This blog is taken from a recent HealthStream webinar entitled “Nurturing the Nurse Caring for Perinatal Loss.” The webinar focused on equipping nurses with strategies to address their patient’s emotional needs and help clinicians deal with their own emotional burdens. The webinar was moderated by HealthStream’s Daniel Pawlus, Senior Manager of Digital Events and featured Lindsey Wimmer, DNP, RN, PHN, CPNP, CPLC, Founder and Executive Director of the Star Legacy Foundation and James Wilber, RN, Clinical Programs Success Manager, HealthStream.
Dr. Wimmer explained that definitions of perinatal loss may vary depending on whether one is trying to define it from an academic or legal standpoint. However, generally it is defined as stillbirth or neonatal loss occurring in the last half of pregnancy or the first 28 days of the life of a newborn. Dr. Wimmer pointed out that in the bereavement community and within the Star Legacy Foundation, perinatal loss happens anytime a baby dies at any point during pregnancy or infancy. Wimmer explained that regardless of when the loss occurs, there are an abundance of common denominators in the bereavement journey including one that happens as a result of miscarriage. She defined miscarriage as the loss of a baby at any time up to the 20th week of gestation. In addition, she defined neonatal death as any baby who is born alive, or with signs of life, that dies within the first 28 days of life.
Unfortunately, this kind of loss is not at all uncommon. Wimmer estimated that between 15% and 20% of all pregnancies will end in miscarriage and there are roughly one million losses every year for stillbirths and 13,000 neonatal deaths. As with many maternal health measures, there are significant racial and ethnic disparities across all types of loss.
Wilber asked Dr. Wimmer to describe some of the normal emotions that parents might experience during the loss of a child and she explained that there are a wide range of emotions that parents may experience. In the early stages of loss, it is common for parents to experience shock, sadness, and anger, but as they continue to grieve, they may also experience guilt and helplessness as they wonder about what they could have done differently. They may feel helpless or vulnerable and Dr. Wimmer stressed that these emotions would likely manifest themselves differently from one person to the next. She also stressed that the stages of grief are helpful to understand, but that not everyone will experience such a linear expression of emotions and that very unpredictability makes it difficult for both grieving parents and those that are caring for them.
Wilber also asked Dr. Wimmer about how perinatal loss affects nurses and she shared that many of them will have the exact same types of emotions as parents, including feelings of guilt about what they might have done differently. In addition, because perinatal loss is relatively common, it is plausible that some nurses may be processing their own trauma around perinatal loss which can further complicate the emotions that they may be feeling. Those feelings are further complicated by the tendency of healthcare providers to direct care outward and to focus less on processing their own emotions.
When thinking about the ways in which nurses can help grieving parents, Dr. Wimmer urged them to consider the likelihood of personal and cultural preferences associated with loss. She stressed that it is important to ask about preferences and avoid making assumptions about what a particular faith, tradition or people group may want. Dr. Wimmer then encouraged nurses to pivot to the role of advocate to ensure that the families’ wishes can be implemented.
She also encouraged organizations to consider palliative care for grieving families. While many of these programs are in nascent stages, Dr. Wimmer advocates that the healthcare professionals who had spent time with the families prior to their loss be part of the effort to determine what their goals are. She then stressed the importance of care coordination and sharing these goals to ensure that they are communicated to providers.
Providers should have a plan to cope with loss as well as Dr. Wimmer cited research that connected perinatal loss to work stress and burnout for practitioners. She encouraged providers to engage in debriefing programs even if they are brief and/or informal in nature.
When asked to address strategies to reduce adverse biopsychosocial outcomes, Dr. Wimmer pointed out two tactics that have proven helpful in reducing adverse outcomes.
She also advocated for more follow up with families so that providers can evaluate patients for signs of post-partum depression and provide supportive services for their grief. Some examples of this may look like creating an extra page for discharge instructions that respects the patient’s recent perinatal loss. She also recommends clear communication across palliative care so each provider is aware of the loss the patient has experienced, thereby sparing the patient the pain of having to share that part of their story repeatedly. She also recommended special appointment times for these patients with the goal of avoiding the potentially painful sight of new mothers with their babies.
Wilber provided an overview of HealthStream’s Perinatal Bereavement Certificate Program which was designed to achieve the highest levels of compassionate and respectful care by focusing on three key problems:
Wilber shared that the program includes a pre and post-test. It also has audio with a close-captioned script and has been optimized for mobile devices. The completion time is just under five hours and is designed for use by nurses, physicians, physician assistants, and other practitioners.
There are nine interactive modules which address three focus areas:
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