Transitar el laberinto: trayectorias de cuidado entre mujeres que deciden abortar en el Ecuador / Traversing the labyrinth: Trajectories of care among women who decide to have an abortion in Ecuador

El acercamiento a las experiencias de mujeres que decidieron abortar en Ecuador, a partir de sus relatos biográficos, nos permitió comprender las trayectorias de cuidado por las que debieron transitar. Se desarrolló una metodología cualitativa, con enfoque biográfico narrativo, con la participación de 19 mujeres mayores de edad, residentes en diferentes provincias del Ecuador, un territorio con medidas restrictivas sancionatorias legales y morales alrededor del aborto. Encontramos que los contextos socio biográficos de las participantes se caracterizaron por la presencia de múltiples formas de violencia; sus decisiones en salud sexual y reproductiva constituyen una carga moral que las responsabiliza y les impone una serie de mandatos sociales en medio de grandes limitaciones y restricciones; sus trayectorias y búsqueda de cuidados se caracterizan por un Estado ausente como garante, lo que las lleva resguardarse en sí mismas o en algunas mujeres que construyen redes de soporte por fuera de la institucionalidad formal de protección, transitando rutas diversas donde el descuido y las violencia vuelven a ser predominantes. Estos hallazgos derivan en una serie de discusiones en torno a la vida de las participantes, como el tránsito por un laberinto donde las violencias que experimentan crean encrucijadas y rodeos difíciles de evadir y superar; por otra parte, la maternidad se presenta como una propuesta que enfrenta a las mujeres a tensiones permanentes, donde la decisión de abortar es una postergación de aquella más que su negación, tensiones como las mutaciones de la religiosidad, que no solo dan soporte del ideal femenino y de su rol básico de la maternidad, sino también un elemento de soporte para la decisión. Se concluye con la propuesta del Cuidado Sororo de la Salud Sexual y Reproductiva (SSR), inspirada en las teorías feministas y en los aportes de las organizaciones sociales que defienden los derechos sexuales y reproductivos de las mujeres. Dicha propuesta se deriva de las narrativas de las mujeres y se centra en su autonomía para reivindicar la importancia del cuidado desde una perspectiva más humanizada, respetuosa, solidaria y empática. (AU)

The approach to the experiences of women who decided to have an abortion in Ecuador allowed us to understand the care trajectories they had to go through, based on their biographical accounts. A qualitative methodology was used with a biographical narrative approach and the participation of 19 women of legal age, residents of different provinces of Ecuador, a territory with restrictive legal and moral sanctioning measures around abortion. We found that the socio-biographical contexts of the participants were characterized by the presence of multiple forms of violence; their sexual and reproductive health decisions constitute a moral burden that makes them responsible and impose a series of social mandates in the midst of great limitations and restrictions; their trajectories and search for care are characterized by an absent State as guarantor, which leads them to take refuge in themselves or in some women who build support networks outside the formal institutionality of protection, going through diverse routes where neglect and violence are once again predominant. These findings lead to a series of discussions about the life of the participants as the transit through a labyrinth, where the violence they experience creates crossroads and detours difficult to avoid and overcome; motherhood as a proposal that confronts women with permanent tensions, where the decision to abort is a postponement of it, rather than its denial and the mutations of religiosity that not only support the feminine ideal and its basic role of motherhood, but also an element of support for the decision. It concludes with the proposal of Sororo Care of Sexual and Reproductive Care (SRH), inspired by feminist theories and the contributions of social organizations that defend women's sexual and reproductive rights. This proposal is derived from women's narratives and focuses on their autonomy, to vindicate the importance of care from a more humanized, respectful, supportive and empathetic perspective. (AU)

The role of nurses and midwives in the provision of abortion care: A scoping review.

AIMS AND OBJECTIVES: To define the role and scope of the nurse and midwife within the global context of abortion. BACKGROUND: An estimated 56 million women seek abortions each year; nurses and midwives are commonly involved in their care (Singh et al., 2018, https://www.guttmacher.org/sites/default/files/report_pdf/abortion-worldwide-2017.pdf). As new models of abortion care emerge, there is a pressing need to develop a baseline understanding of the role and scope of nurses and midwives who care for women seeking abortions. DESIGN: The review design was Arksey and O'Malley's five-stage methodological framework. The review follows the PRISMA-ScR checklist. METHODS: MEDLINE, CINAHL, Scopus and ScienceDirect were used to identify original research, commentaries and reports, published between 2008-2019, from which we selected 74 publications reporting on the nursing or midwifery role in abortion care. RESULTS: Nurses and midwives provide abortion care in a variety of practice. Three themes emerged from the literature: the regulated role; providing psychosocial care; and the expanding scope of practice. CONCLUSIONS: The literature on nursing and midwifery practice in abortion care is broad. Abortion-related practices are potentially over-regulated. Appropriately trained nurses and midwives can provide abortions as safely as physicians. The preparation of nurses and midwives to provide abortion care requires further research. Also, healthcare organisations should explore person-centred models of abortion care. RELEVANCE TO CLINICAL PRACTICE: Abortion care is a common procedure performed across many healthcare settings. Nurses and midwives provide technical and psychosocial care to women who seek abortions. Governments and regulatory bodies could safely extend their scope of practice to increase women's access to safe abortions. Introduction of education programmes, as well as embedding practice in person-centred models of care, may improve outcomes for women seeking abortions.

Medical Abortion in Midwifery Scope of Practice: A Qualitative Exploration of the Attitudes of Registered Midwives in British Columbia.

INTRODUCTION: Across Canada and internationally, access to abortion remains challenging, particularly for those living in rural and remote communities. International research and policy call for the training of advanced practice clinicians, including midwives, to provide abortion services to fill the ever-increasing access gap. Research in other jurisdictions has examined the attitudes of midwives toward this potential expansion of scope of practice, but such studies have not been undertaken in British Columbia. This qualitative research study explored the attitudes of registered midwives toward expanding their scope of practice to include the provision of medication abortion in British Columbia. METHODS: In-depth qualitative interviews with British Columbia registered midwives were conducted and analyzed using thematic analysis. RESULTS: Fifteen interviews were conducted. Analysis of the interviews identified 5 primary themes: the incorporation of medication abortion into the midwifery scope of practice to increase access, the congruence of the midwifery model of care and provision of medication abortion, the role of registered midwives as guardians of reproductive rights, the need for a paradigm shift in how the profession is viewed, and the practicalities of potential scope expansion. DISCUSSION: This study shows some British Columbia registered midwives are interested in including medication abortion in their scope of practice. Midwives have the potential to bridge some of the health care delivery gaps in areas underserved by abortion providers and communities where medication abortion is not available. Further research is needed to more fully understand the perspectives of registered midwives in British Columbia as a whole.

Feasibility of a hospital outpatient day procedure for medication abortion at 13-18 weeks gestation: Findings from Nepal.

OBJECTIVES: To evaluate the safety, acceptability and feasibility of a one-day outpatient medication abortion service at gestations 13-18 weeks. STUDY DESIGN: Open-label prospective study in which participants received mifepristone 200 mg orally to swallow at home or at the clinic followed 24 h later by misoprostol 400 mcg buccally. They presented to the outpatient clinic 24-48 h after mifepristone for misoprostol 400 mcg buccally every three hours (no maximum dose). The primary outcome was successful abortion without transfer to overnight inpatient care. Secondary outcomes included time to abortion from initial misoprostol dose, safety, additional interventions and side effects. RESULTS: We enrolled 230 women from December 2017 to November 2018. Approximately nine of ten (n = 206, 89.6%) achieved a successful abortion without transfer to overnight care. Twenty-four were transferred to overnight inpatient care; of these 18 were to manage a complication, five for incomplete abortion and two by choice. Among these 24, three women experienced an SAE. The median time to successful abortion from time of the first misoprostol dose was 7.2 h (range: 0.75-92.3), with an average of three misoprostol doses. Most participants expelled the fetus and the placenta at or around the same time; median time between fetal and placental expulsion was 15 minutes (range: 0-4.5 h). Fifteen participants (6.6%) received more than five misoprostol doses and were transferred to inpatient care. Administration of more than five doses of misoprostol was associated with nulliparity. Provision of antibiotics (27.9%, n = 64), manual removal of placenta (15.3%, n = 35), uterotonics (4.4%, n = 10) and surgical interventions (4.4%, n = 10) were also reported. About one in four participants experienced nausea, vomiting and chills; fever was infrequent (2.5%, n = 5). CONCLUSIONS: For gestations 13-18 weeks, an outpatient day process for medication abortion is safe, effective and feasible. IMPLICATIONS: Medication abortion in 13 - 18 weeks need not be limited to inpatient care; nine of ten cases can be managed as an outpatient day service.

Morality versus duty - A qualitative study exploring midwives' perspectives on post-abortion care in Uganda.

OBJECTIVE: We aimed to explore midwives' perspectives on post-abortion care (PAC) in Uganda. Specifically, we sought to improve understanding of the quality of care. DESIGN: This was a qualitative study using individual in-depth interviews and an inductive thematic analysis. SETTING AND PARTICIPANTS: Interviews were conducted with 22 midwives (the 'informants') providing PAC in a public hospital in Kampala, Uganda. The narratives were based on experiences in current and previous workplaces, in rural and urban settings. FINDINGS: The findings comprise one main theme - morality versus duty to provide quality post-abortion care - and three sub-themes. Our findings confirm that the midwives were committed to saving women's lives but had conflicting personal morality in relation to abortion and sense of professional duty, which seemed to influence their quality of care. Midwives were proud to provide PAC, which was described as a natural part of midwifery. However, structural challenges, such as lack of supplies and equipment and high patient loads, hampered provision of good quality care and left informants feeling frustrated. Although abortion was often implied to be immoral, the experience of PAC provision appeared to shape views on legality, leading to an ambiguous, yet more liberal, stance. Abortion stigma was reported to exist within communities and the health workforce, extending to both providers and care-seeking women. Informants had witnessed mistreatment of women seeking care due to abortion complications, through deliberate care delays and denial of pain medication. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: Midwives in PAC were dedicated to saving women's lives; however, conflicting morality and duty and poor working conditions seemed to impede good-quality care. Enabling midwives to provide good quality care includes increasing the patient-midwife ratio and ensuring essential resources are available. Additionally, efforts that de-stigmatise abortion and promote accountability are needed. Implementation of policies on respectful post-abortion care could aid in ensuring all women are treated with respect.

Policy, law and post-abortion care services in Kenya.

BACKGROUND: Unsafe abortion is still a leading cause of maternal death in most Sub-Saharan African countries. Post-abortion care (PAC) aims to minimize morbidity and mortality following unsafe abortion, addressing incomplete abortion by treating complications, and reducing possible future unwanted pregnancies by providing contraceptive advice. In this article, we draw on data from PAC service providers and patients in Kenya to illustrate how the quality of PAC in healthcare facilities is impacted by law and government policy. METHODS: A cross-sectional design was used for this study, with in-depth interviews conducted to collect qualitative data from PAC service providers and seekers in healthcare facilities. Data were analyzed both deductively and inductively, with diverse sub-themes related to specific components of PAC quality. RESULTS: The provision of quality PAC in healthcare facilities in Kenya is still low, with access hindered by restrictions on abortion. Negative attitudes towards abortion result in the continued undirected self-administration of abortifacients. Intermittent service interruptions through industrial strikes and inequitable access to care also drive unsafe terminations. Poor PAC service availability and lack of capacity to manage complications in primary care facilities result in multiple referrals and delays in care following abortion, leading to further complications. Inefficient infection control exposes patients and caregivers to unrelated infections within facilities, and the adequate provision of contraception is a continued challenge. DISCUSSION: Legal, policy and cultural restrictions to access PAC increase the level of complications. In Kenya, there is limited policy focus on PAC, especially at primary care level, and no guidelines for health providers to provide legal, safe abortion. Discrimination at the point of care discourages women from presenting for care, and discourages providers from freely offering post-abortion contraceptive guidance and services. Poor communication between facilities and communities continues to result in delayed care and access-related discrimination. CONCLUSION: Greater emphasis should be placed on the prevention of unsafe abortion and improved access to post-abortion care services in healthcare facilities. There is a definite need for service guidelines for this to occur.

Walking on a tightrope-Caring for ambivalent women considering abortions in the first trimester.

AIMS AND OBJECTIVES: To improve the understanding and competence of health personnel when caring for ambivalent pregnant women, the aim of this study was to explore the experiences of encountering women who are unsure whether to complete or terminate pregnancy. BACKGROUND: Feelings of ambivalence are present in a significant number of women preparing for abortions and may challenge the provision of health care. Health personnel have reported an ideal to be nonjudgemental and supportive. Insufficient attention has been directed to the experiences of health personnel who prepare women for abortions in gynaecological units. DESIGN: Qualitative design with a hermeneutic-phenomenological approach. METHODS: Focus group interviews were conducted with health personnel from four gynaecological outpatient clinics and wards in Norway (n = 20). RESULTS: The health personnel felt responsible for contributing to patient well-being. This demanded focused attention towards all women being prepared for abortions and meant a consciousness and balancing act towards revealing, handling and being involved in the woman's potential unsureness without influencing her decision. When involved, the health personnel risked being confronted with their own vulnerabilities and values. CONCLUSIONS: The health personnel tried to balance their care and support without influencing the woman's decision. Although they viewed the women as fully autonomous and responsible, they became personally involved, to varying degrees, in the uncertainty and were faced with their own vulnerabilities and values. They lacked a possibility for immediate debriefing and regular counselling after complicated consultations. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the experiences of health personnel can provide input for professional development at gynaecological departments. These findings contribute to discussions about what information should be given and whether the woman's feelings should be discussed in preparation for an abortion. The ability of health personnel to discuss subjects related to ethically challenging encounters with women who are considering abortions should be established, namely, professional education and workshops at the national level and small groups with counselling and case study discussions at hospitals.

Nursing and Hospital Abortions in the United States, 1967-1973.

Before elective abortion was legalized nationally in 1973 with the U.S. Supreme Court decision Roe v. Wade, seventeen states and the District of Columbia liberalized their abortion statutes. While scholars have examined the history of physicians who had performed abortions before and after it was legal and of feminists' work to expand the range of healthcare choices available to women, we know relatively little about nurses' work with abortion. By focusing on the history of nursing in those states that liberalized their abortion laws before Roe, this article reveals how women who sought greater control over their lives by choosing abortion encountered medical professionals who were only just beginning to question the gendered conventions that framed labor roles in American hospitals. Nurses, whose workloads increased exponentially when abortion laws were liberalized, were rarely given sufficient training to care for abortion patients. Many nurses directed their frustrations to the women patients who sought the procedure. This essay considers how the expansion of women's right to abortion prompted nurses to question the gendered conventions that had shaped their work experiences.

Effectiveness and safety of early medication abortion provided in pharmacies by auxiliary nurse-midwives: A non-inferiority study in Nepal.

BACKGROUND: Expanding access to medication abortion through pharmacies is a promising avenue to reach women with safe and convenient care, yet no pharmacy provision interventions have been evaluated. This observational non-inferiority study investigated the effectiveness and safety of mifepristone-misoprostol medication abortion provided at pharmacies, compared to government-certified public health facilities, by trained auxiliary nurse-midwives in Nepal. METHODS: Auxiliary nurse-midwives were trained to provide medication abortion through twelve pharmacies and public facilities as part of a demonstration project in two districts. Eligible women were ≤63 days pregnant, aged 16-45, and had no medical contraindications. Between 2014-2015, participants (n = 605) obtained 200 mg mifepristone orally and 800 µg misoprostol sublingually or intravaginally 24 hours later, and followed-up 14-21 days later. The primary outcome was complete abortion without manual vacuum aspiration; the secondary outcome was complication requiring treatment. We assessed risk differences by facility type with multivariable logistic mixed-effects regression. RESULTS: Over 99% of enrolled women completed follow-up (n = 600). Complete abortions occurred in 588 (98·0%) cases, with ten incomplete abortions and two continuing pregnancies. 293/297 (98·7%) pharmacy participants and 295/303 (97·4%) public facility participants had complete abortions, with an adjusted risk difference falling within the pre-specified 5 percentage-point non-inferiority margin (1·5% [-0·8%, 3·8%]). No serious adverse events occurred. Five (1.7%) pharmacy and two (0.7%) public facility participants experienced a complication warranting treatment (aRD, 0.8% [-1.0%-2.7%]). CONCLUSIONS: Early mifepristone-misoprostol abortion was as effective and safe when provided by trained auxiliary nurse-midwives at pharmacies as at government-certified health facilities. Findings support policy expanding provision through registered pharmacies by trained auxiliary nurse-midwives to improve access to safe care.

Observation of clinical efficacy of yousiyue for endometrium regeneration after superconducting visual abortion and its nursing.

Present study is carried out to observe and analyze the curative effect of Yousiyue (Drospirenone and Ethinylestradiol tablets) on endometrium regeneration after superconducting visual abortion and explore the nursing mode. A total of 150 patients who underwent superconducting visual abortion in our hospital were enrolled and divided into study and reference groups with 75 patients each according to random grouping. Both groups were treated with vaginal ultrasonography-mediated abortion. The study group was treated with Yousiyue after the operation plus comprehensive nursing intervention program. The reference group only received general routine nursing and treatment. The treatment outcomes of the two groups were compared. Comparison of endometrial thickness, menses return time and menstrual reduction rate reveals significant advantage of study group over reference group, p<0.05; study group has an overall satisfaction significantly higher than the reference group, p<0.05. The implementation of Yousiyue in endometrium regeneration after superconducting visual abortion can receive good results, which is worthy of popularization and application.

The experience of Italian nurses and midwives in the termination of pregnancy: a qualitative study.

OBJECTIVES: The aim of the study was to provide insight into the experiences of nurses and midwives working in the Italian abortion service. METHODS: Study participants were recruited through purposive sampling. Semi-structured interviews were conducted between July and September 2016, among 22 nurses and two midwives working in five abortion services in Milan, Italy. Transcripts of interviews were analysed using a phenomenological approach to data analysis. RESULTS: Five main themes emerged from the analysis: (a) coping with caring for women undergoing a termination of pregnancy; (b) improving professional training; (c) approaching work in a mechanistic way as a means of overcoming difficulties; (4) performing medical abortions; (d) recounting an experience. CONCLUSIONS: This first study about assisting with pregnancy termination in Italy may enable critical comparison with studies carried out in other countries. Both nurses and midwives suggested strategies, which may improve the provision of care: collaboration between primary and tertiary care, continuous training, multidisciplinary collaboration, increase of staff turnover and being kept abreast of new pharmaceutical products. Our findings are applicable to wider medical practice.

Cuidados de enfermería en situaciones de aborto inducido / provocado: una revisión integral de la literatura / Assistência de enfermagem em situações de aborto induzido / provocado: uma revisão integrativa da literature / Nursing care in situations of induced /caused abortion: an integrative literature review

Objetivo: Identificar en la literatura científica sobre los cuidados de enfermería en los casos de aborto inducido / provocado. Método: Revisión integral destinada a responder a la pregunta «¿Cómo es la práctica de enfermería en situaciones de aborto provocado?» Los datos fueron recolectados en agosto de 2014, sin límites de tiempo o de idioma, que estiviesen en su totalidad en las bases de datos LILACS, BDENF, MEDLINE y SciELO, a partir de los descriptores: «aborto», «aborto provocado» y «cuidados de enfermería». Al final del proceso de análisis de datos se seleccionaron 13 publicaciones condensadas en forma de figuras. Resultados: Se observó que el trabajo de las enfermeras se realiza de manera tecnicista, discriminatoria, juzgadora y burocrática, lo que contradice las directrices del código de ética de la profesión. Conclusión: La discriminación y los peligros para la salud impuestos a las mujeres por razones culturales, legales y religiosas que involucran el tema del aborto, han contribuido a la precariedad de la asistencia (AU)

Objetivo: Identificar na literatura científica sobre a assistência de enfermagem em situações de aborto induzido/provocado. Método: Revisão integrativa, visando responder a questão «Como se dá a prática de enfermagem em situações de aborto provocado?» Os dados foram coletados em agosto de 2014, sem delimitação temporal ou de idioma, que estivessem na íntegra, nas bases de dados LILACS, BDENF, MEDLINE e SCIELO, a partir dos descritores: «aborto», «aborto provocado» e «cuidados de enfermagem». Ao final do processo da análise dos dados foram selecionadas 13 publicações condensadas na forma de figuras. Resultados: Percebeu-se que a atuação do enfermeiro é realizada de forma tecnicista, discriminatória, julgatória e burocrática, contradizendo as diretrizes do código de ética da profissão. Conclusão: A discriminação e os agravos à saúde impostos às mulheres, por razões culturais, legais e religiosas que envolvem a questão do aborto, têm contribuído para a precariedade da assistência (AU)

Objective: To identify the scientific literature on nursing care in cases of induced abortion /induced. Method: Integrative review aimed to answer the question «How is the nursing practice in situations of abortion?» The data were collected in August 2014, without time or language boundaries, which were in full in the databases LILACS, BDENf, MEDLINE and SciELO, the descriptors: «abortion», «abortion» and «nursing care». At the end of the process of data analysis 13 publications in condensed form figures were selected. Results: It was observed that the work of nurses is performed technicality, discriminatory, julgatória and bureaucratic way, contradicting the guidelines of the code of ethics of the profession. Conclusion: Discrimination and health hazards imposed on women by cultural, legal and religious grounds involving the issue of abortion, have contributed to the weakness of the assistance (AU)

Concealing emotions: nurses' experiences with induced abortion care.

AIMS AND OBJECTIVES: To explore the experiences of nurses involved with induced abortion care in the delivery room in Taiwan. BACKGROUND: Induced abortion has emotional, ethical and legal facets. In Taiwan, several studies have addressed the ethical issues, abortion methods and women's experiences with abortion care. Although abortion rates have increased, there has been insufficient attention on the views and experiences of nurses working in the delivery room who are involved with induced abortion care. DESIGN: Qualitative, semistructured interviews. METHODS: This study used a purposive sampling method. In total, 22 nurses involved with induced abortion care were selected. Semistructured interviews with guidelines were conducted, and the content analysis method was used to analyse the data. RESULTS: Our study identified one main theme and five associated subthemes: concealing emotions, which included the inability to refuse, contradictory emotions, mental unease, respect for life and self-protection. CONCLUSION: This is the first specific qualitative study performed in Taiwan to explore nurses' experiences, and this study also sought to address the concealing of emotions by nurses when they perform induced abortion care, which causes moral distress and creates ethical dilemmas. The findings of this study showed that social-cultural beliefs profoundly influence nurses' values and that the rights of nurses are neglected. RELEVANCE TO CLINICAL PRACTICE: The profession should promote small-group and case-study discussions, the clarification of values and reflective thinking among nurses. Continued professional education that provides stress relief will allow nurses to develop self-healing and self-care behaviours, which will enable them to overcome the fear of death while strengthening pregnancy termination counselling, leading to better quality professional care.

[Support and training of nursing teams in elective abortions]. / Accompagnement et formation des équipes soignantes à l'IVG.

The pathway of patients requesting an elective abortion, while improved, is not always easy. To investigate this observation further, it is interesting to analyse the existing structures and the professionals working in this field. Do the health policies and training envisaged for supporting these caregivers enable them to meet women's needs everywhere across the country?

Calculus formation: nurses' decision-making in abortion-related care.

Nurses routinely provide care to patients in ethically challenging situations. To explore the continuum between conscientious objectors and designated staff in the provision of care to women seeking abortions, the aim of this study was to thickly describe decision-making, using abortion as the clinical context to elucidate how nurses approach ethically challenging work. A purposive sample of 25 nurses who worked in abortion clinics, emergency departments, intensive care units, labor, and delivery, operating rooms, and post anesthesia care units were interviewed. Qualitative description and thematic analysis were used to identify the cognitive, emotional, and behavioral processes in nurses' decisions to care for women needing abortions. Nurses developed and used multifaceted, real-time calculi when making decisions about their participation in emergent or routine abortion care. Nurses tacked back and forth between the personal and professional and/or held multiple contradictory positions simultaneously. Nurses weighed the role and opinion of others to determine if they know how to or know why they would provide abortion care to women, particularly in the elective abortion context. The parameters of the nurse-patient relationship were complex and specific to the experiences of both the nurse and patient. Findings from this study further develop the science of ethically challenging decision-making and expand our understanding of factors that influence how nurses develop relationships to ethically challenging work.

Recruitment and retention strategies for expert nurses in abortion care provision.

OBJECTIVE(S): The purpose of this thematic analysis is to describe recruitment, retention and career development strategies for expert nurses in abortion care provision. STUDY DESIGN: Thematic analysis influenced by grounded theory methods were used to analyze interviews, which examined cognitive, emotional, and behavioral processes associated with how nurses make decisions about participation in abortion care provision. The purposive sample consisted of 16 nurses, who were interviewed between November 2012 and August 2013, who work (or have worked) with women seeking abortions in abortion clinics, emergency departments, labor and delivery units and post anesthesia care units. RESULTS: Several themes emerged from the broad categories that contribute to successful nurse recruitment, retention, and career development in abortion care provision. All areas were significantly influenced by engagement in leadership activities and professional society membership. The most notable theme specific to recruitment was exposure to abortion through education as a student, or through an employer. Retention is most influenced by flexibility in practice, including: advocating for patients, translating one's skill set, believing that nursing is shared work, and juggling multiple roles. Lastly, providing on the job training opportunities for knowledge and skill advancement best enables career development. CONCLUSION(S): Clear mechanisms exist to develop expert nurses in abortion care provision. IMPLICATIONS: The findings from our study should encourage employers to provide exposure opportunities, develop activities to recruit and retain nurses, and to support career development in abortion care provision. Additionally, future workforce development efforts should include and engage nursing education institutions and employers to design structured support for this trajectory.

Doula support during first-trimester surgical abortion: a randomized controlled trial.

OBJECTIVE: The objective of the study was to evaluate the impact of doula support on first-trimester abortion care. STUDY DESIGN: Women were randomized to receive doula support or routine care during first-trimester surgical abortion. We examined the effect of doula support on pain during abortion using a 100 mm visual analog scale. The study had the statistical power to detect a 20% difference in mean pain scores. Secondary measures included satisfaction, procedure duration, and patient recommendations regarding doula support. RESULTS: Two hundred fourteen women completed the study: 106 received doula support, and 108 received routine care. The groups did not differ regarding demographics, gestational age, or medical history. Pain scores in the doula and control groups did not differ at speculum insertion (38.6 [±26.3 mm] vs 43.6 mm [±25.9 mm], P = .18) or procedure completion (68.2 [±28.0 mm] vs 70.6 mm [±23.5 mm], P = .52). Procedure duration (3.39 [±2.83 min] vs 3.18 min [±2.36 min], P = .55) and patient satisfaction (75.2 [±28.6 mm] vs 74.6 mm [±27.4 mm], P = .89) did not differ between the doula and control groups. Among women who received doula support, 96.2% recommended routine doula support for abortion and 60.4% indicated interest in training as doulas. Among women who did not receive doula support, 71.6% of women would have wanted it. Additional clinical staff was needed to provide support for 2.9% of women in the doula group and 14.7% of controls (P < .01). CONCLUSION: Although doula support did not have a measurable effect on pain or satisfaction, women overwhelmingly recommended it for routine care. Women receiving doula support were less likely to require additional clinic support resources. Doula support therefore may address patient psychosocial needs.

A reflective study on abortions in theatre.

This article discusses the concept of conscientious objection in relation to surgical terminations of pregnancy. It explores a scrub nurse's duty of care not only to the patient but to themselves. It highlights the importance of being self-aware of one's moral and emotional attitude towards abortions in theatre. Doing so enables the nurse/ODP to practice professionally and autonomously, and to deliver the highest level of perioperative care whilst respecting their personal rights.