Running head: Hidden Danger 1

Hidden Danger

Evangelina Estrada

James Madison University RN-BSN

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Hidden Danger

A placental abruption is considered to be obstetrical emergency requiring immediate

attention. Approximately 1% of pregnancies in the United States result in an abruption (Deering,

2018). In medical emergencies there is little time to spare requiring for the nurse or care team to

act simultaneously and efficiently to provide the best possible outcome for the patient(s). The

exemplar provided is an example of Magnet level of professional practice.

In nursing and medicine, we hope for the best but prepare for the worst. A little past

midnight our unit receives a call from the emergency department informing us a triage patient

was headed our way with a chief complaint of “no fetal movement”. I was the primary nurse to a

labor patient who delivered with no complications an hour ago and getting ready to transfer her

to postpartum while two other colleagues were handling the triage who had already arrived. I

quickly finished the patient’s recovery, wheeled her over to her new room, and ensured she was

comfortable for the time being. I glanced quickly at our electronic fetal monitoring system and

saw normal fetal heart rhythm, so I began working on stripping my labor room for housekeeping.

I came out immediately when I noticed on the monitor a sustained drop in fetal heartrate. One of

my colleagues heard me approach and urgently stated to find our scrub tech to begin prepping for

a stat cesarean section. This was the beginning of a significant experience that modelled

exemplary professional practice.

My two colleagues who were primarily involved in the case are well seasoned nurses

with much experience in obstetrical emergencies. On the other hand, I have a little over a year in

obstetrics and working for a smaller hospital does not present much opportunity for high risk and

rare complications to learning from. I couldn’t have asked for better colleagues to be working

that evening. Both exemplified Force #11 of Magnet (ANA, n.d.), Nurses as Teachers, as we
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worked together to deliver the best care possible under the strained circumstance. When

communicating with me on how to proceed and what was needed, both spoke clearly and calmly

allowing me to both understand and focus on the process. Their calmness provided teaching

moments that are incomprehensible unless in the moment creating a greater opportunity for the

student, myself. They were aware of my abilities as a nurse and encouraged autonomy in

preparing what was needed for the patient and the infant within the c-section suite demonstrating

Force #9 of Magnet behavior (ANA, n.d.).

In less than thirty minutes, the Obstetrician (OB), the two-primary nurse, and myself

were all in the suite prepping the patient for surgery. Anesthesia had been called but were still a

couple minutes out. The OB made the decision to perform the surgery under local anesthesia due

to the severity and urgency of the case. One of the primary nurses, who was also the charge

nurse, had already called for extra resources prior to entering the suite. The pediatrician and their

back-up had been notified along with the emergency room physician and nurses. This was a

moment for all hands-on deck. Calling upon available resources in preparation for a worst-case

scenario can only be demonstrated by a staff who model Magnet force #8, Consultations and

Resources (ANA, n.d.). By calling in the extra personnel from another department, we were

attempting to provide the best possible outcome and provide the best care for both of the

patients.

As one could only have predicted from the last fetal heart tone obtained from within the

c-section suite, neonatal resuscitation was in full swing as soon as the full-term infant arrived to

the radiant warmer. Working seamlessly with the ER personnel made the resuscitation effortless.

At this time, the pediatrician and her back up were present along with the operating room nurses

who helped assist with the mother’s intraoperative and post anesthesia care as we were focused
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on attending to the infant. With each team member communicating effectively and knowing their

role, interdisciplinary relationships (force #13) (ANA, n.d.) were fortified and respected as

invaluable components of the team.

The OB pronounced the culprit for the obstetrical emergency as an occult

abruption, or a detachment of the placenta without vaginal bleeding or evident signs. We would

soon find out we were part of thirty-three percent of concealed abruptions that ended in fetal

death (Kasai et al., 2014). After thirty minutes of effective resuscitation efforts, the pediatricians

decided to cease efforts. Once the mom was regained consciousness, she began asking questions

and demanding to see her infant. The team took a moment of silence before the primary triage

nurse swaddled the baby so mom could see him. The head pediatrician, who had several years of

expertise in informing parents of their loss, began conveying her sympathies to the mother. She

cautiously told the mom the cause of her loss and the efforts that were performed in attempt to

save her newborn. The compassion and sincerity in the pediatrician’s voice made us all shed a

tear. The professionalism shown by everyone that night was extraordinary and had a lasting

impression on not only the mother of the deceased newborn, but on all those that were present.

In a later update written on the family’s social media page, the mother conveyed a

heartfelt message thanking the team at our hospital and the care and attentiveness provided by

the nursing staff during her postpartum recovery. She stated the compassion she had received

from the nurses made her time there bearable despite the recent events. As a moment in my

career that would be unforgettable, the written exemplar demonstrated several components of the

Magnet Model within a non-Magnet hospital. It is evident that although our hospital has no title

of Magnet, it does not prevent the nurses and other team members from possessing Magnet

qualities.
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Reference

American Nurses Association (ANA). (n.d.). Magnet model: Creating a magnet culture.

https://www.nursingworld.org/organizational-programs/magnet/magnet-model/

Deering, S. (2018, Nov 30). Abruptio placentae. Medscape.

https://emedicine.medscape.com/article/252810-overview#a5

Kasai, M., Aoki, S., Ogawa, M., Kurasawa, K., Takahashi, T., & Hirahara, F. (2014). Prediction

of perinatal outcomes based on primary symptoms in women with placental abruption.

Journal of Obstetrics and Gynaecology Research, 41(6), 850–856.

https://doi.org/10.1111/jog.12637