Amy Levi

The Ethics of Nursing Student International Clinical Experiences

This article explores the motivations for offering international nursing student experiences and the reasons students choose to participate. Students should prepare by learning cultural humility rather than cultural competency, and they should be oriented to the ethical responsibility implicit in caring for those in developing countries. Programs that provide these experiences need to be developed with an eye to sustainability so the lives of those receiving care will be enriched after the students go home.

Reframing unintended pregnancy prevention: a public health model

The goal of reducing unintended pregnancy was identified in Healthy People 2000 [1], but the measures and objectives created to reach this goal have often focused solely on increasing access to contraception. While increasing access to contraception is a vitally important tool, it does not sufficiently address the problem of unintended pregnancy. Clarifying the roles and responsibilities of primary care clinicians and providing them with state-of-the-art tools and training in this aspect of reproductive health care is equally important for solving this public health challenge. In order to achieve this goal, we need to establish culturally appropriate evidenceand competency-based clinical guidelines for the prevention and management of unintended pregnancy that can be integrated into primary care and the broader health system and that are built on a comprehensive public health framework for pregnancy prevention that specifies the essential competencies required of all members of the health care team. There are several reasons for health professionals to make unintended pregnancy a high priority. First, unintended pregnancy is an extremely common occurrence in womens lives — half of all pregnancies in the United States are unintended [2]. Furthermore, higher rates of unintended pregnancy among African-American and Hispanic women indicate a major health disparity in this aspect of reproductive health [3]. Second, unintended pregnancy has negative consequences for the health of women and their children [4], and is associatedwith significant costs to the health care system [5]. In spite of its frequency and significant costs, unintended pregnancy has received less attention in both research and the developmentofclinicalandpreventivecarestrategies thanother similarly important health threats. This oversight can be attributed to the general fragmentation of health care services coupled with the politicization of reproductive health, and abortion in particular. These trends have contributed to the persistence of high rates of unintended pregnancy in theUnited States. Primary care providers have both an opportunity and a responsibility to their patients and society at large tohelp reduce the number of pregnancies that are not intended.

Meeting the National Health Goal to Reduce Unintended Pregnancy

In spite of advances in health care, the rate of unintended pregnancy has not diminished. Healthy People 2020 and the Affordable Care Act of 2010 have promoted prevention as the most effective means of ensuring the health of the citizens of the United States. This shift in the national approach to the promotion of prevention holds the potential to appropriately address pregnancy planning from a comprehensive public health framework.

Midwifery Data Collection: Options and Opportunities

Most midwives are aware of the need to collect clinical practice data and of its usefulness in supporting the care they provide, which contributes to healthy outcomes for mothers and babies. For the individual midwife, there is more than one easily accessible, standardized data collection instrument from which to choose. However, despite these choices, in an American College of Nurse-Midwives (ACNM) Division of Research (DOR) survey on midwifery clinical data collection (N = 263), the majority of member respondents (n = 135; 51%) reported using a self-designed data collection tool, and more than one-third did not know of the ACNM Nurse-Midwifery Clinical Data Sets (NMCDS). On a larger scale, the midwifery profession is also in need of an organized and consistent approach to data collection for the purpose of capturing midwifery practice and outcomes in order to provide data to support legislation, practice, and policy changes. However, the profession currently lacks a single common midwifery practice database. In order to facilitate data aggregation that captures a larger view of midwifery practice at the local, regional, and national levels, it is imperative that all midwives collect relevant data that are uniform and standardized, and that the midwifery professional organizations move forward with the development of a common electronic database. This article describes currently available data collection tools as well as their best uses, applications to practice, and future directions.

From Home to Hospital: Mistreatment of Childbearing Women and Barriers to Facility-Based Birth in Nicaragua

Worldwide, women continue to die during childbirth despite efforts to reduce maternal mortality. Nicaragua, particularly the North Atlantic Autonomous Region (RAAN), possesses extremely high rates of maternal mortality. It has been suggested that promoting facility-based birth is an effective method to reduce maternal mortality through providing essential obstetric and emergency obstetric care to the most women. A significant barrier to increasing rates of facility-based birth globally is mistreatment of women patients in health care settings. This case report illustrates the mistreatment of childbearing women during facility-based birth in the RAAN, including verbal abuse, physical abuse, neglect, and use of unnecessary medical interventions.

Recruitment and retention strategies for expert nurses in abortion care provision

OBJECTIVE(S) The purpose of this thematic analysis is to describe recruitment, retention and career development strategies for expert nurses in abortion care provision. STUDY DESIGN Thematic analysis influenced by grounded theory methods were used to analyze interviews, which examined cognitive, emotional, and behavioral processes associated with how nurses make decisions about participation in abortion care provision. The purposive sample consisted of 16 nurses, who were interviewed between November 2012 and August 2013, who work (or have worked) with women seeking abortions in abortion clinics, emergency departments, labor and delivery units and post anesthesia care units. RESULTS Several themes emerged from the broad categories that contribute to successful nurse recruitment, retention, and career development in abortion care provision. All areas were significantly influenced by engagement in leadership activities and professional society membership. The most notable theme specific to recruitment was exposure to abortion through education as a student, or through an employer. Retention is most influenced by flexibility in practice, including: advocating for patients, translating ones skill set, believing that nursing is shared work, and juggling multiple roles. Lastly, providing on the job training opportunities for knowledge and skill advancement best enables career development. CONCLUSION(S) Clear mechanisms exist to develop expert nurses in abortion care provision. IMPLICATIONS The findings from our study should encourage employers to provide exposure opportunities, develop activities to recruit and retain nurses, and to support career development in abortion care provision. Additionally, future workforce development efforts should include and engage nursing education institutions and employers to design structured support for this trajectory.

Core competencies in sexual and reproductive health for the interprofessional primary care team

OBJECTIVE A primary care workforce that is well prepared to provide high-quality sexual and reproductive health (SRH) care has the potential to enhance access to care and reduce health disparities. This project aimed to identify core competencies to guide SRH training across the primary care professions. STUDY DESIGN A six-member interprofessional expert working group drafted SRH competencies for primary care team members. Primary care providers including family physicians, nurses, nurse practitioners and certified nurse midwives, physician assistants and pharmacists were invited to participate in a three-round electronic Delphi survey. In each round, participants voted by email to retain, eliminate or revise each competency, with their suggested edits to the competencies incorporated by the researchers after each round. RESULTS Fifty providers from six professions participated. In Round 1, 17 of 33 draft competencies reached the 75% predetermined agreement level to be accepted as written. Five were combined, reducing the total number to 28. Based on Round 2 feedback, 21 competencies were reworded, and 2 were combined. In Round 3, all 26 competencies reached at least 83.7% agreement, with 9 achieving 100% agreement. CONCLUSION The 33 core competencies encompass professional ethics and reproductive justice, collaboration, SRH services and conditions affecting SRH. These core competencies will be disseminated and adapted to each professions scope of practice to inform required curricula. IMPLICATIONS SRH competencies for primary care can inform the required curricula across professions, filling the gap between an established standard of care necessary to meet patient needs and the outcomes of that care.

Expanding Access to Sexual and Reproductive Health Services Through Nursing Education

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.

Letter to the Editor re: article: “A systematic review of the safety, efficacy and acceptability of task sharing tubal sterilization to mid-level providers” by Rodriguez and Gordon-Maclean (Epub)

The publication of the recent systematic reviewbyRodriguez and Gordon-Maclean exemplifies (and exacerbates) the confusion that currently exists about health workforce nomenclature. Two terms used as the units of analysis in the systematic review — “midlevel provider” and clinical “task-sharing” are controversial and not well defined within global health workforce research and policy. While the authors include a table from the World Health Organization (WHO) that defines health worker cadres, they do not reference the controversies that exist among the global health workforce policy-making organizations; nor do they consider nomenclature from existing publications. In reviewing both the WHO and Global Health Workforce Alliance (GHWA) websites, there is a lack of consensus about creating new health workforce categories. It appears that one sector of the GHWA andWHO (represented by maternal–child and reproductive health groups) have developed two reports on midlevel providers (2010) and midlevel health workers (2013); these reports were published in spite of major opposition from the members of the GHWA Forum. Most made the case that the focus should be on country-level workforce assessment/planning rather than rhetorical imposition of an outdated, hierarchical term with the recommendation that standard of care and competencies guide the nomenclature and policy debate on health workforce changes. Notably, a 2013 Strategic Plan for Advancing the Health Workforce Agenda within Universal Health Coverage, Strategy 2013–2016 (also by the GHWA) does not refer to midlevel providers/workers; rather, they recommend focusing on patient needs and care (not merely tasks) from a teamapproach. In addition, the Lancet Commission report, Health Professionals for a New Century: Transforming education to Contraception 91 (2015) 264–265

Premature or Just Small? Training Guatemalan Birth Attendants to Weigh and Assess Gestational Age of Newborns: An Analysis of Outcomes

We describe Guatemalan birth attendants’ identification of vulnerable newborns, their evaluation of gestational age and anthropometry, and the validity of the Capurro and New Ballard newborn gestational age assessment methods. We interviewed 49 birth attendants and trained 10 of these women to assess 63 newborns. The Capurro and Ballard methods were correlated (Spearman rho = .75, p < .001) and showed agreement (Bland-Altman plot, difference and bias, −0.33 ± 1.3 weeks). Prematurity was estimated at 27% (Ballard) and 24% (Capurro); low birth weight (LBW) was 30%. Capurro provided a simplified, equivalent estimate of gestational age compared with New Ballard that could be used by birth attendants.