The Ethical Justification for Conscience Clauses in Nurse-Midwifery Practice: Context, Power, and a Changing Landscape.

In the last century, conscientious objection has moved from objection to conscripted military service to include health care providers who have moral concerns about participation in specific aspects of health care. Although guidance for the use of conscientious objection has developed in both nursing and midwifery, changes in the political landscape may be creating a source of conflict between providers and the use of conscientious objection. Particularly in aspects of sexual and reproductive care like abortion, contraception, and lesbian, gay, bisexual, transgender, or queer health care, the ethical requirement for prompt referral is becoming increasingly difficult to meet in many contexts. Changes to federal regulations protecting conscience clauses have tilted strongly in favor of the rights of providers in recent years; this challenges the delicate balance of patient and provider rights that has developed over the years. These may now represent an unavoidable conflict between different aspects of the ethical obligations of providers, in particular the obligation to seek justice, and bring into question whether the current status of conscientious objection is sustainable. In this article, we examine these conflicts in the context of the current political climate.

Attitudes of California Registered Nurses About Abortion.

OBJECTIVE: To describe attitudes about abortion among registered nurses (RNs) licensed in California and to determine if demographic characteristics were associated with these attitudes. DESIGN: Cross-sectional, one-time survey. SETTING: Online between 2015 and 2017. PARTICIPANTS: Nurses with active RN licenses in California (N = 2,500). METHODS: An anonymous survey was sent to a random sample of 2,500 RNs with active California licenses between 2015 and 2017 to assess their personal and professional demographic characteristics and their attitudes toward abortion. Using scores on the Abortion Attitudes Scale, we dichotomized participants into proabortion and antiabortion categories. We used chi-square tests to determine differences based on demographic characteristics. RESULTS: Data from 504 RNs licensed in California are included in this analysis. Most respondents identified as female (n = 462, 92%), older than 50 years of age (n = 379, 75%), married (n = 364, 72%), White (n = 354, 70%), and Christian (n = 322, 64%). They were more likely to have negative attitudes toward abortion care if they identified as Christian (p < .001) and more positive attitudes if they identified as White (p < .001) independent of identifying as Christian. CONCLUSIONS: Respondents had a complex range of attitudes about abortion. In some cases, these attitudes aligned and/or conflicted with stated religious orientation. This study highlights the demographic characteristics that are associated with the attitudes and beliefs about abortion among RNs licensed in California.

Expanding Access to Sexual and Reproductive Health Services Through Nursing Education.

Thoughtful, unbiased, evidence-based content in nursing education is crucial for the development of confident and competent nurses who provide care in every setting. The purpose of this article is twofold: to provide evidence to show that comprehensive sexual and reproductive health care by nurses is informed by educational exposure to content and to provide recommendations for change at the individual, institutional, and structural levels to improve and expand sexual and reproductive health services.

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.

Premature or just small? Training Guatemalan birth attendants to weigh and assess gestational age of newborns: an analysis of outcomes.

We describe Guatemalan birth attendants' identification of vulnerable newborns, their evaluation of gestational age and anthropometry, and the validity of the Capurro and New Ballard newborn gestational age assessment methods. We interviewed 49 birth attendants and trained 10 of these women to assess 63 newborns. The Capurro and Ballard methods were correlated (Spearman rho = .75, p < .001) and showed agreement (Bland-Altman plot, difference and bias, -0.33 ± 1.3 weeks). Prematurity was estimated at 27% (Ballard) and 24% (Capurro); low birth weight (LBW) was 30%. Capurro provided a simplified, equivalent estimate of gestational age compared with New Ballard that could be used by birth attendants.

A radio-education intervention to improve maternal knowledge of obstetric danger signs.

OBJECTIVE: To examine whether a radio-education intervention (REI) is associated with improved maternal knowledge of pregnancy danger signs (PDS) in Nicaragua. METHODS: This cross-sectional pilot study used pretests and posttests to evaluate whether an REI was associated with improved knowledge of PDS among 77 pregnant and postpartum women in Nicaragua. RESULTS: The total number of PDS identified by study participants increased from 130 before the intervention to 200 after the intervention, an increase of 53.8% (Wilcoxon signed-rank test (z) = -4.18; P < 0.00001). The three PDS for which participant knowledge increased significantly after the intervention were 1) swelling of the face and hands, 2) convulsions, and 3) vaginal bleeding. Participants who 1) reported having a sister who had experienced a pregnancy complication, 2) lived in an urban setting, and 3) had more than a sixth-grade education were significantly more likely to score higher on posttests related to knowledge of PDS than those without those attributes (90.9% versus 56.9% [Χ² (degrees of freedom) = 4.60 (1); P = 0.043; n = 76]; 75% versus 45.9% [Χ² = 6.8 (1); P = 0.009; n = 77]; and 62.5% (12+ years education) versus 79.3% (6-12 years) versus 50.0% (0-6 years education) versus 25.0% (no education) [Χ² = 8.11 (1); P = 0.044; n = 77] respectively). CONCLUSIONS: Exposure to the REI was associated with a significant increase in the ability to identify PDS. Further studies should establish whether this increase in knowledge of PDS is associated with increases in use of maternity care services and decreases in delays in seeking care.

A radio-education intervention to improve maternal knowledge of obstetric danger signs / Una intervención de educación por radio para mejorar el conocimiento materno de los signos de peligro obstétrico

OBJECTIVE: To examine whether a radio-education intervention (REI) is associated with improved maternal knowledge of pregnancy danger signs (PDS) in Nicaragua. METHODS: This cross-sectional pilot study used pretests and posttests to evaluate whether an REI was associated with improved knowledge of PDS among 77 pregnant and postpartum women in Nicaragua. RESULTS: The total number of PDS identified by study participants increased from 130 before the intervention to 200 after the intervention, an increase of 53.8% (Wilcoxon signed-rank test (z) = -4.18; P < 0.00001). The three PDS for which participant knowledge increased significantly after the intervention were 1) swelling of the face and hands, 2) convulsions, and 3) vaginal bleeding. Participants who 1) reported having a sister who had experienced a pregnancy complication, 2) lived in an urban setting, and 3) had more than a sixth-grade education were significantly more likely to score higher on posttests related to knowledge of PDS than those without those attributes (90.9% versus 56.9% [Χ² (degrees of freedom) = 4.60 (1); P = 0.043; n = 76]; 75% versus 45.9% [Χ² = 6.8 (1); P = 0.009; n = 77]; and 62.5% (12+ years education) versus 79.3% (6-12 years) versus 50.0% (0-6 years education) versus 25.0% (no education) [Χ² = 8.11 (1); P = 0.044; n = 77] respectively). CONCLUSIONS: Exposure to the REI was associated with a significant increase in the ability to identify PDS. Further studies should establish whether this increase in knowledge of PDS is associated with increases in use of maternity care services and decreases in delays in seeking care.

OBJETIVO: Analizar si una intervención de educación por radio se asocia con un mejor conocimiento materno de los signos de peligro durante el embarazo (SPE) en Nicaragua. MÉTODOS: Este estudio piloto transversal evaluó si la intervención se asociaba con un mejor conocimiento de los SPE en 77 mujeres embarazadas o puérperas de Nicaragua mediante evaluaciones previas y posteriores a la intervención. RESULTADOS: El número total de SPE reconocidos por las participantes en el estudio aumentó de 130 antes de la intervención a 200 después de esta, un aumento de 53,8% (prueba de los rangos con signo de Wilcoxon (z) = -4,18; P < 0,00001). Los tres SPE cuyo conocimiento aumentó significativamente entre las participantes después de la intervención fueron 1) la hinchazón de la cara y las manos, 2) las convulsiones y 3) la hemorragia vaginal. Las participantes que 1) notificaron que tenían una hermana que había presentado una complicación del embarazo, 2) vivían en un entorno urbano y 3) tenían un nivel educativo superior al sexto grado tenían significativamente más probabilidades de obtener una mayor puntuación en las evaluaciones posteriores relacionadas con el conocimiento de los SPE que las que no cumplían esas condiciones (90,9 frente a 56,9% [Χ² (grados de libertad) = 4,6 (1); P = 0,043; n = 76]; 75 frente a 45,9% [Χ² = 6,8 (1); P = 0,009; n = 77]; y 62,5% (más de 12 años de formación) frente a 79,3% (6 a 12 años), frente a 50,0% (0 a 6 años), frente a 25,0% (sin formación) [Χ² = 8,1 (1); P = 0,044; n = 77], respectivamente). CONCLUSIONES: La exposición a la intervención de educación por radio se asoció con un aumento significativo de la capacidad de reconocer los SPE. Sería preciso llevar a cabo otros estudios para establecer si este aumento de conocimientos en materia de SPE se asocia con un incremento en el uso de los servicios de atención a la maternidad y una disminución de las demoras en la búsqueda de atención.

The role of nursing in the management of unintended pregnancy.

This article explores the role of nurses in the prevention, management, and treatment of unintended pregnancy. All nurses have a responsibility to understand the importance of reproductive health care in the primary care of women and their families, and to be prepared to respond to patients' needs for the prevention and management of unintended pregnancy. A public health framework provides an opportunity to identify the role of the nurse in primary, secondary, and tertiary prevention strategies that can contribute to the management of unintended pregnancy for the health of women and their families. Nursing education and the role of nurses in advocacy for reproductive health concerns are also addressed.