关于提供堕胎护理的体验和心理社会影响的元民族志研究。

A meta-ethnography on the experience and psychosocial implications of providing abortion care.

机构信息

School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa; Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.

School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.

出版信息

Soc Sci Med. 2023 Jul;328:115964. doi: 10.1016/j.socscimed.2023.115964. Epub 2023 May 13.

DOI:10.1016/j.socscimed.2023.115964

PMID:37229933

Abstract

RATIONALE

Challenges unique to abortion care have negative implications for access to safe abortion and the psychosocial well-being of healthcare providers. A deeper understanding of the experience of providing abortion care can inform responsive interventions toward supporting abortion providers and strengthening health systems.

OBJECTIVE

A meta-ethnography was conducted to describe the experiences of providing abortion care and offer broad conceptual implications of abortion providers' experiences on their psychosocial coping and well-being.

METHODS

International grey and published research reported in English between 2000 and 2020 was identified via Web of Science Core Collection, PsycInfo, PubMed, Science Direct and Africa-Wide. Studies conducted in contexts where elective abortion is legally permitted were included. Study samples included nurses, physicians, counsellors, administrative staff and other healthcare providers involved in abortion care. Qualitative studies and qualitative data from mixed designs were included. The Critical Appraisal Skills Programme tool was used for appraisal and data was analysed using a meta-ethnographic approach.

FINDINGS

The review included 47 articles. Five themes arose from the data including the emotional challenges of providing clinical and psychological care, organisational and structural challenges, experiences characterised by stigma, pro-choice narratives, and coping with challenges. Outcomes ranged from moral and emotional alignment, resistance to abortion stigma, and job satisfaction to moral distress, emotional suppression, internalised stigma, selective participation and discontinuation of abortion care. Outcomes were dependent on the nature of interpersonal relationships, working conditions, the internalization of positive or negative messages about abortion, personal history and individual coping styles.

CONCLUSIONS

Despite facing significant challenges in their work, the presence of positive outcomes among abortion providers and the moderating role of external and individual-level factors on well-being have encouraging implications for supporting psychosocial wellness among abortion providers.

摘要

背景

提供堕胎护理所面临的挑战对安全堕胎的机会和医疗保健提供者的心理社会健康产生负面影响。更深入地了解提供堕胎护理的经验可以为支持堕胎提供者和加强卫生系统提供响应性干预措施提供信息。

目的

进行了元民族志研究，以描述提供堕胎护理的经验，并提供堕胎提供者经验对其心理社会应对和福祉的广泛概念影响。

方法

通过 Web of Science 核心合集、PsycInfo、PubMed、Science Direct 和 Africa-Wide 检索了 2000 年至 2020 年期间以英文发表的国际灰色文献和已发表研究。纳入了在合法允许选择性堕胎的背景下进行的研究。研究样本包括参与堕胎护理的护士、医生、顾问、行政人员和其他医疗保健提供者。纳入了定性研究和混合设计的定性数据。使用批判性评估技能计划工具进行评估，使用元民族志方法分析数据。

发现

综述包括 47 篇文章。从数据中出现了五个主题，包括提供临床和心理护理的情感挑战、组织和结构挑战、以耻辱为特征的经历、支持选择的叙述以及应对挑战。结果范围从道德和情感一致、抵制堕胎耻辱感以及对工作的满意度，到道德困境、情绪压抑、内化耻辱感、选择性参与和停止堕胎护理。结果取决于人际关系的性质、工作条件、对堕胎的积极或消极信息的内化、个人经历和个人应对方式。