With the increasing prevalence of obstetric deserts, the closing of labor and delivery departments, and legislation across the country making harder to provide comprehensive obstetrics care, emergency departments are seeing more and more pregnant patients and even deliveries. That’s why it’s imperative your ED is ready for these patients when they inevitably arrive. Nurses who want to prepare can find a host of educational opportunities focused on obstetrics at Emergency Nursing 2024. This year’s curriculum includes the sessions listed below. The complete list of educational opportunities at the conference is available on ENA’s website.
Ready to Deliver: Freestanding ED’s Simulated Precision Training for Imminent Delivery with Telemedicine Expertise
Freestanding emergency departments are often limited in their resources, so when a pregnant patient arrives about to give birth, it’s important to be ready.
Sandra E. Blocker, DNP, RRT, RN-CEN
The session “Ready to Deliver: Freestanding ED’s Simulated Precision Training for Imminent Delivery with Telemedicine Expertise” will walk attendees through a simulated training program that helps prepare freestanding ED staff for delivering a baby with the help of remote obstetricians via telemedicine. The session takes place Sept. 5 from 10:30-11:15 a.m.
“Many emergency departments rarely deliver babies, so they may benefit from additional training, and having an expert available,” said session speaker Sandra E. Blocker, DNP, RRT, RN-CEN, nurse manager for the Springhill and Kanapaha emergency departments at UF Health Shands in Gainesville, Florida.
Simulated training with remote obstetricians can help nurses become familiar with using telemedicine and other equipment for deliveries, as well as understanding who to contact and how to connect with them. They can practice scenarios like premature or breech delivery, identify which medication and equipment they need to have on hand, assign predetermined roles, and learn how to tap outside resources like ambulance services. Such simulations also help teams identify gaps in equipment, education and training, and help them feel more prepared.
“That mother is going to roll in the door,” Blocker said. “Is your team trained?”
Pregnancy Emergencies in Obstetric Deserts: Education, Support and Decision Making
Nearly every emergency nurse and doctor would rather not see a patient with a pregnancy-related emergency arriving in their EDs. But seeing these patients is not only unavoidable, it’s becoming more common.
Lisa A. Wolf, PhD, RN, CEN, FAEN, FAAN
“There are large pieces of the United States that are what we call ‘obstetric deserts,’” said ENA Director of Emergency Nursing Research Lisa A. Wolf, PhD, RN, CEN, FAEN, FAAN. “A maternal care desert is a county where there are no obstetric providers. And there are more and more of them.”
That’s why ENA worked with the American College of Obstetricians and Gynecologists and several other stakeholder groups to develop a toolkit for managing obstetric care in non-obstetric settings.
At the session “Pregnancy Emergencies in Obstetric Deserts: Education, Support and Decision Making,” attendees will learn about the critical pieces of managing pregnant or postpartum patients in an emergency department, as well as receive practical, hands-on resources to use in their own EDs. The session takes place from 1:30-2:15 p.m. on Sept. 6.
Wolf, who is the session’s speaker, will provide attendees with an explanation of the toolkit, algorithms and tangible tools “that people can physically take home with them.”
“Half of your patients are pregnancy capable,” she said. “This is not an unusual or uncommon problem to walk into the emergency department.”
Gestating Disasters: Life-Threatening Challenges to the OB Patient
The United States has the highest rate of maternal mortality than any other high-resource country in the world, especially for people of color. Many ED nurses feel enormous discomfort regarding the care of the pregnant patient.
Teri Campbell, MSN, RN, CFRN, CEN, PHRN
“ED people hate anything that has to do with obstetrics. They avoid it like a plague,” said flight nurse Teri Campbell, MSN, RN, CFRN, CEN, PHRN. “Because of that fear, there’s a substantial gap in knowledge.”
During the session “Gestating Disasters: Life-Threatening Challenges to the OB Patient,” Campbell will use humor and real-world experiences to provide attendees with practical, hands-on “practice pearls” that will increase their confidence and improve the care they provide to maternity patients. She’ll also teach them how to assess obstetric patients and which “minor” complaints should raise red flags, such as how heartburn with elevated blood pressure should be considered preeclampsia “until proven otherwise.”
“I’m going to teach them when their antennas should raise and when the hair on the back of their neck should stand up,” Campbell said. “After this presentation, the nurses will leave much more confident that they’re giving competent care.”
The session takes place from 2:30-3:15 p.m. on Sept. 6.
Pioneering New Frontiers: Teaching ED Nurses to Obtain Fetal Heart Rates Using Point-of-Care Ultrasound
When a pregnant patient arrives to the emergency department, there are two patients to consider.
Gayla Miles, RN, MSN, CEN
“After the first trimester of the pregnancy, obtaining the fetal heart rate is important when a pregnant woman arrives at the ED. It matters in the triaging and the care of the patient,” said Gayla Miles, RN, MSN, CEN, a research nurse in the trauma department at Texas Health Harris Methodist Hospital in Fort Worth.
If the patient is in their second or third trimester, the standard of care is for the ED nurse to obtain a fetal heart rate along with the mother’s vital signs. The fetal heart rate is important and helpful in the triaging and treatment of the patient.
In the past, handheld dopplers have been used to obtain the fetal heart rate, but that’s an audible assessment only. Because the heart rate can only be heard, there is the potential to identify the lower maternal heart rate as the fetal heart rate, causing false concern.
At the session “Pioneering New Frontiers: Teaching ED Nurses to Obtain Fetal Heart Rates Using Point-of-Care Ultrasound,” Miles will discuss using point-of-care ultrasound to enable nurses to find the fetal sac, identify the heart rhythm and calculate the heart rate. The method also prevents misidentification of the maternal heart rate as the fetal heart rate.
The session takes place from 4:30-5 p.m. on Sept. 5.
Navigating the Complexity of Preeclampsia in the ED: A Holistic Exploration from Case to Advocacy
With birthing centers and maternity units closing across the country, there will be an increase of postpartum patients seeking treatment in the ED. In addition, the United States has the highest rate of maternal mortality among industrialized nations, and that rate is three to four times higher for Black patients than white patients.
Crystal Miles-Threatt, BSN, RN, CEN, TCRN, NPD-BC
That’s why ED nurses should know obstetric emergency signs and symptoms, including hypertensive disorders.
In this session “Navigating the Complexity of Preeclampsia in the ED: A Holistic Exploration from Case to Advocacy,” Crystal Miles-Threatt, BSN, RN, CEN, TCRN, NPD-BC, a nurse manager at Stanford Health Care, will present a case study about a postpartum patient visiting the ED. The session will take place from 5:15-5:45 p.m. on Sept. 6.
Attendees will learn why they should ask all patients of child-bearing age their pregnancy status, how to identify systolic blood pressure red flags, the importance of advocating for their obstetric patients, and to not disregard complaints based on patient race or ethnicity.
“I have heard so many women tell stories of their traumatic birthing experience,” Miles-Threatt said. “I hope that nurses will be more mindful when triaging and managing postpartum patients.”