‘In the hospital there are no care guidelines’: experiences and practices in perinatal loss in Spain

Abstract

In the hospital there are no care guidelines': experiences and practices in perinatal loss in Spain Background and objectives: Healthcare professionals play an important role in supporting and attending to families that experience a perinatal loss. Previous research has identified the existence of obstacles that professionals may encounter during their practices. The main objective of the current research was to identify and examine the subjective experiences and practices of experienced professionals attending to perinatal loss in the hospital context in Spain. Design: Qualitative descriptive design. Setting: Three different hospitals in Spain. Participants: Sixteen professionals were interviewed, including doctors, nurses, midwives, nursing assistants, a psychologist and a funeral home manager. Methods: Individual semi-structured interviews focusing on three areas were carried out: practices with the babyfoetus, practices with parents and interaction with the team. A thematic analysis was performed using the three main focuses of the semi-structured interview (deductive approach) and the codes that emerged from the data (inductive approach). Results: Regarding guideline-based care for the baby/foetus, participants made a distinction between the initial process of care for the baby and the decision-making process with parents. Where support for families was concerned, participants identified considerable variability in the practices used and lack of organisational and care guidelines, psychological support and follow-up. Finally, interactions with other team members were perceived as a source of support, although participants identified a significant lack of coordination. Conclusion: Participants reported variability of practices in care for the baby and parents, lack of continuity-of-care guidelines and the importance of support from a coordinated healthcare team.

Nurses' and midwives' perceptions and strategies to cope with perinatal death situations: A systematic literature review

“…Also, Chan et al (2005) show that many professionals consider their understanding of the bereavement situation to be merely instinctive, and in relation to this, Ravaldi et al (2018) reveal that many of their actions were based on personal beliefs and guided only by compassion; in their study, 75% of nurses/midwives had never attended a course on perinatal bereavement care (Ravaldi et al, 2018), a widespread pattern (Chan et al, 2008, 2010) that, for Jonas‐Simpson et al (2013), could be solved by providing bereavement education in nursing schools or even at work. Our results about training deficits are in line with previous research that has shown a great variability in the bereavement care offered to families, probably resulting from the absence of guidelines on care, in both NPC/PH settings (Cerratti et al, 2020; Dahò, 2021) and mixed settings (NPC‐PH/Obstetrics and Gynaecology [OAG]; Fernández‐Alcántara et al, 2020; Gruszka et al, 2019).…”

“…Notwithstanding the above, the way nurses/midwives experience their care of people suffering perinatal death situations may be different in PH or maternity units, for several important reasons. These include the following: the nature of the situation (foreseen or unforeseen) and the family's subsequent choices—for example to go forward or not with the pregnancy of a foetus affected by a medical condition that is incompatible with life (Dahò, 2020); the time available to plan the care for the women/families (André et al, 2020); the previous training of the nurses/midwives (Laing et al, 2020; Shen et al, 2022); the extent to which the organizational culture of the team and the centre is death‐oriented (André et al, 2020); and the existence of protocols to deal with this type of situation (also after hospital discharge) along with other kinds of institutional support (Camacho Avila et al, 2020; Fernández‐Alcántara et al, 2020). This review will focus on the care provided in the latter clinical setting (maternity units), including obstetric and gynaecologic settings.…”

Care and support when a baby is stillborn: A systematic review and an interpretive meta-synthesis of qualitative studies in high-income countries

“…Table 2 shows the primary key features of included articles. Of the 16 included articles, eleven dealt with the research question from a parental perspective [ 23 – 26 , 29 – 30 , 33 – 37 ], one study had a sibling perspective [ 22 ], and four studies covered the perspectives of healthcare professionals [ 27 – 30 , 31 , 32 ]. The studies included 380 parents, preferably mothers [ 23 – 26 , 29 , 30 , 33 – 37 ], thirteen siblings aged 13 to 17 years [ 22 ], and 51 healthcare workers of various professions [ 27 – 32 ], which added to a total of 421 participants.…”

“…Of the 16 included articles, eleven dealt with the research question from a parental perspective [ 23 – 26 , 29 – 30 , 33 – 37 ], one study had a sibling perspective [ 22 ], and four studies covered the perspectives of healthcare professionals [ 27 – 30 , 31 , 32 ]. The studies included 380 parents, preferably mothers [ 23 – 26 , 29 , 30 , 33 – 37 ], thirteen siblings aged 13 to 17 years [ 22 ], and 51 healthcare workers of various professions [ 27 – 32 ], which added to a total of 421 participants. The studies used varying qualitative analysis methods such as qualitative content analysis [ 22 , 23 , 26 , 29 , 30 , 35 , 37 ], phenomenology [ 24 , 31 – 34 , 37 ], Grounded Theory [ 25 ], and qualitative analysis according to Parse [ 28 ] and thematic analysis [ 27 ].…”

Unravelling the grief of involuntary pregnancy loss: A meta‐ethnography of midwives’ and nurses’ emotional experiences

“…Caring for parents following an involuntary pregnancy loss involved dealing with an unsupportive organisational environment, lack of preparation or knowledge and an emotionally demanding care [5,6,46]. Still, some midwives and nurses find reasons to care for and meet the suffering of these parents.…”