Rana Limbo

Meaningful moments: The use of ritual in perinatal and pediatric death

Rituals provide meaning and order to transitions, and symbolically connect people and events. Despite the prevalence of perinatal loss (miscarriage, stillbirth, and newborn death) and pediatric deaths, little has been written about the use of rituals surrounding these losses. The purpose of this article is to define the dimensions of a ritual as each pertains to perinatal and pediatric death, and provide concrete applications for use in clinical practice. Intention, participation, and meaning-making are the key dimensions of rituals that arise from clinical encounters. Initiating the discussion about ritual and the timing of the ritual itself are critical elements for the nurse who is caring for a bereaved family. Because of the paucity of research on using rituals in perinatal and pediatric death, nurse researchers should design studies that explore the outcomes of using rituals, both in the short- and long-term, following the death.

Making a case: creating a perinatal palliative care service using a perinatal bereavement program model.

ABSTRACT This article explores the innovative approach of creating a perinatal palliative care service in an institution that already has a perinatal bereavement program. The proposed model focuses on the importance of establishing and maintaining relationship among and between nurses, other clinicians, and parents. The authors examine theoretical and clinical perspectives, recognizing the presence of both grief and hope from the moment of a life-threatening fetal diagnosis. The article identifies key program development processes, potential barriers, and practical implementation strategies as methods to ensure the delivery of seamless perinatal palliative care from diagnosis, through pregnancy, delivery, and the babys living and dying.

The tie that binds: relationships in perinatal bereavement.

Relationship is a central concept to the delivery of quality perinatal bereavement care. This article explores relevant bereavement research and clinically based writings about relationship in the care of families experiencing perinatal loss. Focusing on relationship provides a framework to guide interventions that will be perceived as meaningful and helpful to grieving parents. From the moment parents learn the difficult news of their babys poor prognosis or death, nurses must strive to establish trust while building an effective working relationship with the family. A nurse with an understanding of the relationship needs can guide parents in creating a context for supporting each family member dealing with this unexpected family tragedy. Through sensitive follow-up bereavement care, nurses provide a source of hope for grieving families over time. Ultimately, nurses must find meaningful ways of self-care as a way of reinvesting in future relationship with other grieving families.

Respectful disposition in early pregnancy loss.

This article discusses an issue rarely seen in the professional literature: the tangible ways nurses can respect a womans needs following miscarriage by ensuring the safe handling and disposition of fetal tissue or remains. Concepts of personhood, place, and protection are important for nurses to understand within the context of a womans response to miscarriage. Hospitals or clinics that foster a culture of respectful fetal disposition should have a system in place to bury tissue or fetal remains in a designated area; in fact, several states have enacted laws that regulate what hospitals and clinics must do, or what women must be offered, after a miscarriage or ectopic pregnancy. Barriers may exist to creating a culture of respectful disposition, including staff attitudes, perceived time and financial constraints, lack of knowledge, and inefficient communication between departments. Nurses can begin implementing change in this regard through conducting a needs assessment using guiding questions contained in this article. In addition, through communication, education, and implementation of respectful disposition, nurses can promote safe processes that will honor womens preferences and wishes for care following a miscarriage.

Being Sure: women's experience with inevitable miscarriage.

Purpose:To extend understanding of womens experience of miscarriage by exploring their approach to decisions about what to do after learning a miscarriage was likely. Study Design and Methods:Using dimensional analysis, a technique generic to grounded theory, we analyzed interview transcripts of 23 women who experienced miscarriage (before 14 weeks gestation) at a midwestern medical center. We explored womens experiences by focusing on (1) how they came to know they were having a miscarriage and (2) how they decided what to do next. Both are key, yet relatively unexplored, constructs of early miscarriage. Results:Being Sure emerged as the central process for women as they made decisions about what was happening to them, and about their treatment options. Participants needed to be sure that they were having a miscarriage (that the pregnancy was truly over), and also be sure that they were choosing the right treatment option for them (surgical, medical, or expectant management). Clinical Implications:Nurses caring for women in the throes of an inevitable miscarriage can use the information in this article to support women in their quest toward Being Sure. Helping women thusly encompasses assisting women to understand their symptoms, come to terms with the inevitability of the pregnancy loss, and be comfortable with which treatment they choose for the miscarriage.

Languages of Grief: a model for understanding the expressions of the bereaved

The aim of this work is to provide an overview of the key features of the expressions of grief. Grief is a response to loss or anticipated loss. Although universal, its oral and nonverbal expression varies across cultures and individuals. Loss is produced by an event perceived to be negative to varying degrees by the individuals involved and has the potential to trigger long-term changes in a persons cognitions and relationships. The languages used by the bereaved to express grief differ from the language used by professionals, creating dissonance between the two. Data were obtained from English language Medline and CINAHL databases, from professional and personal experiences, interviews with experts, and exploration of cemetery memorials. Blog websites and social networks provided additional materials for further refinement of the model. Content analysis of the materials and agreement by the authors as to the themes resulted in the development of the model. To bridge the gap between professional language and that used by the bereaved, a Languages of Grief model was developed consisting of four Modes of Expression, four Types of Language, plus three Contingent Factors. The Languages of Grief provides a framework for comprehending the grief of the individual, contributing to clinical understanding, and fruitful exploration by professionals in better understanding the use of languages by the bereaved. Attention to the Modes of Expression, Types of Language, and Contingent Factors provides the professional with a richer understanding of the grieving individual, a step in providing appropriate support to the bereaved. The Languages of Grief provides a framework for application to discrete occurrences with the goal of understanding grief from the perspective of the bereaved.

Will Our Baby Be Alive Again? Supporting Parents of Young Children When a Baby Dies

Many families who experience perinatal loss may have young children who were looking forward to being a big brother or sister. Suddenly, these children become bereaved siblings before they had much of a chance to be just siblings, and nurses are often called upon to help parents decide when and how to tell surviving children.

Perinatal Palliative Care

Q1 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 Pcomprehensive and holistic services for expectant parents who receive a diagnosis of a life-limiting fetal condition (LLFC) and opt to continue the pregnancy. The diagnosis of an LLFC transforms the pregnancy from one of joy and expectation to one of apprehension and grief. Between 37% and 85% of parents choose to continue such pregnancies (Wool, 2013). Providers who offer PPC give standard medical care in tandem with individually tailored emotional, psychosocial, and spiritual support during pregnancy, labor and birth, and the postpartum period. The maternal–fetal dyad is cared for by a team of clinicians from various disciplines appropriate to the fetal diagnosis. Nurses are instrumental in providing care for parents and are often the experts who assist with coordinating services. In collaboration with other professionals, nurses often lead the creation of a plan of care for the pregnancy and birth and the infant’s postbirth needs (Kobler & Limbo, 2011; Wool et al., 2015).

Respectful Disposition after Miscarriage: Clinical Practice Recommendations

Abstract Compassionate clinical practice guidelines for healthcare providers for respectful disposition after miscarriage are presented. When woven into the whole of a clinicians practice, these guidelines provide the framework for giving women and their families the care they want and deserve when experiencing miscarriage. Relying on theoretical concepts of personhood, place, and protection, care providers can assess the unique meaning a woman assigns to her early pregnancy loss and offer interventions that embrace the concept of respectful disposition. Respectful methods of disposition involve a continuum of care that shows respect for remains and relies on person-, family-, and culture-centered nursing care. Policies, practices, and perspectives that flow from respectful disposition have women and families at their core and flexibility to cocreate care. This involves courage and competence. Several states have enacted fetal disposition laws, but these mandates are of questionable benefit because the expertise of healthcare leaders, nurses, physicians, chaplains, and other stakeholders must be involved in this sensitive and important area of care. Compassionate care cannot be legislated. We offer a practical approach to respectful disposition, including how to handle and prepare remains and examples of burial and memorial services, which will give clinicians the ability to respond empathetically and respectfully to the heart-rending plea of a woman who asks, “Where is my baby?”

ResearchDimensions of a Woman's Experience of Inevitable Miscarriage

Poster Presentation Objective To explore a womans experience of early pregnancy loss when she is diagnosed with an inevitable miscarriage through understanding her description of symptoms and treatment decisions. Design This qualitative study consisted of transcribed data from a recorded telephone interview lasting from 30 to 45 minutes. Researchers used a semistructured interview guide. Setting Nurses recruited the participants from an obstetrics/gynecology outpatient clinic at a Midwestern medical center. Sample A purposive sample of women who experienced a miscarriage at or before 14 weeks of pregnancy, needed to make a treatment decision (medical, surgical, expectant management), were at least 18 years old, and spoke English were recruited. Methods Dimensional analysis, a method generic to grounded theory but appropriate for existing data, was used to analyze transcripts. Women were asked, “Tell me about your miscarriage” with follow‐up questions such as, “How did you decide what to do next?” or “What went into knowing what to do next?” Using line‐by‐line analysis, the research team identified dimensions and related conditions. Results Participants ranged in age from 23 to 40 years, with a mean age of 31. All were married. Fifteen women decided on surgical intervention, one chose medical, and seven chose expectant management. The women described two central dimensions: being sure they were miscarrying and being sure they chose the right treatment option. Making decisions about treatment were compelling due to potential for pregnancy viability. Conditions for being sure included relationship with their health care provider (physician or nurse midwife), severity or extent of symptoms (bleeding and cramping, absence or change in pregnancy symptoms), medical technology, personal intuition, and input and advice from others (e.g., friend who had miscarried). Conclusion/Implications for Nursing Practice Women wanted to know what to watch for (e.g., how to determine how much bleeding is too much) when they learned their miscarriage was inevitable. They were also traumatized by miscarrying in the toilet and either retrieving or flushing the products of conception. Findings support the critical role of nurses in health care of women with early pregnancy loss. Understanding symptoms, helping women know what to expect, the importance of confirmed nonviability of pregnancy, and the need for support from the womans health care team are key to evidence‐ and relationship‐based nursing care.