As you will be aware, taking a smear test has a number of required components. All sample takers must undertake accredited National Standard Training in order to become registered cervical screening sample takers and, once registered, they will also have to attend a minimum three yearly update of this training in order to stay abreast of any changes to the NHS Cervical Screening Programme. You can find out more information about where to access accredited training in your area from your local CCG, Health Board, Health and Social Care Trust or your local Screening and Immunisation Team.
Furthermore, in some areas of the UK it is now best practice for sample takers to be registered on a cervical sample taker database and issued with a number that will be on all their future cervical screening samples. This database will provide them with quality reports on their screening, as well as reminding them when their mandatory training updates are due.
One of the most important skills needed as a sample taker is to help your patient feel more at ease and better informed about the test. Here we give you some easy pointers of things you can do to improve your smear taking practice, both before the test and after.
Your essential smear test checklist
Welcoming the patient
Welcoming your patient is critical to the success of this appointment, getting the appointment off to the right start sets the tone for the test and for the woman feeling comfortable. It is compulsory to check the woman’s identity when she comes into the room so the welcome is an opportunity to do this immediately.
Establish a rapport and ensuring the room is warm and comfortable
This is your chance to ensure the patient feels comfortable and safe. If your patient attends for her appointment unaccompanied always ask if she would prefer to have a chaperone present during the procedure.
Many women tell us that they worry someone will come in during their smear test, so ensuring you explain to your patient that your are locking the door and why, will help them feel at ease.
Checking understanding and knowledge of the test
Once the woman is seated, this is your chance to check that the women understands what the test of for, what the results mean and she is consenting for you to take the test.
The following should be used to help you identify her information needs:
- Do they understand the reasons for having a cervical screening (smear test)? Always allow the woman time to tell you what they know
- Discuss the purpose of cervical screening and it’s limitations
- Discuss/explain what will happen if the cells show any changes and what these changes might mean (ie. cervical abnormalities and HPV testing)
- Bring HPV into the conversation and test their understanding. Offer information if they need it (need HPV resources? Jo's Cervical Cancer Trust have free reliable online information and printed resources for you)
- Discuss previous cervical screening results and, where appropriate, ‘congratulate’ the patient on coming back to attend for this screening
- Discuss any past and present clinical history including contraception (you could use the HMR101 form to show the history)
- Be observant of the woman’s age, over 60 she may require more information about inadequate results and last age of invitation. If she is under 25 you will need to check the reasons that this women has come and whether you will conduct the screening test. Keep in mind the under 25 vaginal bleeding guidelines.
- If the woman is peri- or post-menopausal, she may suffer from vaginal dryness due to low oestrogen levels. This may make speculum insertion more difficult and could make having a cervical sample taken painful for the woman. Low oestrogen levels can sometimes affect your ability to locate the cervix and be able to take an adequate sample. In these cases it may be worthwhile suggesting a course of vaginal oestrogen to improve the quality of the sample and experience for the woman. Keep in mind the NICE Guideline NG23 Menopause: diagnosis and management.
Preparing for the test and obtaining consent from the woman
This is your chance to ensure the woman is ready for the test. If you have followed all the steps above she will be able to give informed consent for the test. Some final tips below to help you:
- Prepare the test request form
- Ensure consent is obtained to continue
- Ask if she needs to use the toilet (a full bladder can be uncomfortable and further obstruct viewing the cervix)
- Prepare couch and trolley
- Show the women where she can change.
Privacy for undressing
Many patients feel embarrassed about coming for a smear test and this can be a difficult moment for the patient. Ensuring they have privacy to undress and prepare is essential and should not be overlooked.
Taking the test
Always ensure the woman is comfortable and that you have obtained permission to begin the test. Make sure that when you are taking the smear you observe facial expression and body movement. Talk through it until you have removed the speculum.
The Royal College of Nursing also offers advice on best practice for taking a cervical screening test.