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Research Evaluation of a termination of pregnancy education programme in the Republic of Ireland: part 2 Abstract Background/Aims The extension of termination of pregnancy services in the Republic of Ireland represents a significant change to practice. As a result, education was provided to assist midwives and nurses to fulfil their expanded role. Using Kirkpatrick’s framework, this study aimed to conduct an in-depth evaluation to ascertain if knowledge gained at a termination of pregnancy education programme was applied to clinical practice. Methods Semi-structured interviews were conducted with a purposeful sample of seven midwives and nurses, 3 months after attending a termination of pregnancy education programme. Results Attendance at the programme prompted reflection on practice, with participants providing examples of how they applied the knowledge gained to the care they provide. The complexities of providing a termination of pregnancy service were highlighted, along with additional educational requirements. Conclusions Knowledge gained from the education programme was applied to practice improving termination of pregnancy care. Additional education and training needs identified will guide the development of future programmes. Key words Education  |  Ireland  |  Kirkpatrick model  |  Midwives  | Nurses  | Termination of pregnancy Antoinette Fletcher Midwife tutor and specialist coordinator1 afletcher@coombe.ie Triona Cowman Director1 Hazel Cazzini Midwifer y specialist coordinator1 Judith Fleming Midwifer y specialist coordinator1 Niamh Healy Educational Technologist1 1Centre for Midwifer y Education, Dublin, Ireland This is the second article in a two-part ser ies evaluating, a national termination of pregnancy education programme in the Republic of Ireland using Kirkpatr ick’s model of evaluation (Kirkpatr ick and Kirkpatr ick, 2016).The first article provided the findings of levels one and two of the model, participants’ reaction to the training exper ience and their knowledge before and after attending the education programme (Fletcher et al, 2023). This article descr ibes the findings of level three of Kirkpatr ick’s model of evaluation: to identify if participants applied knowledge gained from attending the programme to clinical practice. Additional education and training required to support midwives and nurses working in termination of pregnancy services was also explored. As a result of a surge in COVID-19 cases and pressures at the front line, the fourth level of Kirkpatr ick’s model of evaluation was not measured. Background The signing into law of the Health (Regulation of Termination of Pregnancy) Act 2018 broadened the circumstances in which termination of pregnancy could be legally performed in the Republic of Ireland (Government of Ireland, 2018). The Ir ish draft model of care for the termination of pregnancy services highlights the importance of healthcare professionals remaining abreast of the latest international evidence on termination of pregnancy (Health Service Executive, 2018). A thorough understanding of termination of pregnancy legislation and clinical practice guidelines is paramount to reduce maternal mortality and morbidity and ensure high-quality services are provided based on the best available evidence (Dennis et al, 2017). The Ir ish Institute of Obstetr ics and Gynaecologists (2018) recommends that all clinical staff involved in the care of women undergoing a termination of pregnancy should have access to appropr iate training and support. To support the delivery of evidence-based termination of pregnancy care, two national education programmes were delivered over a 5-month per iod, between November 2020 and March 2021. Both programmes took td Healthcare L 2024 MA © 6 British Journal of Midwifer y, Januar y 2024, Vol 32, No 1
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Research place virtually, over 6 hours, and included presentations from clinical experts focusing on the following key areas: ● Current legislation in the Republic of Ireland guiding termination of pregnancy service provision ● Support services available to those consider ing a termination of pregnancy ● Care required for women electing for a termination of pregnancy in early pregnancy ● Care required for women choosing a termination of pregnancy for a fatal fetal abnormality. The first article on this research study descr ibed the findings from online questionnaires which were used to capture participants’ reaction to the training exper ience and their self-assessed knowledge before and after training (Fletcher et al, 2023). The questionnaires highlighted how a short education programme increased participants’ knowledge and confidence in car ing for women having a termination of pregnancy. Participants agreed that the programme content was relevant, met their expectations and would be applied to their practice. The study identified the positive impact that education had on participants’ knowledge of the legislation, their confidence in providing infor mation to women in order for them to make informed decisions regarding their reproductive health, and in car ing for women who present with complications following termination of pregnancy. This second article delves further into participants’ exper iences of attending a termination of pregnancy education programme, by examining if their newfound knowledge and confidence enhanced their clinical practice. Additional education and training needs were also explored, as it is envisaged that this research will guide future termination of pregnancy curr iculum development. td Healthcare L 2024 MA © Methods Individual, semi-structured interviews took place with participants 3 months following attendance at a termination of pregnancy education programme. A purposeful sample of seven midwives and nurses who volunteered to participate in the study were interviewed, and data saturation was reached at this point. An interview schedule (Table 1) incorporating Kirkpatr ick’s model of evaluation was developed to ensure consistency. The interview schedule consisted of open questions generated from the programme content. A pilot interview was car r ied out, following which minor modifications were made to the research questions. Recruitment All midwives and nurses that booked to attend one of the two advertised termination of pregnancy programmes, from the six hospitals where ethical approval had been granted, were invited to participate in the research study. Box 1. Interview guide 1. You attended a termination of pregnancy education programme 3 months ago. How has the information you received on the programme impacted your experience of caring for a woman having a termination of pregnancy? 2. Do you feel that the content of the programme was relevant? 3. Can you give me some examples of how you have applied your learning to practice? ● Has attending the educational programme changed/improved your understanding of the Health (Regulation of Termination of Pregnancy) Act? ● Tell me about your experience in clinical practice of empowering women to make informed decisions regarding their reproductive health choices. ● Have you had the oppor tunity to apply your knowledge related to women who present with complications following termination of pregnancy? ● Would you feel confident in providing care to a woman with a diagnosis of fatal or complex fetal abnormality? 4. Have you had the oppor tunity to put your learning into practice? 5. Have you managed to pass your learning on to colleagues? 6. Do you feel that you have any additional education and training needs to enhance the care you provide to women attending for termination of pregnancy? The education centre’s event booking system was used to invite participants to tick a box if they were willing to be contacted by email about the research study. Those who consented to participate were emailed an infor mation leaflet, links to the questionnaires (examined in the first article of this ser ies), and provided with the researchers’ contact details, should they wish to partake in an individual interview. Data collection Interviews were facilitated by the pr incipal researcher, who was unknown to the participants. Interviews were conducted face to face and lasted between 30 and 45 minutes. To ensure credibility, interviews were digitally recorded and field notes were taken, and the data were transcr ibed verbatim by the researcher dur ing data collection. Every effort was made to enhance r igor by being open and transparent in all stages of the research process. To establish dependability and confir mability, the researcher chronicled a record of the research steps to provide an audit trail (Parahoo, 2014). To guarantee personal bias did not influence data collection or inter pretation, the researcher practised reflexivity throughout the research process (Sandelowski, 2010). A reflective diary was maintained by the pr incipal researcher dur ing each stage of the research process, captur ing their thoughts and emotions at that time, which aided transparency and accountability.This was important to ensure that the researcher’s personal beliefs and values did not influence inter pretation of the data (Polit and Beck, 2014), but was instead a true reflection of the participant’s exper iences, which added to the credibility of the research. British Journal of Midwifer y, Januar y 2024, Vol 32, No 1 7

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Research

Evaluation of a termination of pregnancy education programme in the Republic of Ireland: part 2

Abstract Background/Aims The extension of termination of pregnancy services in the Republic of Ireland represents a significant change to practice. As a result, education was provided to assist midwives and nurses to fulfil their expanded role. Using Kirkpatrick’s framework, this study aimed to conduct an in-depth evaluation to ascertain if knowledge gained at a termination of pregnancy education programme was applied to clinical practice. Methods Semi-structured interviews were conducted with a purposeful sample of seven midwives and nurses, 3 months after attending a termination of pregnancy education programme. Results Attendance at the programme prompted reflection on practice, with participants providing examples of how they applied the knowledge gained to the care they provide. The complexities of providing a termination of pregnancy service were highlighted, along with additional educational requirements. Conclusions Knowledge gained from the education programme was applied to practice improving termination of pregnancy care. Additional education and training needs identified will guide the development of future programmes.

Key words Education  |  Ireland  |  Kirkpatrick model  |  Midwives  | Nurses  | Termination of pregnancy

Antoinette Fletcher Midwife tutor and specialist coordinator1 afletcher@coombe.ie Triona Cowman Director1

Hazel Cazzini Midwifer y specialist coordinator1

Judith Fleming Midwifer y specialist coordinator1

Niamh Healy Educational Technologist1

1Centre for Midwifer y Education, Dublin, Ireland

This is the second article in a two-part ser ies evaluating, a national termination of pregnancy education programme in the Republic of Ireland using Kirkpatr ick’s model of evaluation (Kirkpatr ick and Kirkpatr ick, 2016).The first article provided the findings of levels one and two of the model, participants’ reaction to the training exper ience and their knowledge before and after attending the education programme (Fletcher et al, 2023). This article descr ibes the findings of level three of Kirkpatr ick’s model of evaluation: to identify if participants applied knowledge gained from attending the programme to clinical practice. Additional education and training required to support midwives and nurses working in termination of pregnancy services was also explored. As a result of a surge in COVID-19 cases and pressures at the front line, the fourth level of Kirkpatr ick’s model of evaluation was not measured.

Background The signing into law of the Health (Regulation of Termination of Pregnancy) Act 2018 broadened the circumstances in which termination of pregnancy could be legally performed in the Republic of Ireland (Government of Ireland, 2018). The Ir ish draft model of care for the termination of pregnancy services highlights the importance of healthcare professionals remaining abreast of the latest international evidence on termination of pregnancy (Health Service Executive, 2018). A thorough understanding of termination of pregnancy legislation and clinical practice guidelines is paramount to reduce maternal mortality and morbidity and ensure high-quality services are provided based on the best available evidence (Dennis et al, 2017). The Ir ish Institute of Obstetr ics and Gynaecologists (2018) recommends that all clinical staff involved in the care of women undergoing a termination of pregnancy should have access to appropr iate training and support.

To support the delivery of evidence-based termination of pregnancy care, two national education programmes were delivered over a 5-month per iod, between November 2020 and March 2021. Both programmes took td

Healthcare L

2024 MA

©

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British Journal of Midwifer y, Januar y 2024, Vol 32, No 1

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