nursing care r/t pregnancy termination

[CeilingCat, ASN, RN]

staff note:please, answer the op's questions about how to provide proper care for patients following the loss of a pregnancy (for whatever reason) and the other things she wanted to know. do not post about the inadequacy of her instructor/program in this thread. do not turn this into a thread about the morality or immorality of abortion. thank you.

i don't wish to start a flame war, but i have some honest questions.

i am just weeks from graduation from a public college, to become a rn. my program director admits to keeping anything remotely relating to abortion completely off-limits. her values are very conservative, so the curriculum seems to reflect it (birth control was also left out). the textbooks they chose don't mention the nurse's role when a pregnancy ends without a live birth. when i did maternity/peds rotation, it was never mentioned. as we got to the part about molar pregnancies and eclampsia, all i was told was that the "resolve the pregnancy". i still know nothing about it, other than it makes some people angry enough to picket planned parenthood and it saves the lives of other people. the internet is even worse -- everyone shouting at each other and very little medical-focused info.

nursing care: i am guessing it might be to monitor for hemorrhage and infection. but there has got to be more to it than that? is care any different depending on trimester? on miscarriage ("natural") vs pharmaceutical vs surgical terminations?

if conditions are incompatible with life later in the pregnancy, is it considered an "abortion" to use surgical intervention to remove an already deceased fetus?

do nurses get training in how to handle the psych aspect for a post-abortion patient? not all women who have abortions want to terminate. is a psych or post-partum type screening typical done?

do nurses interested in a obgyn/reproductive health type specialty get any additional education? or do you just pick it up on the job as you go? and can you ask colleagues about it and be sure to get an accurate answer? or is talk relating to it greatly discouraged in the workplace, too?

does anyone here regularly give nursing care to women following pregnancy termination (intentional or miscarriage)? forgive what might be a naive question: but if you work in a clinic setting, is it true you have to be scared of terrorists and harassment? or has television really exaggerated that?

what is the nurse's role as patient advocate, when a dr's personal/religious beliefs cause permanent harm to a patient? eg. when a mother's life is in danger and a provider doesn't want to consider terminating the pregnancy or doesn't want to treat a recent post-termination pt who is having a complication.

thanks for giving me your professional advice, as i graduate and head into practice. i apologize in advance if i've offended anyone by asking about this topic. i know how strongly some people belief for/against this issue, and i do respect everyone's' beliefs on this issue. i just need some factual information. thank you.

[Bella'sMyBaby]

Sounds to me like your "Program Director" is in the wrong occupation.

You have been cheated out of your education & this Director needs to be reported.

[Anisettes, BSN, RN]

Sounds to me like your "Program Director" is in the wrong occupation.

You have been cheated out of your education & this Director needs to be reported.

I agree. Every person has the right to their own beliefs and opinions, but to keep medical, nursing, and scientific knowledge from a professional education is reprehensible. Reality is that abortion exists and you should be equipped to care for a woman who has had one whether or not you personally believe she should be allowed to have one - once it's done it is a moot point. The very idea that a woman could show up post-op in your care and you have NO idea how to care for her is unacceptable. UNACCEPTABLE and REPREHENSIBLE.

[MandaRN94]

Hmmm, that is an interesting point. Thinking back to my nursing school days (graduated in 1994) I don't remember any abortion information during our OB/GYN semester. I can tell you that I work at a family planning clinic that offers abortion services. I know this a huge hot topic (almost shut down our government) that I also do not want to get into on this site so if you want to shoot me your email or message me I can give you the info you are asking about.

[ExpatHopeful, LPN, LVN]

Hi CeilingCat,

Your post had a lot of food for thought and questions. I can answer some of them from one perspective and I'm sure others will have a different perspective and answers for your other questions.

You are not alone in graduating from nursing school with no discussion of these issues. I am about to graduate from NYU, which you would think might be on the liberal end of things, and we have also had no discussion of birth control or abortion in any of our courses, including maternity nursing. We briefly touched on miscarriage and ectopic pregnancy but that was it.

Luckily I can answer a few of your questions because I previously worked at a Planned Parenthood clinic alongside RNs and NPs. Planned Parenthood had very well developed in house trainings for all of its staff, both when starting and for continuing education. I would guess and hope that if you decide to go into ob/gyn nursing you will get more specialized training at any employer. The RNs and NPs at Planned Parenthood had an orientation that included preceptorship and supervised practice and that was tailored to their previous experience - longer for new grads. This training definitely included counseling skills, and contrary to what some people believe, yes, education in helping patients to consider parenthood or adoption if they were unsure that abortion was the right choice for them. Women who came for abortions spent a long time in the clinic talking with a variety of staff, including RNs and NPs, about their decision to make sure they were confident it was the best choice for them and to make sure they were making the decision, not someone else.

The dangers of working at an agency that provides abortions depends on the community and area you are in. The clinic I worked at was in a more liberal area of the US and although we had occasional protesters, they were polite about it (quiet praying), and I never felt in danger. However, working at a clinic in a different part of the country would be a whole other story, and the media does not exaggerate. Let's not forget that a ob/gyn who provided abortions, Dr. George Tiller, was shot to death in his Kansas church two years ago by a protester.

In terms of nursing care you are right on the money with infection and hemorrhage. Counseling is a big part of it too. Education on post-procedure care is important, as well as starting them on a birth control method if they want one and teaching them how to use it. For surgical procedures sedation, either oral or iv is used, so just as in an endoscopy or other minor procedure there is post-procedure recovery and vital signs monitoring. Rhogam is given to RH negative women to protect future pregnancies and future visits for regular checkups or STI screening are encouraged.

If you are interested, why don't you try to find a text book on the subject and learn on your own? You could also look for journal articles on the subject while you still have access to your school's library databases.

I hope I helped answer a few of your questions and, like you, I'm not interested in starting a flame war about beliefs, I'm just putting my perspective and experience out there.

[morte, LPN, LVN]

Your education has been/is incomplete, as you are aware. This is unethical and immoral, if not illegal. Someone needs to report this program/director to the BON or other acrediting body.

[monsuun]

I don't mean to be offensive, but I'm a little tired of attitudes like this. I don't like the idea of abortion at all, but I realize it's probably not going away and I'm sensitive enough to not argue about it (normally) but then I see people all the time, trying to say that the people who are AGAINST abortion are somehow horrible monsters with no morals. What?!

[morte, LPN, LVN]

I don't mean to be offensive, but I'm a little tired of attitudes like this. I don't like the idea of abortion at all, but I realize it's probably not going away and I'm sensitive enough to not argue about it (normally) but then I see people all the time, trying to say that the people who are AGAINST abortion are somehow horrible monsters with no morals. What?!

Please reread the OP, she/he has received NO education on how to care for a post abortion patient. Either naturally occuring or induced. She/he has also asked not to start a flame war.

[BabyLady, BSN, RN]

Sounds to me like your "Program Director" is in the wrong occupation.

You have been cheated out of your education & this Director needs to be reported.

I agree, you have been cheated out of a quality education.

Not every pregnancy ends in a live birth...you need to know how to handle that.

Even if you are PRO-LIFE, you can refuse to participate in the procedure, but let's say a woman had an abortion on Monday and then that night had complications and was admitted to the hospital, you CANNOT refuse to take care of her because she had an abortion.

Also, family planning and teaching is a huge part of women's health as is preventing teen pregnancy.

Seriously, you have been beyond cheated.

[roser13, ASN, RN]

I don't mean to be offensive, but I'm a little tired of attitudes like this. I don't like the idea of abortion at all, but I realize it's probably not going away and I'm sensitive enough to not argue about it (normally) but then I see people all the time, trying to say that the people who are AGAINST abortion are somehow horrible monsters with no morals. What?!

I'm sorry - what post did you read?

Certainly not the calm, rational request for basic information (incorporating the some-posters-might-not-want-to-address-this-issues caveat) post that I read.

[rn/writer, RN]

STAFF NOTE:

The subject of this thread is nursing care r/t pregnancy termination (intentional or otherwise) and answering the questions in the OP's opening post.

Please, do not turn this into an abortion thread. Please, do not turn this into a thread about the OP's educators/school. What's done is done (or undone, in this case) and now she needs to be given factual information to get her up to speed.

Off-topic posts are subject to editing/removal.

Thank you.

[MassED, BSN, RN]

odd if you're at a public school not to have more information and education regarding terminations or missed AB's. We care for patients who have had abortions, and every other thing in between regarding pregnancies. You have to be aware and be able to intervene appropriately so not to have the baseline education is irresponsible on the part of your instructor. Find some other books and educate yourself on complications of pregnancy, as well as induced (medically necessary or self) abortions.