Clinical MidwifeNurse Specialist (Endometriosis- Chronic Pelvic Pain) Cork University Maternity Hospital

Cork University Maternity Hospital (CUMH) is a 144 bedded Tertiary Referral Centre for Maternity Neonatology and Gynaecology located on the campus of Cork University Hospital. CUMH incorporates the Obstetric Gynaecology and Neonatology Services within the Health Service Executive South West region. CUMH has approximately 7 000 births per annum and is a tertiary referral centre.

Services at CUMH are delivered within the South West Region which is based on the principles of partnership and integration and strongly supports the involvement of the multidisciplinary team in service provision.

CUMH is the site for clinical placements for student midwives and student nurses in undergraduate and postgraduate programmes delivered in partnership with University College Cork.

CUMH Services incorporates the use of the MN-CMS (Maternal Newborn Clinical Management System) into care delivered at CUMH.

The Groups Primary Academic partner is University College Cork. A wide range of educational programmes and research is conducted within all hospitals in the Group.

Six Health Regions have been established within the HSE on the basis of the geographical boundaries agreed by the Government in July 2019 and they will be operational from 2024.

Each Health Region will be tasked with population specific planning resourcing and delivery of health and social care services for the needs of its unique population. This will result in improved accountability and governance in terms of finance and performance while also bringing decision-making closer to the frontline.

Health Regions will enable and empower staff to provide services that are:

Integrated locally planned and delivered

Easier to access and navigate

Available closer to home

Health Regions are geographically-based units with clearly defined populations. They align community and hospital services within specific areas. The HSE will retain a strong but leaner central organisation with more service provision developed at a local level.

The HSE South West health region will manage and deliver all public health and social care services in Cork and Kerry. HSE South West includes all hospital and community healthcare services in the region.

This includes:

South / South West Hospital Group S/SWHG

Cork Kerry Community Healthcare CKCH

The Department of Population and Public Health is also now aligned with this health region

Services in the South West health region:

HSE Services working within this region include:

Acute Hospitals

Primary care services

Community services

Social care services

Health and social care professionals

Voluntary sector services

Purpose of the post

The CNS post holder will deliver care in line with the five core concepts of the role set out in the Framework for the Establishment of Clinical Nurse/Midwife Specialist Posts 4th edition National Council for the Professional Development of Nursing and Midwifery (NCNM) 2008.

Caseload

The CNS will focus initially on the following service user groups: any patient requiring Chronic Pain Support in the Endometriosis Service.

The concepts are:

o Clinical Focus (Direct and Indirect Care)

o Service user/client Advocacy

o Education and Training

o Audit and Research

o Consultancy (including leadership in clinical practice)

Endometriosis and Chronic Pelvic Pain

To deepen clinical understanding of chronic pelvic pain and endometriosis highlighting diagnostic challenges multifactorial nature treatment pathways and the broader biopsychosocial impacts on women. Endometriosis affects at least 1 in 10 women globally with significant underdiagnosis and misdiagnosis. Chronic Pelvic Pain (CPP) can be defined as either cyclic or non-cyclic pain lasting >6 months localized to the pelvis abdomen or lower back and has multiple causes. Endometriosis defined as the presence of endometrium-like tissue outside the uterus is one cause of CPP.

Direct Care:

Pathophysiology- Ectopic endometrial tissue causes inflammation fibrosis and neuropathic pain.

Hormone fluctuations lead to cyclical exacerbation of symptoms.

Symptomatology- Severe dysmenorrhea premenstrual pain dyspareunia dyschezia dysuria.

Infertility; 30% of women with endometriosis have fertility issues and 50% of women attending fertility clinics have endometriosis.

Pain is often disproportionate to the extent of the disease

Diagnostic challenges- Average delay to diagnosis: 79 years.

Previous reliance on laparoscopy for definitive diagnosis current guidelines advocate a presumptive or working diagnosis based on patient symptoms

Limitations of imaging and biomarkers; endometriosis can be under-or overcalled by different imaging modalities. Advanced transvaginal ultrasound is more commonly utilised currently

Treatment modalities- Medical: NSAIDs hormonal therapies (COCP progestins GnRH analoguess). Surgical: ablation excision of endometriosis / endometriomas oophorectomy hysterectomy where there is adenomyosis and in cases refractory to more conservative treatments

Multidisciplinary: Pain management physiotherapy fertility support.

Indirect Care:

Psychological Burden- High rates of depression anxiety and emotional distress. Impact on body image sexual health and self-esteem.

Social & Occupational Functioning- Absenteeism reduced productivity and career disruption. Strained relationships and social isolation.

Economic Costs-Direct costs: diagnostics medications surgeries. Indirect costs: lost income disability claims long-term care.

Healthcare System Strain- Repeated GP visits referrals and emergency presentations.

Need for specialist-led care pathways and early intervention protocols.

The application of speciality-focused knowledge and skills of the Clinical Nurse Specialist (CNS) (hereafter referred to the CNS) will provide for the care and on-going management of patients with conditions relating to chronic pelvic pain in endometriosis patients. The post holder will be required to work as a key member of the endometriosis team in the hospital providing physical psychological and emotional support to the woman and their families/carers throughout their disease trajectory. The post holder will act as a liaison between Services for women with complex gynaecological conditions Primary Care community services and other agencies.

The appointment of the CNS is an essential element in the provision of effective high quality seamless integrated care for women complex health care needs with a multidimensional and multidisciplinary input for women in this cohort.

The person holding this post is required the support the principle that the care of the patient comes first at all times and will approach their work with the flexibility and enthusiasm necessary to make this principle a reality for every patient to the greatest possible degree.

Maintain throughout the hospital awareness of the primacy of the patient in relation to all hospital activities.

Performance management systems are part of the role and participation in the Groups performance management programme.

We welcome enquiries about the role.

Katie Bourke Director of Midwifery CUMH

Email:

Telephone: 086-8231188

Lorraine OConnor Assistant Director of Nursing

Email:

Tel: 021-4920756

Required Experience:

IC