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Trostian B, McCloughen A, Curtis K. What proportion of women presenting to the emergency department with early pregnancy bleeding receive appropriate care? Emerg Med Australas 2024. [PMID: 39375882 DOI: 10.1111/1742-6723.14507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 09/12/2024] [Indexed: 10/09/2024]
Abstract
OBJECTIVE To determine the proportion of women presenting to EDs across a regional health district, with early pregnancy bleeding, who received appropriate care. METHODS Retrospective cohort review of linked data from five data sets: ED, pathology, radiology, costs and non-admitted/outpatient. Data collected from five EDs between January 2011 and December 2020, across one health district in NSW, Australia, with 150 000 annual ED presentations. Management received by women of reproductive age, with early pregnancy (<20 weeks gestation) bleeding was compared to seven indicators for recommended care. Indicators included blood tests, psychosocial support, administration of Rhesus D immunoglobulin and US. Indicators were determined by a systematic analysis of published primary research, expert consensus clinical practice guidelines and literature reviews on initial assessment, intervention and diagnostics for women with early pregnancy bleeding. RESULTS There was no evidence of almost one third of women (n = 3661, 29.4%) receiving any indicators and 54 (0.4%) received five or more indicators of appropriate care. Presentations to rural facility had the lowest number and proportion of indicators being performed (n = 603, 58.0% for no indicators). Cost increased with the number of indicators. Over the study period, the proportion of all indicators being performed increased, and indicator six - psychosocial support referral or care had the biggest growth (almost 500%). CONCLUSIONS Variation in care for women presenting with early pregnancy bleeding to ED was identified. There is an evidence-practice gap and need for inquiry into barriers and facilitators to prescribed clinical practice for this population.
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Affiliation(s)
- Baylie Trostian
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Emergency Department, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrea McCloughen
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Emergency Department, Wollongong Hospital, Wollongong, New South Wales, Australia
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Freeman N, Moroney T, Warland J, Cheney K, Bradfield Z. Midwives' and registered nurses' role and scope of practice in acute early pregnancy care settings in Australia: A qualitative descriptive study. Women Birth 2024; 37:101643. [PMID: 39018604 DOI: 10.1016/j.wombi.2024.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/30/2024] [Accepted: 06/30/2024] [Indexed: 07/19/2024]
Abstract
PROBLEM There is little documented evidence regarding the practice of midwives providing care for women with acute concerns in early pregnancy (< 20 weeks) in Australia. BACKGROUND Women can experience unexpected complications at any gestation of pregnancy and may seek acute care in an emergency or gynaecology service, usually staffed by registered nurses (RNs). They may not receive care from specialised pregnancy clinicians, including midwives. The role and scope of practice of midwives working in acute early pregnancy settings in Australia has not been previously reported. This study provides an opportunity to document practice in an area of pregnancy care not often visible within maternity services in Australia. RESEARCH AIM To describe midwives' and RNs perceptions, perspectives and experiences of role and scope of practice in acute early pregnancy care provision in Australia. METHODS A qualitative descriptive approach was adopted. Midwives and RNs with acute early pregnancy knowledge and experience were recruited. Semi-structured interviews were conducted, and data analysed using inductive thematic analysis. FINDINGS Fifteen participants were interviewed. Three themes were constructed from interview data: Personal and Professional Influences; Being There for Women; The Impact of Setting. DISCUSSION Findings reinforce the lack of clarity around how midwives' scope is enabled in traditional acute early pregnancy care. Setting of care has influenced practice and seen a barrier for midwives who don't hold nursing registration from fulfilling professional scope. Results provide novel benchmarking evidence regarding a largely hidden area of midwifery, signposting areas for reform within education, policy and health service sectors.
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Affiliation(s)
- Nicole Freeman
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, Western Australia, Australia.
| | - Tracey Moroney
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Jane Warland
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kate Cheney
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Zoe Bradfield
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, Western Australia, Australia
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Emond T, de Montigny F, Webster J, Zeghiche S, Bossé M. Compassionate Care for Parents Experiencing Miscarriage in the Emergency Department: A Situation-Specific Theory. ANS Adv Nurs Sci 2024; 47:288-301. [PMID: 36928273 DOI: 10.1097/ans.0000000000000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
In many countries, parents experiencing miscarriage seek treatment in the emergency department (ED). Parents frequently report dissatisfaction with ED care, while nurses report not knowing how to provide optimal care. This article describes the development of a situation-specific theory, Compassionate care for parents experiencing miscarriage in the ED , based on 4 concepts (change trigger, transition properties, conditions of change, and interventions). This theory evolved from a comprehensive review of the literature, 2 empirical studies, Transitions Theory, and collaborative efforts of an experienced team. The detailed theory development process facilitates its integration in practice and supports new theory development.
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Affiliation(s)
- Tina Emond
- Author Affiliations: Faculty of Nursing, Université de Moncton, Edmundston, New Brunswick, Canada (Dr Emond); Faculty of Nursing, Université du Québec en Outaouais, Québec, Canada (Dr de Montigny); Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada (Ms Webster); Department of Social Work, Université du Québec en Outaouais, Québec, Canada (Dr Zeghiche); and Emergency/ICU Department, Edmundston Regional Hospital, Vitalité Health Network, Edmundston, New Brunswick, Canada (Ms Bossé)
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Roberts LR, Nick JM, Sarpy NL, Peters J, Tamares S. Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review. JBI Evid Synth 2024:02174543-990000000-00324. [PMID: 38932508 DOI: 10.11124/jbies-23-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE The objective of the scoping review was to explore the evidence and describe what is known about perinatal bereavement care guidelines provided within health care facilities prior to discharge. Additionally, the review sought to identify what is known about parents' mental health outcomes, and map these outcomes to the characteristics of the bereavement care guidelines. INTRODUCTION Perinatal loss poses a serious risk of emotional trauma and mental health sequelae. Conflicting evidence for international bereavement care guidelines and inconsistent implementation, a lack of experimental studies, and older syntheses with a limited focus or population made synthesis complex. Therefore, a scoping review was undertaken to determine the breadth and depth of the existing literature on this topic. INCLUSION CRITERIA Sources pertaining to bereavement care guidelines used in health care facilities immediately after perinatal loss (miscarriage, stillbirth, or neonatal death) and parents' mental health outcomes were included. Sources pertaining to family members other than parents, perinatal loss occurring outside of a health care facility, and physical care guidelines were excluded. METHODS The review was conducted using JBI methodology for scoping reviews. The team considered quantitative and qualitative studies, practice guidelines, case reports, expert opinions, systematic reviews, professional organization websites, and gray literature. CINAHL (EBSCOhost), PsycINFO (EBSCOhost), SocINDEX (EBSCOhost), Cochrane Library, JBI Evidence-based Practice Database (Ovid), Embase, PubMed (NLM), ProQuest Dissertations and Theses A&I (ProQuest), Web of Science Core Collection, and Epistemonikos were the major databases searched. OpenGrey, Google Scholar, and organizational websites were also searched. The earliest empirical study publication found (1976) served as the starting date limit. After pilot-testing the screening process, data were extracted, collated, and presented in narrative form as well as in tables and figures. The search was first conducted in September and October 2021, and an updated search was performed on February 9, 2023. RESULTS The results provide a broad view of bereavement care guidelines to support grieving parents' mental health. The included sources (n = 195) were comprised of 28 syntheses, 96 primary studies, and 71 literature review/text and opinion. From the studies that specified the number of participants, 33,834 participants were included. Key characteristics of bereavement care guidelines were categorized as i) making meaning/memories, ii) good communication, iii) shared decision-making, iv) effective emotional and social support, and v) organizational response. Parents' reported mental health outcomes included both negative outcomes, such as depression, anxiety, anger, and helplessness, and positive outcomes, including coping, healing, recovery, and well-being. CONCLUSIONS Conceptually the characteristics of published guidelines are fairly consistent across settings, with cultural variations in specific components of the guidelines. Despite the exponential increase in research pertaining to bereavement care after perinatal loss, there is a gap in research pertaining to certain characteristics of bereavement care guidelines accepted as best practice to support parents' mental health outcomes. This review provides support for future research given the trauma and mental health risks following perinatal loss. Policies ensuring consistent and appropriate implementation of bereavement care guidelines are essential to improve parents' mental health outcomes.
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Affiliation(s)
- Lisa R Roberts
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
| | - Jan M Nick
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
| | - Nancy L Sarpy
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Judith Peters
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Shanalee Tamares
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
- Del Webb Library, Loma Linda University, Loma Linda, CA, USA
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Freeman N, Warland J, Cheney K, Bradfield Z. Midwives' and registered nurses' role and scope of practice in acute early pregnancy care services: a scoping review. JBI Evid Synth 2024:02174543-990000000-00312. [PMID: 38769931 DOI: 10.11124/jbies-23-00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE The objective of this scoping review was to investigate and describe what is reported on the role and scope of practice of midwives and registered nurses providing care for women with pregnancy complications under 20 weeks' gestation in acute clinical settings in Australia. INTRODUCTION In many high-income countries, women experiencing unexpected complications in early pregnancy attend an acute care service, such as an emergency department, rather than a maternity or obstetric unit. This service structure can impact the care women receive, and determine who provides it. Women and their partners, who are often experiencing emotional distress, have reported difficult experiences when accessing acute services, particularly emergency departments, which are not traditionally staffed by midwives. The role and scope of practice of both midwives and registered nurses providing acute early pregnancy care in most high-income countries, including Australia, is poorly reported. Documenting this area of practice is an important first step in facilitating ongoing research in this important aspect of pregnancy care. INCLUSION CRITERIA Published and gray literature that described the role and scope of practice of midwives and/or registered nurses providing care in acute early pregnancy settings in Australia were considered for this review. METHODS A scoping review of the literature was conducted following JBI methodological guidance and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A 3-step search strategy was conducted to explore evidence from databases and search engines, gray literature sources, and selected reference lists. After screening, data were extracted from records selected for the final review, mapped, and analyzed using content analysis. RESULTS The evidence reviewed (n=23) included primary research studies, conference abstracts, and gray literature, such as clinical guidance documents, academic theses, and websites from January 2008 to October 2023. The most common setting for care provision was the emergency department. Midwives' and registered nurses' roles and scope of practice in acute early pregnancy care in Australia can be summarized into 4 areas: physical care, psychosocial support, care co-ordination, and communication. Women's access to midwifery care at this time in pregnancy appears to be limited. Registered nurses, usually employed in emergency departments, have the most prominent role and scope in the provision of care for women with acute early pregnancy complications. Descriptions of midwives' practice focuses more on psychosocial support and follow-up care, particularly in early pregnancy assessment service models. CONCLUSIONS This review highlights the inconsistency in midwives' and registered nurses' roles and scope in acute early pregnancy in Australia, a finding which is relevant to other international settings. Both professions could further fulfill role and scope capacity in the provision of supportive, individualized, and timely care for women and families accessing a range of acute early pregnancy services. Emergency departments are the usual practice domain of registered nurses who may be limited in terms of the scope of care they can provide to women with early pregnancy complications. Leaders of the midwifery profession should conduct further research into innovative service models that embed a role for midwives in all settings that provide care for pregnant women, regardless of gestation. REVIEW REGISTRATION Open Science Framework osf.io/7zchu.
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Affiliation(s)
- Nicole Freeman
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, WA, Australia
| | - Jane Warland
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, WA, Australia
| | - Kate Cheney
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Zoe Bradfield
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, WA, Australia
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Shah PB, Gupta K, Bedi M. Association of Serum Proteins Electrophoretic Pattern and Serum Hormones in Women with Spontaneous Pregnancy Loss. Int J Appl Basic Med Res 2024; 14:114-123. [PMID: 38912357 PMCID: PMC11189267 DOI: 10.4103/ijabmr.ijabmr_383_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/24/2024] [Accepted: 03/18/2024] [Indexed: 06/25/2024] Open
Abstract
Background Pregnancy is the state of carrying a developing embryo or fetus within a female body. Once pregnancy is established, a range of endocrinological events appear in its maintenance, finally helping in the successful pregnancy. The complications which are usually observed in pregnancy are gestational diabetes, preeclampsia, preterm labor, and spontaneous pregnancy loss or miscarriage, while 10%-15% of clinically recognized pregnancies terminate into spontaneous miscarriage. Thus, many attempts have been made by different researchers for the diagnosis of high-risk pregnancy on altered protein pattern using placental villous tissue or follicular fluid, but these are difficult to obtain and results of different studies are not constant. Aim This study was designed to identify the association (if any) among serum protein(s) electrophoretic pattern and different serum hormones in normal pregnant women (controls) and gestational age-matched women with spontaneous pregnancy loss (cases). Materials and Methods This study was carried out for 1½ year from October 2018 to March 2020 and included 120 participants (60 normal pregnant women and 60 women with spontaneous pregnancy loss) between 20 and 45 years of age with no mean age difference. The electrophoresis of serum was carried out using slab gel electrophoretic unit and serum thyroid-stimulating hormone (TSH), total tri-iodothyronine (TT3), total thyroxine (TT4), prolactin, and beta human chorionic gonadotropin (β-hCG) levels were analyzed using TSOSH AIA analyzer at Adesh University, Bathinda. Results Significant variations in the expression of proteins with molecular weight around ~150 kDa, ~50 kDa, and ~25 kDa were observed in normal pregnant women and women with spontaneous pregnancy loss. However, the protein band of ~50 kDa was found to be highly expressed in the serum of 1st and 2nd trimester women experiencing spontaneous pregnancy loss. Therefore, selected protein band of ~50 kDa was further processed by ECI-mass spectrophotometry QUAD time of flight and 365 different proteins were found, out of these; 34 proteins were found to be unidentified protein products (Verified using NCBI data base). Further, TT3, total proteins, β-hCG, and prolactin level were found to be low, whereas, TSH was found to be high in women experiencing spontaneous pregnancy loss. However, difference in the level of β-hCG in the 1st trimester and TT4 among normal pregnant women and women with spontaneous pregnancy loss was observed to be statistically insignificant. Conclusion This study indicated that the evaluation of serum protein variations along with hormonal profile may provide valuable information about high-risk pregnancy. Moreover, the differential expression of proteins in women with spontaneous pregnancy loss can be further explored to develop potential biomarker for the early identification of high-risk pregnancy and appropriate preventive measure.
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Affiliation(s)
- Prithvi Bahadur Shah
- Centre for Interdisciplinary Biomedical Research (CIBR), Adesh University, Bathinda, Punjab, India
| | - Kapil Gupta
- Department of Biochemistry, Adesh Institute of Medical Science and Research, Adesh University, Bathinda, Punjab, India
| | - Mini Bedi
- Department of Obstetrics and Gynaecology, Adesh Institute of Medical Science and Research, Adesh University, Bathinda, Punjab, India
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Bond C, Datta S, Milne WK. Hot off the press: Microaggressions in the emergency department. Acad Emerg Med 2024; 31:404-407. [PMID: 38465881 DOI: 10.1111/acem.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Affiliation(s)
| | - Suchisimita Datta
- NYU Grossman Long Island School of Medicine, New York, New York, USA
| | - William K Milne
- University of Western Ontario OH5, Goderich, Ontario, Canada
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Kusi Amponsah A, Boateng EA, Armah J, Dompim JK, Gyamfi D, Lomotey A, Annobil FA, Amankrah AE, Youshah RA, Beauty EU, Diji F, Bam V. The psychosocial experiences of pregnant women in the early stages of the COVID-19 pandemic: A retrospective qualitative study. PLoS One 2024; 19:e0299219. [PMID: 38416742 PMCID: PMC10901345 DOI: 10.1371/journal.pone.0299219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/05/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Pregnant women are among the most vulnerable and suffer the most during pandemics, according to earlier studies. Pregnant women had to seek healthcare for both themselves and their unborn child(ren) in the wake of the COVID-19 pandemic, which was unprecedented. Pregnant women's psychosocial experiences during pandemics are crucial since they both directly and indirectly affect the course of pregnancy and childbirth. The study therefore sought to explore the psychosocial experiences of pregnant women during the COVID-19 pandemic. METHODS In this retrospective qualitative study, 15 nursing mothers who were attending a postnatal clinic at the Kwame Nkrumah University of Science and Technology (KNUST) hospital in Ghana were recruited. Individual interviews were conducted with mothers who were pregnant between March and December 2020. The audio-recorded interviews were transcribed verbatim and inductively analysed into themes. RESULTS Nursing mothers were aged 25-30 years and had infants ranging from 5 months to 15 months. Thirteen (13) were married and two were single. Two (2) major themes and five (5) subthemes emerged from the study. The unpleasant feelings connected to the potential for contracting COVID-19 and experiencing stress were described by the theme, "Fear and Stress". Participants' social experiences (support from significant others), alterations in daily routine and the economic impact because of the pandemic were presented as the "Socioeconomic impact". CONCLUSION Pregnant women go through several challenges during pregnancy such as perceived stress and anxiety. These are likely to heighten during a pandemic, as presented in the study. They therefore need emotional and psychosocial support in such uncertain times to improve outcomes of pregnancy.
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Affiliation(s)
- Abigail Kusi Amponsah
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Nursing Sciences, University of Turku, Turku, Finland
| | - Edward Appiah Boateng
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jerry Armah
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joana Kyei Dompim
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Douglas Gyamfi
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alberta Lomotey
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Faithful Adwoa Annobil
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Amena Ekua Amankrah
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rifka Abdallah Youshah
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Elizabeth Uzoka Beauty
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Francis Diji
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- St. Martins Catholic Hospital, Kumasi, Ghana
| | - Victoria Bam
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Punches BE, Osuji E, Bischof JJ, Li-Sauerwine S, Young H, Lyons MS, Southerland LT. Patient perceptions of microaggressions and discrimination toward patients during emergency department care. Acad Emerg Med 2023; 30:1192-1200. [PMID: 37335980 PMCID: PMC11075179 DOI: 10.1111/acem.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Disparities in emergency department (ED) care based on race and ethnicity have been demonstrated. Patient perceptions of emergency care can have broad impacts, including poor health outcomes. Our objective was to measure and explore patient experiences of microaggressions and discrimination during ED care. METHODS This mixed-methods study of adult patients from two urban academic EDs integrates quantitative discrimination measures and semistructured interviews of discrimination experiences during ED care. Participants completed demographic questionnaires and the Discrimination in Medical Settings (DMS) scale and were invited for a follow-up interview. Transcripts of recorded interviews were analyzed leveraging conventional content analysis with line-by-line coding for thematic descriptions. RESULTS The cohort included 52 participants, with 30 completing the interview. Nearly half the participants were Black (n = 24, 46.1%) and half were male (n = 26, 50%). "No" or "rare" experiences of discrimination during the ED visit were reported by 22/48 (46%), some/moderate discrimination by 19/48 (39%), and significant discrimination in 7/48 (15%). Five main themes were found: (1) clinician behaviors-communication and empathy, (2) emotional response to health care team actions, (3) perceived reasons for discrimination, (4) environmental pressures in the ED, and (5) patients are hesitant to complain. We found an emergent concept where persons with moderate/high DMS scores, in discussing instances of discrimination, frequently reflected on previous health care experiences rather than on their current ED visit. CONCLUSIONS Patients attributed microaggressions to many factors beyond race and gender, including age, socioeconomic status, and environmental pressures in the ED. Of those who endorsed moderate to significant discrimination via survey response during their recent ED visit, most described historical experiences of discrimination during their interview. Previous experiences of discrimination may have lasting effects on patient perceptions of current health care. System and clinician investment in patient rapport and satisfaction is important to prevent negative expectations for future encounters and counteract those already in place.
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Affiliation(s)
- Brittany E. Punches
- The Ohio State University College of Nursing, Columbus, Ohio, USA
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Evans Osuji
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Simiao Li-Sauerwine
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Henry Young
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael S. Lyons
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lauren T. Southerland
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Punches BE, Brown JL, Taul NK, Sall HA, Bakas T, Gillespie GL, Martin-Boone JE, Boyer EW, Lyons MS. Patient motivators to use opioids for acute pain after emergency care. FRONTIERS IN PAIN RESEARCH 2023; 4:1151704. [PMID: 37818444 PMCID: PMC10560756 DOI: 10.3389/fpain.2023.1151704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Patients are stakeholders in their own pain management. Factors motivating individuals to seek or use opioids therapeutically for treatment of acute pain are not well characterized but could be targeted to reduce incident iatrogenic opioid use disorder (OUD). Emergency departments (EDs) commonly encounter patients in acute pain for whom decisions regarding opioid therapy are required. Decision-making is necessarily challenged in episodic, unscheduled care settings given time pressure, limited information, and lack of pre-existing patient provider relationship. Patients may decline to take prescribed opioids or conversely seek opioids from other providers or non-medical sources. Methods Using a framework analysis approach, we qualitatively analyzed transcripts from 29 patients after discharge from an ED visit for acute pain at a large, urban, academic hospital in the midwestern United States to describe motivating factors influencing patient decisions regarding opioid use for acute pain. A semi-structured interview guide framed participant discussion in either a focus group or interview transcribed and analyzed with conventional content analysis. Results Four major themes emerged from our analysis including a) pain management literacy, b) control preferences, c) risk tolerance, and d) cues to action. Discussion Our findings suggest targets for future intervention development and a framework to guide the engagement of patients as stakeholders in their own acute pain management.
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Affiliation(s)
- Brittany E. Punches
- College of Nursing, The Ohio State University, Columbus, OH, United States
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jennifer L. Brown
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, United States
| | - Natalie K. Taul
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Hawa A. Sall
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH, United States
| | | | | | - Edward W. Boyer
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Michael S. Lyons
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
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Benson LS, Holt SK, Gore JL, Callegari LS, Chipman AK, Kessler L, Dalton VK. Early Pregnancy Loss Management in the Emergency Department vs Outpatient Setting. JAMA Netw Open 2023; 6:e232639. [PMID: 36920395 PMCID: PMC10018323 DOI: 10.1001/jamanetworkopen.2023.2639] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
IMPORTANCE Early pregnancy loss (EPL), or miscarriage, is the most common complication of early pregnancy, and many patients experiencing EPL present to the emergency department (ED). Little is known about how patients who present to the ED with EPL differ from those who present to outpatient clinics and how their management and outcomes differ. OBJECTIVE To compare the management and outcomes of patients with EPL who present to the ED vs outpatient clinics. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used the IBM MarketScan Research Database, a national insurance claims database. Participants were pregnant people aged 15 to 49 years in the US who presented to either an ED or outpatient clinic for initial diagnosis of EPL from October 2015 through December 2019. Data analysis was performed from May 2021 to March 2022. EXPOSURES The primary exposure was location of service (ED vs outpatient clinic). Other exposures of interest included demographic characteristics, current pregnancy history, and comorbidities. MAIN OUTCOMES AND MEASURES The primary outcome was EPL management type (surgical, medication, or expectant management). Complications, including blood transfusion and hospitalization, and characteristics associated with location of service were also evaluated. Bivariable analyses and multivariable logistic regression were used for data analysis. RESULTS A total of 117 749 patients with EPL diagnoses were identified, with a mean (SD) age of 31.8 (6.1) years. Of these patients, 20 826 (17.7%) initially presented to the ED, and 96 923 (82.3%) presented to outpatient clinics. Compared with the outpatient setting, patients in the ED were less likely to receive surgical (2925 patients [14.0%] vs 23 588 patients [24.3%]) or medication (1116 patients [5.4%] vs 10 878 patients [11.2%]) management. In the adjusted analysis, characteristics associated with decreased odds of active (surgical or medication) vs expectant management included ED (vs outpatient) presentation (adjusted odds ratio [aOR], 0.46; 95% CI, 0.44-0.47), urban location (aOR, 0.87; 95% CI, 0.82-0.91), and being a dependent on an insurance policy (vs primary policy holder) (aOR, 0.71; 95% CI, 0.67-0.74); whereas older age (aOR per 1-year increase 1.01; 95% CI, 1.01-1.01), established prenatal care (aOR, 2.35; 95% CI, 2.29-2.42), and medical comorbidities (aOR, 1.05; 95% CI, 1.02-1.09) were associated with increased odds of receiving active management. Patients in the ED were more likely than those in outpatient clinics to need a blood transfusion (287 patients [1.4%] vs 202 patients [0.2%]) or hospitalization (463 patients [2.2%] vs 472 patients [0.5%]), but complications were low regardless of location of service. CONCLUSIONS AND RELEVANCE In this cohort study of privately insured patients with EPL, differences in management between the ED vs outpatient setting may reflect barriers to accessing comprehensive EPL management options. More research is needed to understand these significant differences in management approaches by practice setting, and to what extent EPL management reflects patient preferences in both outpatient and ED settings.
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Affiliation(s)
- Lyndsey S. Benson
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle
| | - Sarah K. Holt
- Department of Urology, University of Washington School of Medicine, Seattle
| | - John L. Gore
- Department of Urology, University of Washington School of Medicine, Seattle
| | - Lisa S. Callegari
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle
- US Department of Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Anne K. Chipman
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Larry Kessler
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Vanessa K. Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
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12
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Aziz T, Gobioff S, Flink-Bochacki R. Effect of a family planning program on documented emotional support and reproductive goals counseling after previable pregnancy loss. PATIENT EDUCATION AND COUNSELING 2022; 105:3071-3077. [PMID: 35738964 DOI: 10.1016/j.pec.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To evaluate the effect of the Ryan Program for family planning training on patient counseling surrounding previable pregnancy loss. METHODS We conducted a retrospective cohort study of patients with first- and second-trimester miscarriages, therapeutic abortions, ectopic and molar pregnancies, from years before and after establishing a Ryan Program. We compared documentation of coping and future reproductive goals by patient factors, using chi square testing and logistic regression. RESULTS We included 285 pregnancies: 138 pre-Ryan, 147 post-Ryan. Documentation of coping and future goals was greater post-Ryan than pre-Ryan (57.8% vs. 26.8% for coping, 72.8% vs. 50.7% for goals; both p < 0.001). Coping was less likely to be documented for adolescents (aOR 0.02), patients of Asian race (aOR 0.08), those diagnosed in the emergency department (aOR 0.22), and those with ectopic or molar pregnancy (aOR 0.14) (all p < 0.005). Coping documentation increased with second-trimester loss (aOR 6.19) and outpatient follow-up (aOR 3.41) (all p < 0.005). CONCLUSIONS Establishment of a Ryan Program was associated with greater attention to patient coping and goals after previable pregnancy loss. Patients experiencing medically-dangerous pregnancy losses receive less attention to their coping. PRACTICE IMPLICATIONS Comprehensive family planning training and outpatient access may improve patient-centeredness of care for previable pregnancy loss.
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Affiliation(s)
- Tania Aziz
- Albany Medical Center, Department of Obstetrics and Gynecology, 43 New Scotland Ave. MC-74, Albany, NY 12208, USA.
| | - Samantha Gobioff
- Albany Medical College, 47 New Scotland Ave. MC-74, Albany, NY 12208, USA.
| | - Rachel Flink-Bochacki
- Albany Medical Center, Department of Obstetrics and Gynecology, 43 New Scotland Ave. MC-74, Albany, NY 12208, USA.
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13
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Ho AL, Hernandez A, Robb JM, Zeszutek S, Luong S, Okada E, Kumar K. Spontaneous Miscarriage Management Experience: A Systematic Review. Cureus 2022; 14:e24269. [PMID: 35602780 PMCID: PMC9118363 DOI: 10.7759/cureus.24269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The estimated frequency of spontaneous miscarriage is about a quarter of all clinically identified pregnancies in the United States. Women typically go to the emergency department (ED) or outpatient clinic when they experience symptoms, including but not limited to vaginal bleeding, abdominal pain, and contractions. The care that is provided varies from place to place. METHODS Researchers searched articles from 2010 to 2021 for reports mentioning treatment for spontaneous abortion. Search terms included "miscarriage aftercare" and "spontaneous abortion care," seeking articles addressing the psychological effects of miscarriage and reporting patient experiences in different clinical settings. Data were independently reviewed, graded for evidence quality, and assessed for risk bias using the AMSTAR checklist. RESULTS The search strategy yielded 2,275 articles, six of which met the inclusion criteria. Conservative, medical, and surgical management were provided, with surgical management being more common among women with higher education and socioeconomic status. All qualitative studies reported dissatisfaction with care provided in the emergency department, partially due to a lack of emotional support. Structured bereavement intervention was beneficial for women experiencing early pregnancy loss and led to fewer reports of despair. The quantitative studies referenced interventions that aided patients in coping with pregnancy loss and identified several factors influencing the type of treatment received as well as the patient's ability to cope with feeling depressed following a miscarriage. CONCLUSION Psychological management is not regularly addressed in the emergency department, and protocols including bereavement education for healthcare providers as well as patient involvement in management would improve the overall patient experience with spontaneous miscarriage care.
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Affiliation(s)
- Angela L Ho
- Obstetrics and Gynecology, Touro College of Osteopathic Medicine, Middletown, USA
| | - Algeny Hernandez
- Obstetrics and Gynecology, Touro College of Osteopathic Medicine, Middletown, USA
| | - John M Robb
- Obstetrics and Gynecology, University of California Irvine, Irvine, USA
| | - Stephanie Zeszutek
- Obstetrics and Gynecology, Touro College of Osteopathic Medicine, Middletown, USA
| | - Sandy Luong
- Obstetrics and Gynecology, Drake University, Des Moines, USA
| | - Emiru Okada
- Obstetrics and Gynecology, University of California Irvine, Irvine, USA
| | - Karan Kumar
- Surgery, Touro College of Osteopathic Medicine, Middletown, USA
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14
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Galeotti M, Mitchell G, Tomlinson M, Aventin Á. Factors affecting the emotional wellbeing of women and men who experience miscarriage in hospital settings: a scoping review. BMC Pregnancy Childbirth 2022; 22:270. [PMID: 35361132 PMCID: PMC8974061 DOI: 10.1186/s12884-022-04585-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Miscarriage can be a devastating event for women and men that can lead to short- and long-term emotional distress. Studies have reported associations between miscarriage and depression, anxiety, and post-traumatic stress disorder in women. Men can also experience intense grief and sadness following their partner's miscarriage. While numerous studies have reported hospital-related factors impacting the emotional wellbeing of parents experiencing miscarriage, there is a lack of review evidence which synthesises the findings of current research. AIMS The aim of this review was to synthesise the findings of studies of emotional distress and wellbeing among women and men experiencing miscarriage in hospital settings. METHODS A systematic search of the literature was conducted in October 2020 across three different databases (CINAHL, MEDLINE and PsycInfo) and relevant charity organisation websites, Google, and OpenGrey. A Mixed Methods appraisal tool (MMAT) and AACODS checklist were used to assess the quality of primary studies. RESULTS Thirty studies were included in this review representing qualitative (N = 21), quantitative (N = 7), and mixed-methods (N = 2) research from eleven countries. Findings indicated that women and men's emotional wellbeing is influenced by interactions with health professionals, provision of information, and the hospital environment. Parents' experiences in hospitals were characterised by a perceived lack of understanding among healthcare professionals of the significance of their loss and emotional support required. Parents reported that their distress was exacerbated by a lack of information, support, and feelings of isolation in the aftermath of miscarriage. Further, concerns were expressed about the hospital environment, in particular the lack of privacy. CONCLUSION Women and men are dissatisfied with the emotional support received in hospital settings and describe a number of hospital-related factors as exacerbators of emotional distress. IMPLICATIONS FOR PRACTICE This review highlights the need for hospitals to take evidence-informed action to improve emotional support services for people experiencing miscarriage within their services.
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Affiliation(s)
- Martina Galeotti
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Gary Mitchell
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Mark Tomlinson
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Áine Aventin
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
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15
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Liang T, Chamdawala HS, Tay ET, Chao J, Waseem M, Lee H, Mortel D, Agoritsas K, Teo HO, Meltzer JA. Pediatric emergency care in New York City during the COVID-19 pandemic shutdown and reopening periods. Am J Emerg Med 2022; 56:137-144. [PMID: 35397354 PMCID: PMC8966116 DOI: 10.1016/j.ajem.2022.03.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/20/2022] Open
Abstract
Objective New York City (NYC) is home to the largest public healthcare system in the United States and was an early epicenter of coronavirus disease 2019 (COVID-19) infections. This system serves as the safety net for underserved and marginalized communities disproportionately affected by the pandemic. Prior studies reported substantial declines in pediatric emergency department (ED) volume during the initial pandemic surge, but few describe the ongoing impact of COVID-19 throughout the year. We evaluated the characteristics of pediatric ED visits to NYC public hospitals during the pandemic lockdown and reopening periods of 2020 compared to the prior year. Methods Retrospective cross-sectional analysis of pediatric ED visits from 11 NYC public hospitals from January 2019–December 2020. Visit demographics, throughput times, and diagnosis information during the early (3/7/20–6/7/20) and late (6/8/20–12/31/20) pandemic periods coinciding with the New York State of emergency declaration (3/7/20) and the first reopening date (6/7/20) were compared to similar time periods in 2019. Findings were correlated with key pandemic shutdown and reopening events. Results There was a 47% decrease in ED volume in 2020 compared to 2019 (125,649 versus 238,024 visits). After reopening orders began in June 2020, volumes increased but peaked at <60% of 2019 volumes. Admission rates, triage acuity, and risk of presenting with a serious medical illness were significantly higher in 2020 versus 2019 (P < 0.001). Time-to-provider times decreased however provider-to-disposition times increased during the pandemic (P < 0.001). Infectious and asthma diagnoses declined >70% during the pandemic in contrast to the year prior. After reopening periods began, penetrating traumatic injuries significantly increased compared to 2019 [+34%, Relative Risk: 3.2 (2.6, 3.8)]. Conclusions NYC public hospitals experienced a sharp decrease in pediatric volume but an increase in patient acuity during both the initial pandemic surge and through the reopening periods. As COVID-19 variants emerge, the threat of the current pandemic expanding remains. Understanding its influence on pediatric ED utilization can optimize resource allocation and ensure equitable care for future surge events.
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Affiliation(s)
- Tian Liang
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York University Langone Health, 550 1st Ave, New York, NY 10016, United States of America; New York City Health + Hospitals, Bellevue, 462 1st Ave, New York, NY 10016, United States of America.
| | - Haamid S Chamdawala
- Department of Pediatrics, Division of Emergency Medicine, New York City Health + Hospitals, Jacobi, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America; Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America
| | - Ee Tein Tay
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York University Langone Health, 550 1st Ave, New York, NY 10016, United States of America; New York City Health + Hospitals, Bellevue, 462 1st Ave, New York, NY 10016, United States of America
| | - Jennifer Chao
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York City Health + Hospitals, Kings County, 451 Clarkson Ave, Brooklyn, NY 11203, United States of America; State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America
| | - Muhammad Waseem
- Department of Emergency Medicine, New York City Health + Hospitals, Lincoln, 234 E 149th St, Bronx, NY 10451, United States of America; Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States of America
| | - Horton Lee
- Department of Pediatrics, New York City Health + Hospitals, Elmhurst, 79-01 Broadway, Queens, NY 11373, United States of America; Division of Emergency Medicine and Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON, United States of America
| | - David Mortel
- Department of Emergency Medicine, New York City Health + Hospitals, Harlem, 506 Lenox Ave, New York, NY 10037, United States of America; Columbia University College of Physicians & Surgeons, 630 W 168th St, New York, NY 10032, United States of America
| | - Konstantinos Agoritsas
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York City Health + Hospitals, Kings County, 451 Clarkson Ave, Brooklyn, NY 11203, United States of America; State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America
| | - Hugo O Teo
- New York City Health + Hospitals, 125 Worth St, New York, NY 10013, United States of America
| | - James A Meltzer
- Department of Pediatrics, Division of Emergency Medicine, New York City Health + Hospitals, Jacobi, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America; Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America
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16
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Nord GA, Doty AMB, Monick AJ, McCarthy DM, Casten RJ, Aldeen AZ, Nawrocki PS, Rising KL. Emergency Medicine Clinician Experiences Addressing Uncertainty in First-Trimester Bleeding. J Patient Exp 2022; 9:23743735221140698. [DOI: 10.1177/23743735221140698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of this work is to understand Emergency Department (ED) clinicians’ experiences in communicating uncertainty about first-trimester bleeding (FTB) and their need for training on this topic. This cross-sectional study surveyed a national sample of attending physicians and advanced practice providers (APPs). The survey included quantitative and qualitative questions about communicating with patients presenting with FTB. These questions assessed clinicians’ frequency encountering challenges, comfort, training, prior experience, and interest in training on the topic. Of 402 respondents, 54% reported that they encountered challenges at least sometimes when discussing FTB with patients where the pregnancy outcome is uncertain. While the majority (84%) were at least somewhat prepared for these conversations from their training, which commonly addressed the diagnostic approach to this scenario, 39% strongly or moderately agreed that they could benefit from training on the topic. Because the majority of ED clinicians identified at least sometimes encountering challenges communicating with pregnant patients about FTB, our study indicates a need exists for more training in this skill.
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Affiliation(s)
- Garrison A Nord
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amanda MB Doty
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew J Monick
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Danielle M McCarthy
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robin J Casten
- Department of Psychiatry, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Philip S Nawrocki
- US Acute Care Solutions, Canton, OH, USA
- Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
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17
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Rzońca E, Bień A, Bączek G, Rzońca P, Filip M, Gałązkowski R. Suspected Miscarriage in the Experience of Emergency Medical Services Teams-Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12305. [PMID: 34886025 PMCID: PMC8657126 DOI: 10.3390/ijerph182312305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
Vaginal bleeding and abdominal pain are symptoms indicative of a threat to pregnancy that prompt women to seek assistance from health care professionals. The purpose of the study was to present the characteristics of Emergency Medical Services (EMS) team interventions in cases of suspected miscarriage. The study involved a retrospective analysis of EMS team interventions in cases of suspected miscarriage carried out between January 2018 and December 2019 in Poland. Data obtained from Poland's National Monitoring Center of Emergency Medical Services included emergency medical procedure records and EMS team dispatch records in electronic format. The mean patient age was 30.53 years. Most were primiparous (48.90%) and up to the 13th gestational week (76.65%). The most commonly reported symptom was vaginal bleeding (80.71%). EMS teams were most commonly dispatched in the winter (27.03%), between 7 A.M. and 6:59 P.M. (51.87%), in urban areas (69.23%), with urgency code 2 (55.60%), and in most cases, they transferred the patient to a hospital (97.53%). The present study addresses very important issues concerning the characteristics of Polish suspected miscarriage cases handled by different EMS team types, in different locations (urban vs. rural areas), and concerning patients in a different obstetric situation (gestational week, gravidity, parity). Our findings suggest a need for further studies in this field and for gestational health promotion activities to be implemented, specifically including actions to reduce the risk of vaginal bleeding during pregnancy.
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Affiliation(s)
- Ewa Rzońca
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland;
| | - Agnieszka Bień
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4-6 Staszica St., 20-081 Lublin, Poland;
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland;
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, 5 Chałubińskiego St., 02-004 Warsaw, Poland;
| | - Michał Filip
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 16 Staszica St., 20-081 Lublin, Poland;
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland;
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18
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Ito Y, Tsubaki M, Kobayashi M. Families' experiences of grief and bereavement in the emergency department: A scoping review. Jpn J Nurs Sci 2021; 19:e12451. [PMID: 34490984 DOI: 10.1111/jjns.12451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
AIM Death is a frequent event in the emergency department, and many family members experience grief and bereavement. However, little is known about what families experience. The aim of this study was to explore previous findings about families' experiences of grief and bereavement in the emergency department to clarify and understand their experience. METHODS A scoping review was chosen as the design for this research. Studies were searched from four electronic databases. The obtained studies were screened independently by two reviewers and selected by mutual agreement of the entire team based upon the eligibility criteria. All relevant data were extracted, and thematic analysis was conducted to assess families' grief and bereavement experiences in the emergency department. RESULTS The database searches initially resulted in 982 studies; these were finally narrowed to 20 studies for data extraction. Publication years ranged from 1987 to 2020. The studies were conducted across nine countries; most were from the United States and had a qualitative research design. Analysis elicited the following themes: "lack of information," "breaking bad news," "being present during resuscitation," "chaotic environment," "psychosocial reaction in bereavement," and "support and care needs from healthcare professionals." CONCLUSION These themes reveal challenges in providing support and care from emergency nurses to bereaved families, including inadequate provision of information, poor design of the emergency department due to the lack of privacy, and families' unmet support and care needs. Emergency nurses need to better understand families' experience of grief and bereavement.
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Affiliation(s)
- Yoshiyasu Ito
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
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19
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Trostian B, Curtis K, McCloughen A, Shepherd B, Munroe B, Davis W, Hirst E, Tracy SK. Experiences and outcomes of women with bleeding in early pregnancy presenting to the Emergency Department: An integrative review. Australas Emerg Care 2021; 25:55-83. [PMID: 34083158 DOI: 10.1016/j.auec.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/26/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bleeding in early pregnancy occurs in approximately a quarter of all pregnancies and is a common reason for presentation to the Emergency Department (ED). This review combined current knowledge about experiences, interventions, outcomes and frequency of women presenting to the ED with per vaginal (PV) bleeding in the first 20 weeks of pregnancy. METHODS This integrative literature review was conducted using electronic database and hand searching methods for primary research published from 2000; followed by screening and appraisal. Articles were compared and grouped to identify characteristics and patterns that guided the synthesis of categories. RESULTS Forty-two primary research articles met inclusion criteria. Four main categories related to experiences and outcomes of women with bleeding in early pregnancy presenting to the ED were identified: presentation frequency and characteristics; women and their partners' experiences in the ED; interventions and treatments; patient and health service outcomes. CONCLUSIONS Negative and often frustrating experiences are reported by women experiencing PV bleeding, their partners and ED healthcare providers. While strategies such as early pregnancy assessment services contribute to improved outcomes, the availability of these services vary. Further research is needed to identify specific needs of this group of women and their partners, and the staff providing their care in the ED, to inform strategies for improved quality of care.
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Affiliation(s)
- Baylie Trostian
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia; Emergency Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Australia; Department of Obstetrics and Gynaecology, Illawarra Shoalhaven Local Health District, Wollongong, Australia.
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Emergency Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Australia
| | - Andrea McCloughen
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia
| | - Ben Shepherd
- Emergency Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Australia
| | - Belinda Munroe
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia; Emergency Services, Critical Care Division, Illawarra Shoalhaven Local Health District, Australia
| | - Warren Davis
- Department of Obstetrics and Gynaecology, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Elizabeth Hirst
- Department of Obstetrics and Gynaecology, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Sally K Tracy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Molly Wardaguga Research Centre, CDU, Darwin, Australia
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20
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Evans CS. Early Pregnancy Loss in the Emergency Department: Lessons Learned as a Spouse, New Father, and Emergency Medicine Resident. Ann Emerg Med 2020; 77:233-236. [PMID: 33077250 DOI: 10.1016/j.annemergmed.2020.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Christopher S Evans
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.
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21
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Freeman A, Neiterman E, Varathasundaram S. Women's experiences of health care utilization in cases of early pregnancy loss: A scoping review. Women Birth 2020; 34:316-324. [PMID: 32859562 DOI: 10.1016/j.wombi.2020.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Approximately 25% of pregnancies end in miscarriage, most occurring within the first trimester (<13 weeks). For many women early pregnancy loss has implications for short- and long- term mental health, and women's well-being following early pregnancy loss is impacted by their experiences within the healthcare setting. To improve quality of care, it is crucial to understand women's' experiences within the healthcare system in cases of early pregnancy loss. QUESTIONS What does the research literature tell us about the experiences of early pregnancy loss within healthcare settings? Are these experiences positive or negative? 'How can care improve for those experiencing early pregnancy loss?' METHODS A scoping review of the research literature was undertaken. Three research databases were searched for relevant articles published in English since 2009, with key words related to 'Experience', 'Healthcare' and 'Early Pregnancy Loss'. A thematic analysis was undertaken to identify and summarize key findings emerging from the research literature. FINDINGS Twenty-seven (27) articles met our inclusion criteria. Three main themes were identified: (1) issues related to communication, (2) challenges within care environments, and (3) inadequacies in aftercare. DISCUSSION The literature suggests that women's experiences related to healthcare for early pregnancy loss are largely negative, particularly within emergency departments. Recommendations to improve women's experiences should extend beyond attempts to improve existing care structures, to include emerging environments and providers. CONCLUSION Women's experiences identified within the literature provide further insights on what women are seeking from their care, and how care models can be improved.
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Affiliation(s)
- Angela Freeman
- School of Public Health and Health Systems (SPHHS), Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Elena Neiterman
- School of Public Health and Health Systems (SPHHS), Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Shya Varathasundaram
- School of Public Health and Health Systems (SPHHS), Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Abstract
BACKGROUND Stillbirth and neonatal death are one of the most stressful life events, with negative outcomes for parents. Society does not recognize this type of loss, and parental grieving is particularly complicated and intense. PURPOSE The aim of this study was to describe and understand the experiences of parents in relation to professional and social support following stillbirth and neonatal death. METHODS This was a qualitative study based on Gadamer's hermeneutic phenomenology. Twenty-one semistructured interviews were carried out. Inductive analysis was used to find themes based on the data. RESULTS Twenty-one parents (13 mothers and 8 fathers) from 6 families participated in the study. The analysis identified 2 main themes: (1) "professional care in dealing with parents' grief," with the subthemes "important aspects of professional care," "continuing of pathways of care"; and (2) "effects of social support in parental grief," including the subthemes "the silence that surrounds grieving parents," "family and other children: a key element," and "perinatal loss support groups: a reciprocal help." IMPLICATIONS FOR PRACTICE Counseling and support according to parents' requirements by an interdisciplinary team of professionals educated in perinatal loss and ethical family-centered care is needed. A social support system for families is necessary to avoid negative emotional consequences. IMPLICATIONS FOR RESEARCH Further research is needed to analyze midwives' and nurses' experience as facilitators to improve parental grief and the difficulties experienced by the family, other children, and friends of parents with perinatal loss in providing support.
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Watson J, Simmonds A, La Fontaine M, Fockler ME. Pregnancy and infant loss: a survey of families' experiences in Ontario Canada. BMC Pregnancy Childbirth 2019; 19:129. [PMID: 30991981 PMCID: PMC6469137 DOI: 10.1186/s12884-019-2270-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/27/2019] [Indexed: 11/29/2022] Open
Abstract
Background Pregnancy and infant loss has a pervasive impact on families, health systems, and communities. During and after loss, compassionate, individualized, and skilled support from professionals and organizations is important, but often lacking. Historically, little has been known about how families in Ontario access existing care and supports around the time of their loss and their experiences of receiving such care. Methods An online cross-sectional survey, including both closed-ended multiple choice questions and one open-ended question, was completed by 596 people in Ontario, Canada relating to their experiences of care and support following pregnancy loss and infant death. Quantitative data were analyzed descriptively using frequency distributions. Responses to the one open-ended question were thematically analyzed using a qualitative inductive approach. Results The majority of families told us that around the time of their loss, they felt they were not adequately informed, supported and cared for by healthcare professionals, and that their healthcare provider lacked the skills needed to care for them. Almost half of respondents reported experiencing stigma from providers, exacerbating their experience of loss. Positive encounters with care providers were marked by timely, individualized, and compassionate care. Families indicated that improvements in care could be made by providing information and explanations, discharge and follow-up instructions, and through discussions about available supports. Conclusions Healthcare professionals can make a positive difference in how loss is experienced and in overall well-being by recognizing the impact of the loss, minimizing uncertainty and isolation, and by thoughtfully working within physical environments often not designed for the experience of loss. Ongoing supports are needed and should be tailored to parents’ changing needs. Prioritizing access to specialized education for professionals providing services and care to this population may help to reduce the stigma experienced by bereaved families.
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Affiliation(s)
- Jo Watson
- Pregnancy and Infant Loss (PAIL) Network, Women and Babies Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Anne Simmonds
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Michelle La Fontaine
- Pregnancy and Infant Loss (PAIL) Network, Women and Babies Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Megan E Fockler
- Pregnancy and Infant Loss (PAIL) Network, Women and Babies Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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