Abortion Care in the Dobbs Era.

Nurses are at the front line.

Abordagem do tema do aborto no ensino de graduação na perspectiva das enfermeiras recém-graduadas / Approaching the topic of abortion in undergraduate education from the perspective of newly graduated nurses / Enfoque del tema del aborto en la enseñanza de graduación en la perspectiva de enfermeras recién graduadas

Objetivo: descrever a abordagem do tema do aborto no ensino da graduação e seus nexos com a formação crítica na perspectiva das enfermeiras recém-graduadas. Método: pesquisa qualitativa realizada com 26 enfermeiras recém-graduadas e matriculadas em programas de residência no município do Rio de Janeiro. As entrevistas individuais ocorreram no período de abril a julho de 2016, sendo analisadas pela hermenêutica-dialética e com base referencial de Paulo Freire. O estudo respeitou as normas éticas e obteve por comitê de ética. Resultados: a abordagem do tema do aborto na graduação é limitada, pois foi ensinado em poucos momentos e como morbidade do ciclo gravídico-puerperal. As enfermeiras se sentem despreparadas para assistirem as mulheres no aborto legal. Conclusão: o tema do aborto apresenta uma abordagem restrita para a formação da consciência crítico-reflexiva e parece favorecer a reprodução do senso comum sobre o aborto.

Objective: to describe the approach to the subject of abortion in undergraduate education and its relation with critical education from the perspective of newly graduated nurses. Method: qualitative study carried out with 26 newly graduated nurses and enrolled in residency programs in the city of Rio de Janeiro. Individual interviews took place from April to July 2016, being analyzed by dialectic hermeneutics and under Paulo Freire's perspective. The study was approved by Ethics Research Committee. Results: The subject of abortion has a limited approach in undergraduate education. It was taught in few moments and as morbidity factor during pregnancy-puerperal cycle. Nurses feel unprepared to assist women in legal abortion. Conclusion: the restricted approach to the topic of abortion means a poor contribution to a critical-reflexive awareness and seems to favor the reproduction of common sense about abortion.

Objetivo: describir el enfoque del tema del aborto en la enseñanza de la graduación y sus nexos con la formación crítica en la perspectiva de las enfermeras recién graduadas. Método: investigación cualitativa realizada con 26 enfermeras recién graduadas y matriculadas en programas de residencia en el municipio de Rio de Janeiro. Las entrevistas individuales ocurrieron en el período de abril a julio de 2016, siendo analizadas por la hermenéutica dialéctica y con base referencial de Paulo Freire. El estudio respetó las normas éticas y fue aprobado poor comite de ética. Resultados: el abordaje del tema del aborto en la graduación es limitado, pues fue enseñado en pocos momentos y como morbilidad del ciclo embarazo-puerperio. Las enfermeras se sienten despreparadas para asistir a las mujeres en el aborto legal. Conclusión: el tema del aborto presenta un abordaje restringido para la formación de la conciencia crítico-reflexiva y parece favorecer la reproducción del sentido común sobre el aborto.

Retrospective Evaluation of the Procedural Sedation Practices of Expert Nurses During Abortion Care.

OBJECTIVE: To evaluate the provision of procedural sedation during abortion by expert nurses and to describe the factors that are associated with time to discharge for women who receive this sedation. DESIGN: Retrospective chart review. METHODS: Descriptive statistics were generated to describe a retrospective cohort of women presenting for abortion under procedural sedation. Analysis of variance was used to determine significant characteristics that influenced time to discharge. SETTING: A single clinical site that employs seven expert nurses. PARTICIPANTS: A total of 194 medical records were available for this analysis. RESULTS: All women were discharged home with accompaniment, and no incidents of respiratory distress or other adverse complications occurred. Most women (n = 136) received at least 150 µg fentanyl and 3 mg midazolam, and 71% of women in the first trimester and 83% of women in the second trimester entered the recovery area with no pain. Variables significantly associated with time spent in the recovery area were gestational age at time of abortion (t = -2.68, p = .008), pain at entry to recovery area (t = -0.254, p = .008), and pain at 15 minutes (t = 0.25, p = .038). CONCLUSION: Expert nurses can administer procedural sedation for pain control associated with abortion and are capable of monitoring women and helping them return to baseline status after the procedure.

A guide to critiquing a research paper. Methodological appraisal of a paper on nurses in abortion care.

In this paper, we have taken a previously published article on nurses' judgements in abortion care performing a systematic critique of the merits of this research using a recognised critiquing framework. OBJECTIVES DESIGN: The qualitative paper chosen for the critique is a grounded theory design and the research terms and terminology associated with this method such as symbolic interactionism are defined. The published paper reported on findings from a study exploring the characteristics of nurses in abortion care. REVIEW METHODS: A published critiquing tool has been applied. It was chosen because it is pragmatic, clearly laid out and accessible as full text to the people likely to need it. It comprises two stages, the first of which centres on the believability of the research. The second stage is more detailed and examines the research process and establishes the credibility of the research in its application to practice. OUTCOME: Develop critical and analytical skills through methodically appraising the merits of published research. CONCLUSION: Nursing as an evidence-based profession requires nurses at both pre- and post-registration levels to be able to understand, synthesise and critique research, this being a fundamental part of many nursing curricula. These have become core skills to acquire since implementing up to date evidence is the cornerstone of contemporary nursing practice.

Reflexiones sobre la despenalización del aborto en México / Reflections on the decriminalization of abortion in Mexico

Hace aproximadamente cinco años, se aprobó por la Asamblea de Representantes del Distrito Federal la despenalización del aborto en el D. F. Esta situación hace reflexionar acerca de la condición moral y ética de los representantes que elegimos para que salvaguardaran nuestros intereses en la Cámara de Diputados. ¿A quién le preguntaron si estábamos de acuerdo con la modificación del Código Penal? ¿Cómo influirá en la práctica de enfermería esta nueva ley que obliga a las enfermeras a participar en actos contrarios a sus creencias y principios? ¿Dónde quedó el respeto al derecho de objeción de conciencia de los profesionales de salud? Son preguntas que quedarán por resolverse. Lo que sí es necesario hacer es un análisis de la situación desde el punto de vista ético-legal, y las implicaciones que acarrea para la práctica profesional. El presente ensayo hace una reflexión sobre los aspectos éticos y morales que se deben de cuestionar las enfermeras cuando les toque enfrentar alguna situación como la que se está tratando; así mismo, se realizará un resumen de las leyes, tanto nacionales como internacionales que protegen al no nacido y que fueron pasadas por alto para aprobar el decreto que despenaliza al aborto en el Distrito Federal.

About five years ago, was approved by the Representatives Assembly of the Federal District, the legalization of abortion in D. F. This situation does reflect on the moral and ethical representatives who chose to have safeguarded our interests in the House of Representatives, because who asked if we agreed with the amendment of the penal code? How to influence nursing practice this new law requiring nurses to participate in acts contrary to their beliefs and principles? What happened to respect the right of conscientious objection by health professionals? This are questions that remain to be resolved. What if you need to do is analyze the situation from the standpoint of legal ethics, and carries implications for professional practice. This paper will make a beginning of reflection on the ethical and moral question that must be nurses when they touch face a situation such as being treated, and it will be a summary of the laws, both national and international protect the unborn and that were overlooked in order to pass the decree decriminalizing abortion in Mexico City.

Can nurses perform manual vacuum aspiration (MVA) as safely and effectively as physicians? Evidence from India.

BACKGROUND: Although legal, access to safe abortion remains limited in India. Given positive experiences of task-shifting from other developing countries, there is a need to explore the feasibility of expanding the manual vacuum aspiration (MVA) provider base to include nurses in India. STUDY DESIGN: A prospective, two-sided equivalence study was undertaken in five facilities of a non-government organisation in Bihar and Jharkhand to explore whether efficacy and safety rates associated with MVA provided by newly trained nurses were equivalent to those provided by physicians. Eight hundred and ninety-seven consenting women with gestation ages of ≤ 10 weeks were recruited. RESULTS: Nurses were as skilled as physicians in assessing gestation age and completed abortion status, performing MVA and obtaining patient compliance. Overall failure and complication rates were low and equivalent between the two provider types, and both provider types were equally acceptable to women who underwent the procedure (98%). CONCLUSION: Findings of the study make a compelling case for amending existing laws to expand the MVA provider base in order to increase access to safe abortion in India.

Nurses and care of women seeking abortions, 1971 to 2011.

In its first issue in 1972, JOGNN published a review article reporting surveillance data about abortions in the United States (Bourne, Kahn, Conger, & Tyler, 1972). This historical article predated Roe v. Wade, the U.S. Supreme Court decision legalizing abortion. Since this landmark decision, numerous articles have addressed nurses' role in abortion care. We review current literature on nurses and abortion care and use thematic categories to highlight areas of investigation.

From the outside in: a unique model for stimulating curricula reform in nursing education.

Given the current demands on nursing education, the introduction of new content into curricula can present significant challenges for nursing faculty. This is particularly true when the content being introduced is the subject of deep ethical, religious, or political controversy. This article offers a unique model for approaching curricula reform that draws on a decade-long effort to increase abortion-related content in nursing programs in New England and other regions of the United States mounted by a nonprofit organization. Strategies used and successes of the project are discussed. Faculty interested in introducing controversial topics into curricula, as well as advocacy groups that seek to stimulate curricula reform, may find this discussion to be particularly relevant and instructive to their efforts.

Conscientious objection and the nurse: a right or a privilege?

This article examines to what extent nurses can at present opt out of clinical procedures on the basis of conscience in English law. It considers the current rights to opt out on the basis of conscience contained in section 4 of the Abortion Act 1967 and section 38 of the Human Fertilisation and Embryology Act 1990. It examines how through codes of practice and guidance, there is recognition of the ability to opt out beyond theses statutes. It suggests that rather than let practice evolve to enable persons to opt out, the fundamental issues as to whether it should be a right or a privilege needs careful consideration across healthcare professions as a whole and a broader public debate.

Supporting the significant other in women undergoing abortion.

Abortion remains an ethical, legal and professional challenge to nurses. In the last decade there have been many innovations in abortion care and nurses have developed woman-centred, responsive services. Despite this progress, the needs of significant others - particularly partners attending with women - have yet to be fully met. A significant other is encouraged to stay with the woman during certain parts of the procedure if it is a surgical abortion, or may remain with the woman continuously during a medical abortion. There are benefits in encouraging significant others to stay with the woman, including the provision of additional support during the procedure as well as health promotion opportunities. The nurse has a vital function in assisting them in their role, as it is essential that significant others are adequately prepared and supported throughout. Providing they are managed proactively, involving significant others in supporting the woman undergoing abortion is commended.

A woman centred service in termination of pregnancy: a grounded theory study.

The issue of abortion is contentious. It challenges those involved emotionally and ethically and, although in the UK it is set within legal parameters, it remains controversial. The involvement of nurses and midwives in abortion care has not been explored to any great depth. In the UK, there has been a sustained increase in the number of medical compared to surgical terminations over the last decade. Nurses/midwives are at the forefront of this procedure and, because of the current political climate, their involvement is likely to increase in the future. This grounded theory study aimed to explore how nurses and midwives perceive their role with women undergoing termination of pregnancy and how they cope with their increased involvement with these women.

The role of advanced practice clinicians in the availability of abortion services in the United States.

Although abortion is one of the most common surgical procedures performed in the United States, the number of abortion providers is declining. Advanced practice clinicians, including nurse practitioners and certified nurse-midwives, may help to alleviate this shortage. However, some states bar nonphysicians from performing abortions. Not only should training in abortion techniques be made available to nonphysician providers who desire it, but legal obstacles must also be overcome in order to allow advanced practice clinicians the right to provide abortion services.

Termination of pregnancy: a case for a change in the law.

In recent months there has been renewed public and parliamentary debate on whether the abortion law in the United Kingdom should be reformed. Parliament has debated the issue on three occasions and now the House of Commons Select Committee on Science and Technology are calling for evidence in support of their inquiry into reform of the Abortion Act 1967. The inquiry gives district nurses the opportunity to inform the debate and ensure that their voices are heard given that topics for reform include nurse-led abortions and home abortions. In this article Richard Griffith and Cassam Tengnah review the development of the law relating to abortion and highlight the areas of reform to be considered by the select committee.

Ethics of justice and ethics of care. Values and attitudes among midwifery students on adolescent sexuality and abortion in Vietnam and their implications for midwifery education: a survey by questionnaire and interview.

UNLABELLED: Adolescent's sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam, whose task it is to promote adolescents' sexual and reproductive health and prevent reproductive ill health. It is important to understand future midwives' perceptions and attitudes in order to improve their education and training programmes. AIM: The aim of this study was to investigate Vietnamese midwifery students' values and attitudes towards adolescent sexuality, abortion and contraception and their views on professional preparation. METHODS: A quantitative survey including 235 midwifery students from four different secondary medical colleges in northern Vietnam was carried out in 2003. A qualitative study addressing similar questions was performed and 18 midwifery students were individually interviewed. FINDINGS: Findings revealed a general disapproval of adolescent pre-marital sexual relations and abortion-'an ethics of justice'-but also an empathic attitude and willingness to support young women, who bear the consequences of unwanted pregnancies and social condemnation-'an ethics of care'. Gender-based imbalance in sexual relationships, limited knowledge about reproductive health issues among youth, and negative societal attitudes were concerns expressed by the students. The students saw their future tasks mainly related to childbearing and less to other reproductive health issues, such as abortion and prevention of STI/HIV. CONCLUSION: Midwifery education in Vietnam should encourage value-reflective thinking around gender inequality and ethical dilemmas, in order to prepare midwives to address adolescents' reproductive health needs.