Need opinions RE: Fetal Demise in ER

Larry77, RN · Oct 17, 2007

Sounds great...we could use something like that in our dept as well. Usually we offer social services or a chaplain but they are not specialized like you. Sounds like you have a lot of initiative and I can't see their manager turning you down.

hospitalstaph · Oct 17, 2007

I bet all it will take is your ER department knowing about your services! Everything that you described would be a welcome addition in ours.

We do generally handle miscarriages poorly and it would be nice to be able to give the mother some information/a packet to take with her. We did, however, have a 21 week born on route to the ER. We knew the mother was on the way via EMS (with the baby) and had L/D nurses with us when she arrived. Baby was deceased on arrival. L/D got the baby cleaned up and wrapped for mom while we ensured that she was medically stable. Sad situation, but I think handled very well. Both teams worked perfectly together that day.

RunnerRN, BSN, RN · Oct 17, 2007

We have some semblance of a bereavement program, but many of our nurses aren't comfortable getting into the details with the moms. Pretty much, we have a folder full of info that talks about what the moms will go through physically in the coming days. There is also info on the hospital's bereavement program for fetal demise (worded much better than that!) There is an offer for follow up counseling, and we have the moms sign a paper saying they understand the counseling is available and has been offered to them; they can accept a follow up call from L&D social workers if they'd like, but most don't. They also have to sign a burial consent for their fetus - any products of conception are taken to the lab for testing, then are buried in our hospital's plot at a local cemetary (Catholic hospital). There is a service at the plot 4 times a year, and it is also offered to the parents that they can be notified when this is going to occur.

A few things I've noticed...first, most of them don't want follow up. They usually verbalize to me that they'd rather "get through this myself" or they've had multiple m/c's and don't feel they need the hospital's help. They do appreciate the fact that it is available though, because I think simply offering it lets them know that we are validating their pregnancy and their pain. If you are going to do this, that is great, but I think if it gets delegated out to the ER staff, thorough training is a must. I end up doing a lot of the miscarriages in my dept because I'm comfortable with the process and paperwork. I think there is nothing worse than someone sitting by your bed reading off a piece of paper "The hospital is very sorry for your loss. There are many options available to you."

Great idea - and definitely something that most EDs don't do. Good luck!

(Wow, this got long....sorry!)

rjflyn, ASN, RN · Oct 17, 2007

Most ER's don't have a plan. But putting a packet together and giving a little training is not a good plan either.

This is one of those instances that needs to be individualized, there is a difference between the bleeding college student who didn't even know she was pregnant, to the mom who has been trying to get pregnant for years, to the crack addicted woman who is pregnant for the eighth time. One can not just give them a packet and some kind words and move on.

But thats what will happen. The best plan can be developed and all but in the rush of the ER there are times that thats all that is going to get done. That and there are nurses who are not comfortable with that situation so they are going to do the bare minimum which is that as well.

Rj

dansmom6 · Oct 17, 2007

Thanks so much for all of your input!

RJ, you had some very good points, which are just the aspects I was concerned about.

My intent is not to simply just give the patient a packet and send them on their way. I want to help the ER staff learn about the bereavement process, but I understand that too much at a time will be met with a cold shoulder (at my hospital, anyhow). Day-long sensitivity training would be fantastic, but at this time, I really don't think any of administration would go for it. For now, I think it will have to be baby steps.

I guess my short term goal is to talk to the staff...kind of let them know "do's and don'ts", although every situation is certainly different. Also, they would be informed that they can call any of us (there are 6 bereavement counselors) day or night for situations that would benefit with a trained bereavement counselor. Also, this would help if the ER is too busy to deal with the situation, or if the nurse assigned to the patient has a hard time dealing. Of course, a patient would come in at the same time a code is occuring across the hall from the beligerent drunk in restraints...I really don't know how you guys do it!!!

Regarding burial, we have a cemetary plot where deliveries

Thanks again! I'm getting some great ideas!!!

ERRNTraveler, RN · Oct 18, 2007

I work nights, so there aren't a lot of ancilliary staff on at night, but the hospital where I am on assignment has a counselor-type person call the patient the following day to discuss different bereavement services/support groups, etc.

Melissa94RN, BSN, MSN, NP · Oct 26, 2007

Hello,

I am a ER nurse for the past 10 years as well as a mother who has given birth to a stillborn baby at 40 weeks gestation back in 2005. When I lost my baby I was given the same absolutely wonderful treatment that you are trying to provide. In my ER, it would be wonderful to know that I had someone to call that would be available to come in the event that a mom had a fetal demise. We do not have a high frequency of occcurances of this happening in our department. I think that most ER managers would not have any problem with implementing such a program, Good Luck!

alaskabound · Jul 27, 2008

maybe you could ask the ed to make it mandatory for a social work referral to be made and target the social workers with your education? Give them the info packets and maybe a card with the numbers of the berv staff. on them with a good link to a comforting website??? I would still have a mini in service with the ed staff to let them know future changes are ahead for these traumatized MOTHERS.

littleRNthatcould · Jul 27, 2008

I think this is a wonderful idea. That being said, allow me to play the devil's advocate for a few seconds.

In many emergency rooms, the staff are already overburdened and understaffed. It makes it extremely difficult to deliver the sort of psychosocial and emotional care that we would LOVE to be able to provide our patients. Even the most in-depth discharge instructions (wound care, fracture care etc..) are given in such a rushed manner as to deliver the most amount of information in the smallest amount of time.

Granted in most instances there are chaplains available, although on night shift one would have to wait for them to arrive.

Unless your focus group or department is willing to place a resource person in the ER to handle these delicate matters (that do require sufficient time and tact) then I can see you meeting some resistance with the ER staff.

Please don't take this as ER nurses (or even just me) as being insensitive. We DO care. We just sometimes need extra help getting that point across (from ancillary departments). :twocents:

I wish you the best of luck with your program

LilgirlRN, ADN, RN · Jul 27, 2008

I agree with hospitalstaph, just let the ER know you are there. Perhaps you could put some sort of pamphlet in the waiting room so that patients know to ask for you. Or if nothing else, the pamphlet could be sent home with the patient and they can be at liberty to call you if needed.

I had a woman come in just the other day who had been to another hospital and was told that the baby no longer had a heart beat. She was about 10 weeks pregnant. She wanted another U/S because she could feel the baby moving. To make matters worse she was Spanish speaking only and had a friend interpreting for her. She had no bleeding to reinforce the idea that she would not be taking a baby home. It was her first pregnancy too. I felt so bad for her.

I think any ER would love access to a program that offered support to grieving families.

how weird..... I'm at work and my list pops up.... 7 weeks pregnant and bleeding.

clairebearrn · Jul 29, 2008

Hi! I am not an ER nurse, but need to know what ER nurses think about this. What I am trying to do is improve on the way we deal with fetal demise in our ER...which would help staff and patients.
I'll try not to write a book here, but it's kind of a long story.
Part of my job is perinatal bereavement counseling. On our floor, we see IUFD's, stillborn, and neonatal deaths usually > 20 weeks. Once in awhile, we admit lesser gestations. Our bereavement program is fantastic! We provide great support, take pics, provide momentos, and keep in touch, sending cards, f/u phone calls, etc...
Those who have early AB's, vag bleeding in ER or abort at home receive absolutely no bereavement services at all. I understand that some women may not see the fetus as a baby, and aren't all that upset, but some have that baby in college after the pregnancy test is positive. This can be gut wrenching and life changing for many of these women.
In our ER now (I'm not picking on them at all, it's just how it is), if a fetal demise is delivered, the baby is placed in a specimen container, the woman is kept until her bleeding has slowed, and adios. The woman then goes home, where her loss is many times never validated. If she works, she'll probably get a day or two off, and then, back to "normal".
I want to do something!!!! I feel like I need to help these women. What I want to do is provide brief (10-20 min) inservices to ER, Surgical, and Dr. office staff, develop a little packet (something the mother can take home), with a poem, a letter from bereavement making ourselves available, and a momento...something they can take home in their otherwise empty arms (a charm or small blanket, something). I also want ER to know that our services are available to them if they need us.
I just don't know how to go about this, what anyone else does, and how to get started. I know it's a big endeavor, but to me, it's sooooo worth it!
What do you do in your ER's? What would be helpful to you?
Thanks so much for any input!

In my ER, they dont do this...but sometimes they might admit the patient and send them to the OB floor who sometimes do this...But I think this is a wonderful idea!!! A memory box for the mother would be great!!!! A picture, strand of hair(if fetus is old enough) footprints...I really dont think your NM would turn you down!!! :)