Re: Perinatal death guidelines
From: RobinRn@medispecialty.com
Sat, 19 Jul 2003 15:37:27 -0500 (CDT)
At Wed, 4 Jun 2003, evec@mn.rr.com wrote:
>
>Never allow medical students anywhere near the patient. Specifically,
>do not change the patient's gown in front of 16 medical students. What
>is to be gained by watching a sobbing naked woman? Humiliation of a
>grieving and traumatized patient! Not only must the patient deal with
>the grief of her loss, she also must deal with her RAGE towards the
>students and you. She will never forget the violation, nor forgive it,
>never!
>
>Protection and respect of the patient's dignity, rights and privacy will
>be some the best care you could provide.
>
>Also, if after say 24 hours since administering pitocin for labor and
>deivery, and the delivery is not occurring and the patient has thrown
>the resident out of the room and has demanded a real doctor to access
>the situation because she has begun to fear for her life, it'd be real
>nice if the real doctor actually came in to access the patient instead
>of walking away because he doesn't want to be bothered with a patient
>for whom he only receives twenty cents on the dollar.
>
>It'd also be real nice if the patient doesn't have to deliver her own
>infant, because the real doctor couldn't be bothered with a patient for
>whom he only receives twenty cents on the dollar.
>
>A longer time is needed for the mother to have the opportunity to hold
>her infant. Maybe six hours. The mother may be too traumatized to be
>able to deal with the sadness of seeing and holding her infant
>immediately after delivery. She might avoid holding or seeing the
>infant because she thinks that it would be too much for her husband to
>bear seeing his wife any more upset than she already is. But once he
>leaves, she may need to hold her infant and grieve in privacy. What's
>the rush with wisking the infant away so soon? I'll bet those pesky med
>students are just chomping at the bit to get their hands on that infant!
>
>The study you mention is probably flawed. Patients come in all shapes
>and sizes. Their grieving process, likewise, will vary tremendously.
>There is no easy or predictable protocol that fits all. No study could
>possibly equate a measurement for grief. Perhaps those interventions
>are just accelerating the grieving process and therefore it may seem
>that the patients and families are experiencing more grief initially.
>Perhaps twelve years later they are better off as a result of these
>interventions.
>
>At Wed, 23 Oct 2002, briana.tiemann@und.nodak.edu wrote:
>>
>>Hi, my name is Briana Tiemann. I am a junior nursing student from the University of North Dakota and am currently in my OB rotation of clinicals. Although OB seems like such a “happy” place to work, sad situations like perinatal deaths do occur. Perinatal deaths include losses due to miscarriages, stillbirths or neonatal deaths (Robinson, Baker, & Nackerud, 1999). When a perinatal death occurs we are taught several interventions to help facilitate the grief process for the parents. These include reducing the trauma of hospitalization by allowing the parents time alone with their infant and allowing the mother to recover on a unit besides the post-partum unit, validating the loss by allowing families to hold and name their baby, and pictures and momentos (footprints or a lock of hair), making the loss more real with rituals and remembrances and teaching and referring parents to support groups (Robinson, Baker, & Nackerud, 1999). While we may think these interventions are
>> helpful and beneficial to the recovering parents, a recent study has shown the opposite. Hughes, Hopper and Evans (2002) found that women who saw and held their deceased infant had a higher rate of depression and anxiety in the third trimester of subsequent pregnancies than women who did not see or hold their deceased infant. Depression occurred in 39% of women who saw and held their infant, in 21% who only saw their infant and in 6% who neither saw nor held their infant (Hughes, Hopper, & Evans, 2002). In the women that held the infant, having a funeral made no difference in the outcome. All but one of the women that held her infant kept a momento, this woman had a “good outcome”, but Hughes, Hopper and Evans state no conclusions could be made in this woman’s case (2002).
>> Another study I found stated that despite implications of protocols for caring for families experiencing perinatal deaths, patients still report hurtful comments by nurses (DiMarco, Renker, Medas, Bertosa, & Goranitis, 2002). This study examined the effects of an educational bereavement program on health care professionals’ perceptions of perinatal loss (DiMarco, et al. 2002). The study found that the health care professionals' perceptions of the emotional needs of the families experiencing a perinatal loss greatly increased after attending and educational program. The largest change in scores occurred in the miscarriage vignette (DiMarco, et al. 2002).
>> What are the policies and procedures in your hospital when caring for families that have experienced a perinatal loss? What have you found in practice is helpful for families going through the bereavement process? What, if any, educational programs are available to help educate nurses on how to care for parents experiencing a perinatal loss? Any information would be greatly helpful and appreciated.
>>Thank you,
>>Briana Tiemann, SN
>>References
>>DiMarco, M., Renker, P., Medas, J., Bertosa, H., & Goranitis, J.L. (2002). Effects of and educational bereavement program on health care professionals’ perceptions of perinatal loss. The Journal of Continuing Education in Nursing 33(4), 180-188.
>>Hughes, P., Hopper, T.E., & Evans, C.D.H. (2002). Assessment of guidelines for good practice in psychosocial care of mother after stillbirth: A cohert study. The Lancet 360(9327), 114-123.
>>Robinson, M., Baker, L., & Nackerud, L. (1999). The relationship of attachment theory and perinatal loss. Death Studies 23(3), 257-270.
ok. I am a labor and delivery nurse, and at the hospital i am employed,
we have a program or list that we follow made up from a group of parents
who have experienced such losse, not unlike thousands of hospiatls
throughout the US.. This has tremendously helped our patients begin the
stages of grief. Nurses are not miracle workers, even though we would
like to be.We don't always have the answers or even know the right
things to say, we just do our best. I, not unlike lots of nurses, think
about the way I care for patients, what I say, and procedures I do, when
I wake up in the middle of the night, or even months later those
patients enter my mind. Labor and delivery-- whether a happy or sad
occasion is a TEAM effort. Not just the nurses.
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