• Lisa Wolf, Hannah S Noblewolf, Michael Callihan, and Michael D Moon.
• J Emerg Nurs. 2023 Sep 1; 49 (5): 714723714-723.

IntroductionPrevious research describes a significant knowledge deficit in obstetrical care in emergency settings. In a post-Roe environment, additional medicolegal challenges are documented across the obstetrics and gynecology landscape, but an understudied care setting is the emergency department, where patients may present to a practice environment where there is limited or no obstetrical care available. It is unknown how emergency nurses make decisions around these types of presentations. The purpose of this study was to explore the clinical decision-making processes of emergency nurses in the care of patients with obstetrical emergencies in the context of limited or absent access to abortion care and the impact of those processes on patient care.MethodsQualitative exploratory approach using interview data (n = 13) and situational analysis was used.ResultsSituational mapping uncovered human elements comprised nurses, providers, pregnant people, and families; nonhuman elements comprised legislation, education, and legal understanding. Social worlds mapping included challenges of inexperience, conflict about clinical responsibility, uncertainty about the meaning of legislation, and passivity around implications for patient care. Positional mapping yielded both the overlapping discourses around the phenomenon of interest and the area of silence around abortion-limiting legislation.DiscussionWe found that emergency nurses in states with abortion care-limiting laws had significant self-reported deficits in both education and training around the management of obstetrical emergencies. In this sample, there was a surprising lack of awareness of care-limiting legislation and the clinical, ethical, and legal implications for both emergency care staff and for patients.Copyright © 2023 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

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