Nurse practitioners on 'the leading edge' of medication abortion care: A feminist qualitative approach

Nurse practitioner medication abortion providers in Canada: results from a national survey

BACKGROUND

In 2017, nurse practitioners (NPs) became the first non-physician healthcare providers authorised to independently provide medication abortion (MA) in Canada. We aimed to report on demographic and clinical characteristics of NPs providing mifepristone/misoprostol MA in Canada and to identify context-specific barriers and enablers to NP provision of mifepristone/misoprostol MA in Canada among MA providers and non-providers.

METHODS

From August 2020 to February 2021, we invited Canadian NPs to complete a national, web-based, bilingual (English/French) survey. The survey was distributed through national and provincial nursing associations and national abortion health professional organisations. We collected demographic and clinical care characteristics and present descriptive statistics and bivariate analyses to compare the experiences of NP providers and non-providers of MA.

RESULTS

The 181 respondents represented all Canadian provinces and territories. Sixty-five NPs (36%) had provided MA at the time of the survey and 116 (64%) had not. Nearly half (47%) of respondents worked in rural or remote communities and 81% in primary care clinics. Significant barriers impacting non-providers' abilities to provide MA included limited proximity to a pharmacy that dispensed mifepristone/misoprostol, few experienced abortion providers in their community of practice, poor access to procedural abortion services, policy restrictions in NPs' places of employment, and no access to clinical mentorship. Some 98% of NPs providing MA services had never encountered anti-choice protest activity.

CONCLUSIONS

NPs appear prepared and able to provide MA, yet barriers remain, particularly for NPs in smaller, lower-resourced communities. Our findings inform the development of supports for NPs in this new practice to improve abortion access in Canada.

An Acceptability and Feasibility Study of a Nurse-Led Model of Contraception and Abortion Care in Rural General Practice

AIM

To assess the acceptability and perceived feasibility of integrating a co-designed nurse-led model of contraception and medication abortion care within rural and regional general practices.

DESIGN

Qualitative exploratory design utilising Sidani and Braden's indicators of acceptability and feasibility.

METHODS

We conducted semi-structured interviews with 12 practice nurses, 8 general practitioners and 3 practice managers who currently or previously worked in rural, regional or remote general practice. Participants were recruited purposively through social media, partner organisation newsletters and snowballing. During the interview, participants were presented with an overview of the co-designed model of care and asked specific questions to gain feedback on its acceptability and perceived feasibility. Data were analysed in NVivo using template analysis and iterative categorisation. Findings were mapped according to Sidani and Braden's indicators of acceptability and feasibility.

RESULTS

Three overarching themes were identified: nurses are acceptable providers, factors influencing the feasibility of the model and factors supporting greater feasibility of the model. Participants found the nurse-led model acceptable, describing nurses as suitable and sometimes preferred providers of long-acting reversible contraception and abortion care in rural and regional settings. They also perceived the model as feasible, citing similarities to existing care processes such as infant immunisations and chronic disease management, contributing to its feasibility. However, contextual factors such as the need to adapt the model to each clinic and patient's unique needs, foster strong general practitioner-practice nurse professional relationships and ensure that staff have shared values and adequate training for contraception and abortion provision were described as critical for feasibility.

CONCLUSION

Overall, participants found the nurse-led model of care to be acceptable and feasible for implementation in rural and regional general practices. This perception carries important implications for policy and practice, highlighting the need for supportive policies to enhance the effectiveness of such models across Australian general practice.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Our findings emphasise the need for initiatives aimed at addressing inadequate funding for nurse-led care, improving documentation of this care, enhancing understanding among general practitioners and nurses regarding the scope of practice for practice nurses, and overcoming training barriers specific to rural areas. These measures are essential for enabling nurse-led models of contraception and medication abortion to function effectively in practice.

REPORTING METHOD

This paper is reported according to the consolidated criteria for reporting qualitative research (COREQ) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.

Perceptions and attitudes of nurse practitioners toward artificial intelligence adoption in health care

Background

With the ever-increasing integration of artificial intelligence (AI) into health care, it becomes imperative to gain an in-depth understanding of how health care professionals, specifically nurse practitioners, perceive and approach this transformative technology.

Objectives

This study aimed to gain insights into nurse practitioners' perceptions and attitudes toward AI adoption in health care.

Methods

This qualitative research employed a descriptive and phenomenological approach using in-depth interviews. Data were collected through a semi-structured questionnaire with 37 nurse practitioners selected through purposive sampling, specifically Maximum Variation Sampling and Expert Sampling techniques, to ensure diversity in characteristics. Trustworthiness of the research was maintained through member checking and peer debriefing. Thematic analysis was employed to uncover recurring themes and patterns in the data.

Results

The thematic analysis revealed nine main themes that encapsulated nurse practitioners' perceptions and attitudes toward AI adoption in health care. These included nurse practitioners' perceptions of AI implementation, attitudes toward AI adoption, patient-centered care and AI, quality of health care delivery and AI, ethical and regulatory aspects of AI, education and training needs, collaboration and interdisciplinary relationships, obstacles in integrating AI, and AI and health care policy. While this study found that nurse practitioners held a wide range of perspectives, with many viewings AI as a tool to enhance patient care.

Conclusions

This research provides a valuable contribution to the evolving discourse surrounding AI adoption in health care. The findings underscore the necessity for comprehensive education and training in AI, accompanied by clear and robust ethical and regulatory guidelines to ensure the responsible integration of AI in health care practice. Furthermore, fostering collaboration and interdisciplinary relationships is pivotal for the successful incorporation of AI in health care. Policymakers should also address the challenges and opportunities that AI presents in the health care sector. This study enhances the ongoing conversation on AI adoption in health care by shedding light on the perspectives of nurses, thereby shaping future strategies for AI integration.

Effect of extended precision nursing on neurobehavioral function and pregnancy outcome in patients with threatened abortion

This study aimed to assess the impact of continuous precision nursing on neurobehavioral function and pregnancy outcomes in patients experiencing threatened abortion. A total of 130 patients with early threatened abortion admitted to our hospital between October 2020 and January 2023 were selected and categorized into 2 groups based on intervention methods. The control group received routine nursing intervention, whereas the observation group received continuous precision nursing intervention. Changes in affective status scores, SF-36 scores, knowledge mastery scores, and satisfaction scores in the neurobehavioral function test before and after intervention were recorded in both groups. Additionally, pregnancy outcomes, obstetric adverse reaction rates, and neonatal conditions were documented. Following intervention, scores for tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia, and confusion-bewilderment gradually decreased in both groups, with significantly lower scores observed in the observation group compared to the control group (P < .05). SF-36 scores in 8 dimensions, including physical functioning, role-physical, bodily pain, and overall health rating, showed a gradual increase in both groups, with the observation group scoring higher than the control group (P < .05). Knowledge mastery and satisfaction scores also increased significantly after intervention, with the observation group surpassing the control group (P < .05). The observation group exhibited lower rates of abortion and premature birth, along with a higher rate of full-term pregnancy compared to the control group, with statistically significant differences (P < .05). Furthermore, the observation group displayed lower rates of adverse reactions and low birth weight infants, with significant differences compared to the control group (P < .05). No significant differences were observed in neonatal mortality and neonatal intensive care unit transfer rates between the observation and control groups (P > .05). Continuous precision nursing contributes to improved pregnancy outcomes for patients with threatened miscarriage within the first 12 weeks of pregnancy. This comprehensive care approach is associated with enhanced knowledge retention, protection of neurological function, and an overall improvement in quality of life.

Distance between institutions of incarceration and procedural abortion facilities in Canada

OBJECTIVES

People incarcerated in facilities for women and girls face barriers to accessing abortion, including unclear legislation, operational procedures, and distance. While medication abortion could mitigate distance barriers, prison is not a hospitable environment for medication abortion. Considering this limitation, this paper aimed to identify the distance from institutions of incarceration designated for women and girls to procedural abortion facilities in Canada.

STUDY DESIGN

This study builds on an inventory of the 67 institutions of incarceration designated for women and girls across 13 provinces and territories in Canada, previously created by the authors. Procedural abortion facilities were identified using publicly available directories. Distances were calculated using Google Maps. The closest procedural abortion facility was identified for each institution, as well as the gestational age limit of each facility.

RESULTS

Of the 67 institutions, 23 (34%) were located 0 to 10km from a procedural abortion facility. Fourteen (21%) were located 10.1 to 20km away. Ten (15%) were located 20.1 to 100km away. Eleven were located 100.1 to 300km away (16%). The remaining 9 (13%) were located between 300.1 and 738km away. Distances ranged from 0.1 to 738km. The greatest distances were among institutions in northern Canada.

CONCLUSIONS

This paper identified a large range of distances between institutions of incarceration and procedural abortion facilities in Canada. Physical distance is only one measure of accessibility of abortion services. For incarcerated people, contextual factors including carceral policies and procedures present barriers to care, with significant impact on health equity.

IMPLICATIONS

Distance between carceral institutions and procedural abortion facilities reduces equitable access to reproductive health services for incarcerated populations. Pregnant people should be protected from imprisonment to ensure reproductive autonomy.