“ED is a double-edged sword” : a feminist relational discourse analysis of nurses’ accounts of acute care encounters for threatened miscarriage in Aotearoa : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology - Health Psychology at Massey University, (Distance), New Zealand

Abstract

Threatened miscarriage (signs of pain and/or vaginal bleeding in early pregnancy) represents a common but complex presentation in emergency care, raising distinct emotional and psychosocial needs. While existing research has documented the often-negative experiences of women accessing care in this context, little attention has been paid to provider perspectives, particularly the nuances of patient-provider relationships and the institutional constraints that shape them. In this study, I adopt a contextualised, relational approach grounded in feminist poststructuralist theory and further shaped by my personal experience of miscarriage. Qualitative interviews were conducted with nine registered nurses from six Emergency Departments (EDs) across Aotearoa New Zealand to explore their acute care encounters. Using Feminist Relational Discourse Analysis, I delineated an overarching discursive realm: “ED is a double-edged sword”: Compromises of acute care. This discursive realm captures nurses’ struggle to navigate the dominance of biomedical discourse alongside their desire to provide relational, emotionally attuned care. I then generated three discursive patterns that elaborated on this tension, detailing different aspects of their complicated care work: (1) “We don’t love pregnant women in ED”: Systemic shortcomings; (2) “You’ve got to put a cap on it”: Professionalism and emotional containment; and (3) “I’m going to take care of you”: Situated agency and relational resistance. Across these patterns, the voices of discord, humanity, hostility, apprehension, professionalism, caution, tenderness, and purpose revealed the complex and often conflicting positionalities that nurses took up in their care encounters. Their accounts reflected how gendered expectations and institutional pressures constrained care, but also, how they actively negotiated, resisted, and repurposed those constraints to enact situated agency. These findings contribute to scholarship on reproductive loss, emergency nursing, and feminist health care by amplifying provider perspectives and illuminating the implicit relationality that underpins their practice, considering how the nurses accounted for the moral and emotional significance of potential pregnancy loss. The insights support the revision of ED systems to better respond to the realities of miscarriage, through clinical resources, education and specialised services that facilitate more holistic, adaptive capabilities in the acute setting. Further critical research is encouraged, particularly into diverse provider experiences and Indigenous perspectives.