The process of caring: Nurses' perspectives on caring for women who end pregnancies for fetal anomaly

Abstract

<p>Grounded theory research was conducted with forty-one female, registered nurses from four Canadian hospitals who manage the genetic termination (GT) procedure for women who end a wanted pregnancy due to fetal anomaly. Based on the sociological concept of dirty work , interest focused on nurses' experiences with work that is viewed as unpleasant and undesirable, work that others would prefer not to do or even know about. The hospitals' inadequate organization and low priority of the GT procedure have largely contributed to the problems GT nurses face. These include lack of professional backup, lack of adequate procedures, protocols and policies, lack of specialized training, lack of choice and lack of support. GT nurses readily discuss a working situation fraught with uncertainties, tensions, dilemmas and frustrations, yet they also describe this work as professionally rewarding and personally gratifying. They found two central strategies to respond to the dirty work dimensions of their job. First, nurses see GT patients as presenting a unique opportunity for them to put into practice the most fundamental and core values of their profession--patient-centered care. Second, nurses have created a routine that allows them to more efficiently manage their work, caring for patients the best way they can. The exploration of these strategies led to a number of paradoxes experienced by the nurses. First, their isolation which is a part of the problem, also proved to be part of the solution as it afforded them a measure of professional and moral autonomy. Second, there is a built-in tension between the caring role and the routinization of the procedure that nurses managed by focusing on the unique aspects of GT work. Third, due to the intensely emotional aspects and ethically contentious nature of GTs, nurses care not only for their patients' emotional well being but their own as well. Fourth, nurses saw themselves as having two patients to care for, a mother at risk of needing emergency care and a stillborn baby. Fifth, a subtle degree of coerciveness exercised over the nurses made it clear that if they did not participate in GTs they may face possible disciplinary measures or risk losing camaraderie with their nursing colleagues. The strategies illustrate that amidst professional and ethical constraints GT nurses do not acquiesce to institutional powerlessness. Instead by interacting and negotiating with nurse colleagues and challenging the structure of the hospital and physicians' views, GT nurses have taken advantage of situational circumstances to strengthen their professional influence and provide the best possible care for their patients.</p>