Modernising Abortion
Services…………….
Nurse/Midwife Led Provision
Alison Jones, Consultant Nurse Sexual Health & Teenage Pregnancy
Pontypridd & Rhondda NHS Trust
28 June 2007
Objectives
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Introduction
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Developing nurse/midwife roles
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Opportunities & challenges
Globally
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Over ¼ of worlds population live in countries where
abortion is strictly prohibited
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19,000,000 Women have unsafe abortions annually
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70,000 Women die each year from unsafe abortions
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1 in 3 British Women will have an abortion
In Wales, England & Scotland abortion can be carried out
providing that 2 registered medical practitioners agree that:
Up to 24 weeks:
The continuance of the pregnancy would involve risk greater than if the
pregnancy were terminated to the physical or mental health of the
pregnant woman or any existing children in her family
(i)
(ii) With no gestational limit:
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If termination is necessary to prevent grave permanent injury to the
mental or physical health of the pregnant woman
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There is a risk to the life of the pregnant woman greater than if the
pregnancy were terminated
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There is substantial risk that if the child were born it would suffer
from such physical or mental abnormalities as to be seriously
handicapped
(Abortion Act 1967, amended by the Human Fertilisation & Embryology Act 1990)
Note:
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Parliamentary debate July 2005 upheld the
24 week gestational limit.
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Doctors attending the BMA conference June
2005 supported maintaining the limit by 3:1.
Statistics (Wales & Eng)
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Abortions increased by 0.4% 2004-05
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Teenage abortion rates unchanged
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89% of abortions carried out under 13wks, less
than 2% over 20 weeks (unchanged for 10 years)
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84% abortions were funded/carried out by the NHS
(fpa fact sheet, August 2006, publisher: Sexual Health Direct, London)
Modernising abortion services national policy context
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All Wales Sexual Health Strategy 2006
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Designed to Deliver (Wanless, 2000)
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RCOG Guidelines
Modernising abortion services locally
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Working together: multi professional, multi-organisation
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Identifying the need for change
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Organisational support
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Risk assessment, professional & legal liability
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Clearly specified purpose, roles & responsibilities
Principles of Nurse / Midwife Role
Development
focused on empowering nurses/midwives to develop
knowledge & skills for the benefit of patient care.
avoiding ad hoc acquisition of technical skills or
inappropriate delegation of unpleasant/unwanted
tasks by other professional groups.
Nurse/Midwives Responsibilities
Nurses work within the Abortion Act when they
accept delegated instructions from a registered
medical practitioner & carry out treatment in
accordance with his/her directions
Areas of nurse/midwife role development
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Ultrasound assessment of gestational age
Pre & post abortion counselling
Administration of abortificants
Discharging patients
Vaginal/speculum examination
Assessment for & provision of contraception
Obtaining consent for abortion procedures
Obtaining consent for abortion procedures
……..exceptions
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Under 16 unaccompanied by an adult with
parental responsibility
The woman does not understand the procedures
The woman is unsure
The woman has bleeding / pelvic pain
A medical condition that is contraindicated
The nurse/midwife deems it unsafe
Areas of nurse/midwife role development
…….. Competency Framework
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Identifies qualifications, experience & training
Registered Nurses & Midwives require to enable
competent safe practice
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Provides methodology to quality assure through
assessment & audit
Modernisation….. developing a dedicated service:
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Specified referral process
Developing & enhancing expertise
Responsive to individual needs
Easily accessible for ongoing care
‘One stop shop’ / community settings
Speedier initial consultation
One to one holistic assessment
‘sexual health’ perspective
High levels patient satisfaction
Positive effects on other services
Challenges…….
Primary legislation
Interface between primary & secondary care
‘Cutting edge’. Expect the unexpected ……..
Sustainability
Checklist for service development
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Working together!
Clear identification of need
Policy statement, protocols & procedures
Education & training package
Assessment – theoretical & practical
Audit
Identifying & acting on clinical incidents
Maintenance of competence
Identifying opportunity for continued development
Thank you
Alison Jones
Pontypridd & Rhondda NHS Trust
[email protected]
01443 443443 ext 4246