Nurses' Perspective on Caring for Women Experiencing Perinatal Loss

Midwives' support for parents following stillbirth: How they practise and resources they need from a phenomenological perspective

AIM

To explore the perceptions and experiences of midwives caring for couples who experience a stillbirth.

DESIGN

Qualitative study based on Gadamer's hermeneutic phenomenology.

METHODS

This study was conducted with midwives (n = 18) at the birth unit of a third-level public hospital in Jaén (Spain) in 2023. Personal semi-structured interviews were recorded in audio for later transcription by two researchers following steps described by Fleming.

RESULTS

Two themes were identified as important aspects of the practise of midwives in a situation of the birth of a stillborn child: (1) the importance of each action of the midwife, and (2) the availability of resources determines the care provided.

CONCLUSIONS

Having a stillbirth is a very complex experience, in which the psychological support and human and material resources involved are the basic tool for the care of these families. Acknowledging limitations of the available resources, the assistance and care provided by midwives are in line with the clinical practice guidelines, which can have an emotional impact on them.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The care to be provided in stillbirth requires appropriate human and material resources for these families. Midwifery and nursing professionals are in a unique position for acting in cases of families with a stillbirth, updated protocols and, in general, the coordination of the different agents involved within the healthcare system. WHAT PROBLEM DID THE STUDY ADDRESS?: The midwives´ experiences in cases which end with the delivery of a stillborn. WHAT WERE THE MAIN FINDINGS?: Each action of the midwife is as important as the availability of resources to offer the most appropriate care. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: In each woman who receives the care of a midwife who attends the birth of a stillborn.

REPORTING METHOD

COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution occurred for this study as this research focused on exploring staffs' perspectives from the specific viewpoint of their personal experience.

"You Are in the Middle of a Road, a Road With No End": Experiences of Women Who Underwent Medical Termination of Their Pregnancies: A Phenomenologıcal Study

This article focused on the experiences of women who underwent medical termination of their pregnancies. The study adopted a qualitative phenomenological research design with a sample of 20 pregnant women. Data were collected between April and June 2022 using a personal information form and a semistructured individual interview. The qualitative data were analyzed into 4 categories: "psychosocial impacts," "impacts on functionality," "coping," and "expectations." These categories comprised 8 themes and 24 subthemes. Nurses play a crucial role in adopting family-centered approaches to offer holistic care. They should prioritize providing physical care throughout the medical termination, while also assessing the psychological impact of fetal loss. Perinatal palliative care and bereavement counseling should be integrated into care practices.

Nursing care in perinatal grief. A systematic and critical review of attitudes and knowledge in clinical practice

AIM

To review and synthesize the available evidence on the attitudes and knowledge of nurses regarding the perinatal grief of the parents.

METHODS

A systematic review of original articles published from January 2016 to February 2023 without language limit in the Scopus, PubMed, Cinahl, PsycINFO, ScienceDirect and Web Of Science databases was carried out. The Prisma Statement methodological framework was used for systematic reviews and meta-analyses. The entire process was carried out in pairs, with discrepancies being resolved by a third reviewer. The quality of the articles was evaluated following the CASPe criteria (Critical Appraisal Skills Program Spanish).

RESULTS

Twelve articles were obtained in this review after applying the inclusion criteria, of which. Except for one cross-sectional quantitative study (8.33%), the rest were qualitative studies carried out through interviews (75%) or discussion groups (16.66%). It is highlighted that there are different biopsychosocial problems related to the care needs demanded by the family and that, due to poor training or culture of the health professional, are not adequately addressed.

DISCUSSION

The studies found show various resources to adequately attend to perinatal grief, there being discrepancies in relation to allowing or not allowing the body of the deceased baby to be shown and/or taken; There are also disagreements regarding whether the healthcare team should base its practice on protocols or theories such as the Kubler-Ross theory of grief. Most of the studies (75%) consider that more training and awareness is necessary, contemplating the biopsychosocial nature of the user.

Unmasking grief: Reflections on the complicated relationship between moral distress and grief

Perinatal loss often occurs in the context of discovery of a medical condition that presents patients and healthcare providers (HCPs) with difficult choices. Treatment choices are influenced by medical technology, however inescapable prognostic uncertainty, coupled with shared decision-making can lead to ethical dilemmas (Graf et al., 2023) [1]. When patients experience perinatal loss HCPs must grapple with their own emotions. Their sense of grief arises from their empathic connection with patients, bearing witness to their grief. This grief may compound HCP moral distress. Moral distress has an element of emotion, however it is more than distress in tragic situations. Moral distress is linked to HCPs feeling responsible to take action (Dudzinski, 2016) [2]. In situations of perinatal loss, it is essential to acknowledge the grief and explore how it influences the experience of moral distress. This article will reflect on the impact of HCP grief in ethically complex situation of perinatal loss.

Nurses' and midwives' perceptions and strategies to cope with perinatal death situations: A systematic literature review

AIM

The aim of this paper is to describe the strategies used by nurses and midwives to cope with experiences of dealing with perinatal death and maintain their satisfaction at work.

DESIGN

Systematic literature review, in accordance with the PRISMA Declaration.

DATA SOURCES

(2000-2021) Web of Science, PubMed, Scopus, CINALH and Dialnet, for articles in English and Spanish from the period between January 2000 and March 2021.

REVIEW METHODS

The outcome of the review was the perceptions of nurses and midwives who have cared for people in a situation of perinatal loss.

RESULTS

Thirteen studies were identified that evaluated the attitudes, experiences and needs of these healthcare professionals. The combined size of all samples was 2196 participants.

CONCLUSIONS

The negative effects on these professionals' satisfaction with their situation at work could be mitigated by covering their needs for knowledge, experience, and emotional and technical skills to deal with such events.

IMPACT

As potential protective factors against dissatisfaction in nurses and midwives during perinatal death experiences, we identified older age and experience in perinatal care and coping strategies based on communicating one's feelings to peers, empathetic listening to the families cared for, training and institutional support. No Patient or Public Contribution.

Toward Optimal Emotional Care During the Experience of Miscarriage: An Integrative Review of the Perspectives of Women, Partners, and Health Care Providers

INTRODUCTION

Miscarriage is frequently associated with significant emotional impact, causing psychological distress, trauma, and grief. Unfortunately, women and partners frequently report dissatisfaction with care around miscarriage, and health care providers report feeling ill-prepared and underequipped to provide emotional support. This integrative review synthesizes the individual perspectives of the woman experiencing the miscarriage, the partner, and the different health care provider roles involved in the care to better understand what future research is necessary to improve the experiences of bereaved parents and their health care providers.

METHODS

Electronic databases were searched for studies that covered emotional care around miscarriage from the perspective of women, partners, or health care providers. The review included studies published in English between 2015 and 2022, using either quantitative or qualitative methods. Thematic analysis was carried out, and conclusions from these articles were integrated into themes and subthemes.

RESULTS

A total of 60 studies met the inclusion criteria. Two main themes were identified for women: (1) a need for more information and (2) a need for acknowledgment of their loss. Two main themes were likewise identified for partners: (1) a need for more information and (2) a need for recognition. Three main themes were identified for health care providers: (1) a need for additional training, (2) components of quality care, and (3) perceived barriers to providing care.

DISCUSSION

There is broad overlap in the needs identified by bereaved parents and their health care providers, as well as general agreement regarding the barriers to providing effective care. Five areas of future research priority were identified to understand how best to meet these needs: empirical evaluation of strategies to meet identified needs, investigation of setting-specific needs, integrated consideration of all relevant roles, investigation of the care needs of diverse groups, and an investigation of the predictors of emotional impact.

Experiências e condutas do profissional de saúde frente ao óbito neonatal

Objetivo: identificar as experiências e condutas do profissional de saúde frente ao óbito neonatal disponíveis na literatura. Método: estudo bibliográfico descritivo, do tipo revisão integrativa, com delimitação temporal de 2009 a 2020, realizado nas bases de dados LILACS, BDENF, MEDLINE, Scopus, Web of Science, CINAHL e biblioteca virtual SciELO, por duas pesquisadoras de forma independente em junho de 2021. Foram selecionados 511 artigos, porém somente 21 compuseram o corpus final do estudo após aplicação dos critérios de inclusão/exclusão. Resultados: os estudos evidenciaram que as experiências dos profissionais diante do óbito são permeadas por sentimentos ambivalentes que influenciam na escolha de suas estratégias de enfrentamento. Dentre as condutas adotadas pelos profissionais, destacam-se: a comunicação clara e sensível; o acolhimento ao luto dos familiares; o respeito à decisão dos pais em relação aos cuidados com o recém-nascido; e a entrega de lembranças, foram consideradas atitudes positivas para a superação do óbito neonatal. Considerações finais: os resultados mostram o despreparo dos profissionais para lidar com o processo de morte do recém-nascido e da necessidade de haver estratégias de educação permanente voltada ao óbito neonatal.

Nursing Care of Childbearing Families After Previous Perinatal Loss

Nurses who care for childbearing families facilitate the family's adaptation to the arrival of a newborn through assessment of physical, emotional, and psychological needs. After experiencing a perinatal loss, such as miscarriage, stillbirth, or neonatal death, a woman's perception of pregnancy and of her sense of control in becoming a mother can include fear and anxiety, and she may have significantly different needs than a pregnant woman who has not experienced perinatal loss. In this article, we provide evidence-based information and recommendations for maternal-child nurses caring for childbearing families who are preparing to welcome a new baby (sometimes called a "rainbow baby") after a previous perinatal loss.

The Impact of Perinatal Loss Nursing Simulation among Undergraduate Students

Providing careful and proper care for women experiencing perinatal loss is essential. Nurses and nursing students must be sufficiently prepared to provide adequate care. Caring for women who experienced a perinatal loss requires special education and instruction, but little is provided to nursing students. This study aimed to investigate the impact of simulation education directed toward caring for women with perinatal loss. A single-group pretest posttest study design was adopted. A convenience sample of 77 undergraduate students participated in the study. The nursing students’ nursing anxiety, confidence for clinical decision-making, communication competence, and simulative effectiveness were measured before and after the simulation. In addition, we asked students open-ended questions. No significant differences were noted in variables. However, the rank order of simulation effectiveness and result of open-ended questions had some noteworthy implications. Although there was no significant effect in results, simulation education about the perinatal loss was helpful for nursing students. Nursing students reflected on perinatal loss situation and learned that they should provide empathetical therapeutic communication based on needs of women with perinatal loss. To assure its effectiveness and to include optimal program content, a need exists to measure student reflection before and after the simulation. To fully guide and support women and their families with perinatal loss, providing standardized care is needed and in order to do that, standard for educational program regarding perinatal loss needs to be developed and delivered to nursing students as well as nurses.

Unravelling the grief of involuntary pregnancy loss: A meta-ethnography of midwives' and nurses' emotional experiences

BACKGROUND

Parents who experience involuntary pregnancy loss encounter nurses and midwives when requiring care. But the environment in which this attention is provided turns it into a stressful and challenging event that favours the concealment of emotions. Literature supports the development of compassion in nurses and midwives who tend to parents who experience pregnancy losses.

AIM

To synthesise the emotional experiences of midwives and nurses when caring for parents who have suffered an involuntary pregnancy loss.

METHOD

This is a synthesis of qualitative studies following Noblit and Hare's interpretive meta-ethnography. Eleven studies met the research objective and inclusion criteria.

RESULTS

An overarching metaphor, 'Unravelling the grief of loss', accompanied by four major themes provided interpretive explanations to the experiences of midwives and nurses in caring for involuntary pregnancy losses: 'Pulling the thread' - looking for the meaning of loss; 'Yarn entanglement degree' - determinants for grief expression; 'Detangling tools' - focusing on the loss; and 'Fraying the thread' - moving away from the loss.

DISCUSSION

The provision of whole care to these parents requires midwifery and nursing training and continued education. Furthermore, the organisational culture should prioritise the health and well-being of midwives and nurses.

CONCLUSION

Midwives and nurses encounter the parents' loss in care and personally in various ways and give meaning to the loss conditioned by personal and professional determinants. They unravel the grief of loss by looking for the meaning, expressing their grief, focusing and moving away from the loss.

Women's Experiences With Palliative Care During Pregnancy

OBJECTIVE

To explore the experiences of women who received life-limiting fetal diagnoses during pregnancy and support from a perinatal palliative care program.

DESIGN

Descriptive qualitative.

SETTING

The perinatal palliative care program is part of a not-for-profit system of 24 hospitals serving the U.S. Intermountain West region.

PARTICIPANTS

A convenience sample of 12 women who experienced pregnancies with life-limiting fetal diagnoses and received care from a perinatal palliative care program.

METHODS

Women chose to participate from mailed invitations or responded to a post on private social media and then completed semistructured interviews about their experiences surrounding the fetal diagnoses and support from a perinatal palliative care program. Interviews were approximately 40 minutes in length and were conducted over the phone, recorded, and then transcribed. We performed content analysis by coding, forming categories of similar coded data, and constructing themes by recontextualizing categories through iterative, team-based meetings.

RESULTS

We identified four themes from the data: Importance of Memorabilia to Cope With the Death and Documentation of Pregnancy, Acceptance of Death as Part of the Pregnancy Experience, Continued Life Without a Child, and Importance of Empathy Throughout the Process.

CONCLUSION

The themes support the existing research findings about the needs of pregnant women as they cope with difficult situations. Our findings show the necessity and importance of perinatal palliative care programs.

Managing Ambiguity When Caring for Women Who Experience Stillbirth

OBJECTIVE

To examine the interactions and social processes involved when nurses care for women who experience fetal demise and subsequent stillbirth.

DESIGN

Qualitative design using grounded theory.

SETTING

Single-site urban medical center in New York City.

PARTICIPANTS

Twenty registered nurses who worked in the labor and delivery department.

METHODS

I collected data via in-depth interviews and recorded, transcribed, and analyzed the data using constant comparative analysis.

RESULTS

Managing Ambiguity emerged as the overarching preliminary theory to describe how nurses cared for women who experienced stillbirth. This preliminary theory included three themes: Experiencing a Spectrum of Emotions, Managing Patient Care in an Ambiguous Context, and Managing Institutional Ambiguity. These themes provided an overview of the creative/protective and avoidant/conflicted behaviors that nurses brought to their work with women whose fetuses died in utero and were stillborn. These interactions were complicated by institutional policies and additional factors, such as workload, that often denied nurses the resources needed to engage in the patient care processes required to address the trauma experienced by women and their families.

CONCLUSION

The preliminary theory Managing Ambiguity provided a perspective on the experiences, behaviors, and social processes involved in caring for women who experience stillbirth. The absence of preparatory education, effective protocols, and institutional support contributed to the ambiguity inherent in caring for these women.

Grief among Neonatal Intensive Care Nurses

BACKGROUND

Nurses working in the high-stress environment of the neonatal intensive care unit (NICU) are at high risk of experiencing grief after death of a baby.

DESIGN

Using a quantitative cross-sectional design, a convenience sample of nurses working in a Level IV NICU in Northern California, United States completed online surveys. Level of grief among NICU nurses, perceptions of grief support available at their institution, and past and future grief coping methods were assessed.

PARTICIPANTS

A diverse sample of 55 NICU nurses, mean age 45.5 (SD = 11.7) years.

SETTING

A high-acuity NICU in one large Northern California hospital.

METHODS

Participant demographic data and the Revised Grief Experience Inventory were completed online.

RESULTS

Total grief scores ranged between 22 and 82 with a mean of 46.9 (SD = 17.4). Sixty percent (n = 33) moderately/strongly disagreed on adequacy of current grief support services at their institution and 81% (n = 45) reported hospital staff could benefit from additional grief support. Nurses' past grief support included family, friends, and church. Future grief resources would include family, friends, and co-workers. Participants indicated need for debriefing and additional nurse staffing resources at the time of a patient death.

CONCLUSIONS

Neonatal intensive care unit nurses in our study reported experiencing grief. Debriefing and bereavement support may be helpful for nurses working in high-stress environments where there is a higher likelihood of patient death.

Parents' Experiences About Support Following Stillbirth and Neonatal Death

BACKGROUND

Stillbirth and neonatal death are one of the most stressful life events, with negative outcomes for parents. Society does not recognize this type of loss, and parental grieving is particularly complicated and intense.

PURPOSE

The aim of this study was to describe and understand the experiences of parents in relation to professional and social support following stillbirth and neonatal death.

METHODS

This was a qualitative study based on Gadamer's hermeneutic phenomenology. Twenty-one semistructured interviews were carried out. Inductive analysis was used to find themes based on the data.

RESULTS

Twenty-one parents (13 mothers and 8 fathers) from 6 families participated in the study. The analysis identified 2 main themes: (1) "professional care in dealing with parents' grief," with the subthemes "important aspects of professional care," "continuing of pathways of care"; and (2) "effects of social support in parental grief," including the subthemes "the silence that surrounds grieving parents," "family and other children: a key element," and "perinatal loss support groups: a reciprocal help."

IMPLICATIONS FOR PRACTICE

Counseling and support according to parents' requirements by an interdisciplinary team of professionals educated in perinatal loss and ethical family-centered care is needed. A social support system for families is necessary to avoid negative emotional consequences.

IMPLICATIONS FOR RESEARCH

Further research is needed to analyze midwives' and nurses' experience as facilitators to improve parental grief and the difficulties experienced by the family, other children, and friends of parents with perinatal loss in providing support.

Involuntary Pregnancy Loss and Nursing Care: A Meta-Ethnography

Healthcare professionals find the care of parents following an involuntary pregnancy loss stressful and challenging. They also feel unprepared to support bereaved parents. The challenging nature of this support may have a personal impact on health professionals and the care provided to parents. The aim of this meta-ethnography is to synthesise nurses’ and midwives’ experiences of caring for parents following an involuntary pregnancy loss. A meta-ethnography of ten studies from five countries was carried out. GRADE CERQual was assessed to show the degree of confidence in the review findings. An overarching metaphor, caring in darkness, accompanied by five major themes provided interpretive explanations about the experiences of nurses and midwives in caring for involuntary pregnancy losses: (1) Forces that turn off the light, (2) strength to go into darkness, (3) avoiding stumbling, (4) groping in darkness, and (5) wounded after dealing with darkness. Nursing staff dealt with organizational difficulties, which encouraged task-focused care and avoidance of encounters and emotional connection with parents. However, nurses and midwives might go beyond in their care when they had competencies, support, and a strong value base, despite the personal cost involved.