Chapter 38 - Perinatal Loss and Grief

Question 1

Perinatal loss

Answer 1

Ectopic pregnancy
Fetal death
Miscarriage
Above all early in pregnancy
Stillbirth
Death after birth - Prematurity, Congenital anomalies, Genetic defects

Question 2

Grief Responses

Answer 2

Acute distress
Intense grief - Disorganization –shock,guilt,anger
Reorganization-Why ? Returning to normal activities - Search for meaning
Bittersweet grief-grief response that occurs with reminders of the loss
Can least months to years

Question 3

grandparents

Answer 3

Complicated by emotional pain witnessing and feeling immense grief of their child

Question 4

siblings

Answer 4

Respond more to the reactions of parents

Question 5

Care Management

Answer 5

Help parents and family members actualize loss
Help parents with decision making
Help bereaved acknowledge and express feelings
Normalize grief process and facilitate positive coping

Meet physical needs of postpartum bereaved mother
Assist bereaved in communicating with, supporting, and getting support from family
Create memories for parents to take home
Communicate using caring framework
Have baby wrapped in blanket, clothes, may put on lotion, powder
Encourage parents to see/hold baby

Question 6

Case Management

Answer 6

Autopsy-can be helpful to determine the cause of death in a stillborn infant (not covered by insurance)
Cost
Clergy
Burial-< 20 weeks considered tissue
> 20 weeks burial can vary state to state
Service
Allow parents to validate the experience and feelings of the parents-encourage them to tell their story and listen
Include father

Question 7

Postpartum mother

Answer 7

May transfer to another unit for care
Regular postpartum concerns
Postpartum follow up

Question 8

Care Management (cont.)

Answer 8

Be concerned about cultural and spiritual needs of parents

Cultural meaning of children - Expressions of grief, Provide sensitive care at and after discharge

Question 9

Swanson’s framework identifies five components in a caring concept: ***

Answer 9

Knowing
           Being with
           Doing for
           Enabling
           Maintaining belief

Question 10

Special Loses

Answer 10

Loss of one in a multiple birth

Adolescent grief-family , HCW may “feel it was for the best”

Question 11

Complicated Bereavement

Answer 11

Continued yearning, guilt or anger, depression or anxiety
Parents showing signs of complicated grief should be referred to grief counseling
Responsibility of a qualified mental health professional to determine if parents are experiencing a normal, albeit intense, grief response or if they are also having a serious mental health problem such as depression

Question 12

Key Points

Answer 12

Parental and infant attachment can begin before pregnancy with many hopes and dreams for the future

Question 13

Key Points

Answer 13

Gestational age of baby influences neither severity of grief response nor bereavement process

Question 14

Key Points

Answer 14

When a baby dies, all members of a family are affected, but no two family members grieve in same way

Question 15

Key Points

Answer 15

When birth represents death, the role of the nurse is critical in caring for the woman and her family, regardless of the age of the woman or stage of gestation

Question 16

Key Points

Answer 16

Understanding the grief process is fundamental in implementing the nursing process

Question 17

Key Points

Answer 17

Assessment of each family member’s perception and experience of loss is important

Question 18

Key Points

Answer 18

Culture and religion affect a family’s response to and coping with perinatal deaths

Question 19

Key Points

Answer 19

Therapeutic communication and counseling techniques can help families identify their feelings, feel comfortable in expressing their grief, and understand their bereavement process

Question 20

Key Points

Answer 20

Follow-up after discharge can be an important component in providing care to families who have experienced a loss

Question 21

Key Points

Answer 21

Nurses need to be aware of their own feelings of grief and loss to provide a nonjudgmental environment of care and support for bereaved families