Barriers and enablers to nurse practitioner implementation of medication abortion in Canada: A qualitative study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2023
2023
Historique:
received:
03
05
2022
accepted:
06
01
2023
entrez:
26
1
2023
pubmed:
27
1
2023
medline:
31
1
2023
Statut:
epublish
Résumé
In this study we explored nurse practitioner-provided medication abortion in Canada and identified barriers and enablers to uptake and implementation. Between 2020-2021, we conducted 43 semi-structured interviews with 20 healthcare stakeholders and 23 nurse practitioners who both provided and did not provide medication abortion. Data were analyzed using interpretive description. We identified five overarching themes: 1) Access and use of ultrasound for gestational dating; 2) Advertising and anonymity of services; 3) Abortion as specialized or primary care; 4) Location and proximity to services; and 5) Education, mentorship, and peer support. Under certain conditions, ultrasound is not required for medication abortion, supporting nurse practitioner provision in the absence of access to this technology. Nurse practitioners felt a conflict between wanting to advertise their abortion services while also protecting their anonymity and that of their patients. Some nurse practitioners perceived medication abortion to be a low-resource, easy-to-provide service, while some not providing medication abortion continued to refer patients to specialized clinics. Some participants in rural areas felt unable to provide this service because they were too far from emergency services in the event of complications. Most nurse practitioners did not have any training in abortion care during their education and desired the support of a mentor experienced in abortion provision. Addressing factors that influence nurse practitioner provision of medication abortion will help to broaden access. Nurse practitioners are well-suited to provide medication abortion care but face multiple ongoing barriers to provision. We recommend the integration of medication abortion training into nurse practitioner education. Further, widespread communication from nursing organizations could inform nurse practitioners that medication abortion is within their scope of practice and facilitate public outreach campaigns to inform the public that this service exists and can be provided by nurse practitioners.
Identifiants
pubmed: 36701296
doi: 10.1371/journal.pone.0280757
pii: PONE-D-22-12952
pmc: PMC9879445
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0280757Informations de copyright
Copyright: © 2023 Carson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Nurs Leadersh (Tor Ont). 2022 Mar;35(1):54-68
pubmed: 35339200
Cochrane Database Syst Rev. 2015 Jul 27;(7):CD011242
pubmed: 26214844
Lancet. 2018 Jun 30;391(10140):2642-2692
pubmed: 29753597
Reprod Health. 2017 Mar 14;14(1):39
pubmed: 28288649
BJOG. 2013 Jan;120(1):23-31
pubmed: 22900974
BMJ Open. 2019 Apr 20;9(4):e028443
pubmed: 31005943
Int J Equity Health. 2018 Nov 21;17(1):172
pubmed: 30463561
Ann Fam Med. 2020 Sep;18(5):413-421
pubmed: 32928757
Eur J Contracept Reprod Health Care. 2020 Jun;25(3):190-198
pubmed: 32312130
Fam Med. 2016 Jan;48(1):30-4
pubmed: 26950663
Best Pract Res Clin Obstet Gynaecol. 2010 Oct;24(5):569-78
pubmed: 20385513
J Adv Nurs. 1997 Sep;26(3):623-30
pubmed: 9378886
Contraception. 2022 May;109:37-42
pubmed: 35031301
Perspect Sex Reprod Health. 2002 May-Jun;34(3):154-61
pubmed: 12137129
J Obstet Gynaecol Can. 2016 Apr;38(4):366-89
pubmed: 27208607
Reprod Health Matters. 2009 May;17(33):61-9
pubmed: 19523583
Med Educ. 2021 Mar;55(3):336-343
pubmed: 32967042
Contraception. 2002 Jun;65(6):419-23
pubmed: 12127641
N Engl J Med. 2022 Jan 6;386(1):57-67
pubmed: 34879191
Contraception. 2023 Jan;117:39-44
pubmed: 35970423
Contraception. 2006 Jul;74(1):11-5
pubmed: 16781253
Contraception. 2015 Jun;91(6):474-9
pubmed: 25708505
J Adv Nurs. 2023 Feb;79(2):686-697
pubmed: 36369652
J Obstet Gynaecol Can. 2020 May;42(5):576-582
pubmed: 31924442
CMAJ. 2016 Dec 6;188(17-18):E429-E430
pubmed: 27754893
Am J Public Health. 2014 Sep;104 Suppl 4:S517-9
pubmed: 25100411
Public Health Rep. 2014 Jan-Feb;129 Suppl 2:5-8
pubmed: 24385658
Contraception. 2016 Nov;94(5):483-488
pubmed: 27374736
J Clin Nurs. 2020 May;29(9-10):1513-1526
pubmed: 32045070
J Womens Health (Larchmt). 2010 Mar;19(3):547-53
pubmed: 20156084