Paulina Van

Coping With Grief After Involuntary Pregnancy Loss: Perspectives of African American Women

OBJECTIVE To present the coping strategies used by African American women following their miscarriages, ectopic pregnancies, fetal deaths, and still-births, which the authors have termed involuntary pregnancy losses or IPLs. DESIGN Semistructured audiotaped interviews; grounded theory methods used to collect and analyze the data. SETTING Urban community-based sites in the Western United States. PARTICIPANTS 20 African American adult women who reported a history of involuntary pregnancy loss within 3 years of interview. RESULTS In this study, the womens responses to their IPL were grouped into four areas. They coped with personal reactions, reactions of others, memories of the baby, and subsequent pregnancies. CONCLUSION The women in this study used inner resources to develop self-help strategies to cope with reactions following IPL. Nurses are challenged to harness the influence of family, friends, religion, and cultural traditions to assist women in processing the cognitive, emotional, and social traumas associated with IPL. Educating women to recognize grief responses after IPL and to manage these responses effectively may prevent adverse outcomes to their physical and mental health. A culturally sensitive framework of clinical assessment and intervention for African American women experiencing IPL has been developed.

BREAKING THE SILENCE OF AFRICAN AMERICAN WOMEN: HEALING AFTER PREGNANCY LOSS

African American women experience pregnancy and infant losses at rates twice those of European American women and women of other recognized ethnic and racial groups. Health professionals, families, and friends tend to avoid discussions of these losses because grief following pregnancy or infant loss is frequently considered insignificant. Bereaved mothers whose grief is unrecognized are likely to have grief responses that are exaggerated in intensity and duration. In this article I reflect part of a larger qualitative study in which I explored the pregnancy-related experiences of 10 African American women. The purpose of this article is to describe the perceived strategies these women used to heal after pregnancy or infant loss. Individual interviews were conducted using open-ended questions. Grounded theory methodology was used to analyze the data. The healing strategies used by the participants reflect predominately inner and instinctive processes, resources, and remedies. Culturally appropriate strategies for health care interventions and research activities are offered.

Big dreams, little sleep: dreams during pregnancy after prior pregnancy loss.

Sleep patterns and dream content may be affected by stressful life events such as pregnancy loss. Women who are pregnant subsequent to a prior pregnancy loss tend to have anxious and emotionally charged experiences during their pregnancies. Dreams can affect pregnancy outcomes, specifically premature birth. This qualitative study is the first investigation to explore sleep disturbances caused by dreams as experienced by a diverse group of women pregnant subsequent to a pregnancy loss. Our analysis resulted in the identification of 4 categories of dreams. We offer clinical assessment and intervention strategies to support these women prenatally and present suggestions for research to facilitate our understanding of their experiences.

Competence gaps among unemployed new nursing graduates entering a community-based transition-to-practice program.

Multiple reports document competence gaps among employed new RN graduates. Less is known about the competence and confidence of new RN graduates who have not yet found employment in nursing. As part of an academic/practice partnership model, 4 collaboratives provided transition-to-practice programs for newly graduated and licensed, but unemployed, RNs. The authors describe the new nurses’ characteristics on program entry and discuss implications for nursing education and practice.

Preparing New Nurse Graduates for Practice in Multiple Settings: A Community-Based Academic–Practice Partnership Model

Responding to local and national concerns about the nursing workforce, the California Institute for Nursing and Health Care worked with private and public funders and community health care partners to establish community-based transition-to-practice programs for new RN graduates unable to secure nursing positions in the San Francisco Bay Area. The goals were to retain new RN graduates in nursing and further develop their skills and competencies to increase their employability. Leaders from academic and inpatient, ambulatory, and community-based practice settings, as well as additional community partners, collaboratively provided four 12- to 16-week pilot transition programs in 2010-2011. A total of 345 unemployed new nurse graduates enrolled. Eighty-four percent of 188 respondents to a post-program survey were employed in inpatient and community settings 3 months after completion. Participants and clinical preceptors also reported increases in confidence and competence.

Conversations, Coping, & Connectedness: A Qualitative Study of Women Who Have Experienced Involuntary Pregnancy Loss

The purpose of this qualitative study was to describe processes and strategies used by women to cope after pregnancy loss. Twenty women with a history of involuntary pregnancy loss were interviewed. All of the women were in the last month of a subsequent pregnancy, married or partnered, and most were EuroAmerican or Asian American and had completed college. Taped interviews, fieldnotes, and analytical notes were transcribed then subsequently coded and developed in individual or team sessions. Construction and confirmation of the categories and related themes derived from the data was a collaborative process. Three themes were revealed that described the coping behaviors used by the women: being myself, connecting with others, and avoiding and pretending. The core concept of connectedness and coping after involuntary pregnancy loss was further validated in this study. The purpose of this study was to describe processes and strategies that facilitate coping for 20 women, pregnant subsequent to an involuntary pregnancy loss (IPL). Involuntary pregnancy loss (IPL) refers to miscarriages, ectopic pregnancies, fetal deaths, and stillbirths (Van & Meleis, 2003). This current study was designed to replicate two prior qualitative studies, with African-American women, by the author (Patterson, 2000; Van, 2001). Based on the authors previous work, a theoretical framework entitled “A Model of Living with Grief after Pregnancy Loss” was constructed (Patterson, 2000). For the current study, a more diverse sample was used to potentially expand the applicability of the Model of Living with Grief after Pregnancy Loss to women who are of races other than African American.

Expanding the Visibility of Women's Work: Policy Implications.

S ocie ta l concep tua l i za t ions and images of women and work have an impact on the way health and social policies are formulated and how these policies in turn affect the lives, health, and wellbeing of women. Nurses, the majority of whom are women, have an inherent interest in issues of womens work and womens health. Our purpose in writing this article is to examine the policy implications for womens health that stem from the dominant societal images of womens work. In our discussion, we attempt to uncover the inherent contrasts and inconsistencies between media images, the changing Social and economic realities of womens work, and health and social policies. We advocate the active involvement of nurses in expanding the visibility of womens work and in promoting gender-sensitive policies related to womens work and health poli-

Economic aspects of community-based academic-practice transition programs for unemployed new nursing graduates.

Four partnerships between schools of nursing and practice sites provided grant-funded 12- to 16-week transition programs to increase confidence, competence, and employability among new RN graduates who had not yet found employment in nursing. Per capita program costs were

Academic–Practice Partnerships for Unemployed New Graduates in California

2,721. Eighty-four percent of participants completing a postprogram employment survey became employed within 3 months; 55% of participants became employed at their program practice site. Staff development educators may find this model a useful adjunct to in-house nurse residency programs for new RN graduates.

Preceptor and Self-Evaluation Competencies Among New RN Graduates.

In California, academic-practice partnerships offer innovative transition programs to new registered nurse (RN) graduates who have not yet found positions in nursing. This report describes the formation of 4 partnerships between 1 or more schools of nursing and clinical practice sites that included hospitals and nonacute care settings, such as hospice, clinics, school districts, and skilled nursing facilities. Factors facilitating the partnerships included relationships established as nurse leaders from practice and academia came together to address previous workforce issues, positive interpersonal experiences, an independent convening and coordinating organization, a shared understanding of the employment challenge faced by new RN graduates, and a shared vision for its solution. Partnerships face continuing challenges that include sustaining engagement, resource constraints, and insufficient nursing leadership succession planning. Partnership benefits include improved relationships between academia and practice, a forum to address contemporary issues in nursing education and practice advances, and stimulation of a reassessment of how to integrate ambulatory, transitional, and community-based nursing into prelicensure education.