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Diana Drake, BS, RNC Principal Investigator Lynda J. Dimitroff, PhD, BSN, RN, CHES

Providing physical and emotional care to patients experiencing a perinatal loss: The impact on the nurse. Diana Drake, BS, RNC Principal Investigator Lynda J. Dimitroff, PhD, BSN, RN, CHES

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Diana Drake, BS, RNC Principal Investigator Lynda J. Dimitroff, PhD, BSN, RN, CHES

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  1. Providing physical and emotional care to patients experiencing a perinatal loss: The impact on the nurse. Diana Drake, BS, RNC Principal Investigator Lynda J. Dimitroff, PhD, BSN, RN, CHES Nursing Research Mentor Feb. 23, 2010

  2. Drew - December 8, 1990

  3. Objectives At the end of the session, the participants will be able to: • describe nurses' experiences; • integrate information between themes and demographics; and, • implement a strategy to support nurses.

  4. Purposes The purposes of this study were to: • gain further knowledge; • examine nurses' perceptions; and, • examine the demographics.

  5. Research Question What is the impact on the nurse of providing physical and emotional care to parents experiencing a perinatal loss?

  6. Literature Review • Gardner, 1982 • Stack & Barnas, 1987 • Gardner, 1999 • Kaunonen, 2000 • Matzo, et al., 2003 • Brunelli, 2005

  7. Research Method • Qualitative inquiry • 18 participants • Two-part survey consisting of: open-ended questions demographics

  8. Survey Questions • What issues concern nurses when they provide care to parents experiencing a loss? • What are the considerations that inhibit nurses from discussing psychological concerns with parents suffering a loss?

  9. Survey Questions • How do nurses cope with their feelings about perinatal death? • What are the needs of nurses as a result of performing these tasks? • What are the positive feelings nurses experience related to these tasks?

  10. Data Collection Sample • WCU staff • Teaching Day 2006 • n = 18

  11. Data Analysis • Constant-comparative analysis • Categories named • Emergent themes identified • Themes audited to insure credibility • Four themes emerged

  12. Demographics • Age • 19-29 11% • 30-39 5.5% • 40-49 39% • 50-59 39% • 60 + 5.5%

  13. Demographics • Education • Diploma/AS 61% • BSN, BS 28% • MS+ 11%

  14. Demographics • Years as a Nurse • 0-3 5.5% • 4-9 17% • 10-15 17% • 16-20 17% • 21-25 5.5% • 26+ 39%

  15. Demographics • Years as an OB Nurse • 0-3 17% • 4-9 22% • 10-15 22% • 16-20 0% • 21-25 17% • 26+ 22%

  16. Demographics • Times provided care to parents experiencing a perinatal loss • 1 5.5% • 2 5.5% • 3-5 17% • 6-10 12% • 11+ 61%

  17. Demographics • Experienced personal death • Yes 100% • No 0%

  18. Demographics • Relationship losses • Child 5.5% • Family Member 5.5% • Parent 17% • Sibling 12% • Spouse 0%

  19. Demographics • 61% provided care 11 or more times to someone experiencing a perinatal loss • 100% experienced death of someone close to them • 90% identified the need for support • 67% expressed confidence in self • 75% of those had 10 or more years experience as a nurse

  20. Experience Erring Support Education Experiencing emotions Seek support from others Rushing the process Providing care Compassion Share with patient and family Lack of education/training Take time for self Seek religious consolation Recognition Feedback Dealing with paperwork, other tasks Counseling Comfort with experience Prepare Dealing with differences Special consideration on the job Guidance Ability to relate Satisfaction Confidence Dealing with abortion Dealing with psychological problems

  21. Emergent Themes • Theme I: Dealing with emotions of self and others • Theme II: Taking time to care for self • Theme III: Nurses' need for support • Theme IV: Confidence in self

  22. Theme I • Dealing with emotions of self and others “….I could become more emotional than the parents” “…very difficult to know how to show sympathy without further taxing the patient emotionally” “I worry about saying the wrong thing” “…extremely emotionally draining”

  23. Conclusion I: Emotions expressed by other people (MDs, patients, families, staff, colleagues) must be faced by the nurse caring for parents experiencing the loss of their newborn

  24. Theme II • Taking time to care for self “being with family, friends-talking, eating, walking, crying” “my spiritual beliefs help me” “I have a need to discuss my experience with an experienced peer to debrief.” “…talking with others and crying” “short periods of time outside of the labor room to pull it together”

  25. Conclusion II Nurses expressed the need to take care of themselves and to take time for themselves.

  26. Theme III • Nurses' need for support “a place to debrief or de-stress” “feedback following care” “a listening ear and support of co-workers” “education” “consideration from management” “grief counseling or extra time off (adjust workdays)

  27. Conclusion III Education, support and guidance were identified by the majority of participants as necessary for nurses providing care to patients experiencing a loss.

  28. Theme IV • Confidence in self “I feel as if when talking with parents they get a feeling of emotional support” “…feeling of emotional strength when you make it through the experience and were able to function professionally” “satisfaction that I might have laid the foundation for healthy grief” “being recognized by others staff as effective and a resource to them” “having the ability to impact a horrific family event, so that even as difficult as the situation is, positive memories are left with the families”

  29. Conclusion IV Despite reporting difficulty dealing with their own emotions and the emotions of others, many participants expressed confidence in themselves and their abilities to provide care to bereaved parents. Gardner (1999) reported the same findings.

  30. Final Conclusion "The more fetal deaths in utero I care for, the more comfortable I feel." Participant #6 19-29 yrs. old 4-9 yrs. in nursing 4-9 yrs. in OB

  31. Recommendations • Nursing education is imperative.

  32. Recommendations • Supportive care to nurses should be instituted. Adequate staffing to insure completion of assignment Institutional concessions that promote emotional support: time off schedule for immediate time off voice in assignment lighter assignment grief counseling and debriefing mentor assigned to inexperienced nurses journaling (Sliwoski, 2009)

  33. Explore confidence of experienced and inexperienced OB nurses Continue interviews to increase sample size Explore nursing satisfaction scores of nurses after they have dealt with perinatal loss Future Research

  34. Questions, Answers, Comments

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