Journals, Articles & Research is our new feature for PLIDA members. We will highlight research and scholarly articles on perinatal loss that we feel are particularly noteworthy. These have been vetted by the members of the Education committee, and a brief introduction will accompany the citation for each.
Copyright laws prevent us from posting the actual publication here, but you are encouraged to access them on your own. These guidelines fill a previously unmet need for Emergency Department care and are noteworthy contributions for all caregivers.
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Abstract: Compassionate clinical practice guidelines for healthcare providers for respectful disposition after miscarriage are presented. When woven into the whole of a clinician’s 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?”
Book of the Year Awards 2018 by American Journal of Nursing –
This authoritative publication delivers an in-depth examination of Guided Participation (GP), a dynamic process of teaching and learning that helps others become competent by providing expertise through working alongside the learner. For the nurse specifically, this means educating and working alongside parents and children within an environment that supports health. Consistent with client- and family-centered practice, this fresh approach to nurse/client teaching is drawn from a broad span of disciplines, including education, social and cultural anthropology, relationship-based attachment-caregiving theory, and developmental science.
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It is estimated that 750,000 to 1,000,000 miscarriages occur every year in the United States. Women experiencing a miscarriage enter the healthcare system in a variety of ways. A family may be seen for a miscarriage in the prenatal clinic, the emergency department, same-day surgical department, or perhaps the labor and birth unit. Nurses must be prepared to guide and support these families. Understanding the clinical aspects of miscarriageas well as the emotional care of families experiencing early pregnancy loss is important to nurses in all areas of the medical center. Clinical aspects of miscarriage are reviewed along with the needed emotional care for families experiencing the most common cause of early pregnancy loss.
Merrigan, Joyce, L., DNP, BSN, CPLC, CBC, RNC-OB
Miscarriage is the unwanted ending of a pregnancy before 20 weeks gestation. Women experiencing miscarriagerequire specialized care from nurses and other healthcare professionals. Many women are dissatisfied with emergency care related to miscarriage and desire honest communication, validation of urgency, and more robust information at discharge. Perinatal bereavement education offers an opportunity for emergency department nurses to acquire specific knowledge and communication skills that assist with understanding the individualized experience of early pregnancy loss. For many women, a miscarriage is devastating, whereas for some, a part of life. Therefore, assessing the meaning of miscarriage is an essential step to providing sensitive, supportive care. Education was offered to emergency department nurses based on a 4-hour Resolve Through Sharing®curriculum. Education focused on knowledge of policy and practice, medical aspects of pregnancy loss, information on how to assess the meaning of the miscarriage, respectful handling and disposition of the remains, and communication strategies to initiate and sustain a meaningful relationship with the woman and her family, within the barriers to care that are exclusive to the emergency department. Participants embraced the information and actively participated in dialogue of an evaluation process to identify needed revisions in current policies and practices for caring for this patient population. Recommendations and guidance for emergency room nurses who care for women experiencing miscarriage are offered.
Krosch, D. J., & Shakespeare-Finch, J. (2017). Grief, traumatic stress, and posttraumatic growth in women who have experienced pregnancy loss. Psychological Trauma: Theory, Research, Practice, and Policy, 9(4), 425-433. http://dx.doi.org/10.1037/tra0000183
The psychosocial literature on pregnancy loss has largely focused on negative experiences ranging from adjustment issues to more severe clinical issues including depression, anxiety and posttraumatic stress disorder. This largely reflects psychology’s dominant trend over the last century to focus on psychopathology especially when focusing on issues of trauma.
This article focuses on posttraumatic growth and is the first to look at it in the context of a pregnancy loss. This is important on many levels as it leads to more avenues for clinicians to explore with their patients and can help reduce some of the silence and stigma around pregnancy loss. This article explored how women reach posttraumatic growth by looking at the processes that predict such growth. This will allow clinicians to assess their patients and assess their readiness to engage in this kind of work. With the research to support its unique applicability to a pregnancy loss population there is now a new vista in therapeutic work for this vulnerable and under-supported population.
Catlin, A. (2018). Interdisciplinary guidelines for care of women presenting to the emergency department with pregnancy loss, MCN: The American Journal of Maternal-Child Nursing, 43(1), 13-18. DOI:10.1097/NMC.0000000000000399
This article is reprinted, with permission, by the National Perinatal Association, 2017.
Health care for women experiencing miscarriage has received far less attention than care for women with later perinatal losses. This may be true because these losses often occur away from our institutions, clinics or private practices. However, Catlin (2018) points out that “well over half of all pregnancy losses take place in the Emergency Department (p 17) and the majority of losses occur in the early weeks of pregnancy.
The guidelines are presented as best practice, physical, emotional, cultural, and spiritual,.for families with losses at any stage. Noteworthy is the recognition that with perinatal loss 1) the personal meaning of this pregnancy and its end is unique for each woman, and 2) it is an “emotional emergency” even if not a life-threatening one and should be treated as such.
These guidelines fill a previously unmet need for Emergency Department care. A noteworthy contribution for all caregivers.
The Research & Resources sub-committee members include:
Denise Côté-Arsenault, PhD, RN, CPLC, FNAP, FAAN
Professor of Nursing (co-chair PLIDA Education Committee)
Moshe Winograd, PhD
Summer Hepler, RN, BSN
Labor & Delivery Staff Nurse; Bereavement Nurse