Because of the highly stigmatized nature of abortion care delivery and the restriction of abortion provision in most states, little is known about abortion care quality beyond procedural safety. This study examined which aspects of abortion care contributed to patient experiences. Data from a prospective, observational study of 9087 women aged 16 to 44 years, from 22 clinics across California, who responded to a postprocedure survey, were analyzed using mixed-effects logistic regression. Patient experience scores were very high (mean overall satisfaction = 9.4 [0-10 scale]) for all clinicians trained in abortion provision (physicians, nurse practitioners, nurse-midwives, and physician assistants). Multiple patient factors (pain rating, expectations of care, sociodemographics) and clinic-level factors (timely care, treatment by clinicians and staff) were significantly associated with patient experience. Study findings demonstrated that clinic environment, treatment by clinical staff, and managed pain levels contributed to a patient's experience of abortion care, whereas clinician type was not significantly associated.

a b s t r a c tObjective: Patient experience is an essential component of quality care. Few studies have comprehensively evaluated patient experiences of abortion care. The objectives of this study were to describe women's experiences of abortion care in their own words, and to determine themes across patient experiences. Study Design: Data for this thematic analysis, a qualitative method that allows for the identification, analysis, and report of patterns or themes within data, come from a larger study of safety and quality of aspiration abortion care across 22 clinical sites. Participants completed an abortion experience survey including fixed choice questions and an open-ended question: "Is there anything you would like to tell us about your experience?" The data were then categorized by responses to another survey question: "Overall, was your experience about, better, or worse than you expected?" Results: A total of 5,214 responses were analyzed. Women reported positive abortion care experiences with the majority of women rating their experience as better than expected (n ¼ 3,600). Two major themes that emerged from the data include clinic-and patient-level factors that impact how patients rate their experiences. Analysis of the responses categorized in the worse than expected group (n ¼ 136) found that women primarily faulted clinic-level factors for their negative experiences, such as pain control and management, and wait time for appointments and in clinic. Conclusion: This analysis highlights specific areas of abortion care that influence patients' experience. The few women who were disappointed by care in the clinic tended to fault readily modifiable clinical factors, and provided suggested areas of improvement to enhance positive experiences related to their abortion care.

Despite the frequency of and significant costs related to unintended pregnancy, it has received less attention in research and prevention guidelines development than other important health threats. This lack of attention has resulted in a system-wide failure to provide care to reproductive aged women who are at risk of unintended pregnancy. An evidenced-based blueprint for a coordinated system of primary, secondary and tertiary prevention is proposed for health professionals who provide care for patients at risk for unintended pregnancy.

Throughout history, the care of women's reproductive health needs has included termination of unwanted pregnancy. Unfortunately, access to safe first-trimester abortion is restricted by a lack of skilled providers. In an effort to provide data-based evidence and increase access to first-trimester abortion care in California, the University of California, San Francisco, under the auspices of the Health Workforce Pilot Program, developed a competency-based training model to increase the number of certified nurse-midwives, nurse practitioners, and physician assistants who can provide uterine aspiration. This article describes the training program, which uses a curriculum comprising both self-directed didactic material and supervised clinical experience with a minimum of 40 procedures. Successful completion of the program requires passing a written examination and satisfactory achievement of a competency-based clinical assessment. Thirty-eight trainees have completed the training to date, achieving competency following an average of 6 training days. Competency development in the clinical area is monitored by both the trainer and the trainee, using daily and final competency assessments in 4 domains: patient comfort, procedural completeness, speed, and ability to identify problems. Analysis of complications is used to identify concerns about clinician safety. The availability of a competency-based training curriculum for uterine aspiration has the potential to increase the number of first-trimester abortion providers by making training available to experienced clinicians, including nurse-midwives, who would like to provide this care.

Objective(s): The purpose of this thematic analysis is to describe recruitment, retention and career development strategies for expert nurses in abortion care provision. Study design: Thematic analysis influenced by grounded theory methods were used to analyze interviews, which examined cognitive, emotional, and behavioral processes associated with how nurses make decisions about participation in abortion care provision. The purposive sample consisted of 16 nurses, who were interviewed between November 2012 and August 2013, who work (or have worked) with women seeking abortions in abortion clinics, emergency departments, labor and delivery units and post anesthesia care units. Results: Several themes emerged from the broad categories that contribute to successful nurse recruitment, retention, and career development in abortion care provision. All areas were significantly influenced by engagement in leadership activities and professional society membership. The most notable theme specific to recruitment was exposure to abortion through education as a student, or through an employer. Retention is most influenced by flexibility in practice, including: advocating for patients, translating one's skill set, believing that nursing is shared work, and juggling multiple roles. Lastly, providing on the job training opportunities for knowledge and skill advancement best enables career development. Conclusion(s): Clear mechanisms exist to develop expert nurses in abortion care provision. Implications: The findings from our study should encourage employers to provide exposure opportunities, develop activities to recruit and retain nurses, and to support career development in abortion care provision. Additionally, future workforce development efforts should include and engage nursing education institutions and employers to design structured support for this trajectory.