Womens Health Nursing: Interview with Homera Pourzand, RN, MSN, NP
Providing care and genetic counseling
What is your current position at the Los Angeles Center for Women's Health, Dignity California Hospital?
I am a nurse practitioner who provides care for gynecology patients, which includes genetic counseling and testing. I am also a clinical supervisor.
What are your daily clinical responsibilities?
I see patients for well woman exams. I provide genetic counseling and testing, oversee the clinic, make rounds at the hospital for surgery patients and follow up with post-op patients.
You began your advanced practice nursing career as a women’s health nurse practitioner. What drew you to women’s health as a specialty area?
When I was a child, my father always told me stories about my future as a midwife when I grew up. In one story, we were together at home one night and the neighbors knocked on the door, asking me to help someone in labor. My father accompanied me, waiting for me while I delivered the baby. By the time the baby was delivered, dawn had broken and my father and I returned home. With stories like this, my father planted the seed in me to want to help women in need during vulnerable times of their lives. Sadly, he did not survive to see me serving in this role.
Earlier in my career, I worked as a nurse in maternity and obstetrics. At a certain point, I needed more challenge and freedom, so I pursued a degree in advanced practice, which allowed me to further my skills and knowledge in the area I am passionate about.
You currently focus on breast cancer treatment. How did you transition into that specific area of practice and patient care?
Treating breast cancer patients is an extension of my service to women — it’s an area of cancer that affects a population that I care deeply about. It was a natural progression in my career.
Genetic testing has become an important issue for many women. What is your role in this regard?
When I began working for the Los Angeles Center for Women’s Health, I noted the importance of genetic testing and counseling for patient treatment. Therefore, I participated in a special training at City of Hope in genetic counseling. I strongly believe that genetic information and genetic science are the future of medicine. As a genetic counselor, I evaluate each individual’s family history, putting the puzzle pieces together while helping women receive treatment that is significantly more effective.
Do you think women’s health is a specialty area that will see further job growth and opportunities for nurses in the next 20 years?
Yes, certainly. With the aging of the women of the Baby Boom generation and longer life expectancy for women, there is an increasing need for providers specializing in women’s health. If a nurse is interested in women’s health as a specialty, what experience or education do you recommend in order to be competitive?
Should they focus on advanced practice degrees?
My personal belief is that working as a nurse for a period of time is beneficial for nurses planning to pursue advanced practice.
Based on my personal experience as an assistant clinical professor at UCLA, students who have prior experience in bedside nursing before pursuing advanced practice are better prepared to make decisions and implement care than those who pursue advanced practice without that experience.
Are there certifications and special trainings that nurses must pursue in this particular area of nursing specialization?
Certification always helps. For women’s health NPs, certifications in colposcopy, genetic testing and urodynamics provide additional skills for assisting patients and providing comprehensive care.
What feeds your spirit in your work?
What makes me feel good about my work is assisting my patients during their long and difficult journeys, especially patients with breast cancer. It is an honor to be with them through the many steps along the way, including chemotherapy, surgery, radiation therapy and reconstructive surgery.
The most rewarding aspect of my work is witnessing my patients putting all of these obstacles behind them and returning to their normal lives. It gives me joy and satisfaction that truly cannot be compared with anything else in my life. I simply don’t have the words to describe that feeling.
I believe I am blessed to be able to help these patients. I am so grateful to my patients for allowing me the honor of walking with them on this significant life journey. I feel that it’s a privilege to help women on their journeys and sometimes I ask myself what I did to deserve such a privilege.
What are some of the challenges of your work?
It is sometimes very frustrating when patients are forced to wait for important tests or procedures while we pursue authorization from their insurance companies. Each day is critical in responding to cancer, and I sometimes feel hopeless when I’m not able to significantly expedite that process.
Do you have many male colleagues in this specialty area?
At this time, I’m not acquainted with any male nurses specializing in women’s health.
What are your professional goals?
My main goal is to increase breast cancer awareness among women’s health providers, encouraging them to take patients’ concerns seriously and detect cancer earlier by sending patients with breast-health-related issues for testing. I have noticed that breast cancer in patients in their twenties can go undetected for quite some time — greater provider awareness can definitely change that reality. Other areas that require more awareness are evaluation of family history and the performance of genetic testing.
Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at http://www.nursekeith.com/.
Barbara McClinton, Ph.D., was awarded the Nobel Prize in Medicine in 1983 for her discovery of mobile genetic elements or “jumping genes.” Her pioneering work helped explain why genetic mutations cause some cells to become cancerous. She is shown above in her laboratory on March 26, 1947. Photo: National Institutes of Health.
Angelina Jolie’s difficult decision heralds a new age of medicine
by Aaron Severson
In May 2013, actress and director Angelina Jolie published a startling New York Times op-ed piece announcing that she had undergone a double mastectomy after genetic testing revealed that she had a mutated BRCA1 gene, giving her an 87 percent chance of developing breast cancer. Jolie, whose mother died of ovarian cancer at age 56, decided those odds were simply too great and opted for a preventive mastectomy.
Genetic testing has become increasingly common since the initial decoding of the human genome back in 2001. The Genetics Home Reference maintained by the U.S. National Library of Medicine says there are now more than 1,000 different gene tests. There are several types of tests, but their goal is the same: to identify genetic markers associated with specific diseases.
A major market for genetic testing is parents and prospective parents concerned about whether their children have inherited (or may inherit) a predisposition for a particular disease. There is a growing trend towards using genetic testing as a diagnostic or preventive tool. The hope is that by identifying each patient’s individual health risks, providers can recommend lifestyle changes or preventive measures to mitigate those risks.
PREDISPOSITION IS NOT FATE
Genetic experts are quick to point out that the accuracy of genetic tests is still highly variable and even the most accurate test can only indicate a predisposition to disease.
Not everyone who has a genetic predisposition for a specific illness will actually develop the disease; by the same token, not everyone who contracts a disease is genetically predisposed to it. For example, according to the National Cancer Institute fact sheet on BRCA, people with BRCA1 and BRCA2 mutations account for only 5–10 percent of all breast cancers and 15 percent of ovarian cancers.
Nonetheless, genetic testing can be a powerful tool for the early detection and prevention of life-threatening illnesses. In Jolie’s case, her doctors say the preventive mastectomy has reduced her risk of breast cancer to about 5 percent. Pinchas Cohen, M.D., head of USC’s Davis School of Gerontology, believes that gene-based therapy like this represents not only the future of medicine, but also of aging.
CONSIDERING THE COST
Although there’s now a proliferation of cheap home testing kits, gene testing can still be prohibitively expensive. The tests Jolie underwent cost more than $3,000. In her op-ed piece, she declared, “It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background.”
However, gene testing poses some serious ethical concerns. Federal law now prohibits “genetic discrimination” by insurance companies or larger employers, but many loopholes remain. And while Cohen would like to see the creation of genetic databases to drive research and business, allowing corporations to profit from individual patients’ genetic information could have terrifying implications.
Aaron Severson is the associate editor of Working Nurse.
This article is from workingnurse.com.