Patient perspectives of pregnancy loss in the emergency department.

OBJECTIVES: While threats to pregnancy such as vaginal bleeding are common, half will miscarry. The ED environment is not always conducive to the emotional and psychological needs of women grieving the loss of a pregnancy. Healthcare providers have a great impact on the women's experience of pregnancy loss. This study describes the perspectives of women experiencing a pregnancy loss in the ED. METHODS: The study used a qualitative descriptive research design interviewing women diagnosed with a pregnancy loss in the ED. Data analysis consisted of descriptive statistics of the sample and content analysis of interviews. RESULTS: Eight participant interviews generated five themes related to the ED as part of the crossroads of motherhood and pregnancy loss. The themes were (a) Decisions to get help, (b) The environment of emergency care, (c) Not knowing, (d) Finally knowing and moving on, (e) Assisting with the grieving process. CONCLUSIONS FOR PRACTICE: Understanding the needs of women diagnosed with pregnancy loss allows emergency nurses and providers to provide more holistic, compassionate care. Knowledge of pregnancy loss experiences will assist in the improvement of future patient care, and may positively impact recovery and transition to normalcy.

A Review of the Management of Loss of Pregnancy in the Emergency Department.

INTRODUCTION: Women frequently seek ED care for complications in early pregnancy, including loss of pregnancy. This review evaluates the current literature and discusses the care of patients experiencing loss of pregnancy in the emergency department. METHODS: A review of pertinent studies identified through multiple database searches was conducted to determine the existing body of knowledge for the care of ED patients diagnosed with loss of pregnancy. Each of the studies was examined for inclusion criteria and a subsequent analysis of the included studies identified themes related to the care of the women. RESULTS: Thirty-two original research articles and systematic reviews published between 1990 and 2016 were included in the review. Eleven articles addressed recommendations for clinical practice, 5 reported statistics related to pregnancy outcome and clinical presentation, 4 discussed the use of speculum examinations, 4 discussed interventions to decrease ED length of stay, and 3 investigated the use of ultrasound in the emergency department. Only 5 of the articles reviewed discussed emotional support and/or experiences of women with loss of pregnancy in the emergency department. CONCLUSION: Although there are multiple recommendations for the clinical management of loss of pregnancy in the emergency department, the psychological and emotional support of women was addressed infrequently. Additional studies investigating holistic care would be beneficial for ED providers in the management of early loss of pregnancy.

Barriers to Research Recruitment of Women Experiencing a Pregnancy Loss in the Emergency Department.

Women often come to the emergency department (ED) with signs and symptoms suggesting an early pregnancy loss; yet, little is known about their experience and how it relates to future outcomes. To improve patient outcomes and experiences of women seeking care for a pregnancy loss, research is required. However, recruitment of participants experiencing an event such as a pregnancy loss is challenging. The purpose of this article is to discuss the application of an electronic medical record (EMR)-based participant screening tool recruiting women seeking care for a pregnancy loss in the ED. This study implemented an EMR-based prompt to assist participant screening completed by ED nurses: (a) The prompts were based on criteria built into triggers that activated a recruitment screening form to print upon discharge; (b) nurses completed the form with patients, asking for willingness to be contacted at home; and (c) participants were subsequently contacted and enrolled in the study. Our research screening program was implemented continuously in 2 EDs: a large, urban, academic medical center and a community academic hospital. Data were analyzed through descriptive statistics of reports built within the EMR. These reports signaled when the screening tool flagged participants and subsequently tied the corresponding information to the completed forms. The recruitment tool fired 1,169 times, with 61% (n = 714) screened. Fifty percent (n = 37) of women experiencing an early pregnancy loss were willing to be contacted at home for research recruitment. Of those approached after discharge (n = 24), 33% (n = 8) enrolled in the study. Of note, at one site, 14% (81/577) of potential participants with early pregnancy loss symptoms left before seeing a provider, with 26% (150/577) of these encounters were repeat visits. Staff education, nurse reluctance to approach potential participants, and patients who left without being seen led to barriers in participant screening.

Jordanian nurses' barriers to screening for intimate partner violence.

Screening rates for intimate partner violence (IPV) among nurses are still very low. The study purpose is to evaluate IPV screening and barriers by Jordanian nurses. A cross-sectional design was used with a stratified random sample (N = 125) of Jordanian nurses. Findings included a significantly lower IPV screening rate among Jordanian nurses compared with those in the United States, no difference in screening between IPV victims compared with non-victimized nurses, and that the IPV screening barriers related to a lack of system support were the most clinically important barriers. Nurses can work in partnership with health care providers and managers to increase screening and overcome barriers.

A comparison of intimate partner violence between Jordanian nurses and Jordanian women.

Intimate partner violence is a serious international problem. It is not known if the extent of intimate partner violence for Jordanian nurses is similar to that of Jordanian women. Until the rate is known, implementation of nursing interventions for Jordanian women may be thwarted. The study purpose was to determine the rate of intimate partner violence among Jordanian nurses working in governmental health settings in a northern city of Jordan and to compare the rate to published statistics for a community sample of Jordanian women. A cross-sectional survey design was used for this study. A stratified random sample of 80 Jordanian nurses working in governmental women's health centers and public hospitals in a northern city of Jordan was invited to participate. Institutional review board approval was granted. Participants completed the Woman Abuse Screening Tool in a private room at their work site. No identifiers were added to the survey forms. Chi-squared goodness-of-fit tests were computed to compare the rate of intimate partner violence between the study sample and reported statistics for Jordanian women. Approximately 59% of participants experienced psychological violence, 12.5% experienced physical violence, and 5.1% experienced sexual violence. No significant differences were found in the rates of violence for the study sample and published data for a community sample of Jordanian women. Intimate partner violence is as prevalent against Jordanian nurses as it is for Jordanian women. Intimate partner violence needs to be addressed to prevent potential sequelae such as decreased work productivity and an inability to provide safe patient care.

Bullying, incivility, and disruptive behaviors in the healthcare setting: identification, impact, and intervention.

Bullying, incivility, and their associated disruptive behaviors are insidious and destructive forces with negative consequences that require identification and intervention at the individual and organizational level. Costs incurred secondary to these insensitive behaviors are substantial and involve matters of patient safety, absenteeism, turnover, turnover intentions, organizational commitment, and employee healthcare. Factors that increase the risk of hostile behaviors include changing hierarchies, conflicting loyalties, stress, and the state of the science. Each organization has the responsibility to develop processes for managing threatening and intimidating actions. New criteria are proposed to guide the implementation of successful programs.

Domestic violence screening and treatment in the workplace.

The purpose of this study was to survey occupational health nurses about their perceived ability to screen for and treat domestic violence in the workplace. Occupational health nurses providing direct care or case management anonymously responded to the mailed Occupational Health Nurses' Survey on Screening for Domestic Violence in the Workplace. Findings indicate that occupational health nurses consider domestic violence screening and treatment to be components of their nursing role, but do not believe they have adequate training to competently care for workers who have experienced domestic violence. The occupational health nurses also did not believe policies existed in their workplace to assist them in treating these workers. Findings from this study can be used as the foundation for domestic violence education, policy development, and intervention research.

Incivility and bullying in the workplace and nurses' shame responses.

Incivility and bullying in the workplace are intimidating forces that result in shame responses and threaten the well-being of nurses. Some nurses are accustomed to tolerating behaviors that are outside the realm of considerate conduct and are unaware that they are doing so. These behaviors affect the organizational climate, and their negative effects multiply if left unchecked. Interventions for incivility and bullying behaviors are needed at both individual and administrative levels.

Malnutrition, infection, and sepsis in acute and chronic illness.

Optimal nutritional status contributes to health maintenance and the prevention of infection. The function of healthy cells is maintained by the provision of adequate nutrition. When nutrient availability is disrupted, primary and secondary malnutrition develop. Malnutrition contributes to a cascade of adverse metabolic events that compromise the immune system and impair the body's ability to adapt, recover, and survive. Malnutrition is treated by the early delivery of essential nutrients in an effective and comprehensive manner. Nurses are challenged to understand the importance of adequate nutritional support in the prevention of infection, multiple organ failure, and sepsis.