Not an Emergency: Discovering the Narratives of Emergency Department Nurses Who Care for Women Experiencing an Early Miscarriage
Creators: Drake, Margaret Patrice
Publisher: name: University of Alberta Library
Year: 2022

<p>Early miscarriage presents a conundrum for women, their support people, society, and healthcare providers. Early miscarriage has been the topic of a plethora of research since the early 1980s. The early research focused on women’s experience and sought to illuminate the challenges they faced accessing care and support. While research is abundant about early miscarriage and women’s experiences of this in the decades that have followed, solutions to the challenges women face when they access care have not been found. Finding potential solutions to these challenges requires an examination of those who provide care. The 24-hour character of the emergency department (ED) and the urgent and often unpredictable nature of the symptoms associated with an early miscarriage make it a frequent point of care for women. ED nurses thus provide a significant amount of this care to women. However, the research describing ED nurses’ experiences of caring for women with an early miscarriage has not substantively revealed the unique experience of the ED nurse in providing this care.<br>
RNs who worked or had worked in the ED were invited to participate in this study, by engaging in a semi-structured interview. The stories of eight ED nurses who have cared for women experiencing an early miscarriage were examined and analyzed using narrative inquiry—specifically, Dr. A Frank’s methodology of dialogical narrative analysis. The ED nurses’ stories revealed four narrative resources common to all of the stories: the reality of the ED, the medicalization of miscarriage, the lack of a plan, and nothing I can do. The stories also revealed two underlying narrative plot types that tied the narrative resources together: You’re not an emergency and Seeing the fetus.<br>
The ED nurses in this study described a conundrum they face with miscarriage in the ED. This arises from the fact that they perceived miscarriage to be out of place in their practice in the ED. Specific challenges they revealed include lack of education, lack of policy and procedure, the medicalization of birth and death, the perception that miscarriage is a not an emergency, and the impact of seeing the fetus. The work of the ED nurses was another notable finding from the stories. On the surface, the ED nurses’ stories focused on their psychomotor skills, medical interventions, and what they could not do for these patients. This trivializes the ED nurses’ vital role in facilitating care for these women. However, woven throughout these stories was how much the ED nurses were indeed doing for their female patients. This incongruence lies in the fact that the ED nurses themselves did not appreciate the “work” they were doing with women patients and speaks to challenges that other nurses may face in their practice. The ED nurses’ work and how they value their work is fundamental to answering these questions and extending our understanding.<br>
While there is some support of these findings in recent publications, this research project does not mitigate the few studies that currently amplify the ED nurse’s voice. Hearing accounts of this work and giving it a voice opens the possibility of a new narrative for ED nurses, one through which they can find redemption and agency as they navigate the experience of caring for women having a miscarriage in their ED practice.</p>