Understanding the Experience of Miscarriage in the Emergency Department

MacWilliams, Kate; Hughes, Jean; Aston, Megan; Field, Simon; Moffatt, Faith Wight

doi:10.1016/j.jen.2016.05.011

Cited by 58 publications

(88 citation statements)

References 42 publications

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“…Empathic interpersonal communication was frequently helpful in assisting patients to cope with their experience of illness and being in the ED20 and included purposeful touch 17…”

Section: Resultsmentioning

confidence: 99%

‘They do not care how much you know until they know how much you care’: a qualitative meta-synthesis of patient experience in the emergency department

et al. 2019

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BackgroundPatient experience is positively associated with both clinical effectiveness and patient safety and should be a priority for emergency care providers. While both quantitative and qualitative approaches can be used to evaluate patient experience in the emergency department (ED), the latter is well aligned to develop a detailed understanding of features influencing the lived experience of ED patients. This study aimed to systematically review the literature of qualitative studies to identify determinants of adult patient experience in the ED.MethodsA Preferred Reporting Items for Systematic review and Meta-Analysis compliant systematic review was conducted using PubMed, CINAHL, EMBASE, BNI and bibliography searches to identify qualitative studies exploring patient experiences in ED published in English between 1997 and 2018. Quality assessment was conducted using the Critical Appraisal Skills Programme checklist. Descriptive text and quotations relating to patient experience were extracted from included studies and a meta-synthesis conducted using thematic analysis.ResultsA total of 625 records were screened from which 40 studies underwent full review and 22 were included. Results were coded by two researchers (BG and JML). Meta-synthesis identified 198 discrete units of analysis which were clustered around five analytical themes. These were based on the perceived ‘needs’ of patients visiting the ED and were defined as communication, emotional, competent care, physical/environmental and waiting needs. Findings were translated into a conceptual model for optimising patient experience in the ED.ConclusionThis meta-synthesis provides a framework for understanding the determinants of patient experience in the ED. The resulting conceptual model and recommendations may have the potential to directly inform practice and improve the patient experience.

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“…Empathic interpersonal communication was frequently helpful in assisting patients to cope with their experience of illness and being in the ED20 and included purposeful touch 17…”

Section: Resultsmentioning

confidence: 99%

‘They do not care how much you know until they know how much you care’: a qualitative meta-synthesis of patient experience in the emergency department

et al. 2019

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“…The period of three years was deemed suitable as miscarriage may be a traumatic event remembered several years after the loss (Gerber‐Epstein, Leichtentritt, & Benyamini, ). Participants’ stories were found to be detailed in previous studies on the topic using time frames of up to 6 years (MacWilliams et al, ; Meany et al, ). The exclusion criterion for parents was to have been a nurse in this ED setting.…”

Section: Methodsmentioning

confidence: 99%

“…However, a systematic search in five major electronic databases (CINAHL, Medline, PsycARTICLES, PsycINFO and Social Work Abstracts) reveals that only six studies seem to have addressed the specific experiences of parents who visit the ED during a miscarriage. These qualitative studies were carried out in Australia (Edwards, Birks, Chapman, & Yates, ; McLean & Flynn, ; Warner et al, ), Canada (MacWilliams et al, ) and the USA (Baird et al, ; Koziol‐McLain et al, ). The participating women reported multiple shortcomings in the care they received.…”

Section: Introductionmentioning

confidence: 99%

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

Emond

Montigny

Guillaumie

2019

Journal of Clinical Nursing

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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.

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“…Various factors influence how women perceive their care in the ED when experiencing early pregnancy loss. Women who perceived that ED staff did not show empathy or provide emotional support reported that this negatively affected their experience . Women were also dissatisfied about long wait times particularly as some women believed that pregnancy loss required urgent medical attention .…”

Section: Introductionmentioning

confidence: 99%

“…Women were also dissatisfied about long wait times particularly as some women believed that pregnancy loss required urgent medical attention . Many women also reported that they were dissatisfied with the level of communication from practitioners about their pregnancy loss and want to be involved in shared decision making . Women also feel unsupported without follow‐up care after leaving the ED .…”

Section: Introductionmentioning

confidence: 99%

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

See

Blecher

Craig

et al. 2019

Emerg Medicine Australasia

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Objective To explore women's expectations and experiences when presenting to the ED with early pregnancy bleeding. Methods We conducted a qualitative study where women presenting to the ED with early pregnancy bleeding participated in two semi‐structured interviews. An initial interview explored expectations of care and was conducted prior to ED treatment. A follow‐up interview about experiences with care was conducted after discharge from the ED. Women were recruited from three EDs in suburban Melbourne: one tertiary referral centre and two urban district hospitals. Results Thirty women with early pregnancy bleeding completed the initial interview and 22 completed the follow‐up interview. Eleven participants were primigravid women and 21 participants had never experienced early pregnancy bleeding prior to their ED presentation. Four themes relating to the patient experience were identified: (i) Acknowledgement of patients' concerns by hospital staff, including informing patients of progress and explanation of investigation results; (ii) Early pregnancy bleeding as a distressing experience, with most participants expecting that this would be acknowledged by ED staff, and privacy provided to allow for grieving; (iii) Prolonged waiting time for an urgent medical condition; and (iv) Ongoing care and support, such as providing recommendations of available services to support patients on discharge from the ED. Conclusion Early pregnancy bleeding is a distressing and anxiety‐provoking experience for women attending the ED. Appropriate emotional support is critical to the holistic care for those seeking emergency care.

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Understanding the Experience of Miscarriage in the Emergency Department

Cited by 58 publications

References 42 publications

‘They do not care how much you know until they know how much you care’: a qualitative meta-synthesis of patient experience in the emergency department

‘They do not care how much you know until they know how much you care’: a qualitative meta-synthesis of patient experience in the emergency department

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

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

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