Desempenho de enfermeiros na coleta de material para o exame de papanicolau

Abstract

The Pap test has world-wide recognition as a safe strategy to detect cervical cancer early. Its execution includes manual work, from the material collection to the result emission. Thus, the performance of human resources contributes to the security or not of the results. This is carried out by doctors and nurses that compose the teams of Health Family Program (PSF), but mainly by nurses. In this context, it was decided to carry out this study which had as a general objective to evaluate the material collection for the Pap test by nurses and as specific objectives to verify knowledge and practice of these professionals in relation to cytological collection; to identify the availability of material resources which are necessary for the execution of the collection and to evaluate if the collected material is adequate based on the laboratorial report. It is an evaluative research, with descriptive exploratory character. It was executed in units of the Family Health Program (PSF) in Maranguape-CE, whose data was collected from August to October, 2006, through the direct and participative structured observation made with 21 (100%) nurses, in their area, and through the review of the laboratorial reports of 63 collected slides. The structured observation followed the Instrument of Quality Recognition of Proquali Methodology, and the data was annotated using checking system. The participative observation data was registered in field books. The results were presented under nurse characterization; formation, access to technical handbooks and knowledge to deal with cytological collection; performance of nurses in the material collection for the exam (biosecurity measures, comfort and security of women during exam and collection technique); availability of resources for the execution of the procedure and; suitability of the slides. Most nurses were graduated for 9 to 11 years and had 8 years of experience with cytological collection. Seventeen (81%) evaluated themselves as secure to execute the procedure and sixteen (76%) showed to have the adequate knowledge about the exact localization of the cytological collection. The access to the practice of cytological collection at college was referred by only 7 (33%) of them. Only 4 (19%) washed the hands before the procedure, 21 (100%) used procedure gloves in both hands and the discard of the trash was inadequate in all the units. Users’ comfort was evaluated according to the standpoint of making sure if the woman had emptied the bladder before the exam and of explaining it to the user and was achieved by 2 (9,5%) and 4 (19%) of the nurses respectively. The privacy was evaluated by the criteria of covering the woman, maintaining the office’s door closed and preventing people’s getting in and out during the exam. It was achieved by 20 (95%), 17 (81%) and 14 (67%), respectively. The collection technique was satisfactory with 90,5% or more of the nursed in 7 of the 11 evaluated items and the suitability of blenders was satisfactory in 100% of the 63 reports. The nurses’ performance was the ideal expected in terms of guaranteeing slides with good quality to search cervical cancer. However, practice at college, washing of hands, adequate discard of the trash, users’ comfort and security and the interview about women’s conditions for the execution of the collection need improvement. It was observed risk of desiccation, presence of blood and hypocelular material, but unsatisfactory slides were not generated. It is suggested that studies need to be carried out with the objective of evaluating unnecessary or excessive recommendations for the collection.