Nurses' experiences and decision making at triage when women with miscarriage present to the Emergency Department

The emergency department (ED) is a fast paced, chaotic environment with patients presenting sometimes simultaneously, requiring assessment and treatment. The role of the triage nurse in New Zealand is to made quick decisions using a triage scale, currently the Australasian Triage Scale (ATS), to determine urgency at which the patient should be assessed by a doctor and commence treatment. Miscarriage is a common early pregnancy complication, whereby the loss or potential loss of the pregnancy occurs prior to 20 weeks, before the foetus has reached maturity to survive outside of the uterus. Women with miscarriage present to the ED not only due to their physical symptoms, but also to assess the wellbeing of their pregnancy. Women with miscarriage are a population in which variances in their triage category allocation may occur when compared to a standardised triage scale. To answer the research question: ‘what influences emergency triage nurses’ decision making when women with miscarriage present to the emergency epartment?’, a qualitative method using a descriptive exploratory design was chosen. Recruitment of participants was via social media and sought registered nurses working in ED who had at least six months experience in triage from the lower half of the North Island of New Zealand. It was preferred that participants had triaged women with miscarriage. Eight face-to-face semi-structured interviews were conducted and demographic data was obtained following the interviews. The raw data was transcribed and analysed using a general inductive approach. Three key themes in the data analysis were identified as influences relevant to the research question. The themes were ‘the triage system versus the triage nurse reality’, ‘a different kind of emergency’ and ‘doing something when nothing can be done’. The physical symptoms of miscarriage were identified as influencing decision making for the participants. Participants acknowledged that emotions of loss and grief may also occur with miscarriage. This influenced participant’s decision making as they wanted to improve the journey for women with miscarriage in the ED. Women with miscarriage are a unique population of patients presenting to the ED. A holistic assessment is recommended to ensure that both physical and emotional care needs are identified at triage. Loss and grief may be felt by those experiencing miscarriage, which may be different to that felt by others experiencing loss in the ED. Ongoing research is recommended to explore the perceptions and experiences of miscarriage for both women and nurses in the ED setting in New Zealand and worldwide. This may assist with development of the ATS implementation when women present with miscarriage. Further education is recommended to ED nurses on the physiological changes of miscarriage and common complications of pregnancy. This research may assist with the development of speciality assessment services outside of the ED when women are having a miscarriage and assist with guideline development for ED nurses to directly refer to these services. This may improve outcomes, both physically and emotionally for women with miscarriage.

Name thesis:degree_name

Master of Nursing

Level thesis:degree_level

Masters

Grantor

Eastern Institute of Technology

Year dc:date.issued

2017

Author dc:creator

• Harrison, Stacy

• New Zealand
• triage nurses
• emergency departments (EDs)
• miscarriage
• assessment
• decision making
• influences
• interviews

Statement dc:rights

• All rights reserved

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10652/6337

OAI identifier oai:identifier

oai:null:10652/6337