Perinatal bereavement and training of operators

by Claudia Ravaldi

We present the extract of a degree thesis that we followed with CiaoLapo in the design phase. This work and its results are part of the broader line of research Lucina Study, which since 2008 has been investigating the practices and beliefs of health professionals with respect to perinatal bereavement, trying to identify their training needs, in order to improve their practice and therefore their care.

“The loss of a perinatal child is an event that our culture often ignores, not considering it as a mournful event; the most frequent attitude on the part of relatives and friends in the face of such grief is usually that of minimizing and encouraging a new attempt at conception in order to compensate for the loss.
Pregnancy increases self-esteem and enriches the perception of the mother’s gender identity, thus producing a woman’s personal development. The mother who loses her baby, therefore, undergoes a profound injury to self-esteem and self-image and the attitude of the health care staff towards it is fundamental in making her feel understood in the seriousness of the loss suffered and therefore to facilitate her in the ‘mourning’.

In these seven years of research , in which at the same time the information available to operators has grown through the publication of scientific articles , books and conducting more than one hundred training courses and congresses , it is curious to note how the results of the Lucina are evolving and changing, often even after a short training course. This allows us to say that good training and the use of learning techniques based on team discussion and on some bases of communication inspired by Rogers and Rosenberg can in themselves modify the operator’s approach to the bereaved couple, and improve his skills.

This small study investigates the experience of perinatal bereavement from the point of view of nurses , often involved in the care of women transferred to gynecology after the diagnosis of perinatal death, without having received any appropriate training in this regard.

Nurses like midwives, doctors and psychologists, when present, while maintaining their specific technical role, can activate their communication and relational skills and therefore make a difference in care of the bereaved family: being helped to help allows health professionals to feel an active part of the care process and not spectators in distress of overwhelming and unsolvable pain.

The role of the nurse in perinatal bereavement

Extract from the degree thesis of Solidea Spigato, nurse.

The nurse is a professional figure who has the task of assisting the patient both on a practical and moral level, and it is precisely on this aspect that I have decided to focus.

Carrying out my internship in the operating units of Gynecology and Obstetrics at the San Bassiano hospital in Bassano del Grappa, I was able to attend an event of perinatal loss and I encountered training deficiencies regarding the care of parents by the ward nurses.

I myself, at that moment, did not know how to behave; every word or gesture, in fact, did not seem suitable to me. By administering the questionnaire “Lucina Survey 2012”, an evolution of Lucina 2008, a questionnaire developed and validated by the CiaoLapo Onlus association which for several years has been dealing with the support of parents affected by perinatal bereavement and the training of health workers regarding bereavement in pregnancy I am proposed to evaluate the impact of perinatal death on operators and their beliefs with respect to diagnosis and care; it emerged what I observed during my experience, namely that the difficult global care of the couple is perceived by nurses with emotional involvement in the event and, in some cases, as a sense of inadequacy due to inability to use suitable words or give answers clear to parents. For the realization of this project, in addition to the administration of the questionnaire, a search of the scientific literature was carried out.

The main objective of my thesis is to allow an adequate management of the couple victim of perinatal loss through a specific training course for nurses .

I carried out a survey among the nurses of the complex structure of gynecology and obstetrics with the support of all 26 professionals who serve in these operating units. The tool used was the LUCINA SURVEY 2012 questionnaire, investigating various areas relating to “care” in perinatal bereavement, such as the behaviors implemented by the operators in dealing with these cases, the knowledge relating to the assistance of this mourning event and personal experiences related to the same.

The emotions and sensations felt by the nurses during this event are interesting: involvement (96%), pain (85%) and in some cases embarrassment (35%). These experiences, if not managed correctly by the operator and if not shared within the multidisciplinary team, reduce the care skills of the operator to a mere technicality with consequent emotional detachment, coldness and denial of the problem. It is therefore important to share and discuss experiences within the team . In particular, in my survey 96% of nurses say they talk to their colleagues about the event, 77% with the midwife, 62% with their family members and 54% with the gynecologists.

The importance of sharing such emotions is confirmed not only by the scientific literature, but also by the Nurse’s Code of Ethics .

81% of nurses believe that continuing education on the subject could help them offer better care and some justify their answer by saying that they would be able to learn specific knowledge and improve their approach to parents, using words and providing more information. appropriate at the time of loss.

73% of nurses state that participating in periodic meetings with other operators (briefing and debriefing meetings) could change their approach to critical situations; multidisciplinary briefings and debriefings, as well as promoting greater sharing of experience within the team, favor a better holistic care of the couple by all professionals; 50% of them have already attended a refresher course on perinatal bereavement, 92% of nurses (24) are interested in attending refresher courses on perinatal death, and 54% of the staff interviewed would attend group meetings self help.

To Question 14: “Do you already have guidelines on child and parent care after childbirth in your OU?” Most of the nurses say “yes”: this data is arbitrary since, as confirmed by both Coordinators, there are NO such guidelines within the structure .

It is interesting to note that there are no guidelines within the structure although the Ministry of Health indicates on its website the use of the clinical audit “Stillbirth: clinical audit and improvement of care practice” with the aim of providing tools for the management of perinatal death to the multidisciplinary team .

Also the association “Sands” in the article “Caring for families experience stillbirth: a unified position statement on contact with the baby” recommends that in each clinic, hospital or point of birth there are guidelines applicable by the operators.

According to most nurses, it is important to provide for parental follow-up after the loss. A follow up that according to the article, “Supporting bereaved parents: practical steps in providing compassionate perinatal and neonatal care – A North American perspective” , by Williams et all, envisages two management areas: medical and of emotional coping .

Also, few nurses know about i Self-Help groups and the support network for perinatal bereavement while an article published in the Journal of Perinatal & Neonatal Nursing states that the nurse must be able to refer parents to self-help groups and associations specific to their problem and which welcome not only couples but also their family members.

“A journey of a thousand miles, starts with a single step”.

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