Supporting bereaved parents: practical steps in providing compassionate perinatal and neonatal end-of-life care. A North American perspective

Division of Neonatology, Hospital for Sick Children, University of Toronto, Canada.
Seminars in Fetal and Neonatal Medicine (Impact Factor: 3.03). 06/2008; 13(5):335-40. DOI: 10.1016/j.siny.2008.03.005
Source: PubMed


Providing compassionate bereavement support challenges care-givers in perinatal medicine. A practical and consistent approach tailored to individual families may increase the care-giver's ability to relieve parental grief. This approach includes: (1) clear and consistent communication compassionately delivered; (2) shared decision-making; (3) physical and emotional support; and (4) follow-up medical, psychological and social care. Challenges to providing comprehensive end-of-life care include care-giver comfort, consistency of care, cultural and legal barriers, and lack of adequate training.

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    • "During the past decade, much has been written about how pediatric clinicians can share difficult information with families [1] [2] [3] [4] [6] [7] [8] [9] [10] [11] [12] [13] [14] . Feedback from families has further improved how healthcare providers communicate [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] . "
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    ABSTRACT: Objective: In this study, we explored the providers' perspective of difficult conversations in neonatal critical care. Methods: Between 2008 and 2011, interprofessional neonatal providers voluntarily attended the Program to Enhance Relational and Communication Skills-NICU workshops at Boston Children's Hospital. We analyzed seventy-four participant narratives that described a difficult conversation in the NICU that was particularly challenging or satisfying. Results: Participants described memorable conversations that were exclusively challenging (n = 51), both challenging and satisfying (n = 22), and exclusively satisfying (n = 1). We identified five broad domains (Infant's Clinical Situation, Family Characteristics, Provider Characteristics, the Provider-Family Relationship, and Satisfying Elements) and several themes that further characterized the providers' perspectives. Conclusion: Understanding the practitioners' experience with difficult conversations may help staff to anticipate some challenges inherent in neonatal discussions and to design communication and relational learning educational efforts.
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    • "A perinatal hospice team, for example, may facilitate the development and execution of a birth plan that outlines the mode and site of delivery, delivery room management, and after-birth care of the mother and infant (D'Almeida et al, 2006). A team may also coordinate and provide care after the delivery, especially if the infant goes home, as well as bereavement services later for the parents and family (Williams et al, 2008). Nurses have a unique role in providing perinatal hospice care (Davies et al, 2005). "
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    ABSTRACT: Background: Hospice nurses have a unique role in providing perinatal care, yet little is known about the work environment in which nurses provide care for families and infants at the end of life. Objective: To compare the nurse work environment between perinatal and non-perinatal hospices. Methods: Data from the 2007 US National Home and Hospice Care Survey was used. The sample included 526 US hospice agencies. Comparisons were calculated using the Pearson chi-square and Wald tests. Results: A majority of hospices provided perinatal care (60%). Compared with non-perinatal hospices, the perinatal nurse work environment had a significantly higher proportion of registered nurses (mean 0.87 vs mean 0.79), along with clinical nurse specialists and nurse practitioners to support them (95.6% vs 84.9%). Nurses within perinatal care providers worked in a climate of significantly greater safety (95.6% vs 84.9%) and technology (63.7% vs 47.1%). Conclusions: Understanding the unique perinatal hospice nurse work environment may be essential for advancing knowledge and compassion for mothers and babies at the end of life.
    International journal of palliative nursing 11/2013; 19(11):535-540. DOI:10.12968/ijpn.2013.19.11.535
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    ABSTRACT: Perinatal loss can be emotionally devastating for couples who experience miscarriage, fetal or neonatal death. Nurses in a variety of settings can assist couples through their grief by providing emotional support, giving information about the grief process, and in planning for a future pregnancy or deciding to forego future childbearing. This article explicates the relationship between grief and perinatal loss and its effects on couples, specifically in the interconception period, when the initial grief and distress have begun to subside. Interconception care focuses on bridging the couple from the end of the postpartum period to the subsequent pregnancy or decision not to conceive again. Nurses assist couples in distinguishing between uncomplicated grief, complicated grief, and depression, and make appropriate referrals. Openness to expressions of grief, helping couples mobilize support, considering readiness for another pregnancy, and directing couples to useful Internet sites are essential nursing interventions.
    The Journal of perinatal & neonatal nursing 01/2011; 25(1):44-51. DOI:10.1097/JPN.0b013e3182071a08 · 1.10 Impact Factor
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