UPPC Essential Competencies Resource Guide

 

This Resource Guide is based on Essential Competencies in Unintended Pregnancy Prevention and Care for Nursing Education (Hewitt, C., and Cappiello, J., 2015), which presents 27 core competencies as a framework for curricular development in nursing education. Based on these competencies, this Resource Guide contains tools, articles, presentations, workbooks, and sample materials for faculty to incorporate into their curricula, for nursing students to further their education, and to improve clinical services for women experiencing unintended pregnancy.

Within each of the 27 competencies there is section on “Building Competency” that provides links to relevant Nursing Education Modules on Professional Ethics, Public Health, Options Counseling, Postpartum Contraception, Global Health, and Quality and Safety. These modules were created to supplement existing nursing curricula to broaden the scope and accessibility of education on unintended pregnancy prevention and care.

UPPC Resources

1 : Demonstrate knowledge of the nurse’s professional responsibilities in providing health care to clients in need of unintended pregnancy prevention and care.

Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs
This set of guidelines for the provision of quality family planning and related preventive health services in primary care settings was released as a CDC Morbidity and Mortality Weekly Report (MMWR) in April 2014. The report details recommendations for the provision of contraceptive services, pregnancy testing and counseling, including effective options counseling.

The Role of Nursing in the Management of Unintended Pregnancy (Levi, A. J., et al., 2009)
This article addresses the role of nurses in the prevention, treatment, and management of unintended pregnancy. Through the nurse’s role of educating the patient and her family the authors discuss how the nurse is able to use unintended pregnancy prevention strategies for women and their families.

Caring for Women with Unintended Pregnancies (Simmonds, K. & Likis, F.E., 2011)
This article highlights the nurse’s professional responsibilities in providing care to women with unintended pregnancies which includes appropriate assessment, options counseling, referrals and care coordination, and prevention efforts.

Certified Nurse-Midwives, Nurse Practitioners, and Physician Assistants as Abortion Providers
This fact sheet from Clinicians for Choice details the professional scope of practice of CNMs, NPs, and PAs with regard to abortions care and services.

Sexual and Reproductive Health Core Competencies in Primary Care (World Health Organization, 2011)
In this document the WHO presents core competences in sexual and reproductive health that should be addressed in primary care settings including essential services and principles of service provision.

American College of Nurse Midwives Code of Ethics (2005)
Certified nurse-midwives and certified midwives have three ethical mandates. The first mandate is directed toward the individual women and their families, the second mandate is to a broader “public good” for the benefit of all women and their families, and the third mandate is to the profession of midwifery to assure its integrity.

The Limits of Conscientious Refusal in Reproductive Medicine (ACOG, 2007)
The ACOG Committee on Ethics developed a specific ethical statement on the provision of reproductive health care: Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient’s health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities. Conscientious refusals that conflict with patient well-being should be accommodated only if the primary duty to the patient can be fulfilled.

FIGO Code of Ethics
The International Federation of Gynecology and Obstetrics and states that reproductive and sexual health of women is often compromised, not necessarily because of lack of medical knowledge, but rather as a result of basic infringements of women’s human rights that also violate the basic and universally agreed upon ethical and professional responsibilities of professionals caring for women.

Guide to the Code of Ethics for Nurses (Fowler, M., 2010)
Developed in 1950, the Code of Ethics for Nurses (ANA, 2001), Provision One states that nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. Provision Three states the nurse promotes, advocates for and strives to protect the health, safety and rights of the patient. Provision Five addresses that the nurse owes the same duties to self as to others including the responsibility to preserve integrity (…).

The Concept of ‘Nursing’ in the Abortion Services (Gallagher, K., et al., 2010)
This qualitative study investigates the perceptions of nurses who work in abortion services through in-depth interviews with nine nurses from three different abortion clinics in the United Kingdom.

The International Council of Nurses Code of Ethics (2012)
The ICN Code of Ethics for Nurses, fist adopted in 1953, is a guide for action based on social values and needs. The Code state that inherent in nursing is respect for human rights, including the right to life, to dignity and to be treated with respect and supports nurses’ refusal to participate in activities that conflict with their caring and healing.

Health Professions Education: A Bridge to Quality
Using IOM competencies, the QSEN project defined quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing pre-licensure programs for each competency.

Providing Abortion Care: A Professional Toolkit for Nurse-Midwives, Nurse Practitioners, and Physician Assistants
This toolkit provides a thoroughly researched and referenced discussion of scope of practice and abortion care as pertains to APNs and physician assistants.

Stigma in Abortion Care: Application to a Grounded Theory Study (Lipp, A., 2011)
The author applies a stigma theory to explore the intersection of nursing care and the stigma of providing abortion care.

Self-Preservation in Abortion Care: a Grounded Theory Study (Lipp, A., 2011)
Using a grounded theory approach this article examines why and how nurses concede and conceal their judgment of women seeking medication abortion services.

The Complex Work for RNs: Implications for Healthy Work Environments (Ebright, P., 2010)
This article describes the complex work of registered nurses in today’s healthcare settings.  The article addresses the complexity in delivering patient care by reviewing recent research on the work of nursing and explaining the concept of nurse cognitive stacking.

A Woman Centered Service in Termination of Pregnancy: A Grounded Theory Study (Lipp, A., 2008)
This grounded theory study explores how nurses and midwives perceive their role in working with women undergoing termination of pregnancy and how they manage their increased involvement with these women.

Applying Ethical Practice Competencies to the Prevention and Management of Unintended Pregnancy (Cappiello, J., et al., 2011)
This article uses a case study that incorporates nurse practitioner, patient, and student perspectives to address ethical principles of beneficence, fairness, respect for autonomy, and professionals’ right of conscience. The article is designed to help nurses prepare for providing reproductive health care to women through values clarification and self-reflection.

Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care (ACLU, 2013)
Religious restrictions govern health care at Catholic-sponsored hospitals and networks. Within these systems, health professionals are prohibited from providing specific health services or honoring patients’ health care decision-making when it conflicts with religious doctrine. Often health professionals are prohibited from providing basic counseling and referrals for services prohibited on religious grounds, such as counseling and referrals for unplanned pregnancy.

Care for Women Choosing Medication Abortion (Taylor, D., et al., 2004)
This article addresses the nurse practitioner’s role in providing medication abortions, details the pharmacology involved, and uses case studies to present counseling, complications and potential sides effects, and confirming complete abortion.

Professional Right of Conscience (Beal, M.W. and Cappiello, J., 2008)
This article provides background on professionals’ right of conscience, a review of how the issue has been addressed in literature, and approaches that are recommended from professional organizations are discussed.

Conscientious Objection in Medicine (Savulescu, J., 2006)
This British medical ethicist crafts a strong argument regarding conscientious objection in the daily practice of medicine. His points include that a doctor’s conscience should not be allowed to interfere with medical care, all doctors and medical students should be aware of their responsibility to provide all legal and beneficial care, conscientious objection may be permissible if sufficient doctors are willing to provide the service, conscientious objectors must ensure that their patients are aware of the care they are entitled to and refer them to another professional and that conscientious objectors who compromise the care of their patients must be disciplined.

Conscientious Objection in Health Care: An Ethical Analysis (Wicclair, M.R., 2011)
Wicclair offers a comprehensive ethical analysis of conscientious objection in three representative health care professions: medicine, nursing and pharmacy. He critically examines two extreme positions: the ‘incompatibility thesis’, that it is contrary to the professional obligations of practitioners to refuse provision of any service within the scope of their professional competence; and ‘conscience absolutism’, that they should be exempted from performing any action contrary to their conscience.

The Celestial Fire of Conscience-Refusing to Deliver Medical Care (Charo, R., 2005)
Charo muses on the “tricky business of conscience” and what it means to be a health care provider in the U.S, touching on the surge of conscience clause legislation, pharmacists refusing to dispense legal prescriptions and the influence of religion on our culture.

Theory of Social Justice is Defined as Working to Address Disparities of Health and Care
This In Focus series in the Journal of Obstetrical, Gynecologic, Neonatal Nursing (JOGNN) discusses the application of the theory of social justice to address disparities in health care.  The authors suggest that if nurses adopt an ethical framework of social justice, nurses can better understand and thus influence outcomes and ameliorate health disparities and inequalities.  Readers can apply the social justice theory to the provision of reproductive health care along with other aspects of care.

Religion, Conscience, and Controversial Clinical Practices (Curlin, F.A., et al. 2007)
In this study, the authors conducted a random sample of 2000 U.S. physicians about their beliefs about their ethical rights and obligations when patients request a legal procedure to which the physician objects for moral or religious reasons. The results found that most physicians indicated they would do so, some physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures.

Dishonourable Disobedience – Why Refusal to Treat in Reproductive Healthcare is Not Conscientious Objection (Fialaa, C. and Arthur, J., 2014)
In medicine, the majority of conscientious objection is exercised within the reproductive health care.  According to the authors, current laws and practices suggest that conscientious objection impacts women’s healthcare and rights negatively. Healthcare professionals who exercise conscientious objection are using their position of trust and authority to impose their personal beliefs on patients, which is a failure to perform one’s professional duty.

When Should Conscientious Objection be Accepted? (Magelssen, M., 2012)
The main interests that are at stake in the dilemma of conscientious objection are the patient’s interests and the health professional’s moral integrity. Magelssen defines five criteria for evaluating the acceptability of claims to conscientious objection.

Conscientious Objection in Nursing: Definition and Criteria for Acceptance (Lachman, V. D., 2014)
Lachman provides of review of conscientious objection in nursing with reference to the ANA Code of Ethics and Magelsson’s criteria.

Health Care Refusals: Undermining Quality Care for Women (Weitz, T.A., and Fogel, S.B., 2009)
This report from the National Health Law Program provides provides background and analysis of the ethical and legal concepts of standards of care and informed consent, and then analyzes religious, ideological and political restrictions and denials of care that conflict with and undermine established clinical and professional standards. It also provides detailed descriptions and analysis of the standards of care that govern health professional practice for a range of common health conditions and illustrates how refusals and denials of care violate those standards and put population health at risk, particularly sexual and reproductive health. This analysis provides a new framework for evaluating refusal clauses and denials of care, hospital mergers, and other transactions when they conflict with accepted and expected medical and nursing practice.

Crisis Pregnancy Centers (CPCs)
This web page from NARAL Pro-Choice America describes a woman’s typical experience encountering a CPC, the false information that is often presented at these centers, and some state-specific information on CPCs.

False and Misleading Health Information Provided By Federally Funded Pregnancy Resource Centers
This report from the U.S. House of Representatives’ Committee of Government Reform details the false and misleading information that was provided during an investigative study of pregnancy resource centers.

Evaluating Priorities: Measuring Women’s and Children’s Health and Well-being Against Abortion Restrictions in the States
This joint report from Ibis Reproductive Health and the Center for Reproductive Rights showed that states with more abortion restrictions performed worse overall on women’s and infant’s health indicators compared with states with fewer restrictions.

The Denial of Abortion Care Information, Referrals, and Services Undermines Quality Care for U.S. Women (Weitz, T.A., and Fogel, S.B., 2010)
In this commentary, Weitz and Fogel summarized their careful crafting of an argument as to how conscience clauses affect adherence to evidence-based benchmarks of quality and safety in abortion care. See their full report on the National Health Law Program website.

Building Competency: Nursing Education Modules

Global Health
Professional Ethics
Public Health

2 : Demonstrate the ability to provide unintended pregnancy prevention and care that is free of evidence of bias and judgment.

Objective Structure Clinical Examination: Non-Directive Pregnancy Options Counseling with Communication and Ethical Challenges (Lupi, C., et al. 2012)
This resource consists of two case studies of women who are diagnosed with unexpected early intrauterine pregnancy. The evaluation tool can be used to assess competency in non-directive options counseling, responding to patient ambivalence, delivering bad or unexpected news, and responding to a patient’s request for moral guidance.

Options Counseling: Techniques for Caring for Women with Unintended Pregnancies (Singer, J., 2004)
This article serves as a guide for clinicians to examine their own beliefs and values to improve their skills in providing nonjudgmental and nondirective options counseling for women experiencing unplanned pregnancy.

Options Counseling for Unintended Pregnancy
This presentation from Provide’s ROE (Reproductive Options Education) Consortium was designed to give nurses and APRNs information on attitude, skills, and knowledge needed to provide options counseling to patients who experience unintended pregnancy.

Providing Options Counseling for Women with Unintended Pregnancies (Simmonds, K., and Likis, F., 2005)
This article addresses the conflicts that nurses may experience when providing unintended pregnancy prevention and care, and examines the intersection of personal values with professional responsibilities. The article also provides epidemiological data on unintended pregnancy and strategies for providing options counseling.

The Abortion Option: A Values Clarification Guide for Health Care Professionals
These exercises from the National Abortion Federation are designed to help nurses critically examine factors that might influence their beliefs about parenting, adoption, and abortion and, for some, their desire to become involved in abortion care. There are tools for clarifying values related to abortion, views about the role of health care providers, and case studies are presented to identify and examine potential biases.

Abortion: Quality Care and Public Health Implications
This course from the University of California, San Francisco addresses abortion in a global context, professionalism and patient-centered care, different abortion procedures, obstacles to access.

Building Competency: Nursing Modules

Options Counseling
Public Health

3 : Demonstrate ability to recognize unique reproductive health needs of women from vulnerable and special populations (e.g. adolescents, women with mental or physical disabilities, survivors of violence) affected by many factors (e.g. relationship status, sexual orientation).

Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality (Metzl, J. M., and Hansen, H., 2014)
The term “structural competency” refers to a shift away from approaches that focus solely on cross-cultural understandings of individual patients, toward a broader view of the social and economic forces that affect patient’s health in addition to their individual interactions with health care providers.

Cultural Humility is the First Step to Becoming Global Care Providers (Miller, S., 2009)
This paper describes the shift in nursing education from teaching cultural competency with its focus on the ability of nurses to interact effectively with people of different cultures, to cultural humility. Cultural humility does not have the goal of mastering another culture, rather it suggests a continual, active process of self-reflection; a way of being in the world and being in relationships with others.

Reproductive Injustice: Racial and Gender Discrimination in US Health Care
This report from the Center for Reproductive Rights, the National Latina Institute for Reproductive Health, and SisterSong Women of Color Reproductive Justice Collective evaluates how the United States has addressed racial and gender discrimination in reproductive health care through highlighting disparities in key reproductive health indicators and using international human rights standards as a backdrop.

The Risk of Unintended Pregnancy Among Young Women with Mental Health Symptoms (Hall, K.S., et al., 2014)
This article describes a longitudinal study of 992 women who were assessed for depression and stress symptoms, and the results which show that the risk of unintended pregnancy was higher among women with baseline depression and/or stress.

Clinical Content of Preconception Care: Preconception Care for Special Populations (Ruhl, C. and Moran, B., 2008)
This article emphasizes how preconception management and guidance is essential for women with disabilities, immigrant and refugee women and cancer survivors to ensure they are able to make informed reproductive decisions for optimal reproductive outcomes.

Provision of Contraceptive Services to Homeless Women: Results of a Survey of Health Care for Homeless Providers (Saver, B.G., et al., 2012)
This small study found that significant barriers exist for homeless women seeking contraceptive services, specifically LARC methods, which may contribute to the higher proportion of unintended pregnancies in the homeless population compared to those with stable housing.

Opioid Use, Dependence, and Addiction in Pregnancy (ACOG, 2012)
This is American College of Obstetricians and Gynecologists committee opinion on how to assist women using opiods during pregnancy to obtain effective treatment.

Sexual History Taking Role Play
This exercise from CORE (Curricula Organizer for Reproductive Health Education) is designed to help health care professionals improve their knowledge, skills, and comfort with sexual history taking and risk assessments. The worksheet includes questions to ask when taking a sexual history, specifically when working with LGBTQ patients.

Improving the Health Care of Lesbian, Gay, Bisexual and Transgender People: Understanding and Eliminating Health Disparities
This publication from The Fenway Institute includes facts and terminology regarding the LGBT population, charts and recommendations for collecting key sexual health and behaviors information from patients, and recommendations for improving health care settings to better serve this population.

Do Ask, Do Tell (Potter J.E., 2002)
This article examines the importance of creating an environment that allows patients to disclose their sexual orientation and behaviors, a critical component to establishing a productive, therapeutic patient/doctor relationship. The author uses her own experiences as a lesbian patient and doctor to illustrate how creating such an environment is essential to the provision of preventive health counseling and the challenges and rewards of coming out as a gay physician.

Preventing Pregnancies in Younger Teens (CDC, 2014)
These resources from Centers for Disease Control and Prevention include a fact sheet on teen pregnancy, two brief case studies, ways parents/guardians, health care professionals, and teens can address the issue, and a list of related resources.

Addendum-Adolescent Pregnancy: Current Trends and Issues (American Academy of Pediatrics, 2014)
This addendum serves as an update for pediatricians and other professionals on recent research and data regarding adolescent sexuality, contraceptive use, and childbearing since publication of the original 2005 clinical report, “Adolescent Pregnancy: Current Trends and Issues.”

Shifts in Intended and Unintended Pregnancies in the United States, 2001-2008 (Finer, L. B. and Zolna, M. R., 2014)
The authors monitored trends in pregnancy intendedness nationally and within subpopulations and also reported on pregnancy outcomes.

Intimate Partner Violence During Pregnancy, A Guide for Clinicians
This set of slides from the Centers for Disease Control and Prevention (CDC) provide facts about intimate partner violence, identifies types of abuse, provides data on violence and pregnancy, and gives recommendations for clinicians to identify abuse and support victims.

Understanding and Preventing Violence (CDC, 2013)
This document from Centers for Disease Control and Prevention (CDC) highlights risks for violence and prevention strategies as well as protective influences for different forms of violence including intimate partner violence, youth violence, and dating violence.

Building Competency: Associated Nursing Modules

Global Health
Options Counseling
Professional Ethics
Public Health
Quality and Safety

4 : Demonstrate ability to identify personal beliefs which may interfere with provision of unintended pregnancy prevention and care.

Values Clarification and Options Counseling for Unintended Pregnancy (Hart, J.A., et al., 2013)
This article emphasizes the importance of providing unbiased, compassionate, and factual options counseling for women experiencing unintended pregnancy, and identifies the difficulties of counseling women with religious affiliations to help them address any potentially conflicting feelings between their religious beliefs and their abortion decision.

The Abortion Option: A Values Clarification Guide for Health Care Professionals
These exercises from the National Abortion Federation are designed to help nurses critically examine factors that might influence their beliefs about parenting, adoption, and abortion and, for some, their desire to become involved in abortion care. There are tools for clarifying values related to abortion, views about the role of health care providers, and case studies are presented to identify and examine potential biases.

Effect of Nurses’ Attitudes on Hospital-Based Abortion Procedures in Massachusetts (Kade, K., et al., 2004)
This study used qualitative data from physicians and nurse managers to explore how nurses’ attitudes affect hospital-based abortion services in Massachusetts. The study concludes that nurses’ attitudes toward abortion and their unwillingness to participate in procedures may hinder access to abortion services.

Options Counseling: Techniques for Caring for Women with Unintended Pregnancies (Singer, J., 2004)
This article serves as a guide for clinicians to examine their own beliefs and values to improve their skills in providing nonjudgmental and nondirective options counseling for women experiencing unplanned pregnancy.

Options Counseling for Unintended Pregnancy
This presentation from Provide’s ROE (Reproductive Options Education) Consortium was designed to give nurses and APRNs information on attitude, skills, and knowledge needed to provide options counseling to patients who experience unintended pregnancy.

Providing Options Counseling for Women with Unintended Pregnancies (Simmonds, K., and Likis, F., 2005)
This article addresses the conflicts that nurses may experience when providing unintended pregnancy prevention and care, and examines the intersection of personal values with professional responsibilities. The article also provides epidemiological data on unintended pregnancy and strategies for providing options counseling.

A Review of Termination of Pregnancy: Prevalent Health Care Professional Attitudes and Ways of Influencing Them (Lipp, A., 2008)
This paper explores research that has been conducted on health care professionals’ attitudes towards abortion, and gives consideration to various remedies that create optimal environments for women who undergo a termination of pregnancy.

Abortion Onscreen
This webpage from Advancing New Standards in Reproductive Health (ANSIRH) describes a research program that explores how abortion stories are incorporated into American film and television culture and how this may impact the broader social understanding of abortion.

False and Misleading Health Information Provided By Federally Funded Pregnancy Resource Centers
This report from the U.S. House of Representatives’ Committee of Government Reform details the false and misleading information that was provided during an investigative study of pregnancy resource centers.

Self-Preservation in Abortion Care: a Grounded Theory Study (Lipp, A., 2011)
Using a grounded theory approach this article examines why and how nurses concede and conceal their judgment of women seeking medication abortion services.

Building Competency: Nursing Modules

Professional Ethics

5 : Demonstrate ability to apply the ethical principles of respect for autonomy, beneficence, non-malfeasance, and justice as they relate to the provision of unintended pregnancy prevention and care.

Applying Ethical Practice Competencies to the Prevention and Management of Unintended Pregnancy (Cappiello, J., et al., 2011)
This article uses a case study that incorporates nurse practitioner, patient, and student perspectives to address ethical principles of beneficence, fairness, respect for autonomy, and professionals’ right of conscience. The article is designed to help nurses prepare for providing reproductive health care to women through values clarification and self-reflection.

Guide to the Code of Ethics for Nurses (Fowler, M., 2010)
Developed in 1950, the Code of Ethics for Nurses (ANA, 2001), Provision One states that nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. Provision Three states the nurse promotes, advocates for and strives to protect the health, safety and rights of the patient. Provision Five addresses that the nurse owes the same duties to self as to others including the responsibility to preserve integrity (…).

A Short History of Medical Ethics (Jonsen, A., 2000)
This book provides an overview of the evolution of medical ethics in both Western and Eastern culture and applies medical ethical theory to modern medical science and technology challenge the settled ethics of the long tradition.

Population-Focused Nurse Practitioner Competencies
The National Organization of Nurse Practitioner Faculties promulgated competencies to align with the six population foci in the Advanced Practice Registered Nurse (APRN) Consensus Model. In the women’s health/gender related population foci, an entry level into practice competency states that nurse practitioner graduates must demonstrate skill to: Support a woman’s right to make her own decisions regarding her health and reproductive choices within the context of her belief system.

Objective Structure Clinical Examination: Non-Directive Pregnancy Options Counseling with Communication and Ethical Challenges (Lupi, C., et al. 2012)
This resource consists of two case studies of women who are diagnosed with unexpected early intrauterine pregnancy. The evaluation tool can be used to assess competency in non-directive options counseling, responding to patient ambivalence, delivering bad or unexpected news, and responding to a patient’s request for moral guidance.

Professional Right of Conscience (Beal, M.W. and Cappiello, J., 2008)
This article provides background on professionals’ right of conscience, a review of how the issue has been addressed in literature, and approaches that are recommended from professional organizations are discussed.

Conscientious Refusal: A Workshop to Promote Reflective and Active Learning of Ethics, Communication Skills and Professionalism
This workshop from the Association of Professors of Gynecology and Obstetrics was originally designed for medical students to use independently or in small groups to improve their competency in non-directive options counseling. The workshop is comprised of three learning modules using case studies, videos, and discussion tools: the first module is an introduction into conscientious refusal; the second module consists of a values clarification exercise; and the third module involves role play technique to practice skills on how to handling an ethical conflict with patients seeking objectionable medical interventions.

Theory of Social Justice is Defined as Working to Address Disparities of Health and Care
This In Focus series in the Journal of Obstetrical, Gynecologic, Neonatal Nursing (JOGNN) discusses the application of the theory of social justice to address disparities in health care.  The authors suggest that if nurses adopt an ethical framework of social justice, nurses can better understand and thus influence outcomes and ameliorate health disparities and inequalities.  Readers can apply the social justice theory to the provision of reproductive health care along with other aspects of care.

Building Competency: Nursing Modules

Professional Ethics

6 : Demonstrate knowledge of current state specific laws regulating minors’ access to reproductive care for state(s) in which nurse practices (including contraceptive access and abortion care).

An Overview of Minors’ Consent Law (Guttmacher Institute, 2014)
This Guttmacher Institute brief provides background information and includes a chart with laws by state on minors’ right to consent without parental permission to contraception, STI treatment, abortion, prenatal care, and medical care for minor’s child.

Parental Involvement in Minors’ Abortions (Guttmacher Institute, 2014)
This Guttmacher Institute brief provides background, highlights, and a chart with state-by-state information on requirements for parental involvement in minors’ abortions including consent, notification, and judicial bypass.

Building Competency: Nursing Modules

Public Health
Quality and Safety

7 : Demonstrate basic understanding of female and male anatomy and physiology related to conception and reproduction.

Keep Your Rebel Covered Series: Female Sexual Anatomy
This video from the University of Nevada, Las Vegas Health Center explains and shows details of the female internal and external anatomy as well as the physiology of sexual intercourse and fertilization and implantation processes.

Keep Your Rebel Covered Series: Male Sexual Anatomy
This video from the University of Nevada, Las Vegas Health Center explains and shows details of the anatomy of internal and external male sexual organs, and discusses the physiology of an erection, the formation of sperm and the physiology of ejaculation.

Young Men’s Reproductive and Sexual Health
This presentation from the STFM (Society of Teachers of Family Medicine) Resource Library uses case studies to underscore the barriers young men face to accessing sexual and reproductive health services. Recommendations are provided for offering comprehensive care including creating a male friendly environment, guidelines for clinical care and staff training.

Bring the Popcorn: Using Film to Teach Sexual and Reproductive Health (Cappiello, J.D. and Kerryellen, V., 2011)
This article discusses the use of film for nursing students to explore the intersection of science, theory, and personal values to prepare for providing sexual and reproductive health care for patients.

Building Competency: Nursing Modules

Public Health

8 : Demonstrate knowledge of confidentiality regulations specific to unintended pregnancy prevention and care.

Understanding Health Information Privacy
This webpage from the U.S. Department of Health and Human Services outlines the government HIPPA Privacy Rule that protects personal medical information.

An Overview of Minors’ Consent Law (Guttmacher Institute, 2014)
This Guttmacher Institute brief provides background information and includes a chart with laws by state on minors’ right to consent without parental permission to contraception, STI treatment, abortion, prenatal care, and medical care for minor’s child.

Minor’s Rights Versus Parental Rights: Review of Legal Issues in Adolescent Health Care (Maradiegue, A., 2003)
This article gives a detailed historical overview of privacy and confidentiality laws for minors obtaining contraception and abortion, and discusses the clinical implications for practice.

Parental Involvement in Minors’ Abortions (Guttmacher Institute, 2014)
This Guttmacher Institute brief provides background, highlights, and a chart with state-by-state information on requirements for parental involvement in minors’ abortions including consent, notification, and judicial bypass.

Building Competency: Nursing Modules

Public Health
Quality and Safety

9 : Demonstrate knowledge of types of induced abortion methods, including risks and benefits, which are legally available in the U.S.

Safe Abortion: Technical and Policy Guidelines for Health Systems (WHO, 2012)
This document from the World Health Organization provides evidence-based best practices for the provision of abortion services to guide policymakers, program managers, and abortion providers to protect the health of women worldwide.

Abortion: Quality Care and Public Health Implications
This course from the University of California, San Francisco addresses abortion in a global context, professionalism and patient-centered care, different abortion procedures, obstacles to access.

Abortion in the United States
This three-minute video from the Guttmacher Institute provides abortion data and statistics in the United States.

Safety of Abortion
This publication from the National Abortion Federation details the safety of different types of abortion procedures, possible complications, complication management techniques, and aftercare.

Early Abortion Training Workbook
Chapter 5 and Chapter 7 of this workbook from Advancing New Standards in Reproductive Health (ANSIRH) provides details on uterine aspiration and on medication abortion, respectively, including step-by-step instructions, managing complications, and exercises are provided with relevant questions to evaluate the learner’s understanding. This is an extensive comprehensive resource on abortion care with recommendations and guidance on issues ranging from confidentiality and consent procedures to medications and pain management for different abortions procedures.

Providing Abortion Care: A Professional Toolkit for Nurse-Midwives, Nurse Practitioners, and Physician Assistants
This toolkit provides a thoroughly researched and referenced discussion of scope of practice and abortion care as pertains to APNs and physician assistants.

Clinical Training Curriculum in Abortion Practice, 2nd Edition
Module 7, “Vacuum Aspiration and D&E Technique”, of this evidence-based curriculum from the National Abortion Federation provides specific details on vacuum aspiration and dilation and evacuation procedures.

National Abortion Federation 2015 Clinical Policy Guidelines
These evidence-based guidelines and standards on abortion care from the National Abortion Federation include clinical practices on patient care, counseling, and different types of abortions. These guidelines are revised annually and are based on rigorous review of medical literature and known patient outcomes to support and educate providers on the most current information, standards, and recommendations.

Caring for the Woman with an Unintended Pregnancy: Abortion as an Option
This presentation from Provide’s Reproductive Options Education (ROE) Consortium was developed for Advanced Practice Registered Nurses and students and provides background abortion data, information on types of termination, post-abortion care and the role of an APRN.

First Trimester Abortion: A Comparison of Procedures
This chart from the National Abortion Federation shows a side-by-side comparison of three types of abortion procedures and how they work as well as advantages and disadvantages to each.

Care for Women Choosing Medication Abortion (Taylor, D., et al., 2004)
This article addresses the nurse practitioner’s role in providing medication abortions, details the pharmacology involved, and uses case studies to present counseling, complications and potential sides effects, and confirming complete abortion.

Mifepristone for Medical Abortion: Exploring a New Option for Nurse Practitioners (Taylor D. and Hwang, A.C., 2004)
This article introduces Mifespristone, commonly referred to as RU-486, provides clinical considerations including a chart comparing regimens and a chart comparing medication abortion with vacuum aspiration.

What is Medical Abortion?
This fact sheet from the National Abortion Federation defines and provides details of medication abortions, including how the medications work, how long they take, possible complications, and follow-up care.

Facts About Mifepristone (RU-486)
This fact sheet from the National Abortion Federation defines Mifepristone—a medication that blocks the action of progesterone—discusses how Mifepristone works, effectiveness as an abortifacient when combined with Misoprostol, possible side effects, and what women can expect when using it.

Manual Vacuum Aspiration
This “Quick Reference Guide for Clinicians” from the Association of Reproductive Health Professionals (ARHP) presents a summary of clinical information on manual vacuum aspiration, including indications for use and clinical components of the procedure.

An Overview of Abortion Laws (Guttmacher Institute, 2014)
This brief from the Guttmacher Institute provides background, highlights of abortion laws and terminology, and uses a comparison chart to show state laws and restrictions on abortion services by state.

State Facts About Abortion
This web page from the Guttmacher Institute uses an interactive United States map to provide information on abortion, pregnancy outcomes, and abortion restrictions by state.

A Surge of State Abortion Restrictions Puts Providers—and the Women They Serve—in the Crosshairs (Guttmacher Institute, 2014)
This report highlights the many barriers that exist to access to abortion care based on state restrictions including mandatory waiting periods, doctor and clinic restrictions, and limits on coverage. The report also looks at the lack of abortion providers in the United States.

“Medical” and “Surgical” Abortion: Rethinking the Modifiers (Weitz, T.A., et al., 2004)
Two descriptors, “medical” and “surgical,” have become the most commonly used modifiers for abortion. While these modifiers are comprehensible to most professionals active in the abortion field, the phrases “medical abortion” and “surgical abortion” are confusing for health service providers outside the abortion field, policymakers and the public. The authors suggest that the term “medication” abortion is clearer that the term “medical” and that “aspiration” abortion more accurately describe first trimester procedures.

Fact sheet: Induced Abortion in the United States (Guttmacher Institute, 2014)
This document from the Guttmacher Institute provides an overview of the incidence of abortion, a discussion of who has abortions, safety, information on providers and service, explanation of early medication abortion and law and policy.

Mortality of Inducted Abortion, Other Outpatient Surgical Procedures and Common Activities in the United States (Raymond, E.G., et al., 2014)
The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities.

The Comparative Safety of Legal Induced Abortion and Childbirth in the United States (Raymond, E.G. and Grimes, D.A., 2012)
The authors estimate mortality rates associated with live births and legal induced abortions in the United states in 1998-2005 and conclude that the mortality rate of abortion is far less than the mortality rate among women who birth live neonates.

Building Competency: Nursing Modules

Options Counseling
Postpartum Contraception

10 : Demonstrate understanding of how contraceptive methods work (e.g. hormonal methods, post‐partum and emergency contraception, lactational and fertility methods, IUD, barrier methods, sterilization), risks, benefits, alternatives, effectiveness, and eligibility.

U.S. Selected Practice Recommendations for Contraceptive Use, 2013
These recommendations are designed as a companion guide to the MEC and are intended to help nurses and other health-care providers address issues related to use of contraceptives, including how to help a woman initiate use of a contraceptive method, which examinations and tests are needed before initiating use of a contraceptive method, what regular follow-up is needed, and how to address problems that often arise during use, including missed pills and side effects such as unscheduled bleeding. The document is based on the World Health Association’s (WHO) global health guide to contraception. Although many of the recommendations are the same as those provided by the WHO, they have been adapted to be more specific to U.S. practices or have been modified because of new evidence.

Patient-centered Contraception
This presentation from the Reproductive Health Access Project uses case studies to determine the most appropriate contraceptive methods for different patients, detailing the risks, benefits, mechanisms of action, and other clinical considerations for each case.

Intrauterine Device and Upper-Genital-Tract Infection (Grimes, D.A., 2000)
This article suggests that pelvic inflammatory disease (PID) and infertility are no more likely to occur with IUDs than with any other method of contraception. The presence of STIs, usually chlamydia, not IUDs, use causes PID, thus all adolescents should be screened for STIs at the time of insertion of an IUD to reduce the risk of PID.

Use of Copper Intrauterine Devices and the Risk of Tubal Infertility among Nulligravid Women (Hubacher D, et al., 2001)
This study concluded that “tubal infertility was not associated with the duration of IUD use, the reason for the removal of the IUD, or the presence or absence of gynecologic problems related to its use.”

Increasing Use of Contraceptive Implants and Intrauterine Devices to Reduce Unintended Pregnancy (ACOG, 2009)
This AGOG Committee Report recommends LARC methods be used as first-line contraceptive methods and encouraged for most women.

Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices (ACOG Reaffirmed 2014)
This American College of Obstetricians and Gynecologists Committee Opinion states that “Increasing adolescent access to LARC is a clinical and public health opportunity. With top-tier effectiveness, high rates of satisfaction and continuation, and no need for daily adherence, LARC methods should be first-line recommendations for all women and adolescents. As with all nonbarrier methods, to decrease the risk of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), health care providers should advise sexually active adoescents to consistently use condoms along with LARC methods”.

The Counseling Session
This video from LARC FIRST is available in English and in Spanish, and provides a demonstration of high quality, non-directive counseling on contraception options.

Method Match
This interactive website from the Association of Reproductive Health Professionals (ARHP) provides fact sheets on different methods of contraception that includes information on efficacy, how each method works, benefits and contraindications to each.

IUD’s – Dispelling the Myths
This presentation from the Reproductive Health Access Project uses case studies to present factual information about intrauterine devices, their mechanisms, comparing different types, and side effects including non-contraceptive advantages.

LARC FIRST
This website not only provides information on long-acting reversible contraceptive methods, but also includes videos, counseling tips, training and preceptoring information, quality management, and patient resources.

Extended Use of the Intrauterine Device: A Literature Review and Recommendations for Clinical Practice
This literature review concludes that there are multiple IUDs that can be used effectively to prevent unintended pregnancy beyond their manufacturer-approved timeframe. There is good evidence to support extended use of copper IUDs and levonorgestrel intrauterine system 7 years. The authors found no data to support use of the LNG-IUS 13.5 mg (Skyla®) beyond 3 years. Creinin responds to this article in a letter to the editor that recommendations for extended use of levonorgestrel IUD is premature.

Early Abortion Training Workbook
Chapter 5 and Chapter 7 of this workbook from Advancing New Standards in Reproductive Health (ANSIRH) provides details on uterine aspiration and on medication abortion, respectively, including step-by-step instructions, managing complications, and exercises with relevant questions to evaluate the learner’s understanding. This is a comprehensive resource on abortion care with recommendations and guidance on issues ranging from confidentiality and consent procedures to medications and pain management for different abortion procedures.

Emergency Contraception and Medication Abortion: What’s the Difference?
This one-page chart from the Society of Teachers of Family Medicine (STFM) provides a comparison of emergency contraception and medication abortion (Mifepristone/RU-486).

Emergency Contraception: Dispelling the Myths
This presentation from the Society of Teachers of Family Medicine (STFM) introduces emergency contraception using data and case studies. It also provides information on mechanisms of action of emergency contraception and contraindications.

Breastfeeding (Lactational Amenorrhea Method)
This web page from Association of Reproductive Health Professionals (ARHP) includes a fact sheet and short video describing how lactational amenorrhea can be used for contraception.

Get the Facts: Health Benefits of Using Contraception to Plan, Avoid or Space Pregnancy
This document, written as a collaboration by several health care groups, provides an overview of the health advantages of birth spacing.

Birth Spacing and Risk of Adverse Perinatal Outcomes: A Meta-analysis (Conde-Agudelo, A., et al., 2006)
This meta analysis of 11 births worldwide suggests that birth spacing less than 18 months is associated with an increased risk of adverse perinatal outcomes.

Building Competency: Nursing Modules

Postpartum Contraception
Quality and Safety

11 : Demonstrate knowledge of current evidenced‐based guidelines for primary prevention of unintended pregnancy.

An Evidence-Based Guideline for Unintended Pregnancy Prevention
This article discusses a public health model of an “evidenced-based blueprint for a coordinated system of primary, secondary, and tertiary prevention” strategies for health professionals who care for patients at risk for an unintended pregnancy.

Recommendations to Improve Preconception Health and Health Care — United States
This report from Centers for Disease Control and Prevention (CDC) provides ten recommendations to improve preconception health that focus on changes in consumer knowledge, clinical practice, public health programs, health-care financing, and data and research activities. Each recommendation is accompanied by a series of specific action steps that, when implemented, can yield results within 2–5 years.

Preconception Care Clinical Tool Kit
This extensive, interactive website was designed to help primary care providers and their practices incorporate preconception health into the routine care of women of childbearing age. The toolkit includes clinical guidance, patient resources, talking points, risk reduction strategies, and reproductive life planning assessments.

U.S. Selected Practice Recommendations for Contraceptive Use, 2013
These recommendations are designed as a companion guide to the MEC and are intended to help nurses and other health-care providers address issues related to use of contraceptives, including how to help a woman initiate use of a contraceptive method, which examinations and tests are needed before initiating use of a contraceptive method, what regular follow-up is needed, and how to address problems that often arise during use, including missed pills and side effects such as unscheduled bleeding. The document is based on the World Health Association’s (WHO) global health guide to contraception. Although many of the recommendations are the same as those provided by the WHO, they have been adapted to be more specific to U.S. practices or have been modified because of new evidence.

Providing Abortion Care: A Professional Toolkit for Nurse-Midwives, Nurse Practitioners, and Physician Assistants
This toolkit provides a thoroughly researched and referenced discussion of scope of practice and abortion care as pertains to APNs and physician assistants.

The Postpartum Visit: It’s Time for a Change in Order to Optimally Initiate Contraception (Speroff, L., and Mishnell, D., 2008)
The authors argue that it is time to change the timing of the postpartum visit to three weeks postpartum in order to appropriately assess women’s physical and social well-being and to provide contraception in a timely fashion prior to women resuming sexual intercourse to prevent unintended pregnancy.

Get the Facts: Health Benefits of Using Contraception to Plan, Avoid or Space Pregnancy
This document, written as a collaboration by several health care groups, provides an overview of the health advantages of birth spacing.

Birth Spacing and Risk of Adverse Perinatal Outcomes: A Meta-analysis (Conde-Agudelo, A., et al., 2006)
This meta analysis of 11 births worldwide suggests that birth spacing less than 18 months is associated with an increased risk of adverse perinatal outcomes.

Building Competency: Nursing Modules

Global Health
Postpartum Contraception
Quality and Safety

12 : Demonstrate knowledge of state and local adoption options and resources and applicable regulatory laws and statutes.

The Basics of Adoption Practices: A Bulletin for Professionals
This resource from the U.S. Department of Health and Human Services’ Administration for Children and Families via the Child Welfare information Getaway details types of adoption, family and child assessments, birth parent involvement, and how the placement and adoption process works, including post-adoption services.

Adoption Directory
This resource has an interactive United States map that provides links to adoption-related organizations in each state. There is also a search feature, and various adoption-related categories to find information on adoption agencies, home studies, foster care, counseling, embryo adoption, medical evaluation, etc.

Consent to Adoption
This resource from the U.S. Department of Health and Human Services’ Administration for Children and Families via the Child Welfare information Getaway addresses issues related to consenting to adoption including who is involved and when and how it can take place.

Open Adoption: Could Open Adoption be the Best Choice for You and Your Baby?
This resource from the U.S. Department of Health and Human Services’ Administration for Children and Families via the Child Welfare information Getaway is designed for expectant parents and details open adoption, how it works, the benefits, legalities, and action steps.

Adoption: Resources for Those interested in Making an Adoption Plan
This web page from the Abortion Care Network offers information and resources for women experiencing unintended pregnancy who are considering making an adoption plan. This resource includes links to support networks including adoption agencies that are committed to helping women make informed decisions.

Building Competency: Nursing Modules

Options Counseling
Public Health

13 : Demonstrate proficiency in providing client‐centered pregnancy options counseling including parenting, adoption and abortion.

Patient-Centered Options Counseling for Unintended Pregnancy
This presentation from the STFM (Society of Teachers of Family Medicine) Resource Library provides current pregnancy data in the United States, a values clarification exercise, steps to options counseling, an early abortion method comparison worksheet, and key language for providers to use with patients experiencing unintended pregnancy.

Exploring All Options: Pregnancy Counseling Without Bias
This website from the Title X Family Planning National Training Centers contains a video series of five different scenarios on options counseling provided in a neutral, nonjudgmental manner and includes a discussion guide that addresses topics such as “Essentials of Options Counseling” and “Balancing Personal Values and Your Professional Role.”

Options Counseling: Techniques for Caring for Women with Unintended Pregnancies (Singer, J., 2004)
This article serves as a guide for clinicians to examine their own beliefs and values to improve their skills in providing nonjudgmental and nondirective options counseling for women experiencing unplanned pregnancy.

Options Counseling for Unintended Pregnancy
This presentation from Provide’s ROE (Reproductive Options Education) Consortium was designed to give nurses and APRNs information on attitude, skills, and knowledge needed to provide options counseling to patients who experience unintended pregnancy.

Referrals for Unintended Pregnancy: A Curriculum for Health and Social Service Providers
This curriculum from Provide includes six modules with training tips, materials, role plays, and other exercises to support health care and social service professionals to provide effective referrals for high quality abortion care.

Innovating Education in Reproductive Health
This website provides exercises and presentations from on providing quality options counseling to adolescents, and other related sexual and reproductive health issues such as “Caring for Challenging Patients” and  “A Counseling Model for Ambivalent Patients.”

Sexual and Reproductive Health Core Competencies in Primary Care (World Health Organization, 2011)
In this document the WHO presents core competences in sexual and reproductive health that should be addressed in primary care settings including essential services and principles of service provision.

Abortion: Quality Care and Public Health Implications
This course from the University of California, San Francisco addresses abortion in a global context, professionalism and patient-centered care, different abortion procedures, obstacles to access.

“Pregnancy Diagnosis and Gestational Age Assessment” in Prenatal and Postnatal Care: A Woman Centered Approach (Jordan, R.G., et al., 2013)
The article reviews approaches to accurate diagnosis of early pregnancy and gestational age assessment plus counseling after pregnancy diagnosis. Counseling strategies include giving a negative pregnancy test as well as a positive pregnancy test.  A full range of counseling options for unintended pregnancy are reviewed.

Contraception Counseling: Provider Tips and Patient Questions
This handout from CORE (Curricula Organizer for Reproductive Health Education) identifies specific questions for providers to consider and use when supporting patients in choosing a contraception that is best for them.

Early Abortion Training Workbook
Chapter 5 and Chapter 7 of this workbook from Advancing New Standards in Reproductive Health (ANSIRH) provides details on uterine aspiration and on medication abortion, respectively, including step-by-step instructions, managing complications, and exercises with relevant questions to evaluate the learner’s understanding. This is a comprehensive resource on abortion care with recommendations and guidance on issues ranging from confidentiality and consent procedures to medications and pain management for different abortion procedures.

Community Sexual and Reproductive Health Curriculum (Royal College of Obstetricians and Gynaecologists, 2012)
This training plan from the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists outlines a multi-year training program in sexual and reproductive health care. The modules provide detailed learning objectives for knowledge, attitudes and skills in 15 sexual and reproductive health related topics.

Building Competency: Nursing Modules

Options Counseling

14 : Demonstrate proficiency in promoting sexual‐health self‐care practices.

Comprehensive Counseling for Reproductive Health: An Integrated Curriculum
Part 1, “Principles and Approaches for Client-Centered Communication in Sexual and Reproductive Health, and Part 5, “Helping Clients Assess Their Comprehensive SRH Needs and Providing Appropriate Information”, of this handbook from Engender Health are dedicated to addressing sexuality with patients and includes tips for how providers can gain comfort and competence in working with patients on sexual health. This handbook consists of a series of workshop sessions with key discussion points designed to help providers work with clients to assess their comprehensive sexual health needs. These sessions include key points for practitioners, sample questions to ask, assessing patients’ risk for pregnancy/STIs, and exploring patients’ sexual relationships.

Condom Counseling Role Play
This exercise from CORE (Curricula Organizer for Reproductive Health Education) is designed to be conducted in a classroom or group setting to help students build competence in discussing male and female condom use with patients.

VOICES/VOCES: Video Opportunities for Innovative Condom Education
This video-based intervention from the CDC is a single-session HIV/STD prevention program designed to encourage condom use and improve condom negotiation skills. The program is based on the theory of reasoned action, which explains how behaviors are guided by attitudes, beliefs, experiences, and expectations of other persons’ reactions. VOICES/VOCES is grounded in extensive formative research exploring the culture- and gender-based factors that can facilitate behavior change. An evaluation of the intervention showed that VOICES/VOCES is effective when delivered at a “teachable moment,” for instance when a visit to an STD clinic or a negative pregnancy test may motivate a person to change behavior.

What You Need to Know: Talking to Patients About Sexuality and Sexual Health
This fact sheet from the Association of Reproductive Health Professionals (ARHP) outlines best practices for counseling patients when discussing sexual health and provides sample questions and tips for taking a sexual history and/or facilitating a discussion with a patient about sexuality and sexual health.

Reproductive Life Planning Assessment
This web page describes how to assess a patient’s reproductive life plan, key questions that will help solidify her plan, and how to integrate reproductive life plan assessments in a clinic operations.

The Proactive Sexual Health History (Nusbaum, M., 2002)
This article highlights the importance of integrating discussion of sexual health and sex practices into routine visits with patients. Routinely integrating nonjudgmental discussion of sexual health into clinic practice may ultimately reduce risk behaviors for unintended pregnancy and transmission of STIs.

Building Competency: Nursing Modules

Public Health
Postpartum Contraception

15 : Demonstrate proficiency in providing patient-centered risk reduction counseling specific to unintended pregnancy prevention.

Patient Education and Risk Reduction Messages
This exercise from CORE (Curricula Organizer for Reproductive Health Education) is designed for nursing faculty to use in class. The activity uses interactive case studies, role play with scenarios, and group discussion questions are provided.

Comprehensive Counseling for Reproductive Health: An Integrated Curriculum
Part 5, “Helping Clients Assess Their Comprehensive SRH Needs and Providing Appropriate Information” of this handbook addresses patient risk assessments and improving clients’ own perception of risk, including identifying barriers to recognizing risk factors. This handbook consists of a series of workshop sessions with key discussion points designed to help providers work with clients to assess their comprehensive sexual health needs. These sessions include Session 22 “Risk Assessment – Improving Clients’ Perception of Risk” defines risk assessment and explores barriers to clients’ perception of their own risks.key points, sample questions to ask, assessing patients’ risk for pregnancy/STIs, and exploring patients’’ sexual relationships.

Community Sexual and Reproductive Health Curriculum (Royal College of Obstetricians and Gynaecologists, 2012)
This training plan from the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists outlines a multi-year training program in sexual and reproductive health care. The modules provide detailed learning objectives for knowledge, attitudes and skills in 15 sexual and reproductive health related topics.

Sexual and Reproductive Health Core Competencies in Primary Care (World Health Organization, 2011)
In this document the WHO presents core competences in sexual and reproductive health that should be addressed in primary care settings including essential services and principles of service provision.

Innovating Education in Reproductive Health
This website provides exercises and presentations from on providing quality options counseling to adolescents, and other related sexual and reproductive health issues such as “Caring for Challenging Patients” and  “A Counseling Model for Ambivalent Patients.”

Building Competency: Nursing Modules

Public Health

16 : Demonstrate proficiency in providing pregnancy test results in patient-centered manner.

Giving Pregnancy Test Results: A Primer for Nursing Students
This presentation from Provide serves as a guide for nursing students on giving pregnancy test results, identifying immediate health concerns, providing referrals, and gives an overview of laboratory pregnancy tests. Recommendations are given on specific questions to ask and counseling language to use when providing negative and positive test results, and working with a patient who is ambivalent about the test results.

Exploring All Options: Pregnancy Counseling Without Bias
This website from the Title X Family Planning National Training Centers contains a video series of five different scenarios on options counseling provided in a neutral, non-judgmental manner and includes a discussion guide that addresses topics such as “Essentials of Options Counseling” and “Balancing Personal Values and Your Professional Role.”

Community Sexual and Reproductive Health Curriculum (Royal College of Obstetricians and Gynaecologists, 2012)
This training plan from the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists outlines a multi-year training program in sexual and reproductive health care. The modules provide detailed learning objectives for knowledge, attitudes and skills in 15 sexual and reproductive health related topics.

Sexual and Reproductive Health Core Competencies in Primary Care (World Health Organization, 2011)
In this document the WHO presents core competences in sexual and reproductive health that should be addressed in primary care settings including essential services and principles of service provision.

Building Competency: Nursing Modules

Options Counseling
Quality and Safety

17 : Demonstrate proficiency in using essential counseling techniques (e.g. motivational interviewing, shared decision making and patient engagement) in provision of unintended pregnancy prevention and care.

Motivational Interviewing: A Tool for Behavior Change
This American College of Obstetricians and Gynecologists (AGOG) Committee Opinion defines the principles of motivational interviewing including the stages of readiness for change, its effectiveness as a counseling strategy, practical applications for use during visits, and provides tips on the associated medical coding.

Exploring All Options: Pregnancy Counseling Without Bias
This website from the Title X Family Planning National Training Centers contains a video series of five different scenarios on options counseling provided in a neutral, nonjudgmental manner and includes a discussion guide that addresses topics such as “Essentials of Options Counseling” and “Balancing Personal Values and Your Professional Role.”

Six Steps of Shared Decision Making (SDM)
This presentation from the Informed Medical Decisions Foundation defines shared decision making and provides six steps providers can use which includes sample language for effective patient engagement.

Community Sexual and Reproductive Health Curriculum (Royal College of Obstetricians and Gynaecologists, 2012)
This training plan from the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists outlines a multi-year training program in sexual and reproductive health care. The modules provide detailed learning objectives for knowledge, attitudes and skills in 15 sexual and reproductive health related topics.

Sexual and Reproductive Health Core Competencies in Primary Care (World Health Organization, 2011)
In this document the WHO presents core competences in sexual and reproductive health that should be addressed in primary care settings including essential services and principles of service provision.

Innovating Education in Reproductive Health
This website provides exercises and presentations from on providing quality options counseling to adolescents, and other related sexual and reproductive health issues such as “Caring for Challenging Patients” and  “A Counseling Model for Ambivalent Patients.”

National Abortion Federation 2015 Clinical Policy Guidelines
These evidence-based guidelines and standards on abortion care from the National Abortion Federation include clinical practices on patient care, counseling, and different types of abortions. These guidelines are revised annually and are based on rigorous review of medical literature and known patient outcomes to support and educate providers on the most current information, standards, and recommendations.

Care for Women Choosing Medication Abortion (Taylor, D., et al., 2004)
This article addresses the nurse practitioner’s role in providing medication abortions, details the pharmacology involved, and uses case studies to present counseling, complications and potential sides effects, and confirming complete abortion.

Prenatal and Postnatal Care: A Woman-Centered Approach (Jordan, R.G., et al., 2013)
Nurses will appreciate the difference in this text written by midwives and nurse practitioners compared to standard medical textbooks with a clear focus on women-centered care. See chapters on risk assessment and risk management in prenatal care and prenatal genetic counseling, screening and diagnosis.

Intimate Partner Violence During Pregnancy, A Guide for Clinicians
This set of slides from the Centers for Disease Control and Prevention provide facts about intimate partner violence, identifies types of abuse, provides data on violence and pregnancy, and gives recommendations for clinicians to identify abuse and support victims.

A Guide to Taking a Sexual History
The Centers for Disease Control and Prevention provide recommendations for skills-building in this area which is essential to providing unintended pregnancy prevention care.

Building Competency: Nursing Modules

Options Counseling 

18 : Demonstrate proficiency in effective communication skills that encompasses respect for of culture, sexual orientation and gender identity.

The Process of Inquiry – Communicating in a Multicultural Environment
This online education module from the National Center for Cultural Competence presents a rationale for the importance of communication in health care systems. The module addresses quality of care, attitudes and knowledge, and communication skills building with Limited English Speakers.

Cultural Humility is the First Step to Becoming Global Care Providers (Miller, S., 2009)
This paper describes the shift in nursing education from teaching cultural competency with its focus on the ability of nurses to interact effectively with people of different cultures, to cultural humility. Cultural humility does not have the goal of mastering another culture, rather it suggests a continual, active process of self-reflection; a way of being in the world and being in relationships with others.

Cultural Awareness: Creating Your Own Cultural Genogram
This cultural awareness exercise from the National Center for Cultural Competence is a step-by-step guide to creating one’s own genogram. Completing the exercise in-depth enables participants to consider their own family history and develop a deeper appreciation for the concept of culture and how cultural values shapes families.

Do Ask, Do Tell (Potter J.E., 2002)
This article examines the importance of creating an environment that allows patients to disclose their sexual orientation and behaviors, a critical component to establishing a productive, therapeutic patient/doctor relationship. The author uses her own experiences as a lesbian patient and doctor to illustrate how creating such an environment is essential to the provision of preventive health counseling and the challenges and rewards of coming out as a gay physician.

Recommendations For Gender Sensitive Sexual History Taking
This handout from CORE (Curricula Organizer for Reproductive Health Education) provides guidelines for taking a sexual history that is gender sensitive and free from bias.

Developing Cultural Competence in Reproductive Health Care: Understanding Every Woman
This report from the National Abortion Federation details key recommendations for developing and improving cultural competence at the organization level.

Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine (Jonsen, A., et al., 2006)
The authors teach a clear Four-Topics method of questions about medical indications, patient preferences, quality of life, and contextual features to aid in thinking about clinical ethical issues.

Community Sexual and Reproductive Health Curriculum (Royal College of Obstetricians and Gynaecologists, 2012)
This training plan from the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists outlines a multi-year training program in sexual and reproductive health care. The modules provide detailed learning objectives for knowledge, attitudes and skills in 15 sexual and reproductive health related topics.

Sexual and Reproductive Health Core Competencies in Primary Care (World Health Organization, 2011)
In this document the WHO presents core competences in sexual and reproductive health that should be addressed in primary care settings including essential services and principles of service provision.

Innovating Education in Reproductive Health
This website provides exercises and presentations from on providing quality options counseling to adolescents, and other related sexual and reproductive health issues such as “Caring for Challenging Patients” and  “A Counseling Model for Ambivalent Patients.”

Prenatal and Postnatal Care: A Woman-Centered Approach (Jordan, R.G., et al., 2013)
Nurses will appreciate the difference in this text written by midwives and nurse practitioners compared to standard medical textbooks with a clear focus on women-centered care. See chapters on risk assessment and risk management in prenatal care and prenatal genetic counseling, screening and diagnosis.

A Guide to Taking a Sexual History
The Centers for Disease Control and Prevention provide recommendations for skills-building in this area which is essential to providing unintended pregnancy prevention care.

Building Competency: Nursing Modules

Options Counseling

19 : Demonstrate proficiency in obtaining a complete health history (inclusive of sexual and reproductive history, sexual orientation, partner preference, and appropriate to the developmental level of client).

What You Need to Know: Talking to Patients About Sexuality and Sexual Health
This fact sheet from the Association of Reproductive Health Professionals (ARHP) outlines best practices for counseling patients when discussing sexual health and provides sample questions and tips for taking a sexual history and/or facilitating a discussion with a patient about sexuality and sexual health.

Recommendations For Gender Sensitive Sexual History Taking
This handout from CORE (Curricula Organizer for Reproductive Health Education) provides guidelines for taking a sexual history that is gender sensitive and free from bias.

Taking Routine Histories of Sexual Health: A System-Wide Approach for Health Centers
This toolkit, developed through a partnership between the National LGBT Health Education Center and the National Association of Community Health Centers, includes a Routine Sexual History Tool, a section on Special Populations and Considerations, and recommendations for implementing the tool for the routine integration of sexual histories in the health center setting.

Sexual History Taking Role Play
This exercise from CORE (Curricula Organizer for Reproductive Health Education) is designed to improve knowledge, skills, and comfort with sexual history taking and risk assessments. The worksheet includes questions to ask when taking a sexual history, specifically when working with LGBTQ patients.

Community Sexual and Reproductive Health Curriculum (Royal College of Obstetricians and Gynaecologists, 2012)
This training plan from the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists outlines a multi-year training program in sexual and reproductive health care. The modules provide detailed learning objectives for knowledge, attitudes and skills in 15 sexual and reproductive health related topics.

Sexual and Reproductive Health Core Competencies in Primary Care (World Health Organization, 2011)
In this document the WHO presents core competences in sexual and reproductive health that should be addressed in primary care settings including essential services and principles of service provision.

A Guide to Taking a Sexual History
The Centers for Disease Control and Prevention provide recommendations for skills-building in this area which is essential to providing unintended pregnancy prevention care.

Building Competency: Nursing Modules

Quality and Safety

20 : Demonstrate proficiency in identifying preconception health risks.

Core State Preconception Health Indicators – Pregnancy Risk Assessment Monitory System and Behavioral Risk Factor Surveillance System, 2009
This surveillance summary from Centers for Disease Control and Prevention (CDC) provides data on preconception health indicators through PRAMS (Pregnancy Risk Assessment Monitoring System) and underscores the need for evidence-based preconception health care.

Recommendations to Improve Preconception Health and Health Care — United States
This report from Centers for Disease Control and Prevention (CDC) provides ten recommendations to improve preconception health that focus on changes in consumer knowledge, clinical practice, public health programs, health-care financing, and data and research activities. Each recommendation is accompanied by a series of specific action steps that, when implemented, can yield results within 2–5 years.

Intimate Partner Violence During Pregnancy, A Guide for Clinicians
This set of slides from the Centers for Disease Control and Prevention provide facts about intimate partner violence, identifies types of abuse, provides data on violence and pregnancy, and gives recommendations for clinicians to identify abuse and support victims.

Clinical Content of Preconception Care: Preconception Care for Special Populations (Ruhl, C. and Moran, B., 2008)
This article discusses preconception management and guidance as essential for women with disabilities, immigrant and refugee women, and cancer survivors to ensure they are able to make informed reproductive decisions for optimal reproductive outcomes.

Get the Facts: Health Benefits of Using Contraception to Plan, Avoid or Space Pregnancy
This document, written as a collaboration by several health care groups, provides an overview of the health advantages of birth spacing.

Birth Spacing and Risk of Adverse Perinatal Outcomes: A Meta-analysis (Conde-Agudelo, A., et al., 2006)
This meta analysis of 11 births worldwide suggests that birth spacing less than 18 months is associated with an increased risk of adverse perinatal outcomes.

Impact of Maternal Age on Obstetric Outcome (Cleary-Goldman, J., et al., 2005)
A study of total of over 36,000 women compared age and pregnancy outcomes. Increasing age was significantly associated with miscarriage, chromosomal abnormalities, congenital anomalies, gestational diabetes, placenta previa,  cesarean delivery,  increased risk for abruption, preterm delivery, low birth weight, and perinatal mortality. Increasing age was a continuum rather than a discreet age.

Advanced Maternal Age and Adverse Perinatal Outcome  (Jacobsson, B., et al., 2004)
This national prospective, population-based, cohort study in over 1.5 million women aged 40-44, 45 years or older compared to a control group of women aged 20-29 years who delivered during a 15 year period. Perinatal mortality, intrauterine fetal death, and neonatal death increased with age. There was also an increase in illnesses and pregnancy complications with increasing age, but this did not entirely explain the increase in perinatal mortality with age. Level Of Evidence: II-3.

Advanced Maternal Age and the Risk of Cesarean Birth: A Systematic Review (Bayrampour, H. and Heaman, M., 2010)
This systematic review of 21 studies that met the inclusion criteria were reviewed. All studies demonstrated an increased risk of cesarean birth among women at advanced maternal age compared with younger women, for both nulliparas and multiparas (relative risk varied from 1.39 to 2.76). However, the associated factors for this increased risk are not totally understood in the literature.

Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality (Metzl, J. M., and Hansen, H., 2014)
Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103126-133. doi:10.1016/j.socscimed.2013.06.032
The term “structural competency” refers to a shift away from approaches that focus solely on cross-cultural understandings of individual patients, toward a broader view of the social and economic forces that affect patient’s health in addition to their individual interactions with health care providers.

Building Competency: Nursing Modules

Public Health

21 : Demonstrate ability to make appropriate referrals to community‐based prenatal care providers and resources.

National Abortion Federation Find a Provider
This web page from the National Abortion Federation includes an interactive map that gives state-specific information on abortion services and clinic contact information for each state.

Find a Nurse Practitioner
This resource from the American Association of Nurse Practitioners uses an interactive map to help a consumer find a nurse practitioner in their geographic area.

DoctorFinder
This resource from the American Medical Association provides professional information on almost every licensed physician in the United States and can be used to locate doctors who specialize in prenatal care.

Medicaid and Pregnant Women
This web page from Medicaid.gov describes the eligibility criteria and benefits for pregnant women using Medicaid to pay for services.

Building Competency: Nursing Modules

Options Counseling
Public Health

22 : Demonstrate proficiency in assessing risk for intimate partner violence (including sexual violence and coercion).

Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings (CDC, 2007)
This resource from Centers for Disease Control and Prevention (CDC) is an extensive compilation of screening and assessment tools for intimate partner violence and sexual violence. When applicable, scoring tools, administration methods, follow up procedures, and psychometric properties are included.

Assessing Patients for Sexual Violence (National Sexual Assault Resource Center, 2001)
This guide from the National Sexual Violence Resource Center is for health care professionals that provides tips on assessing patients for violence, which include sample language, developing protocols, use of clinical instruments, and collaborating with community partners.

Reproductive Coercion and Co-occurring Intimate Partner Violence in Obstetrics and Gynecology Patients (Clark, L.E., et al., 2014)
Reproductive Coercion and Co-occurring Intimate Partner Violence in Obstetrics and Gynecology Patients. American Journal of Obstetrics and Gynecology 210(1), 42.e1-42.e8.
This article details a survey that was conducted with 641 women regarding their experiences with reproductive coercion and intimate partner violence and the results underscore the need for increased screening for intimate partner violence in health care settings.

Reproductive Coercion: Connecting the Dots Between Partner Violence and Unintended Pregnancy (Miller, E. et al., 2011)
In this article the authors introduce the concept of “reproductive coercion” as “explicit male behaviors to promote pregnancy (unwanted by the woman)” and highlight the need for improved family planning prevention practices in light of how male partners influence contraceptive decision-making.

Intimate Partner Violence During Pregnancy, A Guide for Clinicians
This set of slides from the Centers for Disease Control and Prevention provide facts about intimate partner violence, identifies types of abuse, provides data on violence and pregnancy, and gives recommendations for clinicians to identify abuse and support victims.

Understanding and Preventing Violence (CDC, 2013)
This document from Centers for Disease Control and Prevention (CDC) highlights risks for violence and prevention strategies as well as protective influences for different forms of violence including intimate partner violence, youth violence, and dating violence.

Counseling Teen Clients Experiencing Sexual Coercion
This 32-minute video shows a counseling session wherein a teenager discloses sexual coercion to a family planning counselor. The video can be used to improve communication and counseling skills when addressing sexual violence or coercion with patients.

National Intimate Partner and Sexual Violence Survey
This report from Centers for Disease Control and Prevention (CDC) includes extensive data on prevalence of various forms of intimate partner and sexual violence, provides information on the impact of such violence, and implications for prevention.

Building Competency: Nursing Modules

Public Health

23 : Demonstrate proficiency in referring clients with unintended pregnancy to area providers and support services.

Referrals for Unintended Pregnancy: A Curriculum for Health and Social Service Providers
This curriculum from Provide includes six modules with training tips, materials, role plays, and other exercises to support health care and social service professionals to provide effective referrals for high quality abortion care.

Referral-making in the Current Landscape of Abortion Access (Zurek, M., et al., 2014)
This article highlights the increasing importance of providing effective referrals for abortion care as clinic closures further limit women’s access to these services.

State Policies on Abortion Coverage in Medicaid and Private Insurance
This web page from the Kaiser Family Foundation uses an interactive United States map to show the changes in insurance coverage for abortion services by state Pre-ACA (2000), at the Passage of ACA (March 2010), and Post ACA (2014).

National Abortion Federation Find a Provider
This web page from the National Abortion Federation includes an interactive map that gives state-specific information on abortion services and clinic contact information for each state.

Find a Nurse Practitioner
This resource from the American Association of Nurse Practitioners uses an interactive map to help a consumer find a nurse practitioner in their geographic area.

Building Competency: Nursing Modules

Options Counseling
Public Health
Quality and Safety

24 : Demonstrate ability to participate effectively in interprofessional, teambased care for unintended pregnancy prevention and care.

Core Competencies for Interprofessional Collaborative Practice
This 2001 report by an expert panel of educators from higher learning institutions presents interprofessional competencies to support the development of a workforce prepared to use effective teamwork and team-based care.

Core Principles & Values of Effective Team-Based Health Care
This discussion paper from the IOM provides common reference points for health care providers to improve coordinated collaboration and interprofessional team-based care. This resource highlights principles and values for effective team-based care, the importance of establishing clear roles, effective communication, and measureable process and outcomes of high-functioning health care teams.

Medical Teamwork and Patient Safety: The Evidence-based Relation (Baker, D.P., et al., 2005)
This publication from the Agency for Healthcare Research and Quality presents evidence to support the relationship between team training and patient safety. The authors address the nature of effective teamwork, teamwork-related knowledge, skills, and attitudes, and contextual issues surrounding teamwork.

Building Competency: Nursing Modules

Quality and Safety

25 : Demonstrate proficiency in evaluating outcomes of plan of care and referrals for women with unintended pregnancies.

National Abortion Federation 2015 Clinical Policy Guidelines
These evidence-based guidelines and standards on abortion care from the National Abortion Federation include clinical practices on patient care, counseling, and different types of abortions. These guidelines are revised annually and are based on rigorous review of medical literature and known patient outcomes to support and educate providers on the most current information, standards, and recommendations. The following modules are specific to this competency:

  • Module 8: Management of Pregnancy of Uncertain Location
  • Module 43: Post-Procedure Care
  • Module 17: Evaluation of Evacuated Uterine Contents

Referrals for Unintended Pregnancy: A Curriculum for Health and Social Service Providers
This curriculum from Provide includes six modules with training tips, materials, role plays, and other exercises to support health care and social service professionals to provide effective referrals for high quality abortion care.

Clinical Training Curriculum in Abortion Practice, 2nd Edition
Module 9, “Post-Abortion Care and Follow-Up”, of this evidence-based curriculum from the National Abortion Federation details the essentials of post-abortion care and follow up, and Module 4, “Medical Abortion Screening, Regimens, Management & Follow Up” provides specific guidance for care after medication abortion.

Building Competency: Nursing Modules

Quality and Safety

26 : Demonstrate ability to obtain or refer for appropriate laboratory tests specific to unintended pregnancy prevention and care.

National Abortion Federation 2015 Clinical Policy Guidelines
These evidence-based guidelines and standards on abortion care from the National Abortion Federation include clinical practices on patient care, counseling, and different types of abortions. These guidelines are revised annually and are based on rigorous review of medical literature and known patient outcomes to support and educate providers on the most current information, standards, and recommendations.

Clinical Training Curriculum in Abortion Practice, 2nd Edition
Module 1, “Pregnancy Verification and Estimation of Gestational Age”, of this evidence-based curriculum from the National Abortion Federation details interpreting HcG results and ultrasound dating, determining gestational age based on last menstrual period, and determining the location of pregnancy.

Early Abortion Training Workbook
Chapter 5 and Chapter 7 of this workbook from Advancing New Standards in Reproductive Health (ANSIRH) provides details on uterine aspiration and on medication abortion, respectively, including step-by-step instructions, managing complications, and exercises with relevant questions to evaluate the learner’s understanding. This is a comprehensive resource on abortion care with recommendations and guidance on issues ranging from confidentiality and consent procedures to medications and pain management for different abortion procedures.

Giving Pregnancy Test Results: A Primer for Nursing Students
This presentation from Provide serves as a guide for nursing students on giving pregnancy test results, identifying immediate health concerns, providing referrals, and gives an overview of laboratory pregnancy tests. Recommendations are given on specific questions to ask and counseling language to use when providing negative and positive test results, and working with a patient who is ambivalent about the test results.

Building Competency: Nursing Modules

Quality and Safety

27 : Demonstrate ability to confirm pregnancy and determine gestation age.

“Pregnancy Diagnosis and Gestational Age Assessment” in Prenatal and Postnatal Care: A Woman Centered Approach (Jordan, R.G., et al., 2013)
The article reviews approaches to accurate diagnosis of early pregnancy and gestational age assessment plus counseling after pregnancy diagnosis. Counseling strategies include giving a negative pregnancy test as well as a positive pregnancy test.  A full range of counseling options for unintended pregnancy are reviewed.

Clinical Manifestations and Diagnosis of Early Pregnancy (Bastian, L. A. and Brown, H. L., 2014)
Diagnosis of pregnancy and knowledge of normal findings associated with early pregnancy are common issues in the health care of reproductive-age women. This article reviews history findings, clinical exam findings and appropriate laboratory testing to diagnosis pregnancy.

Early Abortion Training Workbook
Chapter 5 and Chapter 7 of this workbook from Advancing New Standards in Reproductive Health (ANSIRH) provides details on uterine aspiration and on medication abortion, respectively, including step-by-step instructions, managing complications, and exercises with relevant questions to evaluate the learner’s understanding. This is a comprehensive resource on abortion care with recommendations and guidance on issues ranging from confidentiality and consent procedures to medications and pain management for different abortion procedures.

Clinical Training Curriculum in Abortion Practice, 2nd Edition
Module 1, “Pregnancy Verification and Estimation of Gestational Age”, of this evidence-based curriculum from the National Abortion Federation details interpreting HcG results and ultrasound dating, determining gestational age based on last menstrual period, and determining the location of pregnancy.

Building Competency: Nursing Modules

Options Counseling
Postpartum Contraception

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