8 Abortion (Termination of Pregnancy) Nursing Care Plans

Anxiety

Termination of pregnancy (TOP) is different from other reproductive losses as it involves a “choice” of the woman to terminate a pregnancy or not, but the event itself is a stressful situation and can become traumatic for some women. Posttraumatic stress (PTS) is associated with perinatal grief, depression, and anxiety for pregnant women with prior medical TOP or miscarriage. For women, anxiety was associated with PTS during pregnancy, but for men, anxiety was associated with PTS during and after delivery (Daugirdaite et al., 2015).

Nursing Diagnosis

• Anxiety

May be related to

• Stress
• Situational/maturational crises
• Unmet needs
• Unconscious conflict about essential values/beliefs

Possibly evidenced by

• Apprehension
• Fear of unspecified consequences
• Focus on self
• Impaired attention
• Increased tension
• Preoccupation
• Sympathetic stimulation

Desired Outcomes

• The client will recognize the presence of anxiety.
• The client will identify the cause of anxiety.
• The client will begin to use positive coping strategies to adjust to the situation.
• The client will use resources/support systems effectively.
• The client will report anxiety reduced to a manageable level.

Nursing Assessment and Rationales

1. Assess the client’s anxiety and encourage them to express their feelings.
The client and her partner may be dealing with feelings of guilt, and they typically will go through a grieving process and have symptoms of anxiety and depression. Encourage the client and her partner to allow themselves to grieve. The client and her partner may grieve differently; specifically, they may go through the stages of grief in different orders or at different rates (Griebel et al., 2005).

2. Assess the client’s and her partner’s cultural beliefs.
Polarised debates on abortion result in women being stigmatized and feeling like social outcasts. Abortion laws are also influential as they dictate the timing and medical conditions for which pregnancies can be terminated. The environment in which the client is cared for and the doctor-client relationship also influence the client’s experience. In Vietnam, women’s deference to clinicians prevents them from asking questions, and some women describe feeling ashamed of involving the healthcare provider in an “unpleasant experience.” In contrast, in other medical cultures, women are encouraged to ask questions and, where possible, participate in their care (Lafarge et al., 2014).

Nursing Interventions and Rationales

1. Establish a therapeutic relationship, conveying empathy and unconditional positive regard.
Above all, women value empathic and compassionate care. They are grateful when health professionals acknowledge that their pregnancy is wanted and care for them in a non-judgmental way. They drive comfort from health professionals’ acts of kindness, which sometimes can stretch beyond the usual health care professional-client boundaries. Receiving respect and dignity for themselves and their baby is critical (Lafarge et al., 2014).

2. Provide psychological and mental comfort for the client and her partner.
Comfort from nurses is unique and expected, routinely offered when infants are lost at term, and has recently been taught to other professions. Clients benefit from the comfort provided by nurses perhaps more than any other time. It is critically important that nurses, regardless of their personal feeling about the type of loss, reach out and offer comfort (Catlin, 2018).

3. Provide comfort measures such as breathing and relaxation techniques.
This can influence physiological responses (BP, pulse, and respiration). Tense muscles may interfere with the procedure. Offer relaxation techniques such as back massage, guided imagery, and the use of touch, if culturally acceptable. Being relaxed may encourage the client to verbalize feelings, thus reducing anxiety and fear.

4. Explain procedures before they are performed, and stay with the client to provide concurrent feedback.
A physical presence is reassuring and can increase cooperation and promote a sense of security. Counseling about abortion includes help for the client in identifying how she perceives the pregnancy, information about the choices available, and information about the types of abortion procedures (Alden et al., 2019). Providing the client with information enables them to make informed decisions and cope with the termination long-term. Information provision can also be empowering, enabling women to regain control over a situation many feel they have no control over (Lafarge et al., 2014).

5. Provide a support person/family member to stay with the client, particularly if she is undergoing a second-trimester procedure requiring induction of labor.
The presence of a familiar person can help reduce client anxiety and promote relaxation and coping. According to some studies, anxiety symptoms are associated with a higher incidence of depression and poor social support during pregnancy and postpartum (Loren-Guerrero et al., 2017).

6. Explore spiritual support as a resource.
Spiritual support of the family’s choice and community support groups may help the family work through the grief and anxiety of any pregnancy loss.

7. Encourage questions and provide time for the expression of fears.
This may provide an opportunity to identify and clarify misconceptions and offer emotional support. Women value timely, transparent, and unbiased information that they can understand about the abnormality, the termination procedure, and what to expect post-termination (Lafarge et al., 2014).