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Copyright eContent Management Pty Ltd.Contemporary Nurse(2008) 31:919.

Awoman centred service in

termination of pregnancy: A grounded theory study

ABSTRACTThe issue of abortion is contentious.It challenges those involved

emotionally
and ethically and,although in the UK it is set within legal parameters,it remains controversial.The involvement of nurses and midwives in abortion care

Key Wordshas not been explored to any great depth.In the UK,there has been a sustained
termination ofincrease in the number of medical compared to surgical

terminations over the pregnancy;last decade.Nurses/midwives are at the forefront of this procedure and,because
abortion; feminist ethics;of the current political climate,their involvement is likely to

increase in the groundedfuture.This grounded theory study aimed to explore how nurses and midwives theory;gynae-perceive their role with women undergoing termination of pregnancy and how cology nursingthey cope with their increased involvement with these women.

19 February 2008Accepted 6 August 2008

CN

Received

undergoing a relatively minor procedure involving suction aspiration of the products of conception.This usually occurs under a general anaesthetic.A medical abortion comprises twoALLYSONLIPP Lecturerstages.Firstly,taking the tablet mifepristone andPrincipal Post-Doctoralsecondly,returning to hospital one to three daysRCBC Fellow of Health, later for misoprostol (RCOG 2004).The abor-Faculty and Sciencetion usually occurs about six hours later withSport University of Glamorgan Wales, UKthe products of conception passed vaginally.Pontypridd, There are advantages and disadvantages with INTRODUCTIONboth methods,although they are classed as tion is a contentious issue and thoseequally safe and relatively minor procedures.

Aborinvolved in caring for women undergoingThere has been an increase in medical aborthe procedure confront complex issues on ations relative to surgical abortions in the UK. daily basis.In the UK within certain legal para-The number of abortions in the UK being permeters,a woman can receive a first trimesterformed with the use of medication,commonly abortion in one of two ways,medical or surgical.A surgical abortion usually involves the1991 when mifepristone was first licensed for woman admitted to hospital as a day case anduse in the UK and has more than doubled in the

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Allyson LippCCCCNNNN last five years (Department of Health 2008).unintentional loss,emphasised the challenges Medical abortions accounted for 30% of theof nurses simultaneously managing their own total,compared with 24% in 2005.The totalemotions alongside those of the women. number of abortions in England and Wales inA US exploratory study (Joffe 1999) com2006 was 193,700,compared with 186,400 inprising interviews with 25 long term surgical 2005,a rise of 3.9%.The National Health Ser-abortion providers asked about the transition vice funded 87% of abortions (Department ofto medical abortions.Joffe (1999) found that Health 2007).most viewed it as an acceptable innovation withThe move towards more medical abortionsout the complications of haemorrhage they has meant nurses are becoming more directlyhad feared.In Australia the move towards more involved in the procedure.A recent House ofmedical terminations has been more haphazard Commons Scientific and Technology Commit-(Calcutt 2007;RANZCOG 2005). tee (2007) recommended nurses take a moreDespite the satisfactory safety record of prominent role in both medical and surgicalmedical abortion (Say et al.2002),a woman abortions which would further increase theirundergoing the procedure requires the nurse involvement and responsibilities in this pro-or midwife to be with her to supervise and, cedure.therefore,experience it along with the woman Little research has been undertaken to exam-(Huntington 2002).It is unclear how increased ine how nurses or midwives perceive their involvement will affect the dynamics of the role or how the increasing numbers of medical nurse/midwifepatient relationship or the abortions in the UK has affected the nurses andnurse/midwifes involvement in the long term. midwives involved.A Swedish qualitative study (Alex & Hammarstrom 2004) analysed womensSTUDYAIMS

experiences of induced abortion from a feministThis study aimed to examine: perspective and found that despite positive attitudes towards abortion generally,the womenHow nurses and midwives perceive their held negative attitudes towards their own abor-role with women undergoing termination of tion.Alex and Hammarstom (2004) advise thatpregnancy. nurses and midwives need to be aware of theHow nurses and midwives cope with their womens complex experiences with abortions increased involvement with women underin order to be able to support and empowergoing medical termination of pregnancy. women.In order to be able to assist the women, it is important that nurses/midwives are cog-This research study was undertaken as part of nisant of the effect of their own intense involve-a two-year Research Capacity Building Collaboment in such complex experiences.ration (Wales,UK) post-doctoral fellowship Intense involvement by nurses and midwivesscheme.Like most grounded theory researchers, with their patients has been termed emotionalI have found that there is more than one story labour and has been the subject of research andinherent in the data (Seibold 2000).I have chocommentary (Bolton 2000;Hemmerling et al.sen one specific story,but acknowledge that 2005;McCreight 2005;McQueen 1997;Phil-there may be many others,which have yet to be lips 1996;Smith 1992).In a qualitative study byanalysed. Bolton (2000) examining nurses on a gynaecological ward,emotional labour was classed METHODANDMETHODOLOGY as a gift given freely to the patient.McCreightIt is useful to distinguish between method and (2005),in her study of perinatal grief throughmethodology.Method describes the technique 31,Issue 1,December 2008CCCCNNNN

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A woman centred service in termination of pregnancyCCCCNNNN used in the research whereas methodologyEthical Approval was achieved in addition to describes the set of assumptions or theoreticalapproval from all 13 NHS Research and Develframework underpinning the research (Kingopment Committees in Wales,UK. 1994).As there is a limited amount of literature on this topic,a qualitative approach was chosenRECRUITMENT as an exploratory tool.Grounded theory wasLetters were sent to all nurses/midwives selected as the method for this study because involved in termination of pregnancy to all of its sociological basis and pragmatic originsNational Health Service trusts in Wales,UK via (Charmaz 2006).the nurse/midwife lead.Twenty-seven women The nature of the problem being investigatedexpressed an interest in participating in the was not certain at the outset of the study,as Iresearch.Homogenous sampling was used did not know whether nurses felt challenged orwhich enabled the termination of pregnancy compromised in their care giving.Therefore,subgroup to be accessed (Norwood 2000).All choosing a methodology at the beginning of theparticipants,who expressed an interest but study was not possible (Seibold 2000).Instead,were not recruited,were contacted and thanked a congruent methodology became apparent as for their offer to participate. I gathered data,began some tentative comparative analysis and read around the literature.PARTICIPANTS Reflexively I explored my own frame of refer-To meet the aim of the study,twelve particience,philosophical and ethical stance,which inpants were purposively chosen from nine of the turn evoked a feminist standpoint.Feminist the-thirteen NHS trusts in Wales.They were viewed ory has been recognised as having a substantialas being able to contribute substantially to the contribution to make to nursing since the 1980sresearch as they were experienced in the field (Huntington 2002).Seibold (2000) cites Len-of gynaecology and termination of

pregnancy germann and Niebrugge-Brantley (1988) in list-ranging from 10 to over 30 years experience. ing three broad tenets of feminist methodologyThere were five nurse/midwife specialists,one which were reflected in this study:First,thatmidwifery practitioner,two family planning womens experiences are central;second,thatnurses,three ward sisters and a ward staff the research attempts to see the world from thenurse.For ease of reading and to maintain womens point of view;and third,that theanonymity,the generic term nurse will be used researcher aims to improve the circumstancesthroughout.The educational background of the for women amongst others.In holding to theseparticipants varied from those with little posttenets,I was able to ensure that the balance ofregistration education to graduates. power between the participants and me as the researcher was as equal as possible.WuestDATACOLLECTIONANDANALYSIS (1995) argues that grounded theory accommo-Individual open-ended interviews were perdates feminist theory on several counts;firstlyformed over the summer of 2007 and each one that womens experience is a legitimate sourcelasted from forty-five minutes to an hour.In of knowledge,secondly that exploring a contextorder to meet the aims of the study during the allows discovery of social processes and lastlyopen-ended interview I asked the participants that the researcher is a social being and alsohow they perceived their role working with recreates social processes.women undergoing termination of pregnancy.I also asked about their increasing involvement ETHICALCONSIDERATIONSwith women undergoing medical termination of Prior to the research,Multiple Site Researchpregnancy.Data were collected and analysed 31,Issue 1,December 2008CCCCNNNN11Volume

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Allyson LippCCCCNNNN concurrently using constant comparative analy-and selection of the core category or central sis (Strauss & Corbin 1998).phenomenon of fostering a woman-centred Grounded theory demands sensitive inter-service.A simplified model of the grounded pretation of complex data and ways of rigor-theory can be found in Figure 1. ously exploring themes and discovering and testing patterns and NVivo 7 was used to assistRIGOUR in achieving this.Initially open codes wereTo be a credible source of knowledge,a qualitaestablished from the data.This allowed iden-tive research study should be produced to a rigtification of categories and subcategories.Fol-orous standard.Several ways of evaluating the lowing further interviews,the categories andrigour of such a study are outlined by Horsburgh subcategories were strengthened and refined(2002),for example,the use of the first person, using constant comparative analysis.For exam-the selection of participants,the interpretation ple,there were several references to the womenof their accounts and researcher flexibility and making their decision within their own circum-reflexivity during the research process. stances and that everyone was treated different-In adhering the Horsburghs (2002) guidely.These two categories were grouped into onelines,the first person has been used in this subcategory and eventually became part of theaccount,by me as a researcher and by the parcontext in which care was delivered (Figure 1).ticipants in their accounts of their practice. Eventually no new categories were found whichSample selection has been detailed sufficiently was consistent with data saturation (Charmazfor the reader to be able to determine that it 2006).Following this saturation more complexwas performed based on the participants ability coding was performed following Strauss andto contribute to the study.Participant validation Corbins (1990) method as confirmation of theoccurred after transcription where a

copy of process and to ensure rigour.This also providedeach individuals transcript was sent to all parthe platform for integration of the categoriesticipants for data verification.Throughout the

FIGURE1: A WOMAN-CENTREDSERVICEFORMEDICALTERMINATIONOFPREGNANCY

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A woman centred service in termination of pregnancyCCCCNNNN research process,my researcher flexibility andsee the counsellor they decide that its not the data credibility was enhanced via discussionsright decision for them and they would actuwith a peer mentor.He challenged my codingally like to continue with the pregnancy and process during the data analysis phase.Thesethats fine and they go away and thats lovely challenges also stimulated reflexivity where Iyou know,not a problem.(Interview 2) endeavoured to explore my motives and underpinning rationale as part of the research processEven though they have been counselled in (Lipp 2007).the pregnancy advisory clinic some are very Credibility allows a research study to beunsure.Those who are very unsure nine judged as reliable,and therefore replicable,iftimes out of ten theyd ring up and say Look, the reader can follow a decision trail (Appletonwe are going ahead with the pregnancy. 1995).Briefly describing the process of how the(Interview 3) grounded theory was generated has illuminatedMany of the participants acknowledged that it a decision trail,although word limit precludeswas the womans situation that led them to seek further detail.an abortion.Given other circumstances,some women may have chosen to continue with the FINDINGSpregnancy. In this section,the data will be examined inThe decision in most cases will have been a relation to the strategyof facilitating the deci-difficult one to make and the nurse may have sion,and the contextand influential conditionsofbeen involved from this point in the womans the decisions made,as well as the consequencesofcare: how nurses cope with women undergoing medical terminations of pregnancy.All of these cate-Its the biggest decision that a woman ever gories articulate with and support the centralhas to make,to have a termination.So I dont phenomenon of fostering a woman-centredthink people come to that decision lightly service,which will then be discussed in relationyou know.(Interview 4)

to its impact on nursing (Figure 1).I used to leave the day with a headache.I think thats most to do with the fact that you Facilitating the decisionare very mindful of the situation,or their cirA strategy employed by the participants was tocumstances and very mindful of what you are facilitate the womans decision making rathersaying to these women because number one than assuming that an abortion was the chosenyou dont want to influence their decision option (Figure 1).A womans decision to termi-and number two upset them any more and nate her pregnancy was considered a profoundmake the decision any harder than it is in the one by the participants.It was also deemed tofirst place.(Interview 5) be a decision likely to affect her implicitly or explicitly for a significant length of time.SomeThe above participant highlights the goal of participants were working at the initial stages facilitating the womans own decision-making of the termination of pregnancy service and inrather than advocating a specific decision.This some cases the woman may not have made herapproach relates strongly to the central phedecision,or may be thinking of reversing it:nomenon of fostering woman-centred care. I think that they werent really sure in theAppreciating the context beginning,but lets take the appointmentA number participants acknowledged that the anyway and see what happens and when theywomen made their decision in terms of their 31,Issue 1,December 2008CCCCNNNN13Volume

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Allyson LippCCCCNNNN own current circumstances.This was both anCoping with medical termination influential condition as well as providing a con-A further influential condition was the number text for care (Figure 1):of medical abortions which are rising in the UK At the end of the day,its their decision and I(Department of Health 2006).They are known feel like that the decision that they maketo be safe,effective and efficient (Rorbye et al. today is the right one for them at this time,2005).However,the participants had varying you know.(Interview 11)opinions of medical termination.For some,it was seen as going through the processwhereas Its not necessarily that the women whosurgical termination could be viewed by the attend the service want to have an abortion.Iwomen and even the nurses as a minor gynaecojust think that at the time at that specificlogical procedure such as a dilatation and curetmoment in their life its something thattage (D&C).One participant hypothesised that they have to do for one reason or another.going through the processmay limit the num(Interview 5)bers returning for repeat abortions: Rather than being autonomous in their decisionYes,if theyre typically a patient on the gynae making,the participants spoke of the womenward thats had pain,thats bled,potentially who were tiedinto relationships with others,seen this foetus,and lots of them do,they be it their partners,parents or other children,seem to be.Oh,I dont know,we dont tend and their relationships helped shape their cir-to have many of those coming back for a cumstances and thus their decision making (All-repeat termination ...In some ways its good mark 1995).The participants recognised thatif somebodys been through that process. they had to appreciate the womans individualThey know exactly whats happened;theyve

context and the influential condition of the seen it was a baby;but then is it a form of relationships within it in order to value thepunishment? (Interview 12) womans decision as her own. The participantsexpertise allowed them toViewing the abortion as punishment was an offer the appropriate options as well as perti-intriguing interpretation of events and it is posnent and timely advice,which in the majority ofsible that some women could perceive abortion cases led to timely decisions made by women.as a form of punishment. However,it was acknowledged by some that theIn contrast to the above example,another decision made was heavily dependent on cur-participant spoke in more positive terms of a rent circumstances:medical abortion allowing women to gain control: I only know what she tells me.Shes making a decision based on whatevers going on in herBut people that Ive spoken to afterwards life now,you know? And I just sort of thinkthat have had medical termination said they well if its not right for her now,then its nothave had ownership,they have had the power, right for her.Thats her decision you know?they have been able to,they have been in (Interview 12)control.With the surgical they have been out of control.It has been taken out of their The above example shows that should the deci-hands so when people have said they have had sion have been made in other circumstances ora surgical and then had a medical,erm,that at another time,it may very well have been aits,that they felt more in control,they were different one.more aware of what is going on and that the 31,Issue 1,December 2008CCCCNNNN

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A woman centred service in termination of pregnancyCCCCNNNN after effects were less than when they had theHaving given them the tablets, they see surgical.(Interview 1)the bleeding,they see the products,because they go to the toilet and some people This participant was alone in this study in feel-look and they are so upset because its a ing that some women gained control throughperfectly formed little baby and they dont having a medical abortion.expect it to be like that.(Interview 4) Surgical termination was still favoured by a number of participants who felt that,althoughThe nurses appreciate the toll that this process there was an anaesthetic risk,it was a relativelytook on the women,but only a few spoke of the minor procedure in which the woman has littleemotional burden for them: involvement and thus trauma.Ward participants spoke of the consequences of having moreIt does upset me sometimes when I see them hands-on involvement with medical termina-and you know? The student nurses keep saytions as well as the repercussions on the woman.ing I dont know how you can do this every There was recognition that the emotional side ofdayand I think if you are in it every day you care demanded a lot more of them as those clos-have got to obliterate it from your mind realest to the women during the process:ly,not just think about what you are actually doing sometimes.(Interview 3) Theyd come in for a surgical procedure. Youd prepare them for theatre.Youd takeFOSTERINGAWOMAN-CENTRED them to theatre.Youd care for them post-opSERVICE and theyd go home. it was still there,butThis was the central phenomenon of the the emphasis wasnt on the emotional side.grounded theory.In many of the services repAnd of course when we changed to medicalresented by the participants,nurses were at abortions,we were all thinking at the timethe forefront of service provision.However,it oh,my gosh.Putting patients through thatseems that rather than nurse-led services being a

sounded horrendous.Ignorance,I suppose,goal,the participants strived towards a womanand not familiar with it,but once we startedcentred service.This was evident in the particimanaging them medically,I think thats whenpants placing women as central in their own it really hit home how emotional the proce-decision-making.This strategy was adhered to dure was.(Interview 8)even when it would have been expedient for the nurse to coaxthe woman into making her I think that a SToP,although youve got a riskdecision: from the anaesthetic,I mean its much easier from their point of view,they go to sleep,I just deal with my ladies on a personal basis, they wake up and its done and they are withon a one to one and as an individual,and just us.(Interview 4)treat everybody differently due to their circumstances and do the best I can for them, It is clear that surgical termination allows nurs-erm.Because everybody has a different sort es and women to view surgical abortion as aof scenario and problem.(Interview 5) minor procedure whereas medical termination with the existent foetus makes the pregnancyIn a socio-economically deprived area,this loss a reality resulting in an emotional experi-nurse is in tune with the needs of the women ence for the woman and the nurse involved,asusing the service and has adapted it to be as can be seen in the data below:woman-centred as possible: 31,Issue 1,December 2008CCCCNNNN15Volume

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Allyson LippCCCCNNNN We try to limit the amount of visits to Gestation was a major time constraint on the service because of social problems,workdecision-making as it affected the type of aborcommitments,travel commitments and also,tion,the location of the procedure and even the being such a confidential service,a lot offeasibility of an abortion.The participants were women have to keep this confidential frommindful of ensuring that all the options were their home as well.We actually admit on agiven to the woman contingent on the gestation Sunday but we were finding a lot ofof the foetus.In a US study of factors hindering the women were declining the Sunday admis-access to abortion services,gestation limits sion even though the facilities were betterplayed a major part (Henshaw 1995).Like Henand the privacy was better.I think basicallyshaw (1995),other contextual constraints emanathere were problems with explaining to theirted from the location of the termination of relatives why they were missing on a Sunday.pregnancy service as some trusts offered med(Interview 5)ical termination of pregnancy only or contracted The data above reveal nurses putting the needstheir services out of Wales to England.The gesof the women first at a vulnerable time in theirtation limit differed in each trust,and even lives.between hospitals within trusts,which influenced advice and options that could be given by DISCUSSIONthe participants. The initial part of the discussion gives an insightSherwin (1989) proposes that contextualising into the first aim of the study of how the nursesa problem results in a solution which is possible perceive their role.This is focused on facilitatingwithin the womans circumstances.This view a womans decision on whether to undergo anechoes the data where the participants were abortion within a specific context.The latteracutely aware of how life can change

so rapidly. part of the discussion illuminates the secondThe decision for an abortion had been made in aim of establishing how nurses cope with thethe here and nowby the women and the nursrole of supporting women undergoing medicales seemed to sense this and became unwilling to termination.influence the decision in any way.The here The goal to provide comprehensive infor-relates to the womans individual context which mation in a neutral manner was an overridingthe nurses were at pains to explore in order to theme in the data and contributed towards theprovide individualised care,whereas the now ability of the women to make their own choicesrelates to the time constraints which were preswith their contextual constraints.The parti-ent when making a decision whether to abort cipants were keen to stress that the womansand if so,by which method. decision was a profound one and that their neu-Dealing with a woman undergoing abortion trality in encouraging the right decision wasdemands great skill and sensitivity often within essential.A study which explored womensa constrained period with the nurse circumexperience of referral for abortion in threenavigating embarrassment and vulnerability to inner London boroughs sought to determine ifensure that the woman has made the right deciservices met their expectations (Kumar et al.sion.This situation tested the nursesability to 2004).The authors found,during in-depthform meaningful relationships.Relationships are interviews that because most women had madeoften described as a web (Alderson 1991;Gillia decision to proceed with abortion beforegan 1982).This provides a graphic representaapproaching the health service,they preferredtion of the situation where the nurse is liaising not to discuss their decision but expected infor-with several colleagues,the woman and possibly mation and prompt referral.a partner or friend to ensure that information is 31,Issue 1,December 2008CCCCNNNN

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A woman centred service in termination of pregnancyCCCCNNNN communicated accurately,appropriately andhad been channeled into productive outcomes. sensitively within a limited time scale.AnotherBoltons study of offering emotion work as a gift dimension to the web is that not all relation-to women found that dealing with the womens ships are equal (Sherwin 1989).The womengrief was emotionally intensive for the nurses, attending were in a fragile state that made thembut that none of them regretted imparting the vulnerable to exploitation in relationships.As ingift (Bolton 2000). the above example,inherently the participantsWomen considering an abortion are generalseemed to recognise the inequity in the circum-ly not viewed favourably by society (Eposito & stances and try to reverse it by giving theBasow 1995) or by some health care professionwomen choice and space within the confines ofals (Ventura 1999;Webb 1984).Women also the context.judge themselves harshly when in need of an Viewing the abortion as a punishment was anabortion (Weidner & Griffitt 1984).OGrady intriguing interpretation of events by one par-(2005) explores womens relationship with ticipant.Given the possibility that some womenthemselves and finds that it is often womens could perceive abortion as a form of punish-relationship with others which defines them. ment,it is vital that the nurses and midwivesThis in turn subordinates them and their own involved manage the care to deflect this percep-needs and goals.Women also perform what tion by acting in a non-judgemental mannerOGrady (2005) terms selfpolicinginvolving (Koh 1999).Another participant was alone self-criticism leading to selfdoubt.Against this in feeling that some women gained controlbackdrop of disempowerment and vulnerability, through having a medical abortion.However,athe participants in this study were able to supUS study qualitatively analysed womens experi-port and empower the women to

make their ences of this procedure and found that womenown decisions by providing a woman-centred who chose their method wanted to maintainservice. control of the process (Fielding et al.2002).Much of the qualitative research on abortion The following latter part of the discussioncare has shown the emotional commitment necilluminates the second aim of establishing howessary for those caring for women undergoing nurses cope with the role of supporting womenabortion (Bolton 2000;McCreight 2005;Mcundergoing medical termination.The termQueen 1997).Their findings have been echoed obliteratewas used by one participant andin this research with most participants recognizothers used similar phrases to describe howing the emotional impact of medical abortion they overcame the emotional burden of termi-on the women and a few acknowledging their nation.Froggatt (1998) cites three ways inown burden.Providing a remedy for this emowhich the emotions can be contained:shuttingtional intensity would not be easy in the highoff removing access to the emotions;hard-pressured environment of acute gynaecology ening raising a barrier to the emotions;andservices.Moving abortion care into a less presstepping back being mentally distanced fromsured environment such as primary care may be the emotions.It is evident from the example inan option as long as it fulfills statutory obligaInterview 3 that during their initial experiencestions for the procedure.Formal support for the participant could not readily contain herthose involved such as guided reflection (Johns emotions,but that by shutting them offshe& Freshwater 1998) would highlight this issue at had learned to do so over time.The data never-level of service provision and may help those theless were replete with examples of compas-involved to articulate and work through the sion,dedication and justice for the women foremotions evoked by such intense involvement. whom they cared signifying that their concernsThe majority of quantitative research shows a

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Allyson LippCCCCNNNN degree of animosity towards the service fromprocedure for the woman as well as the nurse or barriers to access in Australia (Calcutt 2007)midwife. and France (Decerf et al.2000) and harassmentAn aim of feminist grounded theory is to in 45% of the 163 hospitals studied in Ferrismake a difference to the lives of those it studies. Canadian study (Ferris et al.1998) to violenceIn acknowledging the complexity of the task of and deaths in the USA cited by Ventura (1999).caring for women undergoing termination of Although no specific examples of harassmentpregnancy for nurses/midwives this research were evident in these data there was an appreci-has initiated the debate on how such care can be ation of the sensitivities surrounding the servicefacilitated in a woman-centred environment. by the participants.Within these constraints, good practice and expertise needs to be sharedAcknowledgements to ensure optimum care.For example,the all-The author would like to thank the Research Wales (UK) Termination of Pregnancy NetworkCapacity Building Collaboration,Wales,UK for meets regularly as a professional developmentthe funding and opportunity to undertake this and reflective practice forum in the area whereresearch. this research was undertaken.References This research has shown that despite the con-Alderson P (1991) Abstract bioethics ignores human tentious nature of the topic that those partici-emotions.Bulletin of Medical Ethics68:1321. pating in this study maintained a facilitativeAlex L and Hammarstrom A (2004) Womens experiapproach to their work,which enabled theences in connection with induced abortion a spective.Scandinavian Journal of Caring women to be at the forefront of the service at afeminist perScience18:160168. time when they were at their most vulnerable.Allmark P (1995) Can there be an ethics of care? Journal of Medical Ethics21:1924. Appleton J (1995) Analysing qualitative interview data:

CONCLUSIONAddressing issues of validity and reliability.Journal of

This study used feminist research as a method-Advanced Nursing22:993997. Who cares? Offering emotion work ology,which offered the opportunity to exam-Bolton SC (2000) as a giftin the nursing labour process.Journal of ine how nurses and midwives perceived theirAdvanced Nursing32(3):580586. role with women undergoing termination ofCalcutt C (2007) Abortion services in Australia. pregnancy and how nurses and midwives copeObstetrics and Gynaecology Magazine9(4):2728. with their increased involvement with theseCharmaz K (2006) Constructing grounded theory. women.London:Sage M,Deworme Publications C,Dumont Ltd.Decerf C and Gesche M A grounded theory of fostering a woman-(2000) Family planning professionals at centers centred service was developed through thewhere abortions are performed:Their beliefs,their process developed by Strauss and Corbin (Strausscoping strategies and their global state of health. & Corbin 1998).The participants used theirBulletin de Psychologie Scolaire et dOrientation49(3): expertise to guide the women through the93117. tment of Health (2006) Abortion statistics,England process so that they made the appropriateDeparand Wales:2006.London:Department of Health. choice of whether to have an abortion.NursesEposito C and Basow S (1995) College students and midwives took the womans individual cir-attitudes towards abortion:The role of knowledge cumstances into account and recognised that itand demographic variables.Journal of Applied Social must always be the womans decision.It becamePsychology25:19962017. clear that some participants had reservationsFerris LE,McMain-Klein M and Iron K (1998) Factors ery of abortion services in about the move towards medical terminationsinfluencing the delivOntario:A descriptive study.Family Planning as it highlighted the emotional impact of thePerspectives30(3):134. 18Volume 31,Issue 1,December 2008CCCCNNNN

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A woman centred service in termination of pregnancyCCCCNNNN

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