ABSTRACT
OBJECTIVE: Ectopic pregnancy can become a life threatening condition. Due to the specific nature of Ectopic pregnancy the grief experienced may well be overlooked compared to other pregnancy losses. Fertility concerns for the future and recovery from surgical or medical treatment may instead become the focus of care. The objective of this study was to gain insight into women's experience of Ectopic pregnancy. STUDY DESIGN: A qualitative semi-structured interview format was utilised. Seven women who had experienced an Ectopic pregnancy in a large tertiary-level Irish maternity hospital were interviewed. This sample was recruited purposively ensuring inclusion of women whose treatment included expectant, medical or surgical management. MAIN OUTCOME MEASURES: Interpretative phenomenological analysis was employed as the analytic strategy as it has an ideographic approach which allows us to gain insight into the women's experiences of Ectopic pregnancy. RESULTS: Key findings were the importance of clear information on treatment options, the diagnostic scan was highlighted as important as it helped the women emotionally detach from the pregnancy. Lack of bereavement counselling and satisfactory completion of outpatient care hindered closure and recovery for these women. There was increased apprehension about fertility and women reported feeling reluctant to conceive again. Women reported difficulty coming to terms with their diagnosis which in turn impacted their recovery and illustrated women's reservations to embark on future pregnancies. CONCLUSIONS: This study has implications for the care of women who experience Ectopic pregnancy particularly in relation to how they are managed from diagnosis to completion of treatment.
Subject(s)
Adaptation, Psychological , Fertility , Grief , Intention , Patient Satisfaction , Pregnancy, Ectopic/psychology , Quality of Health Care , Adult , Bereavement , Counseling , Emotions , Female , Hospitals, Maternity , Humans , Informed Consent , Ireland , Pregnancy , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/therapy , Qualitative ResearchABSTRACT
OBJECTIVE: To evaluate the implementation of early screening for critical congenital heart defects (CCHDs) in the neonatal intensive care unit (NICU) and potential exclusion of sub-populations from universal screening. STUDY DESIGN: Prospective evaluation of CCHD screening at multiple time intervals was conducted in 21 NICUs across five states (n=4556 infants). RESULTS: Of the 4120 infants with complete screens, 92% did not have prenatal CHD diagnosis or echocardiography before screening, 72% were not receiving oxygen at 24 to 48 h and 56% were born ⩾2500 g. Thirty-seven infants failed screening (0.9%); none with an unsuspected CCHD. False positive rates were low for infants not receiving oxygen (0.5%) and those screened after weaning (0.6%), yet higher among infants born at <28 weeks (3.8%). Unnecessary echocardiograms were minimal (0.2%). CONCLUSION: Given the majority of NICU infants were ⩾2500 g, not on oxygen and not preidentified for CCHD, systematic screening at 24 to 48 h may be of benefit for early detection of CCHD with minimal burden.
Subject(s)
Heart Defects, Congenital/diagnosis , Neonatal Screening/methods , Oximetry , Echocardiography , Gestational Age , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/therapy , Humans , Infant, Extremely Low Birth Weight , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Oxygen Inhalation Therapy , Prospective StudiesABSTRACT
OBJECTIVE: The objective of the study was to explore the experiences of those who have experienced miscarriage, focusing on men's and women's accounts of miscarriage. DESIGN: This was a qualitative study using a phenomenological framework. Following in-depth semistructured interviews, analysis was undertaken in order to identify superordinate themes relating to their experience of miscarriage. SETTING: A large tertiary-level maternity hospital in Ireland. PARTICIPANTS: A purposive sample of 16 participants, comprising 10 women and 6 men, was recruited. RESULTS: 6 superordinate themes in relation to the participant's experience of miscarriage were identified: (1) acknowledgement of miscarriage as a valid loss; (2) misperceptions of miscarriage; (3) the hospital environment, management of miscarriage; (4) support and coping; (5) reproductive history; and (6) implications for future pregnancies. CONCLUSIONS: One of the key findings illustrates a need for increased awareness in relation to miscarriage. The study also indicates that the experience of miscarriage has a considerable impact on men and women. This study highlights that a thorough investigation of the underlying causes of miscarriage and continuity of care in subsequent pregnancies are priorities for those who experience miscarriage. Consideration should be given to the manner in which women who have not experienced recurrent miscarriage but have other potential risk factors for miscarriage could be followed up in clinical practice.
Subject(s)
Abortion, Spontaneous , Delivery of Health Care/standards , Grief , Parents/psychology , Quality of Health Care/standards , Reproductive Health Services , Abortion, Spontaneous/psychology , Adaptation, Psychological , Adult , Female , Humans , Ireland/epidemiology , Male , Pregnancy , Qualitative Research , Reproductive Health Services/standards , Social SupportABSTRACT
Stroke rehabilitation units are associated with reduced mortality, morbidity and length of stay, in much the same way that coronary care units are known to improve the acute care of patients who have had a heart attack. Such units have facilitated the development of drugs that may improve the outcomes following a heart attack. The acute stroke unit at King's Healthcare, London, was set up to improve the early management of stroke and facilitate the development of new treatments. The unit has just celebrated its first anniversary and this paper evaluates its work one year on, plus the implications for nursing practice.
