Self-preservation in abortion care: a grounded theory study

Aim. To seek an explanation as to why nurses concede and conceal their judgements towards women having an abortion. Background. Recent advances in abortion techniques and pharmacology have resulted in a greater proportion of medical abortions occurring at a lower gestation than previously. As this technique demands more of nurses, it becomes important to ask whether they are equipped to deal with this greater involvement. Design. A grounded theory approach using a recognised framework was used. Theoretical sampling was used in this study to increase the depth of focus from a previous study of nurses who were found to concede and conceal their judgement in abortion care. Findings. Several important aspects of abortion care were elucidated as to why nurses concealed and conceded their judgements. Lower gestation of abortions was central in determining greater involvement of nurses in the abortion process. It was found that some nurses treated women the same and some treated women differently, but all strived for equitable care. Self-preservation in the form of 'switching off' or 'getting on with it' was employed by nurses when they encountered the foetus or women who were blase. Self-preservation was found to be a key phenomenon and a major reason why nurses conceded and then concealed their judgement. Conclusions. In rapidly advancing abortion care, there needs to be positive ways of ensuring self-preservation in nurses without compromising care. Relevance to clinical practice. Abortion care demands specific skills of nurses, and this is likely to increase in the near future. Self-preservation needs to be embedded into nurses' professional development by the use of positive strategies such as guided reflection in providing a productive woman-centred service.