Armour S, Gilkison A, Hunter M. Midwives holding the space for women undergoing termination of pregnancy: a qualitative inquiry. Women Birth. 2021; 34:e616-e623

Barchard F. Exploring the role of reflection in nurse education and practice. Nursing Standard. 2022; 37:(6)45-49

Ben-Ezra M, Palgi Y, Walker R, Many A, Hamam-Raz Y. The impact of perinatal death on obstetrics nurses: a longitudinal and cross-sectional examination. J Perinat Med. 2014; 42:(1)75-81

Bradfield Z, Duggan R, Hauck Y, Kelly M. Midwives being ‘with woman’: an integrative review. Women Birth. 2018; 31:143-152

Dempsey B, Favier M, Mullally A, Higgins M.F. Exploring providers' experience of stigma following the introduction of more liberal abortion care in the Republic of Ireland. Contraception. 2021; 104:414-419

Dennis A, Blanchard K, Bessenaar T. Identifying indicators for quality abortion care: a systematic literature review. J Family Plan Reprod Health Care. 2017; 43:7-15

European Court of Human Rights, Council of Europe. European Convention on Human Rights. 2013. https//,1.,%2C%20teaching%2C%20practice%20and%20observance (accessed 19th October 2023)

Fernández-Basanta S, Movilla-Fernández MJ, Coronado C, Llorente-García H, Bondas T. Involuntary pregnancy loss and nursing care: a meta-ethnography. Int J Environ Res Public Health. 2020; 17:(5)

Fisher J, Lafarge C. Women's experience of care when undergoing termination of pregnancy for fetal anomaly in England. J. Reprod. Infant Psychol.. 2015; 33:69-87

Fleming V, Frith L, Luyben A, Ramsayer B. Conscientious objection to participation in abortion by midwives and nurses: a systematic review of reasons. BMC Med Ethics. 2018; 19:1-13

Fletcher A, Cowman T, Cazzini H, Fleming J, Healy N. Evaluation of a termination of pregnancy education programme in the Republic of Ireland: part 1. Br J Midwifery. 2023; 31:(6)305-358

Government of Ireland. Health (regulation of termination of pregnancy) act 2018. 2018. https// (accessed 8 January 2023)

Health Service Executive. Draft model of care for the termination of pregnancy service. 2018. https// (accessed 10 January 2023)

Heaney S, Galeotti M, Aventin Á. Pregnancy loss following miscarriage and termination of pregnancy for medical reasons during the COVID-19 pandemic: a thematic analysis of women's experiences of healthcare on the island of Ireland. BMC Pregnancy Childbirth. 2023; 23:(1)1-10

Institute of Obstetrics and Gynaecologists. Interim clinical guidance on termination of pregnancy under 12 weeks. 2018. https// (accessed 10 January 2023)

Irani M, Khadivzadeh T, Nekah S.M.A, Ebrahimipour H, Tara F. Emotional and cognitive experiences of pregnant women following prenatal diagnosis of fetal anomalies: a qualitative study in Iran. Int. J. Community Based Nurs. Midwifery. 2019; 7:22-31

Jones K, Baird K, Fenwick J. Women's experiences of labour and birth when having a termination of pregnancy for fetal abnormality in the second trimester of pregnancy: a qualitative meta-synthesis. Midwifery. 2017; 50:42-54

Kirkman M, Apicella C, Graham J Meanings of abortion in context: accounts of abortion in the lives of women diagnosed with breast cancer. BMC Womens Health. 2017; 17:1-10

Kirkpatrick DL, Kirkpatrick JD. Evaluating training programs: the four levels.San Francisco: CA: Berrett-Koehler Publishers; 2016

Lafarge C, Mitchell K, Fox P. Termination of pregnancy for fetal abnormality: a meta-ethnography of women's experiences. Reproductive health matters. 2014; 22:191-201

Lotto R, Armstrong N, Smith LK. Care provision during termination of pregnancy following diagnosis of a severe congenital anomaly – a qualitative study of what is important to parents. Midwifery. 2016; 43:14-20

Maguire M, Light A, Kuppermann M, Dalton VK, Steinauer JE, Kerns JL. Grief after second-trimester termination for fetal anomaly: a qualitative study. Contraception. 2015; 91:234-239

Mauri PA, Squillace F. The experience of Italian nurses and midwives in the termination of pregnancy: a qualitative study. Eur J Contracept Reprod Health Care. 2017; 22:227-232

McCoyd JL. Pregnancy interrupted: loss of a desired pregnancy after diagnosis of fetal anomaly. J Psychosom Obstet Gynecol.. 2007; 28:37-48

Mullally A, Horgan T, Thompson M, Conlon C, Dempsey B, Higgins MF. Working in the shadows, under the spotlight–reflections on lessons learnt in the Republic of Ireland after the first 18 months of more liberal abortion care. Contraception. 2020; 102:305-307

Nash M, Barry M, Bradshaw C. Midwives' experiences of caring for women with early pregnancy loss in an Irish maternity hospital. Br J Midwifery. 2018; 26:(12)796-805

Nursing and Midwifery Board of Ireland. Code of professional conduct and ethics for registered nurses and registered midwives. 2021. https// (accessed 1 March 2023)

Nursing and Midwifery Board of Ireland. Practice standards for midwives. 2022. https// (accessed 1 March 2023)

O'Shaughnessy E, O'Donoghue K, Leitao S. Termination of pregnancy: staff knowledge and training. Sex Reprod Healthc.. 2021; 28

Parahoo K. Nursing research: principles, process and issues.Hampshire, UK: Palgrave MacMillan; 2014

Pezaro S, Clyne W, Turner A, Fulton EA, Gerada C. ‘Midwives Overboard!’ Inside their hearts are breaking, their makeup may be flaking but their smile still stays on. Women Birth. 2016; 29:e59-e66

Polit DF, Beck CT. Essentials of nursing research: appraising evidence for nursing practice.Philadelphia: Lippincott Williams & Wilkins; 2014

Ramsayer B, Fleming V. Conscience and conscientious objection: The midwife's role in abortion services. Nursing Ethics. 2020; 27:1645-1654

Sandelowski M. What's in a name? Qualitative description revisited. Res Nurs Health. 2010; 33:77-84

Simonovich S. The value of developing a mixed-methods program of research. Nurs Sci Quart. 2017; 30:(3)201-204

Sriarporn P, Turale S, Lordee N, Liamtrirat S, Hanpra W, Kanthino A. Support program for women suffering grief after termination of pregnancy: a pilot study. Nurs. Health Sci.. 2017; 19:75-80

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

02 January 2024
Volume 32 · Issue 1



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.


Semi-structured interviews were conducted with a purposeful sample of seven midwives and nurses, 3 months after attending a termination of pregnancy education programme.


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.


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.

This is the second article in a two-part series evaluating, a national termination of pregnancy education programme in the Republic of Ireland using Kirkpatrick's model of evaluation (Kirkpatrick and Kirkpatrick, 2016). The first article provided the findings of levels one and two of the model, participants' reaction to the training experience and their knowledge before and after attending the education programme (Fletcher et al, 2023). This article describes the findings of level three of Kirkpatrick'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 Kirkpatrick's model of evaluation was not measured.

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 Irish 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 Irish Institute of Obstetrics and Gynaecologists (2018) recommends that all clinical staff involved in the care of women undergoing a termination of pregnancy should have access to appropriate training and support.

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