ch. 37 perinatal loss Flashcards
loss, bereavement, and grief: basic concepts and theories
1) Kubler Ross 5 stages of grief:
- denial
- anger
- bargaining
- depression
- acceptance
2) Kubler ross work was groundbreaking, but there are also limits to her model
- nurses in perinatal settings face challenges in addressing both the grief of their clients and their own distress
defining loss, bereavement, grief, and mourning
1) loss: of baby/infertility
2) bereavement: denial, can’t believe it’s happening
3) grief
4) grief as a process:
- it is a dynamic and involves complex emotions, thoughts, and behaviors that shift and change
- process that is enduring and had no time limit
- highly individualized and manifests differently from person to person
- pervasive involving psychological, social, physica, cognitive, behavioral, and affective responses and can affect every aspect of a person’s life
5) mourning
grief theories in perinatal settings
1) ambiguous loss: fetus never seen or held
- ex: miscarriage, abortion, extremely negative experience for all
2) disenfranchised grief: privately mourns, isolation
- couple won’t talk at all
- can’t tell where family is at
3) complicated grief: chronic grief & s/sx
- ex: substance abuse. difficulty moving on, insomnia
4) two established theories of grief:
(a) continuing bonds theory: bonds of attachment continue in survivor’s future
(b) dual process method: focus on behavior past & future
- what was life like with baby alive?
- build memorial (life before and after)
caring theory to guide nursing practice when pregnancy ends in loss
Swanson’s Caring Theory: 5 concepts to describing key elements in the nurse-client relationship
1) knowing: nurses assess the family & what grief means to them
2) being with: caring presence (reassure family)
3) doing for: interventions nurse provides that give comfort (massage, cry)
4) enabling: nurse offers options of care (does she want to see/hold baby)
5) maintaining belief: nurse encourages women & her family in their ability to survive their loss
- nurse becomes familiar with their strengths/coping abilities
- swaddling, dress, hat, family can unwrap
types of losses associated with pregnancy: defining perinatal loss
1) miscarriage: in utero death prior to 20 weeks of gestation
2) fetal death: any death prior to birth after 20 weeks of gestation
- early: 20-27 weeks of gestation
- late: greater than 28 weeks of gestation
- stillbirth: fetal death occurring at 20 weeks or later
3) death of live born infant:
- early neonatal death: fewer than 7 days old
- late neonatal death: occurring between 2-27 days
- infant death: death within the first year
types of losses associated with pregnancy: types of perinatal losses
1) miscarriage: babies dies in utero
2) serious fetal diagnosis: congenital anomalies
3) pregnancy termination: infertility, octomom
- TOPFA: termination of pregnancy for fetal anomalies
- first screen US: crown-rump, blood draw
- second screen US: some not found until 2nd
- MFPR: multifetal pregnancy reduction
4) other lossess
5) pernnatal care settings: nurses encounter loss
- pernatal palliative care
Miles model of parental grief responses
three overlapping phases
1) acute distress: initial denial, shock
2) intense grief:
- guilt, anger, resentment, bitterness, or irritability
- characterized by disorganization (inappropriate behavior)
- physical symptoms include fatigue, headaches, dizziness, or musculoskeletal aches and pains
3) reorganization:
- better able to function at home and work, experiences a return of self esteem and confidence, can cope with new challenges, and has placed the loss in perspective
- the term recovery is NOT appropriate because the fried related to perinatal loss, as with any loss, can continue for life
family aspects of grief
1) effective case is relationship based
- FOB insolved?
2) grandparents: complicated by emotional pain witnessing and feeling immense grief of their child
3) siblings:
- young children respond more to the reactions of parents
- school age kids
- teenagers
4) resolve through sharing resources
perinatal loss care mgmt
1) when a loss id diagnosed: helping the woman and her family in the aftermath
- simple, ambiguous, and consistent language is crucial
2) helping parents with holding their fetus or infant:
- research evidence supports the importance of parents’ seeing or holding their fetus or infant, but they should never be made to feel they “should” see or hold their baby
- parents appreciate explanations about what to expect
- when brining the baby’s body to the parents, it is important to treat the baby as one would a live baby
TIP:
say:
- what are you thinking
- how can i best support you
- everything you feel is valid
- im sorry for your loss, i can’t imagine
- i need a min to check you to make sure you’re physically okay
DONT say:
- if you need me, press your call button
- everythings gonna be okay
- this is god’s plan
- they’re in a better place
- i know what you’re going through
perinatal loss care mgmt: autopsies
helping parents with decisions regarding autopsies, organ donation, and disposition of the body:
1) autopsy
- would you like to find out/exam cause of death?
- personal, cultural, and religious views
2) organ donation
3) spiritual riturals
4) respectful disposition of the body
5) memorial of funeral service
6) do NOT rush the family into making decisions (donation medical sceince)
perinatal loss care mgmt: bereaved parents
helping the bereaved parents acknowledge and express their feelings:
1) validate the experience and feelings of the parents
2) encourage them to their stories
3) listen with care
4) offer help versus unhelpful responses
5) allot enough time to engage with them without being rushed
perinatal loss care mgmt: helping bereaved family understand differing responses to loss
1) reassure them that their responses are normal
2) prepare them for grief’s potentially lengthy process
3) educate about the grief process, including the physical, social, and emotional responses of individuals and families
4) recognize that there may be incongruent grieving in couples
perinatal loss care mgmt: meeting the physical needs of the bereaved mother in the postpartum period
1) the mother should decide if she wants to remain on the maternity unit or to move to another unit
2) physical needs are the same as those of any woman who has given birth
3) lactation issues (support bras, cabbage leaves, tylenol)
4) postpartum care instructions
perinatal loss care mgmt: assisting/creating
1) assisting:
- assisting the bereaved parents in communicating and establishing support from family members
2) creating:
- creating memorbilia for parents to take home
perinatal loss care mgmt: addressing cultural/spiritual needs of parents
1) the nurse must be sensitive to the responses and needs of parents from various cultural backgrounds and religious groups
2) the nurse needs to be aware of his/her own values and beliefs
3) culture and religious beliefs influence the customs following deathpe
