Exploring the needs of parents who experience miscarriage in the emergency department: A qualitative study with parents and nurses

Abstract

Aims and objectives To understand how parents experienced miscarriage in an emergency department setting. Objectives were to identify parents’ needs, isolate factors that influenced their experience, and provide recommendations to improve care from the perspective of women, their partners, nurses and nurse managers. Background Miscarriage is the most prevalent complication encountered during pregnancy. It subjects parents to a multitude of emotions and may have significant consequences on mental health. Emergency department visits are frequently the only opportunity for parents to receive formal support during a miscarriage; it is thus crucial to understand the experiences of parents in this setting. Design The study employed a descriptive, exploratory, qualitative approach with semi‐structured interviews. Methods The study was founded on the W.K. Kellogg Foundation's Logic Model Development Guide (2004) and Meleis’ Transitions Theory (2015). A total of 26 participants were interviewed (17 parents, 7 emergency department nurses and 2 emergency department nurse managers). Consolidated criteria for reporting qualitative research was used to report results. Results Three categories of needs were identified: physical health, cognitive and emotional. For instance, parents expressed a need to receive more information during their visit to the emergency department (i.e., a cognitive need), whether about the diagnostic test results or how to ensure a better recovery. Parents also reported a desire for professionals to address their emotional concerns. Nurses were aware of the emotional impact of miscarriage but felt that they were not adequately trained in providing optimal care to parents in this situation. Conclusions Parents who visited the emergency department for miscarriage reported several unfulfilled needs that generated dissatisfaction with care. Emergency department organisational constraints hindered optimal nursing care practices. Relevance to clinical practice Nurses have an important role to play in improving parents’ experience. They can do so by understanding the needs of parents and by being involved in developing new guidelines.

Expectations and experiences of women presenting to emergency departments with early pregnancy bleeding

“…Early pregnancy bleeding can have a significant emotional impact on women. The importance of acknowledging women's distress and emotions is not only highlighted in the present study, but is a recurring theme in other studies exploring the management of early pregnancy loss . Many women reported positive experiences during their ED visit when staff showed active listening, thoughtfulness and empathy.…”

“…The importance of acknowledging women's distress and emotions is not only highlighted in the present study, but is a recurring theme in other studies exploring the management of early pregnancy loss. [9][10][11][12][13][14][15] Many women reported positive experiences during their ED visit when staff showed active listening, thoughtfulness and empathy. This could also include provision of tissues, orientating the patient to bathrooms, providing reassurance and offering condolences particularly if pregnancy loss has occurred.…”

“…It is evident that there is some dissatisfaction with care and further work can be done to understand the patient experience. Existing qualitative studies involved interviews with women weeks to years after their ED visit and focus on women who have experienced early pregnancy loss . However, not all women who attend the ED with early pregnancy bleeding experience pregnancy loss .…”

“…9,10,[12][13][14] Women were also dissatisfied about long wait times 10,12,13 particularly as some women believed that pregnancy loss required urgent medical attention. 11 Many women also reported that they were dissatisfied with the level of communication from practitioners about their pregnancy loss [9][10][11][12][13][14][15] and want to be involved in shared decision making. 16,17 Women also feel unsupported without follow-up care after leaving the ED.…”

“…Existing qualitative studies involved interviews with women weeks to years after their ED visit and focus on women who have experienced early pregnancy loss. [9][10][11][12][13][14][15] However, not all women who attend the ED with early pregnancy bleeding experience pregnancy loss. 1,6 There is a period of uncertainty while the woman awaits medical evaluation and investigations, and exploring the needs and expectations of this group of women prior to receiving a • Early pregnancy bleeding can have a significant emotional impact on women.…”