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Entries in abortion care (2)

Monday
Nov112013

Blog Series: Notes from a Full Spectrum Nurse-Midwifery Student

by Holly Carpenter, RN, UCSF School of Nursing-CNM/WHNP Candidate 2014

 

Part I: Finding Full Spectrum Nurse-Midwifery

 

Part II: What are we being taught? What do we "want" to learn?


In the previous post in this series, I introduced the big picture of nursing education in sexual and reproductive health care. This section discusses the extent of training that currently exists within nursing education programs in U.S., including a student-led elective that was piloted at UCSF this past year.

Both APC and pre-licensure nursing students still face a fairly bleak picture in terms of standard SRH training and education. In a preliminary review of existing curriculum and educational programs, the results demonstrate a significant need for further study and development of curriculum. Most importantly, we have zero baseline data regarding the content in RN (or “pre-licensure”) programs in terms of sexual and reproductive health. Without this information, we can only operate on assumptions to make the case for improvement or plans for curricular change.

The sole national survey of APC programs (conducted in 2001 and not updated since) demonstrated that only 53% of schools in the U.S. offer didactic instruction in medication or aspiration abortion, and a mere 21% offer clinical training in these procedures (Foster et al. 2006). This is all despite the fact that “professional associations and accreditation bodies have repeatedly identified the need to include reproductive health in the standard curricula” including The American Association of Colleges of Nursing (AACN), the National Organization of Nurse Practitioner Faculties (NONPF), the AAPA, and the American College of Nurse Midwives (ACNM), all of whom have “...developed guidelines that recognize the need for their graduates to possess competence in providing care related to sexual and reproductive health” (Taylor et al., 2009). Even at UCSF, with the passage of AB154 a firm reality, CNMs only receive two hours of comprehensive options counseling training, and two didactic hours of instruction on medication and aspiration abortion*. Contraception is a very basic, pharmacology-focused online course.

In conversations with other nursing and medical students at UCSF, I have found a shared sentiment of disappointment in this educational gap. Nursing students at all levels are eager for more training and education in sexual and reproductive health - specifically focused on abortion. To meet these demands, a first year medical student and I designed a noontime interprofessional elective entitled “Family Planning and Reproductive Choice”, to which we invited guest speakers who covered options counseling, adoption, values clarification, clinical and public health aspects of abortion, and IUD insertion, among other SRH-related topics. As UCSF students, we were incredibly lucky to have access to the top SRH/abortion researchers and providers in the world, which made the task of selecting speakers very enjoyable. Dr. Tracy Weitz gave an electrifying introductory session on the state of abortion in the U.S., and Dr. Eleanor Drey followed with a comprehensive overview of clinical abortion provision. Residents and Family Planning Fellows taught our IUD and MVA papaya workshop, and Exhale (After Abortion Talkline) hosted a personal experience panel.

Student reception was overwhelmingly positive, and we had packed classrooms throughout the quarter. After presenting on this experience at the National Abortion Federation conference in 2013 and meeting with nursing students from around the country at the conference, it was clear to me that nursing students’ desire to be taught SRH curriculum is a national phenomenon. Anecdotally, their reasons included a desire to achieve competency in patient care provision, desire to increase abortion access in underserved and underinsured populations, and competitiveness in the job market, among others. In collaboration with an incredible, interdisciplinary group of nursing educators and innovators, I’m currently in the process of creating and disseminated the elective as a nationally applicable curriculum. We are planning to implement the first pilots at Oregon Health and Sciences University, Yale University, the University of New Mexico, and the University of Pennsylvania, among others. The elective materials and curricular resources will be added to the Nursing Students for Choice website as well. Through the efforts of dedicated grassroots nursing student activists at these campuses, we hope to demonstrate to faculty and administrators that we strongly believe this content needs to be included in our standard curriculum, not just to satisfy our own interests, but to prepare us to be competitive entrants to the nursing workforce, provide access to high quality sexual and reproductive health care to our patients, and normalize abortion care within the full spectrum of nursing scope of practice.

The final post in this series will review resources and opportunities that exist to build and improve SRH curriculum in U.S. nursing programs at both the pre-licensure and advanced practice levels.

*Due to the admirable efforts of several dedicated faculty, instruction in first trimester MUA is set to be implemented in 2014.

Please direct your feedback and comments to holly.carpenter@ucsf.edu.

References

Foster, A., Polis, C., Allee, M., Simmonds, K., Zurek, M., Brown, A. (2006). Abortion education in nurse practitioner, physician assistant and certified nurse–midwifery programs: a national survey. Contraception 73 (2006) 408–414.

Taylor, D., Safriet, B., Dempsey, G., Kruse, B., & Jackson, C. (2009) Providing Abortion Care: a professional toolkit for Nurse-Midwives, Nurse Practitioners, and Physicians Assistants. University of California, San Francisco. Accessible at: http://www.apctoolkit.org/index.html

Wednesday
Oct092013

Blog Series: Notes From a Full Spectrum Nurse-Midwifery Student

 

by Holly Carpenter, RN, UCSF School of Nursing-CNM/WHNP Candidate 2014 (originally posted on the Nursing Students for Choice Blog

Part I: Finding Full Spectrum Nurse-Midwifery

When I was choosing between various CNM (Certified Nurse Midwife) graduate programs in 2010, the faculty biographies at UCSF were the deciding factor. Every CNM on faculty was described as “Full Spectrum”, meaning they cared for patients through every reproductive health outcome, including abortion. My initial interpretation of this term was, “Wonderful! These midwives are providing abortions, and that means that I’ll be taught how to provide abortions.” As it turns out, while some UCSF CNM faculty provide medication abortions and place laminaria, CNMs in California do not typically perform first trimester “therapeutic abortions” or manual uterine aspiration procedures (MUAs).

This situation is not unique to California; CNMs and other advanced practice clinicians (APCs) are permitted to provide MUAs in only four states: Vermont, New Hampshire, Montana, and Oregon (Weitz et al., 2013). While the skills involved in first trimester MUAs are identical to those used in “miscarriage management” – a procedure that is legally within the APC scope of practice – many states have explicitly banned APCs from providing MUAs. Obviously, anti-choice politics play a major role in these bans, as evidenced by the recent rash of APCs-as-provider bans that have gone forward during the past two years of abortion limitation legislation. The impact of these bans is substantial, and connecting the dots is not difficult:

  • Under the Affordable Care Act, the proportion of the US population receiving primary care from APCs is expected to increase substantially (Taylor, et al., 2009).

  • NPs, CNMs, and PAs are …more likely than physicians to practice in medically underserved settings (Taylor, et al., 2009)

  • Abortion is one of the most commonly performed procedure for women (Boonstra, et al., 2006)

  • Limiting access to abortion is harmful to women (Foster, 2013)

  • The logical conclusion: banning the most accessible providers from performing a commonly demanded procedure is going to have a negative impact on medically underserved women.

However, progress is being made. In California, the Health Worker Pilot Program has been training APCs as first trimester MUA providers under a legal waiver from the CA State Legislature since 2005. The results of this project have been studied and published, and they offer proof that APCs are equal to MDs in safety, efficacy, and patient satisfaction (Weitz et al., 2013). The positive outcomes reported in this study have formed the basis for AB154, a CA bill which formally designates first trimester MUA procedures as within APC scope of practice. With the chances of passage of this bill looking promising, (it is currently on Governor Jerry Brown’s desk awaiting his signature), APCs in California are poised to address the important gap in abortion access that MD-only provider laws have created. There are millions of American women between the ages of 15-45, ⅓ of whom will seek an abortion at some point in their reproductive years (Weitz et al., 2013).

The first step in addressing this gap in access and care, however, starts with provider education at both the pre-licensure (RN) and APC levels. RNs play an important healthcare role by providing pregnancy options and contraceptive counseling in many clinical settings, and therefore need to meet competency standards in SRH care provision as well. In the next post in this blog series, the state of sexual and reproductive health in nursing education will be discussed, as well an innovative UCSF project: a student-led elective focused on abortion and family planning. Thanks for reading!

Please direct your feedback and comments to holly.carpenter@ucsf.edu.

References:

Foster, D., (2013). The Turnaway Study. ANSIRH. Accessible at: http://www.ansirh.org/research/turnaway.php.

Weitz, T., Taylor, D., Desai, S., Upadhyay,  U., Waldman, J., Battistelli, M., & Drey, E. (2013). Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver. Accessible at: http://www.ansirh.org/_documents/library/weitz_AJPH2012.pdf

Boonstra, H., Benson Gold, R., Richards, C., & Finer, L. (2006). Abortion in Women’s Lives. Guttmacher Institute. Accessible at: http://www.guttmacher.org/pubs/2006/05/04/AiWL.pdf.

Taylor, D., Safriet, B., Dempsey, G., Kruse, B., & Jackson, C. (2009) Providing Abortion Care: a professional toolkit for Nurse-Midwives, Nurse Practitioners, and Physicians Assistants. University of California, San Francisco. Accessible at: http://www.apctoolkit.org/index.html.

- See more at: http://www.nursingstudentsforchoice.org/blog-series-notes-from-the-full-spectrum-nurse-midwifery-student/