The occurrence of cancer around the world is receiving increased attention by the medical establishment and the community. Numerous charities, universities, and non-profit organizations expend vast amounts of money and research to eliminate this disease in all of its forms. Unfortunately, not all types of cancer receive the same amount of attention in the media spotlight.  Whether it is due to embarrassment, ignorance, or fear, conversations about cancers involving the sexual reproduction systems are not as freely discussed in the United States or any other societies. 

While penile cancer is rare in the United States, it accounts for approximately 10% of cancers in African and South American men (Huether, McCance, Brashers, and Rote, 2017). A lack of social understanding, as well as the fear and ignorance that accompany diseases associated with sexual subjects, make delays a compounding problem. A specific diagnosis of penile cancer generally comes after a patient has noted a tumor or lesion. Further diagnosis, if it is not delayed, is done through an examination of the size, location, and fixation of the lesion. A biopsy is then performed along with imaging to determine if any metastasis has occurred in the surrounding lymph nodes. Treatment of this condition is usually completed with surgery although multimodal chemotherapy options are also being studied.  

Vaginal or cervical cancer is often discovered by females who experience vaginal bleeding or discomfort. These symptoms, again if not delayed, likely are followed by a physical including a bimanual pelvic examination and a Pap test. Additional testing for suspected cancerous growth includes an HPV test, colposcopy, and biopsy test to look for abnormal cellular growth or signs of cancer. Lastly, imaging, including MRI scans, computerized tomography, and positron emission tomography may be employed to identify and plan for the treatment of abnormal cellular growths. Treatment for cancer in the female reproductive organs is similar to that of men as surgery and chemotherapy, including radiation is often employed. 

Another similarity among men and women developing penile or cervical/vulvar cancer is the acquisition of the Human Papilloma Virus (HPV). Douglawi and Masterson (2019) note that nearly 40% of cases in France have been linked to this virus, which is most often acquired through unprotected sexual contact. Abramowitz et al. (2018) indicate an incidence of 7.5 per 100,000 women in the United States. Recent campaigns to vaccinate young adults, teens, and those in early adulthood has shown positive results in preventing transmission of this disease Joura, et al. (2019) agree that proper vaccination combined with screening can reduce recurrent or subsequent HPV disease transmission. 

A difference in the ability to recognize the presence of cancer includes visibility to the patient. Male sexual organs present an additional chance to catch the presence of a lesion by existing outside the body. Men that use good hygiene and self-examination practices are more likely to note a sore or lump on the penis than a female who must contend with pelvic pain or vaginal bleeding as a warning sign. 

Many of the same behavioral factors that cause cancer in other areas of the body are believed to be linked to the development of cancer within the reproductive organs. Factors such as smoking, poor personal hygiene, and HPV infection from unprotected sexual contact are associated with higher instances of penile or cervical/vulvar cancer (Emilio, Luigi, Riccardo, and Carlo, 2019). Additional factors such as diet and physical activity levels, remain a modifiable risk that can be adjusted with the appropriate education and effort. 

 Continued education of low-risk areas, as well as increased education of high-risk areas in Africa and South America, is the best way to reduce these debilitating illnesses. Information about the risk factors and best practices for maintaining a healthy lifestyle allow uneducated populations to realize access to treatment. The most effective avenue of treatment will include vaccines for males and females, to prevent acquiring HPV and information that stresses a healthier lifestyle, including physical activity and a low-fat diet.

References

Abramowitz, L., Lacau Saint Guily, J., Moyal-Barracco, M., Bergeron, C., Borne, H., Dahlab, A., Bresse, X., Uhart, M., Cancalon, C., Catella, L., and Bénard, S. (2018). Epidemiological and economic burden of potentially HPV-related cancers in France. Plos One, 13(9), e0202564. doi:10.1371/journal.pone.0202564

Emilio, S., Luigi, V., Riccardo, B., & Carlo, G. (2019). Lifestyle in urology: Cancer. Urologia, 86(3), 105–114. doi:10.1177/0391560319846012

Douglawi, A., & Masterson, T. A. (2019). Penile cancer epidemiology and risk factors: a contemporary review. Current Opinion In Urology, 29(2), 145–149. doi:10.1097/MOU.0000000000000581

Joura, E., Kyrgiou, M., Bosch, F., Kesic, V., Niemenen, P., Redman, C. W., & Gultekin, M. (2019). Human papillomavirus vaccination: The ESGO–EFC position paper of the European society of Gynaecologic Oncology and the European Federation for colposcopy. European Journal of Cancer, 116, 21–26. doi:10.1016/j.ejca.2019.04.032

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 Environment, health, nursing, and person interconnect to comprise the metaparadigm of the nursing discipline (Francis, 2017). As nursing is a profession based upon caring for people, I believe the phenomena of person is most relevant to my clinical practice as an OR nurse. Patients undergoing surgery are unable to observe what occurs during their procedure as they are sedated or receive general anesthesia. Consequently, they rely on their OR nurses to advocate for dignity and safety while in an altered level of consciousness. Patient-centered care is a foundational aspect of my nursing career. I also believe that keeping the person as the focal point when providing nursing care enables nurses to be cognizant of treating patients holistically versus only focusing on diagnoses, symptom management, or pharmacological intervention. Occasionally, I encounter anesthesia providers that do not want to allow a few minutes for the nursing staff to properly clean patients after surgery and I remind them that a clean surgical dressing and gown is essential to patient’s hygiene and well-being.  

      Virginia Henderson was an established author, educator of nursing, and co-creator of a patient-centered curriculum utilized by the National League of Nursing (McEwen & Ellis, 2014). Henderson developed the nursing need theory, which is divided into 14 components that emphasized improving patient independence to promote recovery after hospitalization (Ahtisham & Jacoline, 2015). The elements of the nursing need theory provide a holistic nursing approach that encompasses the mental, physical, social, and spiritual aspects of patients. 

      Faye Abdellah was a nursing theorist that presented a patient-focused approach that also integrated using nursing diagnoses into the nursing discipline. Abdellah along with colleagues, created a listing of 21 nursing problems that are equally divided into patient problems and nursing skills during a period were nursing diagnoses were not considered appropriate for nurses (McEwen & Ellis, 2014). Abdellah’s 21 nursing problems are subcategorized into emotional, physiological, social needs of patients along with nurse-patient relationships and patient care.  

Carmetrice Brock 

References 

Ahtisham, Y., & Jacoline, S. (2015). Integrating nursing theory and process into practice;

Virginia’s Henderson need theory. International Journal of Caring Sciences, 8(2), 443

-450. Retrieved from https://web-a-ebscohost-com.prx

-herzing.lirn.net/ehost/pdfviewer/pdfviewer?vid=4&sid=74c93db6-58d8-427f-a012

-97911b447a18%40sessionmgr4009 

Francis, I. (2017). Nursing informatics and the metaparadigms of nursing. Online Journal of

Nursing Informatics, 21(1). Retrieved from https://www.himss.org/library/nursing

-informatics-and-metaparadigms-nursing 

McEwen, M., & Wills, E. (2014). Grand nursing theories based on human needs. In Theoretical

basis for nursing [VitalSource version] (4th ed., p. 134). Retrieved from

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Communication in the workplace is key. It is what makes employees feel comfortable, valuable and successful, which allows them to work to their fullest potential. Effective communication not only builds trust between employers and employees, but has a direct effect on the health and safety of nurses and their patients (Bergman, Dellve, & Skagert, 2016). The Clark Health Workplace Inventory is a tool that is used to determine if a work environment is perceived as healthy. After completing the survey, the results showed that my workplace is an unhealthy environment. Oddly enough, my coworkers and I have had many conversations about some of the very topics discussed in this assessment. That is why this result doesn’t surprise me at all. One of the question on this assessment asked specifically about staffing, which is something that my unit struggles with consistently. The absence of adequate staffing makes the workload difficult to manage. It leads to unnecessary stress. Also, there were several questions pertaining to clear communication through all the levels of the organization, which is something that I think my organization could get better at too. There are a lot of decisions made about the staff without actually getting the staff’s input on those decisions beforehand. It can make employees feel as though their thoughts or input doesn’t matter. No one can expect for every workplace to be perfect. In fact, any work environment has its issues and aspects that make people unhappy. However, overall employees should find some happiness in their jobs. Whether it be the impact of their work, location, coworkers, incentives, or opportunities for career advancement.

Incivility in the Workplace

Incivility in the workplace can cause employees to have little to no happiness in their jobs. Marshall & Broome define incivility as “ behavior of low intensity that can include such behavior as being rude, discourteous, impolite, or violating workplace norms or behavior” (pg, 76). I worked at a subacute rehabilitation center where the Director of Nursing behaved in this manner. She was very demeaning and aggressive when she would speak to the staff. It made for a very stressful environment. The nursing staff constantly felt like we were walking on eggshells, never knowing when we would have an encounter with her. There was a constant turnover of staff, not only among the staff nurses but mostly with the unit managers who worked directly under her. Even though she was a great nurse, I felt that she was not a good nurse leader for this reason. Although several nurses made her aware of their thoughts on how she treated and spoke to people, I can’t remember anything being done on a larger scale to combat the incivility. Looking back, I worked at this facility as a brand new nurse and really did not know that things could be done differently as far as leadership goes. I also wasn’t aware at the time of how working with this person impacted my views on the workplace as a whole. 

References

Bergman, C., Dellve, L., & Skagert, K. (2016). Exploring communication processes in workplace meetings: A mixed-methods study in a Swedish healthcare organization. Work, 53(3), 533-541. DOI: 10.3233/WOR-162366

Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18-23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer

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To be one of the best organizations the mission statement and values set forth by that organization must show respect and overall care for the employees representing such. Organizations like ones we work for have a duty to provide the highest of quality care for patients while maintaining safety. In order to perform at these levels it starts with great communication methods.  As many know communication is a crucial element at the forefront of all successful businesses.  At times the downfalls of organizations stem from unhealthy communication lines. Many organizations lack healthy work environments due to communication breakdown (Laureate Education, 2018). Individuals must know how to communicate thoroughly and effectively. 

 A healthy working environment is essential to overall staff and patient satisfaction. When staffs are being treated fairly and under the right conditions results are felt through patient satisfaction surveys and such.  Within organizations the culture is created with an attempt to amplify the healing and health of the populations serviced (Marshall  & Broome, 2017). When there are broken lines of communication, disruptive behaviors and such it causes a great deal on incivility amongst staff.  According to Marshall & Broome (2017), incivility can be classified as behaviors of low intensity which is displayed as being impolite, or rude placing strains on the working environment (p.76).  After taking the workplace assessment this week, my organization was determined to be an unhealthy environment. My work place would be classified as uncivil with this score based on such determining factors such as the lines of communication amongst each other, the fact staff feel over worked with patient acuity and workloads, and the issues with retention of staff.

                An incident in my workplace where I was a key witness of incivility was with a nurse leader and nurse manager. She was very demeaning with every word she spoke. She was not that took well to constructive criticism, but would greatly give out with much pleasure. There was a difficult patient on our unit for a lengthy time. He was very rude to all staff, very manipulative, and demanding. As much as we all kept trying to keep the moral from drowning because of his behaviors, this one particular day I must say the patient won. The nurse leader received a phone call from this patient which was discharged a day before. The patient was calling regarding medications he thought he had left and was informed the medication was not with us but was with him at discharge. The patient began to become frustrated with the nurse leader. While this conversation took place, the nurse manager overheard this interaction. She instructed the nurse leader to hang up the phone and tell the patient we did not have anything that belongs to him. The nurse leader was trying to diffuse the situation with the patient, and be very courteous and diligent. The nurse manager was still in front of the nurse leader and instructing her to hang up the phone on the patient. Again the nurse leader is trying her best to ease off the phone, but clearly it was not fast enough for the nurse manager. The manager then hangs up the phone on the patient in mid-sentence. She then in the middle of the nurses’ station scolded the nurse leader about her conversation and her actions of insubordination towards her requests to hang up the phone. Staff all around was very shocked at this interaction and quickly shifted away. Now although this was not towards me, I felt every bit of sympathy for my fellow leader. She felt belittled, incompetent, and disrespected. This was no way a leader above us should act nor treat staff as such. The nurse leader did walk away and had a moment where she broke down and cried to me. I felt helpless at that moment, but I could not allow this behavior manager or not. I later talked to the manager and expressed my concerns regarding her actions. She did mention her frustrations, and that she did get carried away. Her frustrations grew from the patient overall and the difficult times he caused on our unit. The manager did express her feelings of sorrow towards her staff and fellow leader.

                The issue was resolved for the moment, but overall we did lose a great leader because the nurse transferred to another unit. I will say although the issue was addressed, it should have never happened and this is not something I can ever condone. In this profession of nursing we are looked upon as the most “trusted and caring professions” (Clark, Olender, Cardoni, & Kenski, 2011).  With this being said nothing short of those actions would make me feel comfort with a nurse like this and these behaviors. It is never ok to allow workplace violence and knowing that I was a voice for a peer allowed me to feel comfortable as a nurse leader and advocate for not only patient but my fellow staff.

References

Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing education and practice: Nurse leader perspectives. Journal of Nursing Administration, 41(7/8), 324–330. doi:10.1097/NNA.0b013e31822509c4

Laureate Education (Producer). (2018). Diagnosis: Communication Breakdown [Video file]. Baltimore, MD: Author.

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

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