Do We Have an Ethical Obligation to Provide a Team Approach to Nursing Care for Obstetric Patients Admitted to the Critical Care Unit?

Abstract

32-year-old woman, 36 weeks' gestation, was admitted from the emergency department with HELLP (hemolysis, elevated liver function, and low platelets) syndrome. She presented with hypotension, tachycardia, and fetal tachycardia as indicators of decom-pensation. The patient was rapidly transported to the operating room on the labor and delivery (L&D) unit for an emergency cesarean delivery under general anesthesia. In the operating room, she ruptured a liver hematoma and had a massive hemorrhage requiring multiple units of blood, an emergency call for a vascular surgeon, and packing of her abdomen to stop the bleeding. A uterine tamponade balloon was placed to promote uterine tone and help stop the hemorrhage. The patient was unstable and was recovered in the L&D unit with a CRNA (certified registered nurse anesthetist) at the bedside. After initial recovery, the patient was transferred to the intensive care unit (ICU). The infant with evidence of hypoxic-ischemic encephalopathy was transferred to a tertiary center for head cooling shortly after delivery. The ICU staff stated that they were uncomfortable monitoring a postpartum patient with this disorder. They were unfamiliar with how to provide breast care, access and in-struct the patient on the use of breast pump, or perform fundal examinations. They did not know the expected ref-erence ranges for vital signs and laboratory values in the postpartum patient. They were also not trained in the management of the uterine tamponade device and therefore not equipped to competently manage this intervention. Lastly, they shared that they were not familiar with how to perform basic postpartum assessments and would need to rely on the obstetric