blood clot development (MEDSAFE 2002). Blood clot as a risk factor for women taking oral contraceptives is primarily attributed to closeness or family history of blood clot, cancer, previous occurrence of blood clot, overweight, varicose veins that are bad, individual having blood disorders and cases of being immobilized like in the case of the young lady. Blood clot is a treatable condition by doctors, through medication called blood-thinning which takes up to several months to correct (MEDSAFE 2002). Although no legal binding is required, it was necessary to give the patient much more details for her to notice medical repercussions and the need to switch to Cerazette by show of consent. In addition, this was essential because application of Cerazette requires that the patient consents or agrees either in writing or verbally (WALLAGE & MCARTHUR 2006). This action was in line with patient group direction policy recommended for trained and qualified nurses who are entitled to give patients on repeat or initial supply of progestogen only contraceptive pill Cerazette without prescription from a medical doctor. The policy gives nurses responsibility to discharge intervention action in clinical practice as per there level of competence without compromising safety of the patient but to offer benefit to the patient (WALLAGE & MCARTHUR 2006). Although Cerazette method is effective and provides safe contraception, its prescription requires explanation and correct usage. This is because it alters the pattern of bleeding and causes systemic side effects. However it has merits over traditional contraceptive pills prescribed as progestogen only pill. One of the main advantages is its 36 hours overlap contraception cover from the previous pill unlike the traditional ones which have over lap of 27 hours (WALLAGE & MCARTHUR 2006). These merited Cerazette as a more suitable progestogen only pill for this patient to cover for the rule of 3 hour late pill that would extend up to 12 hours since she could not get her preferred prescription. Other benefits the patient will gain include ovulation inhibition compared to traditional levonorgestrel use as the contraceptive pill, and better protection especially considering her tender age which means she is fertile on most occasions. Another reason was the suitability of Cerazette recommendation in persons who are immobile. In contrast, the combined pill is highly contra-indicated in instances of major surgical operation, long leg cast, or any surgery that will limit movement for a couple of days(WALLAGE & MCARTHUR 2006). Some pharmaceutical manufacturers indicate the side effects and contra indication literature to guide patient use (SAUNDERS & TINDALL 1991). Subsequently, Cerazette mode of administration is advantageous since a women takes daily dose of tablets back to back even during period times unlike for the combined pill which requires a one week break after 3 weeks of continuous daily dose. Desogestrel if taken at the beginning off menstrual cycle is capable of preventing conception instantly so that other contraception methods are not necessary. Likewise if it is started on first day after delivery, a woman is full protected against pregnancy and does not need additional contraceptive measures (Saunders and Tindall 1991). However it is worthy to note that desogestrel like other oral contraceptives does not protect one from sexually transmitted diseases. For this reason, condom use is a more preferable method for protective purposes. It is also important for women to know that Cerazette will disrupt regular menstrual periods which results to unexpected bleeding or skipping of periods. This occurrence lasts for a short period before it settles. Hormonal contraceptives offer women less chance of breast cancer diagnosis compared to those on other contraceptives (SAUNDERS & TINDALL 1991). Microgynon 30 can be defined as a combined hormonal contraceptive pill with levonorgestrel and ethinylestradiol as active ingredients. The two agents in microgynon 30 are actually synthetic forms of women sex hormones progesterone and oestrogen. Apart from preventing contraception, it is also used to treat menstrual disorders, and endometriosis (SAUNDERS & TINDALL 1991). The mode of action of microgynon acts by over-riding normal occurrence of the menstrual periods. Alteration of the different states and levels of hormones responsible for control nurturing of menstrual cycle renders pregnancy impossible. Therefore means microgynon combined hormonal contraceptive action cheats body that ovulation did occur already. Under such state egg maturity and release by the ovaries on monthly basis is hampered (THOMAS1993). In general, oral contraceptives may contribute to all or some of the following side effects, fatigue, weight gain, loss of hair, vomiting, changes in mood, breast tenderness, nausea, and loss of sexual drive, vaginitis, and acne. The nurse or medical doctor should therefore explain to patients that barbiturates, rifampicin, antiepileptic drugs, griseoflutin and other medicines may render hormonal contraceptives in effective and therefore when seeking further treatment for other reasons the patient should offer full medical history to the doctor (CROOK 1997). A patient who would be immobile for longer periods is advised not to take this pill because of the increased risk of blood clot occurrence in veins. A doctor consulting a patient for a possible surgery specifically orthopaedic or abdominal portions that will render the patient immobile should schedule plan for the operation on the 4th to 6th week after patient stops taking microgynon. A long travel of up to five hours without exercise sessions means one is confined or immobile thereby increasing the risk of developing blood clot (THOMAS1993). The lady patient exposed a challenge to the nurse’s professional conduct. Based on United Kingdom medical eligibility criteria for contraceptive use, the nurse had to sort assistance from further consultation and research. Therefore the UKMEC guideline directs that women with any one or multiple predisposing risk factors for blood clot that outweighs benefits of a particular drug administration should be advised against taking it (MEMBERS’ ENQUIRY RESPONSE 2006). In order to ensure safety of the young lady, the nursing utilized process-oriented model to make decision on shifting the patient to progestogen only pill, through consideration of strong arguments about high risk factors against benefits to the patient (LAURI AND SANNA 1998, pp. 443–452). In this case the young lady’s long leg cast restricts her mobility and is a predisposing risk factor for blood clot. The orthopaedic doctor should have advised her to stop taking microgynon tablets before or after casting her leg or if it was an emergence immediately. Therefore the nurse proposed following healthcare plan for the lady. Predisposing risk factor was long leg cast that rendered the young lady immobile for long period. Intervention plan involved prescription of cerazette progestogen only pill likely not to result to blood clot. Outcome was the safety of the patient (MEMBERS’ ENQUIRY RESPONSE 2006). The lady’s persistence and resistance even after being given a detailed literature on the risks of maintaining microgynon 30 and benefits of shifting to Cerazette were coupled by nursing problem solving strategies based on social aspects of experts and novice. The nurse had to seek more consultation with the doctor on several critical medical accounts that presents similar situation. The doctor’s advice and narration of life examples for successful interventions based on the weight of risk factors conducted on other patients successfully convinced the lady to accept the dose of cerazette. This was as a result of boosting her confidence and filling the gap between nurse and patient interaction by the doctor that changed in her behaviour after picking up role models from the discussion (TAYLOR 1997, p.336). In conclusion, this essay noticed that patients’ long-term and immediate outcomes rely heavily on the decisions made by nurses while providing care to the patient (BRYER, JAYNE & DOMINI 2006, pp. 187-195). Clinical nursing is a continuous self directed and reflective learning and challenges like those presented by the lady patient enabled the nurse to expound and put into use all theories and practice learnt during nursing training (BRYER, JAYNE & DOMINI 2006, pp. 187-195). Like wise, the challenge also build the nurse’s confidence and knowledge in application of problem solving skills by use of various models Modern method of contraceptive use is increasing rapidly among young women without prior knowledge on the precautions for their use. It should be recommended to have multidisplinary avenues, wide-based community interventions, and a combined provision of support, information, access to services that are youth friendly, and essential life skills (BRYER, JAYNE & DOMINI 2006, pp. 187-195). It is quite agreeable that any laxity in nursing problem solving skills and quick intervention would result to detrimental and fatal health status of patients under care. In the current healthcare scenario nursing profession require delivery of effective care top patients and remaining up to date on the new initiatives and innovations (BRYER, JAYNE & DOMINI 2006, pp. 187-195).Dissemination of information in reproductive management and advice to women of the extra benefits for using oral contraceptives will be encouraging to more young women (VINIKER 2005). References BANNING, M 2008, ‘A review of clinical decision making: models and current research,’ Journal of Clinical Nursing, Vol.17, pp. 187–195. BRYER, JAYNE & DOMINI 2006, Influences that drive clinical decision –making among rheumatology nurses, Leeds, Vol.4 no.3, pp. 130-139. CARNEVALI & THOMAS, MD 1993, Diagnostic Reasoning and Treatment Decision Making in Nursing. Lippincott, Philadelphia. CONTRACEPTIVE INFORMATION RESOURCE 2005-2009, Oral contraceptive pills, viewed on 8th may 2009 from . CROOK, D 1997, ‘Do different brands of oral contraceptives differ in their effects on cardiovascular disease,’ British Journal of Obstetrics and Gynaecology, Vol. 104, no. 5, pp. 516-520. KEREMMEREN, ALGRA, AND GROBEE, DE 2001, ‘Third generation oral contraceptives and risk of venous thrombosis: meta-analysis,’ British Medical Journal, Vol.323, no.7305, pp.131- 134. LAURI, SIRKKA AND SALAMTERA, SANNA 1998, ‘Decision making models in different fields of Nursing,’ Research in Nursing & Health, Vol.21, pp. 443–452. MEMBERS’ ENQUIRY RESPONSE 2006, Faculty of family planning and reproductive health care clinical effectiveness unit, viewed on 6th may 2009 from . MEDSAFE. INFORMATION FOR CONSUMERS 2002, Oral Contraception and Blood Clots, viewed on 6th may 2009 from . NEWELL, A AND SIMON, HA 1972, Human problem solving, Prentice Hall, Englewood Cliffs, New Jersey. SAUNDERS AND TINDALL BALLIÈRE 1991, ‘Clinical Decision Making for Nurses and Health Professionals,’ Australian Nursing Resource Services, Ed. Thomas, Wearing, & Bennet, M.Sydney. TAYLOR, CATHERINE 1997, ‘Problem solving in clinical nursing practice,’ Journal of Advanced Nursing, Deakin University, Australia, Vol. 26, pp. 329-336. WALLAGE, S AND MCARTHUR, M. 2006, ‘Patient Group Direction for the Initial and Repeat Supply of the Contraceptive Progestogen Only Pill Cerazette,’ NHS Policy, Viewed on 6th May 2009 from . WILLIAMSON, PARKES, WIGHT, PETTICREW AND HART, GRAHAM 2009, ‘Limits to Modern Contraceptive use among young women in developing countries: a systematic review of qualitative research.’ Reproductive Health, Vol.6, no.3, Electronic version . WORLD HEALTH ORGANISATION 2008, ‘Making Pregnancy Safer,’ Annual Report 2007 Geneva, World Health Organisation. VINIKER, DAVID 2005, ‘Noncontraceptive health benefits of combined oral contraception.’ Women’s Health 2005, Viewed on 6th May 2009 from . Read More