Case study In one of the rural areas in Batangas, Jill a 20-year-old mother of two is complaining if vaginal bleeding, their house is situated in a far-flung place in the area, there is no available transport except a public jeepney and habal-habal (a tricycle accompanied by pieces of wood to make extra seats for the passenger) that can accommodate at least 8 passengers. The road is still not properly constructed. That day Jill wants to go to the nearest clinic, and there is no habal-habal yet, so she needs to walk 7 kilometers to her local clinic to be evaluated for vaginal bleeding. Her last menstrual period was 14 weeks ago, and she has felt the familiar signs of nausea and breast tenderness of early pregnancy. Her husband works as a laborer but due to the pandemic, he lost his job so there are not enough financial resources for the family, that’s why Jill doesn't want another pregnancy. A friend of her gives her a tablet and is advised to insert some tablets into her vagina that can cause abdominal cramps and possible bleeding if she is pregnant thereby inducing an abortion. The friend who gave her the tablets told her they would make it seem like she was having a period, so her family would never know about the pregnancy. Her friend accompanied her to the clinic, the family doesn’t know anything about their plans. She was examined by a nurse at the clinic, review her OB history, recorded the V/S, and lastly performs a vaginal examination. The nurse was surprised when she found a remnant of tablets in the vagina, the nurse suspected that what she saw during vaginal examination is a retained product of conception lying within an open cervical os. The nurse records Jill's OB history and physical examination and told Jill that she needs to see a doctor located in the city. There is no available transport at that time and the ambulance just left to bring another patient to the city. Jill was in pain and bleeding evident, she asks the nurse if she can contact an ambulance to transport her to the hospital, but the nurse said “you’re at fault and no right to demand, just wait outside and I would call you if the ambulance arrived. After approximately 3 hours, the ambulance arrives to take Jill to the district hospital 300 kilometers away. Upon the patient’s arrival, the doctor reviews the nurse’s notes, examines the container of tablets, and asks her many questions about why she killed her unborn baby. He sent Jill to another hospital and adds a note to her records: “Incomplete abortion, suspected use of misoprostol.” Despite her profuse vaginal bleeding and rapid pulse, the doctor calls for an ambulance to take her to another hospital, which is 2 hours away. Jill continues to bleed throughout the long journey by ambulance and is pronounced dead on arrival at the provincial hospital. Questions for discussion Discuss what is Incomplete abortion. Do you think there is a negligent act on the part of the healthcare provider? If No/Yes, support your answer. What appropriate nursing care could be done by the nurse? What are the health risks of delayed treatment of continued heavy bleeding after an incomplete abortion? Based on the case scenario are there any violations of the patient’s rights? Conclude your answer.