Giving Pregnancy Test Results

1. Giving Pregnancy Test Results A primer for nursing students

2. Overview of presentation • Principles of giving pregnancy test results • Identification of immediate health concerns • Overview of laboratory pregnancy tests

3. Ideally, the nurse has the opportunity to interact with a client prior to giving test results: • Why does she think she may be pregnant? • When was her LMP? • How is she feeling about the possibility of pregnancy?

4. If meeting the client for the first time • Introduce yourself and describe your professional position before giving the test results. • Eg. Hi, I am Sarah, a nurse here at the clinic.

5. Giving results • Give the results at the beginning of the client encounter. • Eg. Hi, I am Sarah, a nurse here at the clinic and I have the results of your pregnancy test. The test is positive. You are pregnant. Pause.

6. Be clear and to the point in giving results • Some women may be confused by the “test is positive”. They may be so anxious that they do not understand or are confused by the terminology. By stating “you are pregnant” , the nurse leaves no doubt. • Eg. Hi, I am Sarah, a nurse here at the clinic and I have the results of your pregnancy test. The test is positive. You are pregnant. Pause.

7. Give the client a moment of silence • A woman may need a few moments to process the information and collect her thoughts. • Give her time to reflect back to you how she feels about the result. • Pay attention to non-verbal clues. • Focus on the client's reactions and feelings: "How are you feeling about this?" or "Is this what you were expecting?" or "You seem upset/sad/shocked/happy" etc... 

8. If the test result is negative: • If the women is disappointed, assess further. If there is a concern of infertility, make appropriate referrals. • If the woman is relieved, this is a “teachable moment” for contraceptive counseling.

9. “Teachable Moment” Contraceptive Counseling • Discuss effective contraception and develop a plan with her for accessing safe contraceptives. • Educate her about “behind-the-counter” emergency contraception (Plan B) or if a teen, provide a prescription in advance along with safer sex counseling.

10. If test result is positive: • If the woman is pleased with the positive pregnancy results, congratulate and discuss early pregnancy care. • Many women will experience ambivalence over the positive test results so it is important for the nurse to discuss options of adoption, abortion and of continuing the pregnancy.

11. If the woman is experiencing ambivalence, assist her in identifying life circumstances that will affect her decision to parent or not parent a child at this time in her life. Ambivalence

12. Help the woman identify her support systems • Most women will want to involve a partner, friend or family member in their decision. • Generally health care issues are considered confidential but some states require parental notification or parental consent for a teenager to make a decision about the pregnancy. In the case of abortion, many states with such notification/consent laws have judicial bypass arrangements for teen who cannot/will not involve their parents.

13. Time frame • Reassure her that she need not make the decision today. She can take some time to think through what is best for her. • Arrange subsequent visits or an appointment with a counselor. • Ask women what additional information or support they want.

14. Facilitate referrals and follow-up care, if needed: • To provide referrals in a seamless manner, the nurse needs to know local referral resources. • Have pamphlets and brochures available for: • adoption agencies • abortion services • prenatal care providers • counseling services (if not provided in your setting)

15. If continuing the pregnancy: • Provide a prescription for prenatal vitamins. • Provide education about the effects of alcohol, drug use, smoking, toxins and certain medications on a developing pregnancy. • Screen for any personal or family history of genetic diseases that may require a consult with a genetic specialist.

16. Elicit any immediate concerns • Does the woman have any immediate social concerns? • Screen for domestic violence. • Does the woman need nursing support or medical management for nausea of pregnancy? • Screen for abdominal/pelvic pain with vaginal bleeding. If present, refer the woman for an immediate workup for a possible ectopic pregnancy.

17. Professional responsibilities • Engaging in self reflection and values clarification about the intersection of personal beliefs and professional responsibilities. • Uphold the woman's autonomy and right to care. • The ANA Code of Ethics offers an ethical framework for approaching nursing care.

18. IIf giving pregnancy test results, it is important to understand the type of pregnancy test • Overview of laboratory pregnancy tests • Monoclonal antibody pregnancy testing: • Urine • Serum

19. Monoclonal antibody pregnancy testing: Urine • Detects human chorionic gonadotropin (HCG) in urine. • Highly sensitive, Can detect as little as 20-50mIU/mL in urine. • Qualitative measure (“yes” or “no”) • Quick, simple, low-cost • Over the counter (OTC) versions available

20. Monoclonal antibody pregnancy testing: Serum • Highly sensitive >99% • Candetect as little as 10mIU/mL in serum • Qualitative measure (positive or negative) • Quantitative-Used primarily for clinical management of pregnancies that are problematic or concerning.

21. Serum quantitative hCG Levels • <1 week = 5-50 mIU/mL • 2 week 50-500 • 3 week 100-10,000 • 4 week 1,000-30,000 • 5 week 3,500-115,000 • 6-8 week 12,000-270,000 • 12 week 15,000-220,000

22. Additional Resources • Check www.roeresources.org for additional resources including the ppts: Caring for the Woman with an Unintended Pregnancy: Abortion as an Option and Options Counseling for Unintended Pregnancy • For a hard copy of our referral resource, contact info@provideaccess.org • PPT updated 2.17.14