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" EXPLORING THE NEED OF PARENTS WHO EXPERIENCE MISCARRIAGE IN THE EMERGENCY DEPARTMENT  : a QUALITATIVE STURDY WITH PARENTS AND THE NURSES" By Tina Emond , Francine de Montigny. and Laurence Guillaumie

Summarize the article and ask 3 different question

Answer 1

Method for case study

Design

This descriptive, exploratory, qualitative research study was conducted with parents who have presented to the ED for a miscarriage as well as ED nurses and nurse managers. A qualitative approach was chosen to gain an in‐depth understanding of the experience of parents who visit the ED for miscarriage treatment. These experiences were explored with the ultimate goal of improving them as part of a future study. An exploratory descriptive methodology was chosen so that parents’ experiences could be described in the specific context of the ED, through the stories of those involved (Polit & Beck, 2004). Multi‐perspective qualitative interviews, as defined by Kendall et al. (2009), were chosen; these consist of interviews with both patients and their care providers with the aim of exploring their complex, complementary and contradictory perspectives about experiences and needs. Multi‐perspective interviews generate a richer understanding than the single‐perspective interviews commonly used in qualitative studies. They are especially recommended for studies that aim to improve healthcare practices. In this study, interviews with parents helped uncover high‐quality information about their experiences in visiting the ED for miscarriage treatment. Interviews were conducted with the woman and her partner together, as including the perspective of the partner was a priority of this study. If the partner did not wish to participate, the interview was conducted with the woman alone. Interviews with nurses and nurse managers allowed for a better understanding of their perceptions of the experiences of parents and of the care context. Exploring nurse managers’ perceptions was important because they have a key role to play in planning, implementing and monitoring clinical practice guidelines and interventions.

Conceptual framework

Two conceptual frameworks were used to develop the interview guides, as well as for data analysis and interpretation. First, the Kellogg Foundation's (2004) theory approach logic model for intervention development was used from the outset. It was chosen as the present study is part of a larger research project, the ultimate goal of which is to develop an intervention that optimises parents’ experience in the ED during a miscarriage. This logic modelincludes six steps: (a) conceptualisation of the problem; (b) needs assessment; (c) desired results; (d) influential factors; (e) strategies; and (f) assumptions. This study focused on the second step of the logic model—the identification of parents’ needs. It also helped gather information about the first step, the conceptualisation of the problem. Second, Meleis’ Transitions Theory (2015) was chosen to gain a deeper understanding of the experiences of parents atthe ED. This theory allowed the experience of miscarriage tobe conceptualised as a transition that affects the expectations and roles of parents. Transitions theory focuses on the person or family experiencing a transition and the context that can influence the transition. Whatever a person's reaction to miscarriage,

it will entail a transition that denotes changes in needs (Meleis, 2012). Key concepts of Meleis’ Transitions Theory were used as a “conceptual lens” (Creswell & Poth, 2018) to understand miscarriage experience at the ED. Because the transition associated with miscarriage goes beyond the ED visit, three key concepts of Meleis’ Transitions Theory were of particular interest for this study: conditions of change, patterns of responses and nursing therapeutics. Conditions of change are factors that influence the way a person moves through transition, and these may facilitate or hinder the transition process and influence patterns of responses. Patterns of responses are personal reactions to the change event. They include process patterns, which move the person towards either health or vulnerability, and outcome indicators, which reflect the end of the transition process. Processes of transition related to miscarriage experiences continue beyond the ED visit, and process patterns were therefore of greater interest to this study. Meleis, Sawyer, Im, Hilfinger Messias, and Schumacher (2000) have suggested that outcome indicators should not be evaluated too early in the transition process at the risk of being associated with irrelevant information. Finally, nursing therapeutics are nursing interventions that facilitate and inspire healthy processes and outcome responses (Meleis, 2015;

Meleis et al., 2000).

Setting and sample

This study was carried out in the province of New Brunswick, Canada, at the ED of the Edmundston Regional Hospital. The 169‐ bed hospital serves a population of about 47,800 and offers different types of acute care. The inclusion criteria were as follows: parent participants had to be (a) adults aged 18 or older who had (b) experienced a miscarriage (≤ 20 weeks gestation) in the preceding three years and visited the ED for this reason. The period of three years was deemed suitable as miscarriage may be a traumatic event remembered several years after the loss (Gerber‐Epstein, Leichtentritt, & Benyamini, 2008). Participants’ stories were found to be detailed in previous studies on the topic using time frames of up to 6 years (MacWilliams et al., 2016; Meany et al., 2017). The exclusion criterion for parents was to have been a nurse in this ED setting. The inclusion criteria for nurses were as follows: participants had to (a) be nurses in the ED who (b) have provided care for parents who have experienced a miscarriage. For nurse managers, the inclusion criterion was to be an ED nurse manager.

Data collection

Purposeful sampling was used to recruit participants with maximum variation in their characteristics (Patton, 1990). Parents were invited to participate through advertisements placed on local and social media as well as in different locations frequented by adults in their twenties and thirties (shopping centres, fitness centres, hospital). Parents expressed interest in participating in the research study by contacting the first author by email or telephone. Parents were selected with an emphasis on ensuring a range of characteristics (e.g., age, miscarriage history).

Some partners did not wish to participate in the research study. Women whose partners did not wish to participate were also included as these women could also bring rich information about their experience, and women may consult the ED alone. Potential participants had no contact with the research team prior to their participation in this study. To recruit nurses and nurse managers, the first author met with the two ED nurse managers of the hospital to explain the terms and nature of the study. One of the nurse managers in turn sent research information sheets to all ED nurses by email. Nurses were invited to contact the researcher by email or telephone to express their interest. Nurse managers were not provided any information about the names of nurses who participated in the study. As the first four nurses who agreed to participate in the study have several years of experience at the ED, the first author asked one nurse manager to resend the invitation to participate in the study to nurses with less experience. The interviews with nurse managers were conducted last to reduce any potential for coercion. All participants were provided detailed oral and written information (information sheets and consent forms) about the study from the first author shortly after they expressed interest in participating. They were also informed of the occupation of the first author and the fact that this research was part of her doctoral dissertation in nursing sciences. Considering the unique contributions of each group of informants, specific interview guides were developed for parents, nurses and nurse managers based on the literature review and the two conceptual frameworks. Interviews with parents focused on their experience, their needs and the factors that influenced their experience when visiting the ED for miscarriage treatment. Interviews with nurses and nurse managers focused on their perceptions of parents’ experiences and needs when visiting the EDfor miscarriage treatment and of the professional role of nurses in the situation. Each of the interview guides also focused on recommendations to improve care. Example interview questions are presented in Table 1. Each interview guide was pretested on two people who had experienced a miscarriage more than three years ago. These initial interviews were therefore not included in the final sample.

Semi‐structured in‐person interviews were carried out by the first author, who is female and has previous nursing experience in ED and perinatal care. She is an assistant professor in nursing and a PhD candidate (trained in nursing sciences). Interviews lasted an average of 50 min. They took place in a setting chosen by the participant (home, hospital, university) and were audio‐recorded and fully transcribed. A list of community resources, including counselling services, was provided to the parents at the end of each interview in recognition of the sensitive nature of the topic. Field notes were systematically taken during and following each interview. These notes were mostly reflective in nature; the personal reflections and interpretations of the researcher were used to enrich subsequent interviews and facilitate data analysis. Participants were continually recruited until no new elements were reported in the final two interviews conducted with parents and nurses. All interviews were conducted in French, except one (with Elena). The quotations were translated by a professional translator and revised by the authors and another independent researcher.

Data analysis

A category analysis was conducted to provide a description of parents’ needs (Loiselle, Profetto‐McGrath, Polit, & Beck, 2011). Transcribed interviews and field notes were re‐read in their entirety several times to identify emerging ideas and potential codes. Initial codes for the first three interviews were derived from key concepts of Meleis’ theory while remaining open to codes emerging from the corpus. The codes included information about conditions that facilitated or hindered parents’ experience (conditions of change), parents’ reactions to these conditions (patterns of responses), and participants’ recommendations regarding nursing interventions. Transcripts associated with each code were subsequently analysed to establish separate categories and subcategories based on parents’ needs, as recommended by the Kellogg logic model. These needs were identified from the conditions of change that had most influenced parents’ responses. Each need category and subcategory included information about conditions that facilitated or hindered parents’ experiences, parents’ reactions to these conditions, and participants’ recommendations. A cross‐analysis based on participants’ characteristics (e.g., miscarriage history, age) was performed; as it did not provide any additional insights, it is not reported here. This analysis was carried out by the principal researcher in collaboration with the two coauthors, both of whom are female; one researcher is an expert in perinatal bereavement and is a Canada Research Chair (educational background in nursing sciences) and the other researcher has expertise in patient education and counselling (educational background in education sciences).

Several validation strategies were used to ensure scientific rigour (Creswell & Poth, 2018). To optimise data accuracy, the first author conducted the interviews, validated the transcripts, compared the transcripts with the field notes and led data analysis with the coauthors. Along with the analysis process, authors debriefed regarding the data, coding and categories (Creswell & Poth, 2018). Multiple levels of data analysis from narrower to broader codes were carried out. To increase the credibility of the analysis, the first four interviews were independently coded by two members of the research team. Changes were made to categories, subcategories and their descriptions after comparison with the research team to capture a more complete picture of parents’ experience and needs (Creswell & Poth, 2018; Loiselle et al., 2011). QSR International's NVivo 11 Software facilitated the data analysis process (Edhlund & McDougall, 2016). The conducting and reporting of qualitative results adhered to the Consolidated criteria for reporting qualitative research (COREQ) (Tong, Sainsbury, & Craig, 2007) The needs identified by parents largely aligned with those identified by the nurses. The analysis of participants’ interviews allowed the identification of eight major parental needs during ED visits. These needs were then grouped into three categories: physical health, cognitive and emotional.