1
|
Tillman S, Eagen-Torkko M, Levi A. Ethics, Abortion Access, and Emergency Care Post-Dobbs: The Gray Areas. J Midwifery Womens Health 2023; 68:774-779. [PMID: 38095827 DOI: 10.1111/jmwh.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/23/2023] [Indexed: 12/17/2023]
Abstract
Clinical management of emergency pregnancy care, such as ectopic pregnancy or heavy bleeding with pregnancy of unknown location, includes upholding legal and ethical standards. For health care providers unwilling to provide evidence-based life-saving abortion care due to personal beliefs, clear guidance dictates disclosure of these limitations to the patient and colleagues, followed by immediate referral for appropriate care. However, this decision-making pathway may not be engaged due to a variety of factors: providers' beliefs preclude adherence to referral responsibilities, political discourse confuses patients as to their options and rights, and a constantly changing state and national legal landscape leads providers to question their ability to practice to their full scope of clinical care. Although this disruption of evidence-based standard of care existed pre-Dobbs, the moral disorder is now heightened. This Clinical Rounds highlights a patient vignette describing the risks of abortion restrictions for patients and providers alike, particularly when an individual provider's concerns for violating institutional guidelines sets a precedent for nursing response and forecloses on collaborative input or ethics consultation. The history of physician-only abortion exceptionalism and exclusion of nurses and midwives despite a significant history of nurses and midwives in abortion care grounds an argument for focusing on the impact of unethical and substandard care on the interprofessional care team leading to moral distress and negative patient outcomes. Patient-centered models of care, such as frameworks common in nursing and midwifery, offer opportunities to consider how all providers practicing to their full scope in interprofessional and collaborative ways, such as in emergency rooms and labor departments, might mitigate obstructions to abortion care that risk pregnant people's lives.
Collapse
Affiliation(s)
- Stephanie Tillman
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, Saint Louis, Missouri
- Feminist Midwife, LLC, Chicago, Illinois
| | - Meghan Eagen-Torkko
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, Washington
| | - Amy Levi
- Consultant, Albuquerque, New Mexico
| |
Collapse
|
2
|
Voultsos P, Zymvragou CE, Raikos N. Perceptions and experiences of female nurses when confronted with expressing a conscientious objection towards end-of-life care in Greece. BMC Nurs 2023; 22:372. [PMID: 37817234 PMCID: PMC10563366 DOI: 10.1186/s12912-023-01555-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/05/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Conscientious objection in nursing has been a topic of much discussion in recent years. Healthcare providers' conscientious objection has been included in Greek legislation. However, little is known about the real experiences of nurses who want to apply conscientious objections in their practice. This study aimed to contribute to filling that gap. METHODS This qualitative study was conducted with eighteen experienced female nurses. Data were collected through semi-structured in-depth qualitative interviews conducted with purposively selected nurses during the period from October 2019 to January 2020. Interviews were transcribed verbatim and analysed thematically. The ethical principles of anonymity, voluntary participation and confidentiality were considered. RESULTS Eight major themes and seven subthemes emerged from the thematic data analysis. Oppressive behaviors in the workplace and subservient interactions between nurses and physicians, suboptimal communication and inadequate support of nurses, perceived ineffectiveness of nurses' conscientious objections, missing legal protection against job insecurity, provision of care labeled 'futile', nurses' false knowledge and perceptions on medical situations related to conscientious objections, nurses' fears of isolation bullying and negative gossip in the workplace and a trivial amount of nurses' involvement in medical decisions emerged as barriers to nurses raising conscientious objection. Furthermore, from data analysis, it emerged that some nurses had false knowledge and perceptions on medical situations related to conscientious objections, some nurses experienced mild uncertainty distress about their ethical concerns, nurses considered their remote contribution as participation that can give rise to conscientious objection, a collective conscientious objection raised by nurses might have increased chances of being effective, and upbringing, childhood experiences, education and religion are factors shaping the nurses' core values. CONCLUSION A total of fifteen themes and subthemes emerged from this study. Most of the findings of this study were previously unknown or undervalued and might be helpful to inform nurses and nursing managers or leaders as well as healthcare policy makers. The results of this study might contribute to addressing the need for creating ethically sensitive health care services and ensuring nurses' moral integrity and high quality of patient care.
Collapse
Affiliation(s)
- Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology (Division: Medical law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, GR, Greece.
| | - Christina-Erato Zymvragou
- Laboratory of Forensic Medicine & Toxicology (Division: Medical law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, GR, Greece
| | - Nikolaos Raikos
- Laboratory of Forensic Medicine & Toxicology (Division: Medical law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, GR, Greece
| |
Collapse
|
3
|
Yildirim G, Kaya N, Altunbas N. Relationship between nurses' perceptions of conscience and perceptions of individualized nursing care: A cross-sectional study. Perspect Psychiatr Care 2022; 58:1564-1575. [PMID: 34697813 DOI: 10.1111/ppc.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/13/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To identify the relationship between the perception of conscience and individualized nursing care. DESIGN AND METHODS A cross-sectional study. The sample of the study consisted of 326 nurses working in internal medicine and surgical clinics. The data were collected using the Nurses' Perceptions of Conscience Questionnaire and Individualized Care Scale-Nurse (ICSA) Version. FINDINGS Their mean score for the ICSA-Nurse was 3.96 ± 0.72. There was a statistically significant positive correlation between their scores for the ICSA-Nurse and Voice of Conscience and basic qualities of conscience. CONCLUSION The participants considered their conscience as a reference when performing their care actions and defined conscience as an expression of social and spiritual values. PRACTICE IMPLICATIONS Nurses' awareness of perceptions of conscience and the effect of conscience on the patient-nurse relationship can help them to provide more sensitive care to their patients.
Collapse
Affiliation(s)
- Gulay Yildirim
- Department of Medical Ethics and the History of Medicine, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - Nurdan Kaya
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Nermin Altunbas
- Department of Nursing, Institute of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey
| |
Collapse
|
4
|
Coleman-Minahan K, Alspaugh A. Abortion Knowledge Among Advanced Practice Clinicians in Colorado. Womens Health Issues 2022; 32:461-469. [PMID: 35738986 PMCID: PMC9532373 DOI: 10.1016/j.whi.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/05/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Our objective was to quantify abortion law and care knowledge among Colorado advanced practice clinicians. METHODS We conducted a stratified random survey of advanced practice clinicians, oversampling women's health and rural clinicians. We assessed sample characteristics, positions on abortion legality, and knowledge of abortion law and care. Mean knowledge scores were compared by sample characteristics. Survey responses were compared by provision of pregnancy options counseling and positions on abortion legality. Linear regression models were used to examine knowledge scores. RESULTS A total of 513 participants completed the survey; the response rate was 21%. Abortion law knowledge questions (mean score, 1.7/7.0) ranged from 12% (physician-only law) to 45% (parental consent law) correct. For five of seven questions, "I don't know" was the most frequently chosen response. Abortion care knowledge questions (mean score, 2.8/8.0) ranged from 19% (abortion prevalence) to 60% (no elevated risk of breast cancer) correct. For four of eight questions, "I don't know" was the most frequently chosen response. Practicing in all other areas (e.g., family practice) was associated with lower abortion law and care knowledge than practicing in women's health. Providing options counseling was positively associated with abortion knowledge (law, β = 0.44; 95% confidence interval [CI], 0.10-0.78; care, β = 0.52; 95% CI, 0.08-0.95). Compared with participants who believe abortion should be legal in all circumstances, those who believe abortion should be illegal in all circumstances had similar abortion law knowledge (β = -0.03; 95% CI, -0.65 to 0.59), but lower abortion care knowledge (β = -1.85; 95% CI, -2.34 to -1.36). CONCLUSIONS Abortion knowledge is low among Colorado advanced practice clinicians and education is needed.
Collapse
Affiliation(s)
- Kate Coleman-Minahan
- University of Colorado College of Nursing, Aurora, Colorado; University of Colorado Population Center, Boulder, Colorado.
| | - Amy Alspaugh
- University of Tennessee College of Nursing, Knoxville, Tennessee; ACTIONS Program, University of California, San Francisco, San Francisco, California
| |
Collapse
|
5
|
Karabulut SD, Gül Ş, Keleş Ş, Baykara ZG, Yalım NY. Nurses' attitudes toward, perceptions of, and experiences with conscientious objection. Nurs Ethics 2022; 29:1615-1633. [PMID: 35575202 DOI: 10.1177/09697330221085771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Conscientious objection is a person's refusal to fulfill a legal duty due to their ethical values, religious beliefs, or ideological affiliations. In nursing, it refers to a nurse's refusal to perform an action or participate in a particular situation based on their conscience. Conscientious objection has become a highly contested topic in recent years. RESEARCH OBJECTIVES This study had four objectives: (1) eliciting information on how Turkish nurses perceive conscientious objection, (2) revealing whether their moral beliefs affect the care they provide, (3) determining their experiences with conscientious objection, and (4) identifying existing or potential issues of conscientious objection. RESEARCH DESIGN This qualitative study collected data through semi-structured interviews. The data were analyzed using thematic content analysis. PARTICIPANTS The sample consisted of 21 nurses. ETHICAL CONSIDERATIONS The study was approved by an ethics committee. Confidentiality and anonymity were guaranteed. Participation was voluntary. FINDINGS The analysis revealed four themes: (1) universal values of nursing (professional values), (2) experiences with conscientious objection (refusing to provide care/not providing care), (3) possible effects of conscientious objection (positive and negative), and (4) scope of conscientious objection (grounded and groundless). CONCLUSION Participants did not want to provide care due to (1) patient characteristics or (2) their own religious and moral beliefs. Participants stated that conscientious objection should be limited in the case of moral dilemmas and accepted only if the healthcare team agreed on it. Further research is warranted to define conscientious objection and determine its possible effects, feasibility, and scope in Turkey.
Collapse
Affiliation(s)
- Seyhan Demir Karabulut
- Department of Medical History and Ethics, Faculty of Medicine, 63994Baskent University, Ankara, Turkey
| | - Şenay Gül
- Department of Fundamentals of Nursing, Faculty of Nursing, 37515Hacettepe University, Ankara, Turkey
| | - Şükrü Keleş
- Department of Medical History and Ethics, Faculty of Medicine, 64255Karadeniz Technical University, Trabzon, Turkey
| | - Zehra Göçmen Baykara
- Department of Fundamentals of Nursing, Faculty of Health Science, 369802Gazi University, Ankara, Turkey
| | - Neyyire Yasemin Yalım
- Department of Medical Ethics and History, Faculty of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
6
|
Alspaugh A, Mehra R, Coleman-Minahan K, Hoffmann TJ, Burton CW, Eagen-Torkko M, Bond TM, Franck LS, Olseon LC, Lanshaw N, Rychnovsky JD, McLemore MR. The Space in the Middle: Attitudes of Women's Health and Neonatal Nurses in the United States about Abortion. Womens Health Issues 2021; 32:130-139. [PMID: 34844851 DOI: 10.1016/j.whi.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/17/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Despite playing an integral part in sexual and reproductive health care, including abortion care, nurses are rarely the focus of research regarding their attitudes about abortion. METHODS A sample of 1,820 nurse members of the Association of Women's Health, Obstetric, and Neonatal Nurses were surveyed about their demographic and professional backgrounds, religious beliefs, and abortion attitudes. Scores on the Abortion Attitudes Scale were analyzed categorically and trichotomized in multinomial regression analyses. RESULTS Almost one-third of the sample (32%) had moderately proabortion attitudes, 29% were unsure, 16% had strongly proabortion attitudes, 13% had strongly antiabortion attitudes, and 11% had moderately antiabortion attitudes. Using trichotomized Abortion Attitudes Scale scores (proabortion, unsure, antiabortion), adjusted regression models showed that the following characteristics were associated with proabortion attitudes: being non-Christian, residence in the North or West, having no children, and having had an abortion. CONCLUSIONS Understanding nurses' attitudes toward abortion, and what characteristics may influence their attitudes, is critical to sustaining nursing care for patients considering and seeking abortion. Additionally, because personal characteristics were associated with antiabortion attitudes, it is likely that personal experiences may influence attitudes toward abortion. A large percentage of nurses held attitudes that placed them in the "unsure" category. Given the current ubiquitous polarization of abortion discourse, this finding indicates that the binary narrative of this topic is less pervasive than expected, which lends itself to an emphasis on empathetic and compassionate nursing care.
Collapse
Affiliation(s)
- Amy Alspaugh
- University of Tennessee, Knoxville College of Nursing, Knoxville, Tennessee; University of California, San Francisco School of Nursing and the ACTIONS Program, San Francisco, California.
| | - Renee Mehra
- University of California, San Francisco School of Nursing and the ACTIONS Program, San Francisco, California
| | | | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, and Office of Research, School of Nursing, University of California San Francisco, San Francisco, California
| | - Candace W Burton
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, California
| | - Meghan Eagen-Torkko
- University of Washington Bothell, Bothell, WA & Public Health Seattle-King County, Seattle, Washington
| | - Toni M Bond
- University of California, San Francisco School of Nursing and the ACTIONS Program, San Francisco, California
| | - Linda S Franck
- University of California, San Francisco School of Nursing and the ACTIONS Program, San Francisco, California
| | | | - Nikki Lanshaw
- University of California, San Francisco School of Nursing and the ACTIONS Program, San Francisco, California
| | - Jacqueline D Rychnovsky
- Commissioned Officers Association of the United States Public Health Service, Landover, Maryland
| | - Monica R McLemore
- University of California, San Francisco School of Nursing and the ACTIONS Program, San Francisco, California
| |
Collapse
|
7
|
Eagen-Torkko M, Yanow S. The Critical Role of Midwives in Safe Self-Managed Abortion. J Midwifery Womens Health 2021; 66:795-800. [PMID: 34549524 DOI: 10.1111/jmwh.13289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022]
Abstract
As access to legal abortion in the United States becomes more complex, there is increasing interest in self-managed abortion. Choosing to seek abortion care outside the clinical setting can also help people marginalized or harmed by existing health care systems to access needed care in a way that feels safe and empowering. However, patients and midwives alike often have a lack of information about expected outcomes and potential complications that may arise, as well as how to manage these in a health care system that may make appropriate follow-up difficult to access if needed. This article discusses patient education as a harm-reduction approach, and reviews ways that midwives may strategically and ethically participate in this patient education need. As trusted health care providers who are expert in pregnancy and reproductive health, midwives are ideally positioned to meet patient knowledge needs around self-managed abortion.
Collapse
Affiliation(s)
- Meghan Eagen-Torkko
- University of Washington Bothell & Public Health Seattle-King County, Seattle, Washington
| | - Susan Yanow
- Reproductive Health Consultant, Cambridge, Massachusetts
| |
Collapse
|