La Realidad Multicultural de los Pueblos y Comunidades Indígenas: Una mirada a la

Based on the literature review and the research findings from this study, nurses working with women experiencing a crisis pregnancy would benefit from a standardized process based on evidence. According to Simmonds and Likis (2011), a broad

knowledge base and understanding of support needs is necessary to provide optimal care to women experiencing crisis pregnancy; however, training is not standardized, nursing education is inadequate, and clinical guidelines and competencies have not been

established. Based on the findings from this study and from previous research, nurses were able to clearly define the need for non-biased, non-judgmental interaction with women experiencing crisis pregnancy and the importance of confidentiality.

Defining the Role of the Nurse and Social Support

The findings suggest that these nurses did not clearly define their role in

addressing the social support needs of women experiencing crisis pregnancy. In addition, nurses may not adequately address each component of the Social Support Theory,

particularly informational support, a critical component of making an informed and autonomous decision (Simmonds & Likis, 2011). The findings further reveal that nurses did not see themselves as sources of support, nor did they seem to recognize the

important role they play in a woman’s decision-making process. Previous research has demonstrated that when healthcare professionals adequately address emotional,

relationships and connections with the women with whom they interact; in turn, women experiencing a crisis pregnancy are able to work through the decision-making process in a healthier and more autonomous manner (Aruda, Waddicor, Frese, Cole, & Burke, 2010). Defining the role of the nurse would help nurses to more clearly understand the importance they play in a woman’s support system and how they can help facilitate crisis resolution.

Options Counseling

Options counseling is a critical component of educating a woman and presenting her with every option (Simmonds & Likis, 2011). The findings suggest that options

counseling was not consistently offered. Findings suggest that the nurses did not fully explain or review the details of every option. They appeared to assume that the decision a woman made prior to her clinic visit was her final decision and truly reflective of her intentions; however, according to previous research and the literature review, this is not always the case. Many times women may feel ambivalent when discussing their decision with a healthcare provider; additionally, others who have seemed certain about their decision have changed their minds after having adequate time to reflect and consider their options. Furthermore, many women changed their minds about the pregnancy outcome after becoming educated and informed (Sweeny, 2008).

Limitations

This study has several limitations, such as small sample size and homogeneity of the nurses.

Additionally, it is uncertain and unknown how the women responded to the counseling they received.

Recommendations

Nursing Practice

One recommendation is to more clearly define the role of the nurse in caring for these women; this can be accomplished by using the Social Support Theory as a guide to address each of the components of the theory: emotional, informational, and instrumental support. There is a great need for women to dialogue about their decisions. Nurses can address their social support needs by asking questions, avoiding making assumptions, giving information, providing appropriate referrals, and remaining neutral and non- directive (Aruda et al., 2010). When nurses use Social Support Theory as a guiding framework, they may help women overcome crisis thinking.

Another recommendation suggested by the findings is the need to develop and implement a standardized training session for nurses about options counseling that

includes techniques and approaches based on the literature and the findings of this study. Emotional responses to a pregnancy and coping skills can vary among individuals and are not predictable or necessarily representative of a woman’s true pregnancy intentions (Aruda et al., 2010). Ambivalence is normal; women need time and thoughtful

consideration of all options and their potential impact (Aruda et al., 2010). Nurses must not assume a woman is seeking an abortion, even though she may be in a state of crisis. According to Simmonds and Likis (2011), women who are ambivalent are at risk and need greater levels of involvement from healthcare providers, particularly in providing

strong emotional support and referrals for in-depth counseling; however, evidence-based approaches for options counseling have not been established and nursing literature related to this subject is limited. Based on the findings from this study, nurses may make

assumptions about a woman’s pregnancy intentions, particularly when standardized approaches are lacking. One approach might be to have a protocol or guideline, possibly based on the Social Support Theory, to structure the clinic visit and ensure that a

woman’s comprehensive social support needs are addressed and met (Aruda et al., 2010). A comprehensive assessment tool that includes the social support needs of this population would help nurses to ensure that women have the opportunity to make informed decisions rather than making decisions based on crisis thinking.

Nursing Research

This is the first research study to explore the role of reproductive health nurses in a crisis pregnancy. This study needs to be replicated with a larger, more diverse sample in order to investigate whether all nurses have difficulty clearly defining their role in working with women experiencing a crisis pregnancy. Further research needs to be done to develop a standardized protocol to address women’s social support needs in a crisis pregnancy. A study could be conducted about nurses’ perceptions of the barriers to providing options counseling. Further research exploration of women’s reactions to structured options counseling and their levels of satisfaction related to their pregnancy decision outcome would also benefit women.

Nursing Education

One recommendation for nursing education is that content related to crisis pregnancy and options counseling might be introduced in the undergraduate nursing curriculum. The content might include discussing the needs of this vulnerable population and how the Social Support Theory can be used as a guide for a structured options

counseling session.

Conclusions

The aim of the study was to interview nurses working in reproductive health related to the role of the nurse in providing social support to women experiencing a crisis pregnancy.

Content analysis of the transcripts revealed two themes: defining the role of the reproductive health nurse and defining women’s support needs. Recommendations for nursing practice, research, and education were identified. Findings from this study suggest that nurses need education about the important needs of women during a crisis pregnancy beginning in their undergraduate nursing education. Additionally, nurses would benefit from using a standardized protocol to guide options counseling sessions with women experiencing a crisis pregnancy.

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APPENDIX A

Interview Questions:

1) What sparked your interest about reproductive health nursing? 2) How would you define a crisis pregnancy?

3) How would you describe your role in caring for a woman experiencing a crisis pregnancy?

4) What top needs to do you think these women have when they come in to see you? 5) What does a woman need to know in order to make an informed decision about

her crisis pregnancy?

6) What kinds of emotional support do you think these women need? 7) What kinds of information or education do these women need?

8) What kinds of resource information or information on community services do you think they need?

9) In your experience, how does a woman’s perception of support affect her decision about her pregnancy?

10) How would you describe your role in helping these women make a decision about their pregnancy?

11) Can you give me an example of how you might normally provide emotional support?

12) What kinds of information would you give her?

13) If a woman seems unsure about what to do, how do you deal with this situation? What would you do or what would you tell her?

14) How does a woman’s cultural or ethnic background influence her support needs when making a decision about her crisis pregnancy?

Demographic Questions:

1) How long have you been a nurse?

2) How long have you worked in reproductive health? 3) What is your gender?

4) What is your age?

APPENDIX B

Cover Letter

Nurses’ Perceptions of the Support Needs of Women Experiencing a Crisis Pregnancy

Kristyn Dyson, a graduate student at Boise State University, is conducting a research study to evaluate nurses’ perceptions regarding the support needs of women experiencing a crisis pregnancy. You are being asked to participate in this survey because you are a nurse who works in reproductive health.

Participation is voluntary. The phone interviews will take 30 to 60 minutes to complete. You must be at least 18 years old to participate in this interview. We ask that you try to answer all questions; however, if there are any items that you would prefer to skip, you may let the interviewer know at anytime. Your responses are anonymous.

This study involves no foreseeable serious risks. However, you will be asked questions about your work experience with women experiencing a crisis pregnancy and your perceptions of their needs.

If you think you are interested and would like some additional information about participating, please contact Kristyn or her faculty advisor:

Name: Kristyn Dyson, Graduate Student Dr. Jane Grassley, Associate Professor

Department: Nursing Nursing

Boise State University Boise State University

Phone: (208) 340-6676 (208) 426-1670

Email: [email protected] [email protected]

If you voluntarily agree to participate, please call Kristyn Dyson at 208-340-6676 or email her at [email protected] to arrange a phone interview.

APPENDIX C

Principal Investigator (PI): Kristyn Dyson, M.S.N. Student

Co-Investigator (Co-I): Dr. Grassley, Associate Professor, Faculty Advisor Study Title: Nurses’ Perceptions of the Support Needs of Women Experiencing a Crisis Pregnancy

This consent form will give you the information you will need to understand why this study is being done and why you are being invited to participate. It will also describe what you will need to do to participate and any known inconveniences and benefits that could arise from participating. We encourage you to ask questions at any time. If you decide to participate, you will contact the researcher and give verbal consent that you agree to participate.

PURPOSE AND BACKGROUND

You are invited to participate in a research study to learn more about nurses’ perceptions of the support needs of women experiencing a crisis pregnancy. The information gathered will be used to better understand how nursing interventions have the potential to help this population of women. You are being asked to participate because you are a nurse working in reproductive health.

For interview: PROCEDURES

If you agree to be in the study, you will be asked to participate in a brief phone