“What a difference a day makes” - Second trimester termination of pregnancy in the gynaecology ward: A case study
The focus of this study are the nurses who care for women undergoing termination of pregnancy in the second trimester. Termination of pregnancy (abortion) is the deliberate ending of a pregnancy. In New Zealand for the year ending December 2015, 13,155 abortions were performed and of these, 553 abortions were performed after the 12th week of pregnancy (second trimester). Changes to how abortions are undertaken has resulted in increased participation by nurses and midwives in the process, where the resulting products of conception often resemble a fully formed foetus. Despite abortion being so widely accessed, little is known about the attitudes, opinions or feelings of the nurses who deliver the care.
The purpose of this study was to explore issues for nurses who provide care for women undergoing second trimester termination of pregnancy in the gynaecology inpatient setting. Case study methodology was used. This study used face to face semi structured interviews and retrospective clinical note review as data collection methods. Themes which were identified in the interviews included: staff experiences and attitudes, strategies for managing demands and challenges, and training and support. The study found that whilst the stance of the nurses who participated in second trimester termination of pregnancy care was largely pro-choice they were not necessarily immune to the stressors associated with the processes of termination of pregnancy, particularly as the gestational age of the pregnancy advances. Support for nurses who work in abortion services is at best haphazard and when compared to the disciplines of palliative care and mental health was found woefully lacking. In addition, education for nurses specific to abortion care was ad-hoc, fragmented and relied mostly on informal peer teaching from other nurses.
The key recommendations emanating from the study were that consideration should be given to developing structures, processes and training to support nurses in their practice with a view to maintaining high quality patient care. Training for staff should be evidence-based, patient centric, planned and a priority and not rely primarily on the good will of colleagues. It is envisaged that the findings of the study will provide a framework with which to build robust support structures for nurses working in this unique area of healthcare.