"A horrible place for a miscarriage" : nurses' experiences of caring for women in the emergency department

A woman’s experience of miscarriage has been vastly explored in literature. It is well established that a woman’s physical and emotional responses to miscarriage are influenced by a number of factors and that these same factors have long term effects on the recovery process. In particular, health care professionals and their interaction with these women have been identified to be vital and significant in women defining and assigning meaning to such events. The aim of this study is to explore nurses’ understanding of their practice when caring for women experiencing miscarriage in the emergency department (ED) examined through a descriptive qualitative methodology. The study concludes that the unique context of emergency along with externally and internally perceived influences create no time, space or place for miscarriage. This study involved interviewing ten emergency nurses from a tertiary care Canadian hospital. Nurses who have cared for women experiencing miscarriage in the ED were purposefully selected to ensure their ability to speak to the phenomenon being examined. Semi-structured in-depth interviews were used to collect data centred on exploring factors that inform and guide their practice. The tensions emergency nurses encountered while caring for women experiencing miscarriage were then identified using content analysis. As a result, two spheres of influence were noted to affect nursing practice. External influences with subthemes that examine: 1) a medical triage system that de-prioritizes non-urgent pregnancy related needs; and emotional care as secondary to biomedical care; 2) an emergency nursing ‘image’; and 3) gendered explanations about who can best care for miscarrying women, and internal influences which include: nurses 1) perceived lack of perinatal nursing knowledge; and 2) personal life context. The findings of this study hold several implications towards understanding emergency nursing practice. An ED nurse’s confidence in providing care to women experiencing miscarriage can be improved by enhancing nursing education to encompass greater appreciation and understanding of miscarriage and nurses’ role in caring for women. As well, pursuing further research on miscarriage in the ED and cultivating an awareness of the contextual influences on emergency nursing practice may improve the experiences of nurses providing care.Applied Science, Faculty ofNursing, School ofGraduat