Expanding Access to Sexual and Reproductive Health Services Through Nursing Education

doi:10.1016/j.jogn.2017.02.004

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 46, Issue 5, September–October 2017, Pages e149-e156

https://doi.org/10.1016/j.jogn.2017.02.004 Get rights and content

Abstract

Thoughtful, unbiased, evidence-based content in nursing education is crucial for the development of confident and competent nurses who provide care in every setting. The purpose of this article is twofold: to provide evidence to show that comprehensive sexual and reproductive health care by nurses is informed by educational exposure to content and to provide recommendations for change at the individual, institutional, and structural levels to improve and expand sexual and reproductive health services.

Section snippets

Defining Sexual and Reproductive Health

Nurse educators have been tasked to provide the theoretical and clinical foundations for practice that are crucial for the development of novices to expert nurses (Benner, 1989). However, it is difficult to assess whether busy nurse educators are providing components of SRH content. Throughout this article, we use the following working definition of SRH:

Sexual and reproductive health (SRH) care is sometimes thought of narrowly as maternal and child health care. However, to produce optimal

Levels of Nursing Education

Nurses have long recognized and acknowledged the need for a well-educated workforce, and many scholars, authors, and educators have shown the link between education, expert clinician status, and patient outcomes (Aiken, 2014, Benner, 1989, D'Antonio, 2004, Flood, 2013, Goldmark, 1923, Kutney-Lee et al., 2013, Scheckel, 2009, University of Pennsylvania School of Nursing, nd). Taken together, the multiple pathways, degrees, and designations that are part of the evolution of nursing education in

Educational Exposure and the Provision of SRH Services

Sexual and reproductive health is an essential part of individual and community health and well-being (Faculty of Sexual and Reproductive Healthcare, 2008, United Nations, 1995). However, in the United States, patient-centered, evidence-based SRH care has not been as adequately addressed as other essential services (Taylor, Levi, & Simmonds, 2010). The national health goals to reduce unintended pregnancies and sexually transmitted infections identified in Healthy People 2010 and Healthy People

Currently Available SRH Educational Resources for Nurses

Three entities have attempted to address the provision of SRH content in pre-licensure programs: Provide, 2016, Nursing Students for Sexual & Reproductive Health, 2016, and Innovating Education in Reproductive Health (2015). These entities have developed curricula to build capacity for referring people for SRH services, managing miscarriage, enhancing professionalism in SRH care, and clarifying values.

Discussion and Recommendations for Change

Educational exposure to SRH content is needed for nurses to understand the evidence regarding the range of SRH services for all individuals across the lifespan and to ensure appropriate access to these services in all patient settings. On an institutional level, this requires recognition that educational exposure and clinical opportunities in SRH and abortion care are important to nursing practice but are not readily available in all settings at this time (Cappiello et al., 2016, Lupi and

Conclusion

Historically, SRH care has not been uniformly included in all areas of nursing education. At all educational levels, the inclusion of SRH care in the nursing curriculum requires a better understanding of core competencies, including those for unintended pregnancy care and management. Clinical opportunities for students exist in all areas of nursing practice but can be extended further with the use of clinical practicums in family planning clinics, early pregnancy management centers, and

Monica R. McLemore, PhD, MPH, RN, is an assistant professor in the Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA; a clinician-scientist for Advancing New Standards in Reproductive Health, University of California, San Francisco, San Francisco, CA; and an affiliated scholar with the Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA.

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Cited by (13)

Knowledge and Comfort in Providing Contraception, Sexual, and Reproductive Healthcare Among Pediatric Nurses in California
2024, Teaching and Learning in Nursing
To evaluate the awareness, comfort, and feeling of competence of California registered nurses (RNs) in the provision of contraception and sexual and reproductive healthcare (SRH) to adolescent patients following California Assembly Bill (AB) 2348 legislation that expanded RN scope of practice to include provision of self-administered and injectable hormonal contraception. A cross-sectional, descriptive survey was used to assess pediatric registered nurses’ awareness of AB2348, perceived level of competence and comfort in the provision of sexual and reproductive health care (N = 504). A sample of pediatric RNs in California were included in this analysis. Descriptive statistics were used to assess demographic characteristics and summarize participants responses, and Fisher's exact tests were used to identify difference between groups. Responses from 45 pediatric RNs are reported in this analysis. The majority (80.0%, n = 36) of nurses in this study had no knowledge of AB2348. Many expressed a lack of comfort dispensing contraception (34.6%, n = 16), discussing age-appropriate information on safer sex practices (62.2%, n = 28), and providing sexually transmitted infection education (49.9%, n = 22).While most of the pediatric RNs reported frequently providing care to pediatric patients of reproductive age the majority were not comfortable providing contraception, safer sex education, or sexually transmitted infection education, and were unaware that it is within their scope of practice to independently provide services using standardized procedures. Increased training the provision of SRH care is needed among pediatric RNs to increase their sense of competence and comfort in providing adolescent SRH care.
The value of including reproductive justice into nursing curricula
2023, Nurse Education Today
Abortion Knowledge Among Advanced Practice Clinicians in Colorado
2022, Women's Health Issues
Citation Excerpt :
Providing reminders about abortion laws is associated with increased abortion law knowledge (Dodge et al., 2013). Thus, in addition to including abortion in graduate program curricula (McLemore & Levi, 2017; Tillman & Levi, 2020), it is important to offer continuing education on abortion to practicing clinicians. This study is limited by a lower response rate compared with studies using national clinician databases (Desai, Jones & Castle, 2018) and generalizability to practicing APCs in Colorado is reduced by nonresponse.
Our objective was to quantify abortion law and care knowledge among Colorado advanced practice clinicians.
We conducted a stratified random survey of advanced practice clinicians, oversampling women’s health and rural clinicians. We assessed sample characteristics, positions on abortion legality, and knowledge of abortion law and care. Mean knowledge scores were compared by sample characteristics. Survey responses were compared by provision of pregnancy options counseling and positions on abortion legality. Linear regression models were used to examine knowledge scores.
A total of 513 participants completed the survey; the response rate was 21%. Abortion law knowledge questions (mean score, 1.7/7.0) ranged from 12% (physician-only law) to 45% (parental consent law) correct. For five of seven questions, “I don’t know” was the most frequently chosen response. Abortion care knowledge questions (mean score, 2.8/8.0) ranged from 19% (abortion prevalence) to 60% (no elevated risk of breast cancer) correct. For four of eight questions, “I don’t know” was the most frequently chosen response. Practicing in all other areas (e.g., family practice) was associated with lower abortion law and care knowledge than practicing in women’s health. Providing options counseling was positively associated with abortion knowledge (law, β = 0.44; 95% confidence interval [CI], 0.10–0.78; care, β = 0.52; 95% CI, 0.08–0.95). Compared with participants who believe abortion should be legal in all circumstances, those who believe abortion should be illegal in all circumstances had similar abortion law knowledge (β = −0.03; 95% CI, −0.65 to 0.59), but lower abortion care knowledge (β = −1.85; 95% CI, −2.34 to −1.36).
Abortion knowledge is low among Colorado advanced practice clinicians and education is needed.
Dispersion of contraceptive access policies across the United States from 2006 to 2021
2022, Preventive Medicine Reports
Citation Excerpt :
The most common types of contraceptive policies enacted during the 2006–2021 study period included expansion of prescribing authority for NPs, CNMs, and CNSs, and dispensing authority for NPs and CNMs. Practice laws that limit the types of providers permitted to provide sexual and reproductive health care act as barriers to the provision of high quality sexual and reproductive health services at multiple levels (Auerbach et al., 2012; McLemore and Levi, 2017). Nursing trainees and training programs may prioritize areas with greater exposure and availability of practice opportunity.
Person-centered contraceptive access benefits reproductive autonomy, sexual wellbeing, menstrual regulation, and other preventive health. However, contraceptive access varies by social and geographic position, with policies either perpetuating or alleviating health inequities. We describe geographic and time-trend variation in an index from fewer (less expansive) to greater (more expansive) aggregation of U.S. state-level contraceptive access policies across 50 states and Washington, D.C. (collectively, states) from 2006 to 2021. We collected data from primary and secondary sources on 23 policies regulating contraceptive education, insurance coverage, minor’s rights, provider authority, and more. As of 2021, the most enacted policies expanded contraceptive access through: 1) prescribing authority for nurse practitioners, certified nurse-midwives (n = 50, 98 % of states), and clinical nurse specialists (n = 38, 75 %); 2) Medicaid expansion (n = 38, 75 %); 3) prescription method insurance coverage (n = 30, 59 %); and 4) dispensing authority for nurse practitioners and certified nurse-midwives (n = 29, 57 %). The average overall U.S. policy index value increased in expansiveness from 6.9 in 2006 to 8.6 in 2021. States in the West and Northeast regions had the most expansive contraceptive access landscapes (average index values of 9.0 and 8.2, respectively) and grew more expansive over time (increased by 4–5 policies). The Midwest and South had least expansive landscapes (average index values of 5.0 and 6.1, respectively). Regions with more expansive sexual and reproductive health policy environments further expanded access, whereas least expansive environments were maintained. More nuanced understanding of how contraceptive policy diffusion affects health outcomes and equity is needed to inform public health advocacy and law making.
The Space in the Middle: Attitudes of Women's Health and Neonatal Nurses in the United States about Abortion
2022, Women's Health Issues
Despite playing an integral part in sexual and reproductive health care, including abortion care, nurses are rarely the focus of research regarding their attitudes about abortion.
A sample of 1,820 nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses were surveyed about their demographic and professional backgrounds, religious beliefs, and abortion attitudes. Scores on the Abortion Attitudes Scale were analyzed categorically and trichotomized in multinomial regression analyses.
Almost one-third of the sample (32%) had moderately proabortion attitudes, 29% were unsure, 16% had strongly proabortion attitudes, 13% had strongly antiabortion attitudes, and 11% had moderately antiabortion attitudes. Using trichotomized Abortion Attitudes Scale scores (proabortion, unsure, antiabortion), adjusted regression models showed that the following characteristics were associated with proabortion attitudes: being non-Christian, residence in the North or West, having no children, and having had an abortion.
Understanding nurses’ attitudes toward abortion, and what characteristics may influence their attitudes, is critical to sustaining nursing care for patients considering and seeking abortion. Additionally, because personal characteristics were associated with antiabortion attitudes, it is likely that personal experiences may influence attitudes toward abortion. A large percentage of nurses held attitudes that placed them in the “unsure” category. Given the current ubiquitous polarization of abortion discourse, this finding indicates that the binary narrative of this topic is less pervasive than expected, which lends itself to an emphasis on empathetic and compassionate nursing care.
Relationship of job role and clinic type to perceived stigma and occupational stress among abortion workers
2018, Contraception
Citation Excerpt :
Because abortion care is largely segregated into freestanding clinics, service sustainability remains vulnerable to regulations targeted to close these facilities [7,8]. Lack of clinical training in abortion across disciplines poses challenges for employers filling caregiving roles [9–11]. Thus, attrition within the abortion workforce due to burnout and turnover could pose an especially grave threat to the already threadbare patchwork of abortion service delivery.
To describe the role of worksite characteristics, job role and abortion stigma in clinical abortion workers' occupational stress.
We recruited nurses, medical assistants and counseling staff who provide abortion care at five hospitals and four freestanding clinics in Massachusetts. Study instruments assessed individual-level abortion stigma (the perception that others treat abortion as shameful, dirty and socially taboo) using the Abortion Providers Stigma Scale; job strain through the Job Content Questionnaire; and emotional burnout through the Depersonalization, Emotional Exhaustion and Personal Accomplishment subscales of the Maslach Burnout Inventory. Multivariable linear and logistic regression modeling tested for associations between job role, worksite type, stigma, job strain and burnout, accounting for demographic and job characteristics.
Of 205 eligible workers, 136 participated (66%). Forty-one percent were medical assistants, 50% nurses, and 9% counselors. In adjusted models, abortion workers with high stigma had increased odds of experiencing job strain [adjusted odds ratio (aOR) 3.94, 95% CI 1.19–13.05]. Compared to working in a freestanding clinic, working in a hospital was associated with lower odds of experiencing the low personal accomplishment dimension of burnout (aOR 0.49, 95% CI 0.29–0.84) and lower odds of experiencing the depersonalization dimension of burnout (aOR 0.05, 95% CI 0.01–0.28). Counselors had higher odds of depersonalization compared to nurses (aOR 4.56, 95% CI 2.3–9.0).
Hospital-based abortion workers experience lower risk for burnout than comparable workers in freestanding clinics, accounting for abortion stigma and job characteristics.
Implementing structured supports to alter workflows or improve coping among workers in freestanding abortion clinics may help mitigate risk of worker burnout and associated turnover.

View all citing articles on Scopus

Amy J. Levi, PhD, CNM, WHNP-BC, FACNM, FAAN, is the Leah L. Albers Endowed Professor of Midwifery and Director of Interprofessional Education at the University of New Mexico Health Sciences Center, Albuquerque, NM.

: The authors report no conflict of interest or relevant financial relationships.

View full text

In FocusExpanding Access to Sexual and Reproductive Health Services Through Nursing Education

Abstract

Section snippets

Defining Sexual and Reproductive Health

Levels of Nursing Education

Educational Exposure and the Provision of SRH Services

Currently Available SRH Educational Resources for Nurses

Discussion and Recommendations for Change

Conclusion

Nursing Outlook

Contraception

Contraception

Nurse Education Today

Journal of Obstetric, Gynecologic, & Neonatal Nursing

Contraception

American Journal of Obstetrics and Gynecology

Contraception

Contraception

Baccalaureate nurses and hospital outcomes: More evidence

Medical Care

Educational levels of hospital nurses and surgical patient mortality

Journal of the American Medical Association

ANCC magnet recognition program

Nurse practitioners and sexual and reproductive health services: An analysis of supply and demand

From novice to expert

American Journal of Nursing

Educating nurses: A call for radical transformation

Home

Revisiting and rethinking the rewriting of nursing history

Bulletin of the History of Medicine

Women, nursing, and baccalaureate education in 20th century America

Journal of Nursing Scholarship

New specialty training in community sexual and reproductive health

Nursing, history and health care

Nursing History Review

Nursing and nursing education in the United States: Report of the committee for the study of nursing education and the report of a survey by Josephine Goldmark

Journal of the American Medical Association

Resources for reproductive health educators worldwide

In Focus
Expanding Access to Sexual and Reproductive Health Services Through Nursing Education