{"title":"Identifying barriers and facilitators of full service nurse-led early medication abortion provision: qualitative findings from a Delphi study","authors":"Caroline de Moel-Mandel, A. Taket, Melissa Graham","doi":"10.37464/2020.381.144","DOIUrl":null,"url":null,"abstract":"Objective: To explore factors that can influence implementation of a nurse-led model of care for early medication abortion provision in the primary healthcare setting of regional and rural Victoria, Australia. Background: Global research indicates that an increased involvement of primary healthcare nurses in the delivery of early medication abortion provision has the potential to improve abortion access. In Victoria, access in regional and rural areas is restricted despite abortion being legal. A nurse-led early medication abortion provision model is feasible and can potentially improve the current situation. Study design and methods: An online threeround classic Delphi method was used. This paper reports the qualitative findings. Non-probability sampling techniques were used to recruit a panel of professional experts. Data from the three questionnaires were collected and analysed using thematic analysis. Factors influencing model implementation were categorised into the Capability, Opportunity, Motivation-Behaviour framework. Results: A total of 24 medical and other health professionals participated. They identified a range of factors that can hinder model implementation, including a lack of affordable medication abortion education, no remuneration for nurse-led early medication abortion provision, and concerns related to stigma and support. Discussion and conclusion: Understanding and addressing barriers to model implementation may enable the development of primary healthcare nurses’ role in the delivery of early medication abortion provision to improve abortion access. Impact: To improve abortion access in Victoria’s under-served regions, the potential of nurse-led early medication abortion provision was explored. Barriers to model implementation relate to a lack of medication abortion education and funding, professional support and stigma concerns. The study identified a range of support elements that would enable primary healthcare nurses to develop new roles and responsibilities in the delivery of medication abortion services.\nWhat is already known about the topic?\n\nEvidence indicates that appropriately trained primary healthcare nurses can provide early medication abortion and associated tasks as effectively, safely and satisfactorily as physicians.\nNurse-led early medication abortion provision is a worldwide recognised strategy to overcome the shortage of early medication abortion providers and to improve equity in access to abortion services.\nThe legal climate of Victoria allows qualified registered nurses to independently administer physician-prescribed early medication abortion drugs to women.\n\nWhat this paper adds:\n\nThe Delphi panellists of this study all endorsed nurse-led early medication abortion provision in regional and rural Victoria and beyond.\nThe study provides a range of model implementation barriers, which are categorised into the components of the Capability, Opportunity, and Motivation Model of Behaviour. Those barriers need to be challenged and addressed to improve abortion access in underserved regions.","PeriodicalId":55584,"journal":{"name":"Australian Journal of Advanced Nursing","volume":"38 1","pages":""},"PeriodicalIF":1.2000,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Australian Journal of Advanced Nursing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.37464/2020.381.144","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NURSING","Score":null,"Total":0}
引用次数: 2
Abstract
Objective: To explore factors that can influence implementation of a nurse-led model of care for early medication abortion provision in the primary healthcare setting of regional and rural Victoria, Australia. Background: Global research indicates that an increased involvement of primary healthcare nurses in the delivery of early medication abortion provision has the potential to improve abortion access. In Victoria, access in regional and rural areas is restricted despite abortion being legal. A nurse-led early medication abortion provision model is feasible and can potentially improve the current situation. Study design and methods: An online threeround classic Delphi method was used. This paper reports the qualitative findings. Non-probability sampling techniques were used to recruit a panel of professional experts. Data from the three questionnaires were collected and analysed using thematic analysis. Factors influencing model implementation were categorised into the Capability, Opportunity, Motivation-Behaviour framework. Results: A total of 24 medical and other health professionals participated. They identified a range of factors that can hinder model implementation, including a lack of affordable medication abortion education, no remuneration for nurse-led early medication abortion provision, and concerns related to stigma and support. Discussion and conclusion: Understanding and addressing barriers to model implementation may enable the development of primary healthcare nurses’ role in the delivery of early medication abortion provision to improve abortion access. Impact: To improve abortion access in Victoria’s under-served regions, the potential of nurse-led early medication abortion provision was explored. Barriers to model implementation relate to a lack of medication abortion education and funding, professional support and stigma concerns. The study identified a range of support elements that would enable primary healthcare nurses to develop new roles and responsibilities in the delivery of medication abortion services.
What is already known about the topic?
Evidence indicates that appropriately trained primary healthcare nurses can provide early medication abortion and associated tasks as effectively, safely and satisfactorily as physicians.
Nurse-led early medication abortion provision is a worldwide recognised strategy to overcome the shortage of early medication abortion providers and to improve equity in access to abortion services.
The legal climate of Victoria allows qualified registered nurses to independently administer physician-prescribed early medication abortion drugs to women.
What this paper adds:
The Delphi panellists of this study all endorsed nurse-led early medication abortion provision in regional and rural Victoria and beyond.
The study provides a range of model implementation barriers, which are categorised into the components of the Capability, Opportunity, and Motivation Model of Behaviour. Those barriers need to be challenged and addressed to improve abortion access in underserved regions.
期刊介绍:
The Australian Journal of Advanced Nursing publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to nursing and midwifery practice, health- maternity- and aged- care delivery, public health, healthcare policy and funding, nursing and midwifery education, regulation, management, economics, ethics, and research methodology. Further, the journal publishes personal narratives that convey the art and spirit of nursing and midwifery.
As the official peer-reviewed journal of the ANMF, AJAN is dedicated to publishing and showcasing scholarly material of principal relevance to national nursing and midwifery professional, clinical, research, education, management, and policy audiences. Beyond AJAN’s primarily national focus, manuscripts with regional and international scope are also welcome where their contribution to knowledge and debate on key issues for nursing, midwifery, and healthcare more broadly are significant.