A review of termination of pregnancy: prevalent health care professional attitudes and ways of influencing them

Aim. To review the literature on attitudes of health care professionals to termination of pregnancy and draw out underlying themes. Background. The controversy surrounding therapeutic abortion is unremitting with public opinion often polemic and unyielding. Nurses and midwives are at the centre of this turmoil, and as more termination of pregnancies are being performed using pharmacological agents, they are becoming ever more involved in direct care and treatment. Attitudes towards termination of pregnancy have been found to vary depending on the nationality of those asked, the professionals involved, experience in abortion care, as well as personal attributes of those asked such as their obstetric history and religious beliefs. The reasons for women undergoing abortion were also found to influence attitudes to a greater or lesser extent. Conclusion. This paper explores research studies undertaken into attitudes of health care professionals towards termination of pregnancy, to appreciate the complexity of the debate. It is possible that the increased involvement of nurses in termination of pregnancy, that current methods demand, may lead to change in attitudes. Consideration is given to a number of remedies to create an optimum environment for women undergoing termination of pregnancy. Relevance to clinical practice. This paper establishes via a literature review that attitudes in those working in this area of care depend upon a variety of influences. Suggestions are made for measures to be put into place to foster appropriate attitudes in those working in termination of pregnancy services.     

Nursing Children and Adolescents With Bipolar Disorder: Assessment, Diagnosis, Treatment, and Management

TOPIC:  The role of the mental health nurse in the assessment, diagnosis, treatment, and management of children and adolescents with bipolar disorder in community and hospital settings.
PURPOSE:  In many areas of clinical practice, mental health nurses have more contact with service users than any other professional group. They are therefore well placed to support children and adolescents with bipolar disorder during first contact with primary care services, through engagement with specialist mental health services, and in accessing early intervention and crisis services. This paper summarizes the contribution that child and adolescent mental health nurses make to the care of children and adolescents with bipolar disorder.
SOURCES:  This paper is based on evidence from systematic reviews; meta-analyses and best practice evidence from CINAHL; EMBASE; MEDLINE, PsychINFO; Cochrane Collaboration; National Institute for Health and Clinical Excellence; National Collaborating Centre for Mental Health; NHS Centre for Reviews and Dissemination; Oxford Centre for Evidence Based Medicine; United States Agency for Healthcare Research and Quality.
CONCLUSIONS:  Child and adolescent mental health nurses work with children and adolescents who have bipolar disorder in a range of settings. These include community mental health services, hospitals, and schools. Due to the multidisciplinary nature of the treatment and management of bipolar disorder during childhood and adolescence, nurses have a major role to play in providing frontline assessment services, monitoring treatment, and delivering psychosocial interventions.     

A review of developments in medical termination of pregnancy

Aim. This literature review aims to supplement guidelines by providing an overview of recent evidence relevant to medical termination of pregnancy. Background. Termination of pregnancy is available to women in the UK within legal parameters. Although guidelines form a strong body of evidence on which nurses and midwives can base their practice, there is a need to supplement them with up‐to‐date robust research findings. Method. A systematic search of the literature with high sensitivity and low specificity was undertaken on five databases using medical subject headings (MeSH) terms including (medical) induced abortion, therapeutic abortion and termination of pregnancy. Results. The literature search revealed articles under the following headings: The importance of choice for the women involved the need for the optimal medication type, dose, route and interval between stages one and two, and the optimum place for medical termination to take place. Conclusion. It was found that women attach a great deal of importance to the opportunity to choose their method of termination. The first stage of mifepristone is now a standard practice and an optimum dose has been determined. Several studies examined misoprostol used in the second stage of medical termination. There was some evidence for repeated doses of misoprostol, particularly in later gestation, with conflicting evidence on the optimal route. There were some grounds for reducing the interval between stages. Consideration should be given to home medical termination based on individual circumstances and choice. Gestation and previous obstetric history is an important factor to take into account when determining optimal regimen. Relevance to clinical practice. The number of medical termination of pregnancies performed has risen in recent years together with the nurses’ involvement. As new research is published, it is imperative that nurses adapt to base their involvement on the best available evidence.     

Working with women experiencing mid-trimester termination of pregnancy: the integration of nursing and feminist knowledge in the gynaecological setting

1. Working with women experiencing a mid-trimester termination of pregnancy is part of clinical practice in many gynaecological services. In this paper recent research with nurses working in the gynaecological area is drawn on to explore the issues for nurses working with women experiencing mid-trimester termination. Mid-trimester terminations are those carried out between approximately 12 and 20 weeks. 2. Mid-trimester termination results in the delivery of a fetus and this event requires sensitive management as it is has the potential to cause distress for the women due to the psychological and physical impact of the procedure. However, health professionals involved can also find this a distressing clinical event due to the complex nature of the management and care required. 3. Consideration of this clinical event from a feminist perspective led to my exploring the way in which feminist theory could be applied in the situation of mid-trimester termination. Using notions from feminist theory can assist in the management of this process, and feminist concepts related to the centrality of women's experience can be integrated into actual practice. 4. A series of recommendations are provided in this paper to show the way in which feminist concepts can be integrated into clinical practice. Integrating feminist principles into practice can support both the woman experiencing the abortion and the nurse whose role in the event is sustained and intimate, and result in positive outcomes for both women. This can result in an environment that is safe and supportive for all women involved in mid-trimester terminations.     

Duty and dilemma: Perioperative nurses hiding an objection to participate in organ procurement surgery

Perioperative nurses assist in organ procurement surgery; however, there is a dearth of information of how they encounter making conscientious objection requests or refusals to participate in organ procurement surgery. Organ procurement surgical procedures can present to the operating room ad hoc and can catch a nurse who may not desire to participate by surprise with little opportunity to refuse as a result of staffing, skill mix or organizational work demands. This paper that stems from a larger doctoral research study exploring the experiences of perioperative nurses participating in multi‐organ procurement surgery used a grounded theory method to develop a substantive theory of the nurses’ experiences. This current paper aimed to highlight the experiences of perioperative nurses when confronted with expressing a conscientious objection towards their participation in these procedures. A number of organizational and cultural barriers within the healthcare organization were seen to hamper their ability in expressing a conscience‐based refusal, which lead to their reluctant participation. Perioperative nurses must feel safe to express a conscientious objection towards these types of surgical procedures and feel supported in doing so by their respective hospital organizations and not be forced to participate unwillingly.     

A comparison of senior nurses and managers views on the development of mental health services in NHS trusts in London

Aims  To assess how lead nurses and senior managers of mental health services differed in their views concerning the drivers and barriers to service development in London.
Background  Since 1997, London managers in Mental Health have been surveyed to assess their views about the drivers and barriers to service development ( Peck et al . 1997 ). Under clinical governance, nurses are likely to have an enhanced decision‐making role. Therefore, in 1998, lead nurses were included in the study to identify differences in views.
Methods Lead nurses and senior managers of mental health services in Trusts in the London area were sent self‐administered questionnaire. Only if responses were obtained from the lead nurse and senior manager in the Trust were they included in the current analysis.
Findings  Few differences were identified in the ratings of drivers and barriers to service development. Reasons why lead nurses and senior managers felt drivers and barriers were important differed: senior mangers focused on organizational‐wide development, lead nurses focused staff expertise and clinical issues.
Conclusion Although areas of potential conflict are revealed, these areas may also be complimentary. Lead nurses highlight issues of concern for the optimum clinical functioning of the Trust, allowing management to incorporate these concerns into strategic planning.     

Right or wrong?

In theory, if a woman experiences an unwanted pregnancy, she has the option of abortion if 2 doctors agree that pregnancy poses a greater risk, physically or psychologically, to the woman than abortion. In practice women with unwanted pregnancies are at the mercy of the moral judgements of the health professionals they choose. When a woman turns to a NHS health care professional for help she is often guided, even unconsciously, by the moral position of than person. Most of the counseling that women receive is from doctors, nurses, and midwives, rather than a specialist with training in counseling pregnant women. At the Elizabeth Garrett Anderson Hospital in London, every woman who comes in with an unwanted pregnancy gets counseling whether she wants an abortion or not. She can come back as any times as she likes until she makes a decision; but, this situation is very unusual in the NHS. Often times women are told by the doctors to go home and think about it for a week of 2. Then if she decides to have an abortion, she might be referred to a NHS gynecologist who performs few abortions. Before she knows it she is past 12 weeks and thus unlikely to find help. She might be referred to a private charity like LIFE or Pregnancy advisory Service (PAS). LIFE will provide counseling, but will not refer for abortion services. PAS will refer women back to their local hospital if they choose to continue their pregnancy. PAS has its won abortion clinics and while it does mention alternative in its literature, its primary function is to provide abortion services. Often times women may seek these organizations without knowing their particular biases. The result of this is that women who can not afford a private abortion are being forced to continue their pregnancies because the NHS is so often unwilling to help them. 53% of women pay for their abortions. Few NHS doctors will perform abortion after 12 weeks and many will not perform 2nd abortions.     

Nurses' attitudes to therapeutic abortion

30 trained nurses in 2 health authorities were interviewed, using a tape-recorded and focused converstational apporach, to determine their attitudes toward therapeutic abortion. Strongly negative views about termination of pregnancy were expressed by the gynecology nurses either spontaneously in the course of the interview or in response to the question, "Is there anything you don't like about your work, or what is it that you like least?" Young girls having abortions featured prominently in nurses' comments. Patients were almost always referred to as "girls" rather than women. Older women, perhaps having an abortion because they did not want to add further to their family, were seldom reported and when questioned about this nurses replied that the majority of abortion patients were teenagers. The casual "don't care" attitude on the part of patients extended to use of contraception, too, in nurses' views. When asked what alternative ways they saw of handling the question of unwanted pregnancy, some nurses felt that doctors should refuse to do abortions in order to encourage a more responsible attitude. Prostaglandin terminations were the source of the strongest comments becasue it was disturbing to handle the fetus at the end of the procedure. Nurses felt that generally women who underwent this procedure did not understand beforehand what was involved, particularly that they would experience very painful contractions. Although not liking to participate in the performance of abortions, some nurses thought it preferable that that the abortions be performed in a medical setting that illegally. A high degree of consistency of attitudes was found among the 30 nurses interviewed. To assess how typical their views may be and how their statements fit with other research, the remainder of the discussion reports offical epidemiological statistics relating to abortion and studies of abortion from the perspectives of patients and nurses. The most recent official statistics available show that in 1980 a total of 128,927 residents in England and Wales had abortions, and just over half were performed for single women. Over the whole country, then, there was not a large majority of single women having abortions, as nurses in the study thought. Support for abortion patients emerges as an important issue in the research literature. This type of educational initiative also could provide much needed staff support, by giving them the knowledge, skills, and self confidence they need for their work.     

Italian midwives' experiences of late termination of pregnancy. A phenomenological–hermeneutic study

In this phenomenological–hermeneutic study, we explored how midwives perceive the burden of care, while assisting termination of pregnancy after 16 weeks' gestation. Between February and April 2013, 17 Italian midwives from three different units were interviewed. Data were collected using semistructured interviews. Four themes emerged from the interviews: influences, supports, empathy, and emotions. At the end of the study, researchers observed that midwives assert conscientious objection to the termination of pregnancy, which does not influence their experiences and memories. The midwives felt that it was important to share experiences with colleagues, discussing cases together and with the rest of the team. The midwives also suggested some strategies to improve this type of care: organize shifts in a way that could lead to improved and personalized care for women, continuous development, involvement of relatives, and special measures for these women's rooms. Moreover, they considered help from other professionals as fundamental in order to manage the clinical and emotional complexities related to these terminations.     

Perceptions of adolescents in low resourced areas towards pregnancy and the Choice on Termination of Pregnancy (CTOP)

Teenage pregnancy, unsafe abortion methods and the high incidence of HIV infections among young people are of great concern to the South African public. Due to the lack of accurate information and understanding, some adolescents are forced to succumb to early motherhood from unplanned pregnancies or opt for back-street abortion with at times fatal results. A qualitative exploratory study was conducted in 2003 to determine the adolescents' perceptions towards factors on the Choice on Termination of Pregnancy (CTOP) and the constraints in accessing TOP services. A purposive sampling technique that enabled experts such as health workers to identify suitable candidates for the investigation was employed. Twenty-four (24) adolescents residing in the predominantly rural area of Nkumpi-Lepelle in the Limpopo Province agreed to participate in the focus group interviews. The major findings indicated that most adolescents were uninformed about CTOP. This is attributed to the lack of coordination among health professionals and educators in the dissemination of information. The overwhelming majority of the respondents expressed discomfort at receiving termination of pregnancy services from the local public clinics and hospitals as they regarded such facilities as youth unfriendly. The adolescents also required provision of pre- and post-counselling services for adolescents who would like to terminate pregnancy. The following hypotheses were formulated for future in-depth studies: If adolescents continue to lack information about CTOP, they will not be able to utilize available services to terminate unplanned and unwanted pregnancies. If CTOP services remain inaccessible to the youth, the problem of backstreet abortion will not be eradicated.     

Care of women having termination of first-trimester pregnancy

The care of women having termination of pregnancy has always presented social, ethical and legal concerns to nurses and other healthcare professionals. Women having first-trimester termination of pregnancy may have the choice between medical and surgical methods. The process and procedure of these two approaches are discussed and the implications for nursing practice identified. There is now research evidence that explores women's experiences of these various methods and gives some insight into what the woman may experience. Nurses must have knowledge of these methods of termination to enable women to make the correct choices. The challenge for nurses then is to provide and evaluate information that is as effective as possible in meeting the needs of the individual woman.     

Shades of gray: Conscientious objection in medical assistance in dying

With the advent of legalized medical assistance in dying [MAiD] in Canada in 2016, nursing is facing intriguing new ethical and theoretical challenges. Among them is the concept of conscientious objection, which was built into the legislation as a safeguard to protect the rights of healthcare workers who feel they cannot participate in something that feels morally or ethically wrong. In this paper, we consider the ethical complexity that characterizes nurses' participation in MAiD and propose strategies to support nurses' moral reflection and imagination as they seek to make sense of their decision to participate or not. Deconstructing the multiple and sometimes conflicting ethical and professional obligations inherent in nursing in such a context, we consider ways in which nurses can sustain their role as critically reflective moral agents within a context of a relational practice, serving the diverse needs of patients, families, and communities, as Canadian society continues to evolve within this new way of engaging with matters of living and dying.     

Experiences of working with induced abortion: focus group discussions with gynaecologists and midwives/nurses

Scand J Caring Sci; 2011; 25; 542–548
Experiences of working with induced abortion: focus group discussions with gynaecologists and midwives/nurses Background: While there exists an extensive amount of research regarding the medical aspects of abortion, there is a great lack of studies investigating staff’s views and experiences of working in abortion services. Aims: To elucidate gynaecologists’ and midwives’/nurses’ experiences, perceptions and interactions working in abortion services, their experiences of medical abortions and abortions performed at the woman’s home. An additional aim was to illustrate gynaecologists’, midwives’ and nurses’ visions of their future professional roles within the abortion services. Method: Three focus group discussions within each profession were carried out in 1‐hour sessions with a total of 25 gynaecologists and 15 midwives/nurses from three different hospitals. Results: The content analysis reflected that gynaecologists and midwives/nurses had no doubts about participating in abortions despite the fact that they had experienced complex and difficult situations, such as repeat and late‐term abortions. They experienced their work as paradoxical and frustrating but also as challenging and rewarding. However, they were rarely offered ongoing guidance and continuously professional development education. For gynaecologists, as well as midwives/nurses, their experiences and perceptions were strongly linked to the concurrent development of abortion methods. The interaction between the professions was found to be based on great trust in each other’s skills. Conclusions: In order to promote women’s health, gynaecologists’ and midwives’/nurses’ need for a forum for reflection and ongoing guidance should be acted on. With a higher number of abortions done medically and a higher proportion of home abortions, midwives/nurses will get increased, responsibilities in the abortion services in the future.     

Mifepristone

OBJECTIVE: To review the efficacy and safety of mifepristone (with misoprostol) for the termination of early pregnancy. DATA SOURCES: A MEDLINE search (1966-October 2000) was conducted, and additional references listed in articles were included; unpublished data obtained from the manufacturer were used to identify data from the scientific literature. Studies evaluating mifepristone were considered for inclusion. STUDY SELECTION: Human clinical studies in the English language were reviewed and evaluated. Clinical trials selected for detailed review were limited to those including the regimens of mifepristone and misoprostol, recently approved by the Food and Drug Administration for early pregnancy termination. DATA SYNTHESIS: Mifepristone is an antiprogestin available for pregnancy termination in combination with a prostaglandin such as misoprostol. Mifepristone offers efficacy similar to, if not better than, other drugs used for pregnancy termination, but appears less efficacious overall than surgical termination of pregnancy. Mifepristone in combination with misoprostol commonly causes adverse effects such as abdominal pain and, less commonly, can cause serious adverse effects such as incomplete abortion; endometritis; and bleeding warranting transfusion, hospitalization, or surgery. Mifepristone is metabolized by the cytochrome P450 system. Thus, the potential for drug interactions with this agent exists, although this has not been well studied. Data are included from clinical trials evaluating the safety, tolerability, efficacy, and pharmacoeconomics of mifepristone combined with misoprostol for early pregnancy termination. Data comparing the use of these agents with surgical abortion and other drugs used for pregnancy termination are included where available. CONCLUSIONS: Mifepristone in combination with misoprostol for the termination of early pregnancy (amenorrhea of < or = 49 d) is effective in 92-95% of women. Incomplete abortion requiring surgical abortion after the fact occurs in 3-5% of women, and pregnancy continues 1-2% of the time. Mifepristone with misoprostol treatment is not without significant risks, including hemorrhage, infection, and potential for long-term emotional consequences.     

社区未产孕妇药物流产310例心理分析与健康指导

近年来,由于各种原因导致未产孕妇终止妊娠逐年上升趋势。年轻妇女对怀孕无心理准备,造成心理和身体上的创伤。迫切要求痛苦小,损伤小的药物流产方式。药物流产是一种较安全方便有效的措施,可多次妊娠仍有一定危害。所以社区卫生人员应真对青春妇女进行心理指导、卫生宣教、健康教育。     

Sexual revolution

The FPA--formerly the Family Planning Association--celebrates its 75th anniversary this year. Since its inception, the association's remit has broadened from the provision of contraceptive advice to health education and help with sexual dysfunction. Before contraceptive services became available, women underwent multiple pregnancies. Until 1967, contraceptive advice was available only to married women. Family planning nurses now provide women with the contraceptive pill as well as injections and emergency contraception. The FPA provides termination of pregnancy and vasectomy services.     

The gate still swings both ways in rural Texas

Aims  To give nurse managers a perspective of what it is like to practice in a frontier or rural setting without the resources of the metropolitan centres.
Background  I grew up in rural Texas and more recently had the opportunity to work with rural hospitals seeking to be designated as Nurse Friendly by the Texas Nurses Association. This renewed my interest in and great respect for nurses on the frontier and other rural areas.
Key issues  This article summarizes some characteristics of rural nursing in relation to their practices that address patient safety and quality of care, nurse satisfaction and balanced life style, community service, and teamwork/relationships.
Conclusions  I conclude that there are many advantages and satisfactions in rural nursing that are different from but equally as meaningful and challenging as metro nursing practice.
Implications for nursing management  This article is important because there is a shortage of nurses everywhere; however, direct care nurses and nurse managers in rural areas may have greater challenges in meeting their patient's needs while balancing their personal lives.