Improving communication with women who experience early pregnancy loss in the Emergency Department

Ms Mary McCarthy1, Professor  Susan  McDonald1,2, Dr  Wendy  Pollock1,2,3
1Mercy Hosptial For Women, Heidelberg, Australia, 2La Trobe University, Bundoora, Australia, 3Melbourne University, Parkville, Australia

Background: Many women experience psychological morbidity including grief, anxiety and depression following early pregnancy loss. The quality of communication and the emotional support provided to women by clinicians at the time of miscarriage has an impact on their emotional recovery. The aim of this study was to explore the confidence and competence of nurses (RN) and midwives (RNRM) to provide information and support to women experiencing a miscarriage.
Method: A survey was conducted in 2016 with nursing/midwifery staff in a specialist tertiary Women’s Emergency Department (ED) and nursing staff in a metropolitan general ED. All staff were invited to participate following ethics approval. Data were analysed using SPSS v24 by chi square; Independent Samples t-test; and Independent Samples Median test with p<.05 significant.
Results: Forty of the 71 (56.3%) invited nurses from the general ED responded, and 97.5% (n=39) were registered nurses. In the specialist women’s ED, 31 staff responded out of 54 (57.4%) invited, and 90.3% (n=28) were duel registered midwives/nurses. Fewer staff from the general ED reported receiving education on miscarriage (n=8; 23.5%), compared with staff in the women’s ED (n=22; 75.9%). General ED staff had less confidence to discuss relevant information, mean 4.3 (95%CI 3.5-5.1) compared with Specialist ED staff, mean 7.4 (96%CI 7.0-7.8; p <.001). Fewer general ED staff felt informed on causes of miscarriage (n=11; 26.8%), what to expect with pain and bleeding (n= 21; 51.2%) and aspects of grief reactions (n=14; 34.1%) when compared to the specialist ED staff who felt well informed with the causes of miscarriage (n=24; 77.4%), pain and bleeding (n=31; 100%) and aspects of grief (n=27; 87.1%).
Conclusions: There were marked differences in the exposure to education, confidence and competence to provide information to women experiencing early pregnancy loss between a specialist women’s ED and a general ED. The identified knowledge gaps will inform future education as most women with miscarriage present to general EDs. It is important that women receive accurate, sensitive and evidence-based information wherever they present with early pregnancy loss.

Mary McCarthy: Project lead for the BCV Obstetric triage decision Aid. Is a Registered Nurse/ Midwife, Bachelor of Health Science Nursing, Masters Midwifery. As Manager of the Mercy Women’s Emergency Department has worked extensively to improve the consistency of obstetric triage, customised the Australasian Triage Scale to emergency maternity care and published :“Triage of pregnant women in the emergency department: evaluation of a triage decision aid. EMJ”. Further refinement has produced an Obstetric Triage Decision Aid which has been successfully implemented in both the general emergency setting and maternity unit. She has also developed an evidence based education package for ED staff on how to support women who have experienced early pregnancy loss.