I S S U E S A N D IN N O V A T I O N S I N N U R S I N G P R A C T I C E

Hysterectomy: a case study of one woman’s experience

Valerie Fleming MA PhD RN RM
Professor of Midwifery, School of Nursing, Midwifery and Community Health, Glasgow Caledonian University, Glasgow, UK

Submitted for publication 26 November 2002

Accepted for publication 16 July 2003

Correspondence: F L E M I N G V . ( 2 0 0 3 ) Journal of Advanced Nursing 44(6), 575–582

Valerie Fleming, Hysterectomy: a case study of one woman’s experience
School of Nursing, Background. There are many published qualitative studies in the large volume of
Glasgow Caledonian University,
literature about hysterectomy documenting themes common to the majority of
Glasgow G4 0BA,
participants, such as social support, feelings of illness and wellness, pain and
UK.
E-mail: v.fleming@gcal.ac.uk
resumption of normal life rather than events which were unique or exceptional.
Aim. This study explores the meaning of the experience of abdominal hysterectomy
for one woman.
Methods. Single client case study method was used. An overview of case study is
presented and the rationale for its selection as an appropriate methodology for this
study given. The participant and her ‘significant others’ are introduced.
Findings. Four major themes relating to the participant’s experience were identified:
doubts and justifications, pain, embodiment and sense of betterness. These are
discussed in relation to the participant, the research literature and nursing and
medical practice.
Conclusion. Highlighting the case of one woman and analysing her experience as a
single case study has produced a depth of material not previously available in other
studies. The findings should be of use to staff working in gynaecological nursing, but
could also be used in the education of nursing and midwifery students.

Keywords: hysterectomy, case study, doubts, pain, nursing, midwifery

the use of the laparoscope, while Pinion et al. (1994) in a

Introduction
Hysterectomy is a relatively common operation, with one in
five women undergoing the procedure in the United Kingdom
(UK) and considerably more in other countries (Chapple
1995). Although the procedure of abdominal hysterectomy
has remained relatively unchanged over many years, hospital
stays for these women are becoming shorter, with the average
stay in National Health Service (NHS) hospitals now being
5 days.
Extensive research into hysterectomy has been carried out
by both medical and nurse researchers. While the number of
women having the operation has been a matter of concern
internationally for some considerable time (Coulter 1988,
Fisher 1988), medical research is now focusing on alterna-
tives to traditional approaches to hysterectomy (Kovac
1995). More specifically, Garry and Hercz (1985) focus on
Scottish randomized controlled trial comparing hysterectomy
with other forms of treatment for dysfunctional uterine
bleeding found no difference in outcomes.
The nursing literature, while reinforcing some of the
findings of medical research, has concentrated on the hospital
stay associated with hysterectomy. In a comprehensive review
of documents in the UK, Scriven and Chesterton (1994)
suggest that large amounts of literature were available for
women undergoing the procedure. Although concluding that
such information was generally viewed positively by women
undergoing the procedure, the authors suggest that such
amounts of literature may have reduced the need for
interaction of health professionals with women at a vulner-
able period.
Nurse researchers have also considered the concept of
follow -up care to women following hysterectomy, suggesting

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V. Fleming
that little is offered to women. Daly (1992) compared four
nursing discharge strategies and recommended that a clinical
nurse specialist be appointed to carry out follow-up care.
Read (1996), based on a review of the literature, makes
similar recommendations, but these do not appear to have
been followed up in the UK. More specifically, in Scotland,
with its responsibilities for health devolved from the central
UK government, there are no clinical nurse specialists or
nurse consultants in the field of women’s health or gynae-
cology.
Despite the large amount of research, there has been little
documentation of the results of research aimed at under-
standing the nature of the experience. Of the studies located,
many were carried out in the 1980s when interest in the topic
was at a peak. Webb and Wilson-Barnett (1983) found a
strong need for social support. Webb (1986) later conducted
feminist research into the experiences of women undergoing
hysterectomy, again documenting the need for improved
social support and information, while Giddings and Wood
(1991) used a semi-structured questionnaire to carry out a
thematic analysis of 100 women’s experiences. Later Birks
(1995) using grounded theory, developed a conceptual model
of women’s experiences of early discharge following hyster-
ectomy, and Kinnick and Leners (1995) carried out an
ethnographic study of experiences of hysterectomy.
These studies are qualitative in nature and document
themes common to the majority of their participants, such as
social support, feelings of illness and wellness, pain and
resumption of normal life. All of these themes remain as
topical for women having hysterectomy today as in the past.
However, none of the studies addressed the issues that were
exceptional. This research report addresses that gap through
identifying the meaning of the experience of abdominal
hysterectomy for one woman.
The study
Aim
The aim of this study was to explore the meaning of the
experience of abdominal hysterectomy for one woman.
Methodology
The design of this study was that of a single case study as
described by Yin (1984). The original aim of this study had
been to carry out a phenomenological study looking for
themes and patterns amongst women undergoing abdominal
hysterectomies. However, doubts as to the appropriateness of
this methodology arose for two reasons. The first was that,
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2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 575–582
although phenomenological research has offered opportunit-
ies to study the humanistic aspects of experience and some
extremely valuable contributions have been made to know-
ledge, studies such as those by Giddings and Wood (1991)
and Kinnick and Leners (1995) have claimed generalizability
of their findings, rather than recognizing the diversity of
experiences of their participants. This is in spite of the fact
that most of the reports in a qualitative tradition acknow-
ledge the non-generalizability of the methodology.
Based on a review of 30 studies, all with some relevance to
nursing, Crotty (1996) suggested that the focus on experience
adopted by nurse researchers is in itself problematic, and that
phenomenological researchers should return to the original
intent of phenomenology and seek the essence of the
phenomenon. In some forms of phenomenology, it is through
the process of phenomenological reduction, in which the
researcher’s preconceptions are suspended, that such essences
may be brought to the fore. As Merleau-Ponty (1964)
suggests:
In order to grasp an essence, we consider a concrete experience, and
then we make it change in our thought, trying to imagine it as
effectively modified in all respects. That which remains invariable
through these changes is the essence of phenomenological reduction
(p. 70).
It is important to acknowledge that the nature of experience
is different for each person and, by describing common
themes, researchers may not be acknowledging that essence.
Case study was therefore selected as it offers the possibility of
overcoming some of these limitations.
The second reason for the rejection of multiple participants
was more practical, the first participant’s interview was
taking place in hospital when her consultant gynaecologist
visited. This gynaecologist expressed interest in the study and
therefore, with the woman’s consent, I agreed to interview
the gynaecologist. This data offered a completely different,
although complementary, perspective from that of the
woman. This opened up possibilities of other relevant people
contributing to a richer description of the experience of the
original woman. I then returned to the woman and suggested
that a case study approach be used and, although the aim
would be the same as that to which she had originally
consented, this could provide an alternative way of docu-
menting the experience.
According to Hutchinson (1990), when executed with
systematic rigour a case study has much to offer nursing.
While acknowledging the uniqueness of each situation,
Mariano (1990) has suggested that case study may illuminate
a situation in a way that has relevance for others. This stance
has been supported by Yin (1984), who claims that case
Issues and innovations in nursing practice
studies may be single or multiple. Multiple case studies allow
differences as well as similarities between participants to be
illuminated. Single case studies can provide rich material to a
depth not previously exposed in many research reports, either
in quantitative or qualitative traditions. A striking example of
this is the single case study by Lumby (1992) who, over many
months, collected data relating to one woman’s experience of
liver disease. Other case studies reported in nursing have
tended to have multiple participants (Perry 1985, Leamy
1994).
By using a single case approach in this study it was possible
to study in depth the experience of the participant in a way
not possible in other kinds of studies. While the addition of
secondary participants is not a necessary feature of case study
approaches, I have chosen to use it in order to enhance the
primary participant’s own descriptions of her experience.
These are placed in context and validated by the voices of the
secondary participants. In turn, the literature in the field
provides an added dimension. As well as illuminating the
experience of the participant, Yin (1984) has suggested that
the case study approach may be seen by readers to be ‘fitting’
with their own experiences. Further, it may provide an
appropriate tool for educational purposes.
Ethical considerations
Permission to undertake this study was given by both hospital
management and the local ethics committee. When the
methodology was changed, as outlined above, both were
informed and continued to support the study. All partici-
pants’ names have been changed to preserve anonymity. This
report has deliberately avoided giving the geographical
location of the study, and used pseudonyms in an effort to
maintain the anonymity of the participants to readers.
However, I had to emphasize to each participant that the
nature of the study meant that anonymity within the
participant group was not possible. While individual tran-
scripts and analyses were only revealed to the individual
concerned, the focus of the research was the woman’s
experience and in the final report it would be reasonably
obvious what remarks could be attributed to whom. All
participants agreed, therefore, that the process should be as
open as possible, and a group discussion was also held to
discuss the emergent themes in more detail. This group
discussion was also tape-recorded and added further richness
to the data.
My initial approach seeking permission to participate in
this research was made to the local endometriosis support
group. My written request, including an information sheet,
was sent to the chairperson and then circulated to members

2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 575–582
A woman’s experience of hysterectomy
of the group and Claire (a pseudonym for the woman who
participated in the case study) contacted me by telephone.
I spoke of my aims and how I thought I would go about
meeting these. She agreed to participate and was fully
supportive of the changes in design I later made. Claire was
a 35-year-old woman and Registered Nurse who worked for
a health insurance claims agency. She described herself as
being in a stable relationship and, through choice, she had no
children. During the course of the study she identified herself
as feminist, and acknowledged that her feminist stance had a
bearing both on her reluctance to undergo a hysterectomy
and her choice of gynaecologist.
Claire had experienced worsening dysmenorrhoea and
menorrhagia over the previous 5 years. Following episodes of
fainting and periods of absence from work each month she
had sought help from her general practitioner, who had
referred her to a gynaecologist. A hysterectomy had been
arranged, and this was carried out in a local hospital.
Data collection
All data were collected by means of unstructured interviews,
with one key question starting the discussion. Claire was
interviewed four times: 3 hours preoperatively, and 48 hours,
4 days and 6 weeks postoperatively.
Claire determined at the 48-hour interview whom she felt
to be the most important people in the process of the
experience, and these people were invited to participate in the
study although, as stated above, the gynaecologist spontane-
ously expressed an interest. The others who contributed to
the research, therefore, were Alex, Claire’s partner of
10 years, her primary nurse, Janet, and her gynaecologist,
Emma (all names are pseudonyms). Each was interviewed on
two occasions and one group interview with all participants
was also undertaken. Interviews lasted from 30 to 90 minutes
and took the form of free-flowing conversations.
Data analysis
Over 200 A4 pages of data were transcribed verbatim and
analysis was carried out using NUDIST software. The
framework for analysis described by Fleming et al. (2003)
was adopted, and this involved four key steps:
• All interview texts were examined to find an expression
that reflected the fundamental meaning of the text as a
whole. Gaining an understanding of the whole text was the
starting point of analysis, because the meaning of the
whole will influence the understanding of every other part.
• In the next phase, every single sentence or section was
investigated to expose its meaning for understanding of the
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subject matter. This stage facilitated the identification of
themes, which in turn led to a rich and detailed under-
standing of the phenomenon under investigation. These
themes were then challenged by and in turn challenged my
preunderstandings.
• Every sentence or section was related to the meaning of the
whole text and with this the sense of the text as a whole
was extended. With the extended understanding of the
whole text, the meaning of the parts can widen.
• The final stage involved the identification of passages that
seemed to be representative of the shared understandings
between me and the participants. These passages, which
appeared in the research report, should give the reader
insight into the phenomenon under investigation.
Rigour in this study has been achieved through a standard
approach to data collection and analysis, with the computer
programme assisting with the latter. The notion of credibility
and fittingness of the study (Sandelowski 1993) will be
determined by readers of this report as they follow the
‘process and procedures from research question to evidence
to conclusion and vice versa’ Merleau-Ponty (1964, p. 323),
and they may draw parallels with their own experiences as
health professionals or lay people.
Findings and discussion
With single case studies such as this, the data itself will lead
to generation of the theory, rather than the interpretation
being constrained by one particular theoretical framework.
Claire’s experience generated a great deal of rich data, from
which four major themes of doubts and justifications, pain,
embodied experience and sense of betterness emerged. Each
of these will now be discussed, relating the major findings to
other published literature.
Doubts
Claire was admitted to hospital a few hours prior to surgery
and experienced mixed emotions:
I’m pleased to be here at last…though I can’t help feeling, ‘What if
she doesn’t find anything wrong…it’ll be really embarrassing’. I just
don’t think I can go on any longer, though.
This stance was supported by Emma, Claire’s gynaecologist,
who, speaking postoperatively commented:
I really felt a bit unsure about it all – there was no clear picture. I
mean, it could have been anything or it could have been nothing.
There wasn’t any point in doing a laparoscopy, though, because the
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hysterectomy was justified on the clinical picture…and she was going
through hell.
Conversely Claire’s primary nurse, Janet, suggested that:
She looked fine and relaxed about it…though once I was talking to
her it felt a bit different. I think she was worried that she’d make a
fool of herself.
The notion of being in control supports the findings of Birks
(1995), whose grounded theory suggested that women
undergoing hysterectomy shared similar feelings. The concept
of doubt was also identified by Rome (1993), whose
participants expressed through standardized survey tools
the most concerns prior to admission. The idea of ‘needless
fears’, however, seems to be different from previous findings.
It was as if Claire was minimizing her own feelings and felt
that these could only be justified on pathological grounds.
I explored this further with her, and she replied:
Yes, well, I suppose I do feel a bit like that. I mean, I remember
during my training that we used to get people into hospital, and when
we couldn’t find anything really wrong we’d do terrible things like
give them sterile water injections then confront them with it. So I
suppose that’s a hang up I do have and it’s unreasonable…I know I
need this surgery but…(original emphasis)
Claire’s partner, Alex, who stayed with her until she went to
theatre, gave unequivocal support to this last statement:
I knew that when it’s done, though, she should feel much better. She’s
needed this for years and refused to have anything to do with it
Emma commented:
She’s tried a number of things and finally enough was enough, and I
absolutely agree. I don’t do hysterectomies lightly…I’m considered
pretty conservative by my colleagues, but there was no real question.
While the doubts were shrugged off by Janet and Emma, and
not acknowledged by Alex, at all of her postoperative
interviews confirmation of these doubts was given by Claire:
I’m so relieved it was done…and done for a reason. There was just so
much pathology. I feel so much better…better physically and
relieved, too, that I wasn’t imagining it all.
Emma commented similarly:
I’m so relieved that she had that surgery. There were several
nightmares in there really.
I discussed the notion of doubts with Janet, who acknow-
ledged that she had such limited information available to her
that it was:
Issues and innovations in nursing practice
frustrating. You have so little in the way of information. I knew that
Claire was coming in for an abdominal hysterectomy, but that was
about it. The public hospital nurses (Claire had her operation in a
private hospital) do better than us in that respect. At least they have
more information about the patients. I consider myself pretty good in
situations like that but, I mean, Friday morning it’s crazy and we
can’t always do the job we would like to.
Fear of the operation or anaesthetic has been widely
documented (Jackson 1989, Leamy 1994) and will continue
to be part of most preoperative experiences. However, in
situations such as Claire’s, nurses should acknowledge that
there may be some doubts as to the need for the surgery.
Claire’s own nursing experience substantiates these doubts
and has led to her trivializing her own experience. This
supports the work of Street (1992), who explored hospital
culture and the relative unimportance of nurses. In an effort
not to draw attention to herself, Claire had mirrored the
expectations of the hospital culture by trying to stay in the
background through not admitting to her nursing qualifica-
tion. Such findings strongly suggest that reassurance must be
given where required that the patient’s own experiences are
sufficient to justify major surgery, particularly in the light of
reflection and discussion with their general practitioner,
surgeon and family. Further research is called for in this area.
Pain
The theme of pain was raised by Claire in the preoperative
and in each subsequent interview. Being both a Registered
Nurse and a member of a support group, she had seen and
heard about other women’s experiences of postoperative
pain. In addition, some 20 years previously, she had had
abdominal surgery that she remembered with a shudder:
That was a much smaller operation and yet I remember the nurses
sticking the needles in me the whole time.
[VF: Was it the surgical pain or the pain from the injections you
remember?]
Well, um, now you ask maybe it was the injections…and the
wind…oh, the wind, it was awful. The other women felt sorry for me
and tried to protect me, but that sister just made me eat…when it was
so sore. Somehow I imagine it will be a lot worse this time.
However, immediately postoperatively her experience was
much more positive:
The pain was much less than I thought…a lot, lot less than the last
time. I wonder if that’s the difference between the up-and-down
incision and the bikini line one. The worst thing, though, was trying
to work that silly PCA [patient controlled analgesia]. I mean…this

2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 575–582
A woman’s experience of hysterectomy
whole ‘press the button’ business. They should have done it for me in
the beginning…how can you be expected to remember to do that in
(the) recovery (room)?
Alex supported Claire’s stance on this:
She wasn’t very good at using that pump at first – she seemed to
forget it was there and I kept having to remind her. Later she said it
made her feel sick. The nurses wouldn’t get her anything…in the end
I made them ring the anaesthetist.
By the next morning when her primary nurse was back on
duty, Claire was demanding that the IV line be removed.
Janet commented:
She was really good, though she said the PCA was a hassle at first.
That’s something I think we need to work on. You know, none of
that’s recorded – all her notes say is that it seemed to be effective and
she got up and about very quickly.
This discussion on pain supports the work of White (1986),
who suggested that while patient controlled analgesia is more
effective in reducing physical pain than more traditional
forms of pain relief, it needs to be backed up with patient
education. This has implications for nurses and for anaes-
thetists when deciding on a postoperative medication regime.
It also should be acknowledged that, because a patient may
appear knowledgeable, she need not have knowledge or
experience of every procedure and may need guidance.
As documented in other situations (Lander 1990), the
immediacy of postoperative pain became a memory that was
not revisited by Claire in subsequent interviews. However,
she commented once again in a somewhat depersonalized
way about subsequent experiences of injection pain with
prophylactic anticoagulants given subcutaneously:
How they did things made a difference…particularly the heparin. It
was interesting to watch how they did it, ‘cos sometimes it was fine
and other times…ouch!
While the physical pain was particularly important in the first
few days, as Claire progressed in the post operative period,
her perception of pain changed to an emotional level.
Giddings and Wood (1991) have discussed such pain in
relation to hysterectomy, but have explored it in terms of loss
of the uterus. At no time was this expressed as an issue for
Claire, and so it was not explored. However, she did express
emotional pain as anger on being informed that her surgery
of some 20 years previously had involved the removal of an
ovary and fallopian tube as well as her appendix. At that time
she had thought that she had had a simple appendicectomy:
The thing that will remain with me is anger…I suppose a sort of
mental pain that 20 years ago some doctor did all these things to me
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and didn’t even tell me. Now I can’t get the records…they’ve just
vanished, probably as another hospital closed!
Claire’s anguish was also recognized by Emma:
I noticed immediately the pain on discovering 20 years later the
extent of the surgery she had before. I was worried about that and I
don’t think she’s completely resolved that yet.
Morse et al. (1995) identified the theme of the violated body
from their phenomenological research. Although this referred
to current surgical experiences of their participants, Claire’s
similar feelings about such events are summarized by the use
of the word ‘violation’. Other studies (Fisher 1988, Pinion
et al. 1994), while using other language such as ‘abuse’ and
‘defilement’, have drawn similar conclusions. Such powerful
feelings have clear implications for health professionals,
emphasizing the need for full information to be made
available to patients in terms that they understand. While
information-giving in the form of leaflets may be use for this
purpose, individual experiences need to be taken into
consideration at all stages of the hospitalization experience.
Embodiment
Physical contact with a patient’s body is required often from
a number of professionals throughout a surgical episode, and
Claire was not looking forward to this. At her first interview,
she described herself as
a fairly private person. I don’t know how easy it will be. Maybe
private’s the wrong word…perhaps ‘independent’ would be better,
and to have all these people touching me and doing things to me…ugh!
Postoperatively, Alex expressed some surprise at the way
Claire had dealt with this aspect:
Touch seemed very important to her. She kept differentiating
between the ways in which people touched her, or as she said…her
body. It was as if she had dissociated herself from her body.
When describing the immediate postoperative experience
Claire commented:
The first day or so it was all that technical stuff. That’s fine – you
know it’s going to happen and you just let it happen. You know, take
out the drip, the (drain), the catheter. All that sort of stuff.
This dissociation supports the work of Webb (1986) and has
also been described by some women as ‘leaving your modesty
at the door’. However, on asking Claire about her sense of
dignity she replied:
There was never any loss of that. Nothing was embarrassing. I mean,
all that technical stuff was just that. It’s nothing personal.
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However, in the final interview she commented on moving
away from depersonalization to a need to be touched:
It was on the second day when I was feeling really weepy that Janet
started to do reflexology. It was just wonderful and almost had me
purring. I felt so much better. Later she gave my back a massage…a
real decent one, not a casual rub. It was great,
Janet was also very aware of Claire’s needs:
Not everyone would respond to my use of touch…some people just
shy away from body contact, but once I got to know her I knew what
was right and it made the difference – at least it seemed to.
Touch, when used therapeutically, offers in itself a therapy
that complements medicine (Meehan 1993). For Claire, its
benefits were both unexpected and welcomed. It is often the
unexpected findings such as this that will expedite recovery.
While this approach to Claire’s recovery may have been
unexpected, another even more unanticipated opinion on
touch was offered by Emma in the second interview:
My job is about touching people. I mean, I have to…intrude, if you
like, in very intimate parts of women’s bodies…and I need to set up
the best possible environment for that to happen. With Claire it was
the middle of winter. My hands were always cold and I didn’t like
putting them on her body. It was good that she just took my hands
and warmed them up a bit first. It felt reciprocal…as well as very
practical.
Janet supported Emma’s statement:
I watched her [Claire] in action when her surgeon was with her. It
was good the way they used each other, so to speak. It was a
partnership we don’t often see. I guess, too, it made me think that it’s
the middle of winter and not just Emma’s hands are likely to be cold!
At the final interview Claire commented:
I amazed myself and it’s taught me something about myself. Maybe I
would not have realised it, though, had it not been for you doing this
research…there you see it in writing and you really get a sense of the
whole experience. I’ve learnt things that will be useful to me in
future.
While the embodiment within surgical experience has
emerged in many qualitative studies (Webb & Wilson-
Barnett 1983, Mariano 1990, Read 1996, Williams 1997),
and this research supports its importance, the case study
approach has allowed the unexpected to emerge and assume
its place as important for this participant. Williams (1997)
found that nurses were unable to articulate how they felt
about their bodies when ill. This contrasts strongly with the
present study. Claire’s reflection on her changing percep-
tions of her body throughout the period of this study
Issues and innovations in nursing practice
What is already known about this topic
• Twenty per cent of all women in the UK currently
undergo a hysterectomy.
• Medical research has focused on a number of different
approaches to the procedure.
• Nursing research has concentrated on the educational
and health promotional aspects of the procedure.
What this paper adds
• This paper provides new insight to the experience of
hysterectomy.
• Through a case study, many issues of potential
importance to women undergoing hysterectomy are
identified, previously unreported in other research.
• Guidance is offered to nurses and medical staff with
regard to the importance of the effects of the procedure
of hysterectomy for the women themselves.
suggested that the notion of embodiment was extremely
important.
Sense of betterness
The final major theme in this study was related to Claire’s
recovery. Six weeks postoperative she was able to express
where she felt that she had recovered and where there was
still work to be done:
I still feel angry that they mucked up my smear reports and I’m
furious about the previous debacle [the previous surgery]. However I
feel ultra-positive about this experience. It’s certainly not what I
wanted and I’m having to take a bit of adjusting to the extent of it,
but Emma has handled it and me beautifully.
Alex completed corroborated this description:
She’s so much better physically, but hurting about what she calls past
injustices. She reads all these books and is trying to find a reason not
to take HRT. Now she’s complaining that the literature is full of
conflicting stories!
Emma also commented on the physical recovery but the
emotional anger:
She looks better than I’ve ever seen her. I do feel sorry for her,
though. When I told her what appeared to have been done before and
what I had to do this time she was very good, but I could tell she was
angry…and fair enough, too. Now she’s having to come to terms
with where it all fits with her beliefs of the last few years. It’s hard for
her.

2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 575–582
A woman’s experience of hysterectomy
One of Claire’s final comments came in the form of a
question:
Do you know what I did last week?
[VF: No]
I went snowboarding. I mean, can you believe it? Five weeks after a
hysterectomy. It was brilliant – I skied all day and felt so good. I just
feel so much better. I am challenging my own feminist views,
though – that’s really what stopped me doing this years ago!
While doubts and fears were couched differently preopera-
tively, 6 weeks later there remained doubts of a different
nature. Claire’s sense of betterness supports the work of Birks
(1995), whose thesis was that following hysterectomy women
are better but different. It appears to contradict the work of
Morse et al. (1995), however, whose eight themes expressed
negative ideas. It also highlights the need for information to
be available from a diversity of sources. The conflict between
the medical profession and feminists on hysterectomy has
been well documented (Webb & Wilson-Barnett 1983, Fisher
1988, Coney & Potter 1990, Giddings & Wood 1991), and it
is unlikely that a consensus will be reached. Ultimately, it is
women themselves who will have to make decisions about
their treatment.
Conclusion
These findings have charted the experience of one woman
undergoing a relatively common major operation. The four
themes of doubt, pain, embodiment and betterness may be
seen as representing a journey in time. Although this did not
always take place in a linear fashion, each was uppermost at
different times along the journey and, towards the end of the
research, feelings of doubt had almost disappeared and in
their place was a great sense of betterness. Pain remained,
however, with mental pain stayed foremost in Claire’s mind
at the time of the final interview.
Through highlighting one woman’s experience and ana-
lysing it as a single case study has come a depth of material
not previously available in other studies. As well as
providing a rich description of Claire’s experience, I have
drawn on existing literature to supports or contradict the
analysis of this case. The findings should be of use to nurses
and midwives who work in gynaecological settings, but
additionally could be used in the education of nursing and
midwifery students. It is important for readers to under-
stand and acknowledge that Claire’s story, as reported in
this article, only represents her experience until 6 weeks
post operatively, and that much healing still had to take
place.
581
V. Fleming
As well as nurses and midwives, it is hoped that this study
will be read by women and medical practitioners, so that
each may come to a greater understanding of the others’
contribution to this particular case. By so doing it may be
possible for each group to find elements which may apply to
their own experiences of hysterectomy and other similar
procedures.
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