Continuing our special series on perinatal bereavement and palliative care with examples of initiatives from Ireland and France that aim to improve care for babies and families.
Today, Dr Lucia Hartigan, Specialist Registrar and Dr Keelin O’Donoghue, Senior Lecturer and Consultant Obstetrician, Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland, explain how some basic improvements to the physical setting have significantly improved privacy and confidentiality for women attending their unit.
Privacy, respect for dignity, and confidentiality are central components of good patient care. In the speciality of Obstetrics and Gynaecology, clinical situations of a sensitive nature occur and women may present with unexpected pregnancy loss or receive other bad news about their pregnancy. While we cannot change this, we can make the circumstances worse. The typical surrounding environment and lack of privacy in many clinical areas can compound distress.
The Emergency Room (ER) at Cork University Maternity Hospital (CUMH) is a busy 24-hour facility, and over 17,000 women are seen there annually. We were aware that privacy and confidentiality in the ER were compromised by its physical design. Individual cubicles’ curtains and spacing of trolley gave some visual and auditory discretion, but in reality curtains afforded little privacy.
Following recent renovations, we conducted a study to explore if refurbishments improved the patient experience in our ER. We prepared a survey asking specific questions about women’s perception of privacy and confidentiality. We then repeated the survey following renovations, after which the size of the ER remained the same but curtained spaces were replaced by individual walled cubicles with secure sliding doors. To date, over 120 women have completed the surveys; the majority (84%) were pregnant.
Women commented on what they saw or heard during their visit to the ER; before and after the renovation works:
“I could hear a pregnant woman in labour in a lot of pain right beside me.” [before]
“I was examined behind curtains and men and other patients . . . could see me and it made me very uncomfortable” [before]
“I could see blood on the ground in the cubicle beside me.” [before]
“I was a patient before with the curtains and I could hear all conversations in the room. The new set-up is 100 times better.” [after]
“Everything about the ER was private and the staff were amazing and professional.” [after]
Before the renovations, 49% of women reported overhearing a conversation about themselves during their ER visit. After the walls were put up, this dropped to just 9%. Before the renovation, more than 50% also overheard a conversation about another woman while in a cubicle, with this also dropping to 9% afterwards. Conversations were overheard at the nurses’ station, in the cubicle alongside, and extended to hearing staff on the phone talking about personal medical details. Only one-in-five women found their privacy to be adequate during their visit to the ER before the refurbishments, with this rising to 83% afterwards.
Parents who receive the news that they have lost their baby are particularly vulnerable, and the physical space that surrounds this experience is hugely relevant. How pregnancy loss is managed in a hospital setting has a direct and lasting influence on parents’ ability to cope at that time and recover from the experience. Our study indicates that the refurbishment of our ER has significantly improved privacy and confidentiality for the women attending. We recommend that other Obstetric units consider walled rooms instead of curtained cubicles when renovating or designing new ER departments.
To find out more . . .
- The Pregnancy Research Loss Group at University College Cork, Cork University Maternity Hospital, Cork, Ireland.
- Email Dr Keelin O’Donoghue.
Read more on the EAPC Blog . . .
You can read earlier posts in this series from practitioners in Ireland: Tyrone Horne, Brid Shine and Grace O’Sullivan. We hope to publish more posts in the series from France in a few weeks’ time.
9th EAPC World Research Congress latest . . .
Welcome to Dublin – 9th EAPC World Research Congress, Dublin, Ireland 9-11 June 2016 Follow us on Twitter @EAPCOnlus – our official congress hashtag is #eapc2016irl
Fáilte go Baile Átha Cliath don 9th EAPC World Research Congress, 9-11, Meitheamh, 2016. Leanaigh sin ar twitter (@eapconlus) ar chromhartha ár gComhdháil oifigiuil – #eapc2016irl