A Woman Centred Service

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Copyright eContent Management Pty Ltd.ContemporaryNurse(2008) 31:919.

Awoman centred service in

termination of pregnancy:

A grounded theory study

ABSTRACTThe issue of abortion is contentious.It challenges those involvedemotionallyand ethically and,although in the UK it is set within legal parameters,it

remains controversial.The involvement of nurses and midwives in abortion care

Key Wordshas not been explored to any great depth.In the UK,there hasbeen a sustained

termination ofincrease in the number of medical compared to surgicalterminations over thepregnancy;last decade.Nurses/midwives are at the forefront of this

procedure and,becauseabortion;feminist ethics;of the current political climate,their involvement is likely toincrease in thegroundedfuture.This grounded theory study aimed to explore how nursesand midwivestheory;gynae-perceive their role with women undergoing termination of

pregnancy and howcology nursingthey cope with their increased involvement with thesewomen.


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19 February 2008Accepted 6 August 2008CNReceivedundergoing a relatively minor procedure involv-ing suction aspiration of the products of concep-tion.This usually occurs under a generalanaesthetic.A medical abortion comprises twoALLYSONLIPPLecturerstages.Firstly,taking the tablet mifepristone andPrincipalPost-Doctoralsecondly,returning to hospital one to three daysRCBCFellow

of Health, later for misoprostol (RCOG 2004).The abor-Facultyand Sciencetion usually occurs about six hours later withSportUniversity of GlamorganWales, UKthe products of conception passed vaginally.Pontypridd,

There are advantages and disadvantages with

INTRODUCTIONboth methods,although they are classed astion is a contentious issue and thoseequally safe and relatively minor procedures.

Aborinvolved in caring for

women undergoingThere hasbeen an increase in medicalabor-the procedure confront complex issues on ations relative to surgical abortions inthe UK.daily basis.In the UK within certain legal para-The number of abortions in the UKbeing per-

meters,a woman can receive a first trimesterformed with the use ofmedication,commonlyabortion in one of two ways,medical or sur-gical.A surgical abortion usually involves the1991 when mifepristone was firstlicensed forwoman admitted to hospital as a day case anduse in the UK and has more thandoubled in the


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31,Issue 1,December 2008CCCCNNNN9Volume


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Allyson LippCCCCNNNN

last five years (Department of Health 2008).unintentional loss,emphasised thechallengesMedical abortions accounted for 30% of theof nurses simultaneously managingtheir owntotal,compared with 24% in 2005.The totalemotions alongside those of thewomen.number of abortions in England and Wales inA US exploratory study (Joffe 1999)com-2006 was 193,700,compared with 186,400 inprising interviews with 25 long termsurgical

2005,a rise of 3.9%.The National Health Ser-abortion providers asked about thetransitionvice funded 87% of abortions (Department ofto medical abortions.Joffe (1999)found thatHealth 2007).most viewed it as an acceptable innovation with-The move towards more medical abortionsout the complications of haemorrhagetheyhas meant nurses are becoming more directlyhad feared.In Australia the movetowards moreinvolved in the procedure.A recent House ofmedical terminations has been morehaphazard

Commons Scientific and Technology Commit-(Calcutt 2007;RANZCOG 2005).tee (2007) recommended nurses take a moreDespite the satisfactory safetyrecord ofprominent role in both medical and surgicalmedical abortion (Say et al.2002),awomanabortions which would further increase theirundergoing the procedure requiresthe nurseinvolvement and responsibilities in this pro-or midwife to be with her to superviseand,cedure.therefore,experience it along with the womanLittle research has been undertaken to exam-(Huntington 2002).It is unclear how

increasedine how nurses or midwives perceive their involvement will affect the dynamics oftherole or how the increasing numbers of medical nurse/midwifepatient relationshipor theabortions in the UK has affected the nurses andnurse/midwifes involvement inthe long term.midwives involved.A Swedish qualitative study

(Alex & Hammarstrom 2004) analysed womensSTUDYAIMS


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experiences of induced abortion from a feministThis study aimed to examine:perspective and found that despite positive atti-tudes towards abortion generally,the womenHow nurses and midwives perceivetheirheld negative attitudes towards their own abor-role with women undergoingtermination of

tion.Alex and Hammarstom (2004) advise thatpregnancy.nurses and midwives need to be aware of theHow nurses and midwives copewith theirwomens complex experiences with abortions increased involvement with womenunder-in order to be able to support and empowergoing medical termination ofpregnancy.women.In order to be able to assist the women,it is important that nurses/midwives are cog-This research study was undertakenas part ofnisant of the effect of their own intense involve-a two-year Research Capacity

Building Collabo-ment in such complex experiences.ration (Wales,UK) post-doctoral fellowshipIntense involvement by nurses and midwivesscheme.Like most grounded theoryresearchers,with their patients has been termed emotionalI have found that there is more thanone storylabour and has been the subject of research andinherent in the data (Seibold2000).I have cho-commentary (Bolton 2000;Hemmerling et al.sen one specific story,butacknowledge that2005;McCreight 2005;McQueen 1997;Phil-there may be many others,which have

yet to belips 1996;Smith 1992).In a qualitative study byanalysed.Bolton (2000) examining nurses on a gynae-

cological ward,emotional labour was classed METHODANDMETHODOLOGYas a gift given freely to the patient.McCreightIt is useful to distinguish betweenmethod and(2005),in her study of perinatal grief throughmethodology.Method describes thetechnique

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A woman centred service in termination of pregnancyCCCCNNNN

used in the research whereas methodologyEthical Approval was achieved inaddition todescribes the set of assumptions or theoreticalapproval from all 13 NHS Researchand Devel-framework underpinning the research (Kingopment Committees in Wales,UK.1994).As there is a limited amount of literature

on this topic,a qualitative approach was chosenRECRUITMENTas an exploratory tool.Grounded theory wasLetters were sent to allnurses/midwivesselected as the method for this study because involved in termination of

pregnancy to allof its sociological basis and pragmatic originsNational Health Service trusts inWales,UK via(Charmaz 2006).the nurse/midwife lead.Twenty-seven womenThe nature of the problem being investigatedexpressed an interest in participatingin thewas not certain at the outset of the study,as Iresearch.Homogenous sampling wasuseddid not know whether nurses felt challenged orwhich enabled the termination ofpregnancycompromised in their care giving.Therefore,subgroup to be accessed (Norwood

2000).Allchoosing a methodology at the beginning of theparticipants,who expressed aninterest butstudy was not possible (Seibold 2000).Instead,were not recruited,were contactedand thankeda congruent methodology became apparent as for their offer to participate.I gathered data,began some tentative compara-

tive analysis and read around the literature.PARTICIPANTSReflexively I explored my own frame of refer-To meet the aim of the study,twelvepartici-

ence,philosophical and ethical stance,which inpants were purposively chosen fromnine of theturn evoked a feminist standpoint.Feminist the-thirteen NHS trusts in Wales.Theywere viewedory has been recognised as having a substantialas being able to contributesubstantially to thecontribution to make to nursing since the 1980sresearch as they wereexperienced in the field(Huntington 2002).Seibold (2000) cites Len-of gynaecology and termination of


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pregnancygermann and Niebrugge-Brantley (1988) in list-ranging from 10 to over 30 yearsexperience.ing three broad tenets of feminist methodologyThere were five nurse/midwifespecialists,onewhich were reflected in this study:First,thatmidwifery practitioner,two family

planningwomens experiences are central;second,thatnurses,three ward sisters and a wardstaffthe research attempts to see the world from thenurse.For ease of reading and tomaintainwomens point of view;and third,that theanonymity,the generic term nurse will beusedresearcher aims to improve the circumstancesthroughout.The educationalbackground of thefor women amongst others.In holding to theseparticipants varied from those withlittle post-

tenets,I was able to ensure that the balance ofregistration education to graduates.power between the participants and me asthe researcher was as equal as

possible.WuestDATACOLLECTIONANDANALYSIS(1995) argues that grounded theory accommo-Individual open-ended interviewswere per-dates feminist theory on several counts;firstlyformed over the summer of 2007and each onethat womens experience is a legitimate sourcelasted from forty-five minutes toan hour.Inof knowledge,secondly that exploring a contextorder to meet the aims of the

study during theallows discovery of social processes and lastlyopen-ended interview I asked theparticipantsthat the researcher is a social being and alsohow they perceived their role workingwithrecreates social processes.women undergoing termination of pregnancy.Ialso asked about their increasing involvement

ETHICALCONSIDERATIONSwith women undergoing medical termination ofPrior to the research,Multiple Site Researchpregnancy.Data were collected andanalysed



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concurrently using constant comparative analy-and selection of the core categoryor centralsis (Strauss & Corbin 1998).phenomenon of fostering a woman-centredGrounded theory demands sensitive inter-service.A simplified model of thegroundedpretation of complex data and ways of rigor-theory can be found in Figure 1.ously exploring themes and discovering and

testing patterns and NVivo 7 was used to assistRIGOURin achieving this.Initially open codes wereTo be a credible source of knowledge,aqualita-

established from the data.This allowed iden-tive research study should beproduced to a rig-tification of categories and subcategories.Fol-orous standard.Several ways ofevaluating thelowing further interviews,the categories andrigour of such a study are outlined byHorsburghsubcategories were strengthened and refined(2002),for example,the use of thefirst person,using constant comparative analysis.For exam-the selection of participants,theinterpretationple,there were several references to the womenof their accounts and researcher

flexibility andmaking their decision within their own circum-reflexivity during the researchprocess.stances and that everyone was treated different-In adhering the Horsburghs(2002) guide-ly.These two categories were grouped into onelines,the first person has been usedin thissubcategory and eventually became part of theaccount,by me as a researcherand by the par-context in which care was delivered (Figure 1).ticipants in their accounts of theirpractice.Eventually no new categories were found whichSample selection has beendetailed sufficientlywas consistent with data saturation (Charmazfor the reader to be able todetermine that it2006).Following this saturation more complexwas performed based on theparticipants abilitycoding was performed following Strauss andto contribute to the study.ParticipantvalidationCorbins (1990) method as confirmation of theoccurred after transcription where a


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copy ofprocess and to ensure rigour.This also providedeach individuals transcript wassent to all par-the platform for integration of the categoriesticipants for dataverification.Throughout the

FIGURE1: A WOMAN-CENTREDSERVICEFORMEDICALTERMINATIONOFPREGNANCY



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research process,my researcher flexibility andsee the counsellor they decide thatits not thedata credibility was enhanced via discussionsright decision for them and theywould actu-with a peer mentor.He challenged my codingally like to continue with thepregnancy andprocess during the data analysis phase.Thesethats fine and they go away andthats lovelychallenges also stimulated reflexivity where Iyou know,not a problem.(Interview 2)endeavoured to explore my motives and under-

pinning rationale as part of the research processEven though they have beencounselled in(Lipp 2007).the pregnancy advisory clinic some are veryCredibility allows a research study to beunsure.Those who are very unsure ninejudged as reliable,and therefore replicable,iftimes out of ten theyd ring up andsay Look,the reader can follow a decision trail (Appletonwe are going ahead with thepregnancy.1995).Briefly describing the process of how the(Interview 3)grounded theory was generated has illuminatedMany of the participantsacknowledged that it

a decision trail,although word limit precludeswas the womans situation that ledthem to seekfurther detail.an abortion.Given other circumstances,somewomen may have chosen to continue with the

FINDINGSpregnancy.In this section,the data will be examined inThe decision in most cases will havebeen arelation to the strategyof facilitating the deci-difficult one to make and the nursemay havesion,and the contextand influential conditionsofbeen involved from this point inthe womansthe decisions made,as well as the consequencesofcare:how nurses cope with women undergoing med-ical terminations of pregnancy.All of these cate-Its the biggest decision that awoman evergories articulate with and support the centralhas to make,to have atermination.So I dontphenomenon of fostering a woman-centredthink people come to that decisionlightlyservice,which will then be discussed in relationyou know.(Interview 4)


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to its impact on nursing (Figure 1).I used to leave the day with a headache.Ithink thats most to do with the fact that youFacilitating the decisionare very mindful of the situation,or their cir-A strategy employed by the participants was tocumstances and very mindful ofwhat you arefacilitate the womans decision making rathersaying to these women because

number onethan assuming that an abortion was the chosenyou dont want to influence theirdecisionoption (Figure 1).A womans decision to termi-and number two upset them anymore andnate her pregnancy was considered a profoundmake the decision any harder thanit is in theone by the participants.It was also deemed tofirst place.(Interview 5)be a decision likely to affect her implicitly orexplicitly for a significant length of time.SomeThe above participant highlights thegoal of

participants were working at the initial stages facilitating the womans owndecision-makingof the termination of pregnancy service and inrather than advocating a specificdecision.Thissome cases the woman may not have made herapproach relates strongly to thecentral phe-decision,or may be thinking of reversing it:nomenon of fostering woman-centredcare.

I think that they werent really sure in theAppreciating the contextbeginning,but lets take the appointmentA number participants acknowledged

that theanyway and see what happens and when theywomen made their decision interms of their



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own current circumstances.This was both anCoping with medical terminationinfluential condition as well as providing a con-A further influential condition wasthe numbertext for care (Figure 1):of medical abortions which are rising in the UK

At the end of the day,its their decision and I(Department of Health 2006).Theyare knownfeel like that the decision that they maketo be safe,effective and efficient (Rorbyeet al.today is the right one for them at this time,2005).However,the participants had

varyingyou know.(Interview 11)opinions of medical termination.For some,itwas seen as going through the processwhereasIts not necessarily that the women whosurgical termination could be viewed bytheattend the service want to have an abortion.Iwomen and even the nurses as aminor gynaeco-just think that at the time at that specificlogical procedure such as a dilatationand curet-moment in their life its something thattage (D&C).One participant hypothesisedthat

they have to do for one reason or another.going through the processmay limitthe num-(Interview 5)bers returning for repeat abortions:

Rather than being autonomous in their decisionYes,if theyre typically a patient onthe gynaemaking,the participants spoke of the womenward thats had pain,thatsbled,potentiallywho were tiedinto relationships with others,seen this foetus,and lots of themdo,theybe it their partners,parents or other children,seem to be.Oh,I dont know,we dont

tendand their relationships helped shape their cir-to have many of those coming backfor acumstances and thus their decision making (All-repeat termination ...In someways its goodmark 1995).The participants recognised thatif somebodys been through thatprocess.they had to appreciate the womans individualThey know exactly whatshappened;theyve


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context and the influential condition of the seen it was a baby;but then is it a formofrelationships within it in order to value thepunishment? (Interview 12)womans decision as her own.The participantsexpertise allowed them toViewing the abortion as punishmentwas an

offer the appropriate options as well as perti-intriguing interpretation of eventsand it is pos-nent and timely advice,which in the majority ofsible that some women couldperceive abortioncases led to timely decisions made by women.as a form of punishment.However,it was acknowledged by some that theIn contrast to the aboveexample,anotherdecision made was heavily dependent on cur-participant spoke in more positiveterms of arent circumstances:medical abortion allowing women to gain con-trol:

I only know what she tells me.Shes making adecision based on whatevers going on in herBut people that Ive spoken toafterwards life now,you know? And I just sort of thinkthat have had medical termination saidtheywell if its not right for her now,then its nothave had ownership,they have had thepower,right for her.Thats her decision you know?they have been able to,they have beenin(Interview 12)control.With the surgical they have been outof control.It has been taken out of their

The above example shows that should the deci-hands so when people have saidthey have hadsion have been made in other circumstances ora surgical and then had amedical,erm,thatat another time,it may very well have been aits,that they felt more in control,theyweredifferent one.more aware of what is going on and that the



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after effects were less than when they had theHaving given them the tablets,they seesurgical.(Interview 1)the bleeding,they see the products,becausethey go to the toilet and some peopleThis participant was alone in this study in feel-look and they are so upset becauseits aing that some women gained control throughperfectly formed little baby and theydonthaving a medical abortion.expect it to be like that.(Interview 4)Surgical termination was still favoured by a

number of participants who felt that,althoughThe nurses appreciate the toll thatthis processthere was an anaesthetic risk,it was a relativelytook on the women,but only a fewspoke of theminor procedure in which the woman has littleemotional burden for them:involvement and thus trauma.Ward participantsspoke of the consequences of having moreIt does upset me sometimes when I seethemhands-on involvement with medical termina-and you know? The student nurseskeep say-tions as well as the repercussions on the woman.ing I dont know how you can do

this everyThere was recognition that the emotional side ofdayand I think if you are in itevery day youcare demanded a lot more of them as those clos-have got to obliterate it fromyour mind real-est to the women during the process:ly,not just think about what you are actuallydoing sometimes.(Interview 3)Theyd come in for a surgical procedure.

Youd prepare them for theatre.Youd takeFOSTERINGAWOMAN-CENTREDthem to theatre.Youd care for them post-opSERVICEand theyd go home. it was still there,butThis was the central phenomenon ofthethe emphasis wasnt on the emotional side.grounded theory.In many of theservices rep-And of course when we changed to medicalresented by the participants,nurseswere atabortions,we were all thinking at the timethe forefront of serviceprovision.However,itoh,my gosh.Putting patients through thatseems that rather than nurse-ledservices being a


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sounded horrendous.Ignorance,I suppose,goal,the participants strived towards awoman-and not familiar with it,but once we startedcentred service.This was evident in thepartici-managing them medically,I think thats whenpants placing women as central intheir own

it really hit home how emotional the proce-decision-making.This strategy wasadhered todure was.(Interview 8)even when it would have been expedient forthe nurse to coaxthe woman into making herI think that a SToP,although youve got a riskdecision:from the anaesthetic,I mean its much easierfrom their point of view,they go to sleep,I just deal with my ladies on a personalbasis,they wake up and its done and they are withon a one to one and as anindividual,and justus.(Interview 4)treat everybody differently due to their cir-

cumstances and do the best I can for them,It is clear that surgical termination allows nurs-erm.Because everybody has adifferent sortes and women to view surgical abortion as aof scenario and problem.(Interview 5)minor procedure whereas medical terminationwith the existent foetus makes the pregnancyIn a socio-economically deprivedarea,thisloss a reality resulting in an emotional experi-nurse is in tune with the needs ofthe womenence for the woman and the nurse involved,asusing the service and has adaptedit to be as

can be seen in the data below:woman-centred as possible:



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We try to limit the amount of visits to Gestation was a major time constraint onthe service because of social problems,workdecision-making as it affected thetype of abor-commitments,travel commitments and also,tion,the location of the procedure andeven thebeing such a confidential service,a lot offeasibility of an abortion.The participantswerewomen have to keep this confidential frommindful of ensuring that all the optionsweretheir home as well.We actually admit on agiven to the woman contingent on the

gestationSunday but we were finding a lot ofof the foetus.In a US study of factorshinderingthe women were declining the Sunday admis-access to abortionservices,gestation limitssion even though the facilities were betterplayed a major part (Henshaw1995).Like Hen-and the privacy was better.I think basicallyshaw (1995),other contextualconstraints emana-there were problems with explaining to theirted from the location of thetermination of

relatives why they were missing on a Sunday.pregnancy service as some trustsoffered med-(Interview 5)ical termination of pregnancy only or contracted

The data above reveal nurses putting the needstheir services out of Wales toEngland.The ges-of the women first at a vulnerable time in theirtation limit differed in eachtrust,and evenlives.between hospitals within trusts,which influ-enced advice and options that could be given by

DISCUSSIONthe participants.The initial part of the discussion gives an insightSherwin (1989) proposes thatcontextualisinginto the first aim of the study of how the nursesa problem results in a solutionwhich is possibleperceive their role.This is focused on facilitatingwithin the womanscircumstances.This viewa womans decision on whether to undergo anechoes the data where theparticipants wereabortion within a specific context.The latteracutely aware of how life can change


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so rapidly.part of the discussion illuminates the secondThe decision for an abortion had beenmade inaim of establishing how nurses cope with thethe here and nowby the women andthe nurs-role of supporting women undergoing medicales seemed to sense this and

became unwilling totermination.influence the decision in any way.The hereThe goal to provide comprehensive infor-relates to the womans individual contextwhichmation in a neutral manner was an overridingthe nurses were at pains to explorein order totheme in the data and contributed towards theprovide individualised care,whereasthe nowability of the women to make their own choicesrelates to the time constraintswhich were pres-with their contextual constraints.The parti-ent when making a decision whether to

abortcipants were keen to stress that the womansand if so,by which method.decision was a profound one and that their neu-Dealing with a woman undergoingabortiontrality in encouraging the right decision wasdemands great skill and sensitivityoften withinessential.A study which explored womensa constrained period with the nursecircum-experience of referral for abortion in threenavigating embarrassment andvulnerability toinner London boroughs sought to determine ifensure that the woman has made

the right deci-services met their expectations (Kumar et al.sion.This situation tested thenursesability to2004).The authors found,during in-depthform meaningfulrelationships.Relationships areinterviews that because most women had madeoften described as a web(Alderson 1991;Gilli-a decision to proceed with abortion beforegan 1982).This provides a graphicrepresenta-approaching the health service,they preferredtion of the situation where the nurseis liaising

not to discuss their decision but expected infor-with several colleagues,the womanand possiblymation and prompt referral.a partner or friend to ensure that information is



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communicated accurately,appropriately andhad been channeled into productiveoutcomes.sensitively within a limited time scale.AnotherBoltons study of offering emotionwork as a giftdimension to the web is that not all relation-to women found that dealing with thewomensships are equal (Sherwin 1989).The womengrief was emotionally intensive for thenurses,attending were in a fragile state that made thembut that none of them regrettedimparting the

vulnerable to exploitation in relationships.As ingift (Bolton 2000).the above example,inherently the participantsWomen considering an abortion aregeneral-seemed to recognise the inequity in the circum-ly not viewed favourably bysociety (Eposito &stances and try to reverse it by giving theBasow 1995) or by some health careprofession-women choice and space within the confines ofals (Ventura 1999;Webb1984).Women alsothe context.judge themselves harshly when in need of anViewing the abortion as a punishment was anabortion (Weidner & Griffitt

1984).OGradyintriguing interpretation of events by one par-(2005) explores womensrelationship withticipant.Given the possibility that some womenthemselves and finds that it isoften womenscould perceive abortion as a form of punish-relationship with others which definesthem.ment,it is vital that the nurses and midwivesThis in turn subordinates them andtheir owninvolved manage the care to deflect this percep-needs and goals.Women alsoperform what

tion by acting in a non-judgemental mannerOGrady (2005) terms self-policinginvolving(Koh 1999).Another participant was alone self-criticism leading to self-doubt.Against thisin feeling that some women gained controlbackdrop of disempowerment andvulnerability,through having a medical abortion.However,athe participants in this study wereable to sup-US study qualitatively analysed womens experi-port and empower the women to


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make theirences of this procedure and found that womenown decisions by providing awoman-centredwho chose their method wanted to maintainservice.control of the process (Fielding et al.2002).Much of the qualitative research onabortion

The following latter part of the discussioncare has shown the emotionalcommitment nec-illuminates the second aim of establishing howessary for those caring for womenundergoingnurses cope with the role of supporting womenabortion (Bolton 2000;McCreight2005;Mc-undergoing medical termination.The termQueen 1997).Their findings have beenechoedobliteratewas used by one participant andin this research with most participantsrecogniz-others used similar phrases to describe howing the emotional impact of medical

abortionthey overcame the emotional burden of termi-on the women and a fewacknowledging theirnation.Froggatt (1998) cites three ways inown burden.Providing a remedy for thisemo-which the emotions can be contained:shuttingtional intensity would not be easyin the high-off removing access to the emotions;hard-pressured environment of acutegynaecologyening raising a barrier to the emotions;andservices.Moving abortion care into aless pres-

stepping back being mentally distanced fromsured environment such asprimary care may bethe emotions.It is evident from the example inan option as long as it fulfillsstatutory obliga-Interview 3 that during their initial experiencestions for the procedure.Formalsupport forthe participant could not readily contain herthose involved such as guidedreflection (Johnsemotions,but that by shutting them offshe& Freshwater 1998) would highlightthis issue athad learned to do so over time.The data never-level of service provision and may

help thosetheless were replete with examples of compas-involved to articulate and workthrough thesion,dedication and justice for the women foremotions evoked by such intenseinvolvement.whom they cared signifying that their concernsThe majority of quantitativeresearch shows a


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degree of animosity towards the service fromprocedure for the woman as well asthe nurse orbarriers to access in Australia (Calcutt 2007)midwife.and France (Decerf et al.2000) and harassmentAn aim of feminist groundedtheory is toin 45% of the 163 hospitals studied in Ferrismake a difference to the lives ofthose it studies.Canadian study (Ferris et al.1998) to violenceIn acknowledging the complexity ofthe task ofand deaths in the USA cited by Ventura (1999).caring for women undergoing

termination ofAlthough no specific examples of harassmentpregnancy for nurses/midwives thisresearchwere evident in these data there was an appreci-has initiated the debate on howsuch care can beation of the sensitivities surrounding the servicefacilitated in a woman-centredenvironment.by the participants.Within these constraints,good practice and expertise needs to be sharedAcknowledgementsto ensure optimum care.For example,the all-The author would like to thank theResearch

Wales (UK) Termination of Pregnancy NetworkCapacity BuildingCollaboration,Wales,UK formeets regularly as a professional developmentthe funding and opportunity toundertake thisand reflective practice forum in the area whereresearch.this research was undertaken.ReferencesThis research has shown that despite the con-Alderson P (1991) Abstract bio-ethics ignores humantentious nature of the topic that those partici-emotions.Bulletin of MedicalEthics68:1321.pating in this study maintained a facilitativeAlex L and Hammarstrom A (2004)

Womens experi-approach to their work,which enabled theences in connection with inducedabortion aspective.Scandinavian Journal of Caringwomen to be at the forefront of the service at afeminist perScience18:160168.time when they were at their most vulnerable.Allmark P (1995) Can there be anethics of care?Journal of Medical Ethics21:1924.Appleton J (1995) Analysing qualitative interview data:


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CONCLUSIONAddressing issues of validity and reliability.Journal ofThis study used feminist research as a method-Advanced Nursing22:993997.Who cares? Offering emotion workology,which offered the opportunity to exam-Bolton SC (2000) as a giftin thenursing labour process.Journal of

ine how nurses and midwives perceived theirAdvanced Nursing32(3):580586.role with women undergoing termination ofCalcutt C (2007) Abortion services inAustralia.pregnancy and how nurses and midwives copeObstetrics and GynaecologyMagazine9(4):2728.with their increased involvement with theseCharmaz K (2006) Constructinggrounded theory.women.London:Sage M,Deworme Publications C,Dumont Ltd.Decerf C and GescheMA grounded theory of fostering a woman-(2000) Family planning professionals atcenters

centred service was developed through thewhere abortions are performed:Theirbeliefs,theirprocess developed by Strauss and Corbin (Strausscoping strategies and theirglobal state of health.& Corbin 1998).The participants used theirBulletin de Psychologie Scolaire etdOrientation49(3):expertise to guide the women through the93117.tment of Health (2006)Abortion statistics,Englandprocess so that they made the appropriateDeparandWales:2006.London:Department of Health.choice of whether to have an abortion.NursesEposito C and Basow S (1995)

College studentsand midwives took the womans individual cir-attitudes towards abortion:The roleof knowledgecumstances into account and recognised that itand demographic variables.Journalof Applied Socialmust always be the womans decision.It becamePsychology25:19962017.clear that some participants had reservationsFerris LE,McMain-Klein M and Iron K(1998) Factorsery of abortion services inabout the move towards medical terminationsinfluencing the delivOntario:Adescriptive study.Family Planning

as it highlighted the emotional impact of thePerspectives30(3):134.



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Fielding SL,Edmunds E and Schaff EA (2002) HavingOGrady H (2005)Womans relationshipwith herself.an abortion using mifepristone and home miso-Hove:Routledge.prostol:A qualitative analysis of womens experi-Phillips S (1996) Labouring theemotions:Expandingences.Perspectives on Sexual & Reproductive Healththe remit of nursing work?Journal of Advanced34(1):34.Nursing24:139143.Froggatt K (1998) The place of metaphor and languagein exploring nursesemotional work.Journal ofRANZCOG (2005) Termination of

pregnancy:AAdvanced Nursing28(2):332338.resource for health professionals.Retrieved 19Gilligan C (1982) In a different voice:Psychological theoryFebruary 2008 fromhttp://www.ranzcog.eduand womens development.Cambridge MA:Harvard.au/womenshealth/termination-of-pregnancy.shtmlUniversity Press.RCOG (2004) The care of women requesting inducedHemmerling A,Siedentopf F and Kentenich H (2005)abortion:Evidence-basedclinical Guideline No.7.Emotional impact and acceptability of medicalLondon:Royal College ofObstetricians and

abortion with mifepristone:A German experience.Gynaecologists.Journal of Psychosomatic Obstetrics and GynecologyRorbye C,Norgaard M andNilas L (2005) Medical26(1):2331.versus surgical abortion:Comparing satisfaction andHenshaw S (1995) Factors hindering access to abortionpotential confounders in apartly randomized study.services.Family Planning Perspectives27(2):5487.Human Reproduction20(3):834838.Horsburgh D (2002) Evaluation of qualitative research.Journal of Clinical Nursing12:307312.Say L,Kulier R,Gulmezoglu A and CampanaA (2002)

House of Commons Science and Technology Commit-Medical versus surgicalmethods for first trimestertee (2007) Scientific developments relating to thetermination ofpregnancy.Cochrane Database of Syste-Abortion Act 1967.In House of Commons (Ed.)matic Reviews,Issue 4.12th Report of the session 2006Vol.1:193:TSO.Seibold C (2000) Qualitativeresearch from a feministHuntington A (2002) Working with women experienc-perspective in thepostmodern era:Methodological,


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ing mid-trimester termination of pregnancy:Theethical and reflexiveconcerns.Nursing Inquiry7(3):integration of nursing and feminist knowledge in the147.gynaecological setting.Journal of Clinical Nursing11:Sherwin S (1989) Feminist andmedical ethics:Two273279.different approaches to contextual ethics.Hypatia

Joffe C (1999) Reactions to medical abortion among4(2):1731.providers of surgical abortion:An early snapshot.Smith P (1992) The emotionallabour of nursing.Family Planning Perspectives31(1):3538.Basing-Johns C and Freshwater D (Eds) (1998) Transformingstoke:Macmillan.nursing through reflective practice.Oxford:BlackwellStrauss A and Corbin J (1990)Basics of qualitativeScience.research:Grounded theory procedures and techniques.King K (1994) Method and methodology in feministSage Publications,London.research:What is the difference.Journal of AdvancedStrauss A and Corbin J (1998)Basics of qualitative

Nursing20:1922.research:Techniques and procedures for developingKoh A (1999) Non-judgemental care as a professionalgrounded theory,2ndedn.Thousand Oaks CA:Sageobligation.Nursing Standard13(37):3841.Publications.Lipp A (2007) Developing the reflexive dimension ofVentura M (1999) Wherenurses stand on abortion.reflection:A framework for debate.Multiple ResearchRegistered Nurse62(3):4447.Approaches1(1):1826.McCreight BS (2005) Perinatal grief and emotionalWebb C (1984) Nursesattitudesto therapeuticlabour:A study of nursesexperiences in gynaeabortion.Nursing Times81(1):4447.

wards.International Journal of Nursing Studies42(4):Weidner G and Griffitt W(1984) Abortion as a stigma:439.In the eyes of the beholder.Journal of Research inMcQueen A (1997) The emotional work of caring,withPersonality18(3):359.an emphasis on gynaecological nursing.Journal ofWuest J (1995) Feministgrounded theory:An explora-Advanced Nursing6:233240.tion of the congruency and tensions between twoNorwood S (2000) Research strategies for advanced nursetraditions in knowledgediscovery.Qualitative Healthpractitioners.London:Prentice-Hall.Research5(1):125137.



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