Gynecology Exam. Rehearsal Guide... preparing women with intellectual and developmental disabili es (I/DD) to successfully complete a gynecology exam
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1 Gynecology Exam Rehearsal Guide... preparing women with intellectual and developmental disabili es (I/DD) to successfully complete a gynecology exam
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3 INTRODUCTION FOR CAREGIVERS A rehearsal guide contains realis c pictures, concrete ideas, and clear, brief instruc ons for guiding a person through what can be expected in a specific situa on. It includes helpful sugges ons for caregivers to follow to make the experience meaningful for the person and increase the likelihood of a successful outcome. This approach is beneficial when suppor ng people with intellectual and developmental disabili es (I/DD) who are anxious about situa ons such as doctors appointments, hospitaliza ons, and medical tes ng. A rehearsal guide provides opportuni es for the caregiver to assist the person to learn about a specific situa on. It contains informa on on what is needed and why and explains exactly what can be expected. Such a guide is most effec ve when it is person-centered and used in conjunc on with discussion to allow explora on of specific areas of concern. It can be a powerful tool when used as intended. The expected result is that the person will then experience the situa on in a way that supports health and well-being by being prepared and knowing what to expect. The guide can be used at all stages of the situa on to facilitate a posi ve end result. Thank you for taking the me to use this tool to work with self advocates to improve their health outcomes. HOW TO USE THIS REHEARSAL GUIDE For best results, begin to review this rehearsal guide with the person prior to the day of the appointment. Some mes it will help to review this material with an individual several days or weeks before an appointment; other mes, it may be be er to wait to review this material un l just before the procedure is to take place, perhaps the day before or the morning of the procedure. It is up to the caregiver to determine which will best suit the individual s needs and abili es in understanding the informa on provided; however, it is important not to wait un l 5 minutes before a procedure to introduce this guide to an individual. Give the individual enough me in advance to become familiar with the procedure based on the pictures and informa on contained on each page and on the individual s abili es. It is best to review this guide slowly and to focus on one idea/page at a me, allowing the person to talk and/or ask ques ons a er each idea/page is presented. A caregiver may want to share experiences in regards to having this procedure done personally, but be sure to do so in a posi ve manner, depic ng a posi ve outcome. For best prac ces: Allot me to review this material when the individual is alert and interested in doing so. Ensure that the se ng is free from distrac on. Based on the individual s a en on span, it may be best to review one page at a me, rather than reviewing an en re guide in one si ng. Explain each picture and prac ce the suggested exercises with the individual, such as deep breathing, as they appear throughout the guide. On the day of the procedure, take this guide along to con nue rehearsing the various steps involved in the procedure. Review each page step by step. Remain posi ve, calm, and upbeat. Remember to offer posi ve reinforcement and praise throughout the procedure, especially a er the individual has successfully completed the procedure.
4 A VERY SPECIAL DOCTOR All women need to see a special doctor called a gynecologist. This doctor checks a woman s private parts to make sure they are healthy. This doctor is nice and will take me to talk to you and answer your ques ons. The doctor will be gentle and will not hurt you.
5 WHY SEE A GYNECOLOGIST? To make sure you do not have cancer or any other problems, the doctor will need to check inside of you. The doctor will tell you what is going to happen next before he or she does anything. It is important to relax and listen to the doctor. Note to Caregiver: An individual may use unique words for in mate body parts, menstrual cycle, sexual ac vity, or discomfort. Inform the doctor of these terms prior to the exam to help facilitate be er communica on.
6 GOING TO THE DOCTOR (Name of individual), you have an appointment with the gynecology doctor on (date of appointment). Women get gynecology exams to stay healthy. (Name of caregiver) will go with you and may stay with you during the exam, if you want her to. This exam will take place at (name of loca on). Note to Caregiver: Contact the doctor s office in advance to assure that a female caregiver will be permi ed to remain in the room while the exam is taking place.
7 IN THE WAITING ROOM When you first get to your appointment, you will have to wait un l someone calls your name to be seen by the doctor or nurse prac oner. (Name of caregiver) will stay in the wai ng room with you. You may be given paperwork to complete while wai ng. You may answer the ques ons or ask a caregiver help you. You might want to take a favorite book along to read or some of your favorite music to listen to on your headphones while you wait.
8 WHEN YOUR NAME IS CALLED There will be nurses who will talk with you about what you need to do for the exam. They are friendly and will help you. A nurse may check your blood pressure and your weight. Note to Caregiver: Reassure the individual that the exam room is private. Be pa ent and use a calm, reassuring tone while assis ng the individual.
9 CHANGING INTO A PATIENT GOWN The nurse will take you to a room and ask you to take off your clothes and put on a pa ent gown before the exam. It is okay to listen to these people. (Name of caregiver) will be there to assist you and make sure that you are all right. Note to Caregiver: Reassure the individual that the exam room is private. Be pa ent and use a calm, reassuring tone while assis ng the individual.
10 THE EXAM ROOM The room where the doctor will see you has a special table. See the things s cking at the end of the table? These are called s rrups. When it is me for the exam, you will be asked to lie down on the table and put your feet in these s rrups. They will not hurt you. Note to Caregiver: If you choose to discuss a personal experience regarding a gynecology exam, keep the tone upbeat and posi ve.
11 MEDICAL HISTORY The doctor will come and ask you some ques ons. If you do not know the answers or do not feel comfortable answering these ques ons, (Name of caregiver) will be with you and will help you. Note to Caregiver: An individual may use unique words for in mate body parts, menstrual cycle, sexual ac vity, or discomfort. Inform the doctor of these terms prior to the exam to help facilitate be er communica on.
12 CHECKING YOUR PRIVATE PARTS A er the doctor speaks with you, the doctor will check your breasts to make sure they are healthy. This will not hurt. Remember, (Name of caregiver) will be in the room with you the whole me. The doctor will very gently touch you to make sure there are no lumps in your breasts or under your arms. It is okay to laugh if this ckles you. The doctor can teach you how to do this so you can check your breasts every month to make sure they are healthy.
13 CHECKING YOUR PRIVATE PARTS Now the doctor will ask you to lie down on the table and to put your feet in the s rrups. This is so the doctor can look at your private parts to make sure they are healthy. It is okay for the doctor to look at your private parts. The doctor is only making sure that you are healthy. (Name of caregiver) will be right there in the room with you to make sure you are okay. See how this woman put her feet in the s rrups? Note to Caregiver: Offer the individual praise and encouragement as you explain the following steps.
14 CHECKING YOUR PRIVATE PARTS First, the doctor will look at your private parts that are on the outside of your body to make sure they are healthy. The doctor will touch them very gently to make sure they are okay. Let s prac ce deep breathing. This will help you to relax. (Name of caregiver) will hold your hand, too, if you want. Note to Caregiver: Prac ce deep breathing with the individual. Encourage the individual to take slow, deep breaths with you now and as needed during the exam. This may be a good me to offer to hold the individual s hand to show support. Quiet conversa on about a pleasant topic may be a welcome distrac on. Con nue to offer praise and encouragement as you explain the following steps.
15 CHECKING YOUR PRIVATE PARTS Now the doctor will look at your private parts on the inside of you body to make sure they are healthy, too. The doctor will put something that feels like jelly on a small medical tool called a speculum. This is so the speculum will not hurt you. The doctor will put the speculum inside of you to help the doctor see your inside private parts. You might feel some pressure, but it will be over fast. Let s prac ce deep breathing again. This will help you relax. (Name of caregiver) will keep holding your hand, if you want..
16 RELAX AND BREATHE! The doctor may also place one hand on your stomach while feeling your private parts inside. Deep breaths can help you to relax, so let s prac ce deep breathing again. Note to Caregiver: Prac ce deep breathing with the individual. Encourage the individual to take slow, deep breaths with you now and as needed during the exam.
17 YOU ARE DOING GREAT! When the doctor is done, the doctor or nurse will ask you to sit up. Then you can put your clothes back on. A er you are dressed, the doctor might want to talk to you and (Name of caregiver). This is so you can ask ques ons you might have about the exam and the doctor can tell you if medicine or other tests are needed. Note to Caregiver: Offer the individual praise and encouragement for comple ng the exam.
18 YOU CAN DO IT! I know you always do the best you can! Note to caregiver: Take me to assess how well the person understands what was presented. Ask some very brief ques- ons such as, Do you know what will happen when you go to see the doctor for this exam? Revisit the story as o en as needed to ensure the person understands and is prepared when the day of the doctor s appointment arrives.
19 ADDITIONAL RESOURCES University of Pi sburgh Medical Center (UPMC) - Magee Women s Health. (2018). Your Gynecologic Exam and Pap Test. Retrieved from h p:// ents-visitors/educa on/ womens-health/pages/gynecologic-exam-andpap-test.aspx Weiss, T.C. (2017, November 6). Female Pelvic Examina on: Understanding What is Involved. Disabled World. Retrieved from h ps:// QR: 11.17
20 For addi onal informa on regarding this guide or any of our physical or behavioral health trainings, contact KEPRO SW PA Health Care Quality Unit (KEPRO HCQU) hcqu.kepro.com
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