Qualitative Interpretive Metasynthesis of Parents’ Experiences of Perinatal Loss

ObjectiveTo identify and synthesize common, experiential themes from qualitative studies of parents who experienced perinatal loss.Data SourcesWe searched PubMed, CINAHL, and PsycINFO for qualitative articles about parents’ experiences of perinatal loss.Study SelectionWe included research on parents’ experiences of perinatal loss published in English in the last 10 years. We excluded articles on the perspectives or experiences of health care professionals or persons other than the biological parent who experienced the perinatal loss, systematic reviews, outcome studies, and gray literature.Data ExtractionWe used a priori inclusion and exclusion criteria and identified five articles in which perinatal loss was described from the parents’ perspectives. We extracted thematic findings and supporting quotes from each article and documented them in a table for subsequent synthesis.Data SynthesisWe used a qualitative metasynthesis and interpretive model to synthesize findings from the included studies. Findings were synthesized into one overarching theme, The Paradox of Perinatal Loss, and four subthemes: Complex Emotional Responses, Prenatal Bonding–Acknowledging Personhood, Interactions With Health Care Professionals, and Traversing the Social Sphere.ConclusionOur findings indicate that perinatal loss is often a transformative event during which parents experience multiple losses and intense, complex emotions. Interactions with health care professionals greatly affected the pregnancy experience, which places professionals in a unique position to positively influence parents’ overall experiences. Therefore, it is important to develop protocols related to perinatal loss and ensure that staff are adequately trained and equipped to care for parents during this experience. Findings from this synthesis may also inform the future development of theory related to bereavement surrounding perinatal loss.     

Mixed-Methods Study of the Experience of Pregnancy During the COVID-19 Pandemic

ObjectiveTo understand the experiences of women who were pregnant during the initial stage of the COVID-19 pandemic, March 2020 to May 2020, and how they coped with stress.DesignA convergent mixed-methods design.SettingOnline survey that launched in April 2020.ParticipantsA total of 185 pregnant women.MethodsFor the quantitative strand, we measured adaptation to coping with stress using the Brief Resilient Coping Scale. For the qualitative strand, we asked participants to describe the experience of being pregnant during the pandemic.ResultsThe mean score on the Brief Resilient Coping Scale was 14.7, which indicated a medium-level resilient coper. Using Krippendorff’s content analysis, we identified four themes: Robbed of Enjoying the Expected Pregnancy Experiences, Anxiety and Fear in the Face of a Pandemic Pregnancy, Heightened Source of Worry With Birth on the Horizon, and Choosing Hope.ConclusionTo meet the needs of pregnant women, perinatal nurses and other maternity care providers must understand the experience of pregnancy during times of upheaval, such as the onset of a global pandemic. Health care providers and nurses can help ensure ideal outcomes for pregnant women by recognizing the loss of the expected pregnancy experience, providing support through creative social outlets, and fostering hopeful optimism.     

Managing Ambiguity When Caring for Women Who Experience Stillbirth

ObjectiveTo examine the interactions and social processes involved when nurses care for women who experience fetal demise and subsequent stillbirth.DesignQualitative design using grounded theory.SettingSingle-site urban medical center in New York City.ParticipantsTwenty registered nurses who worked in the labor and delivery department.MethodsI collected data via in-depth interviews and recorded, transcribed, and analyzed the data using constant comparative analysis.ResultsManaging Ambiguity emerged as the overarching preliminary theory to describe how nurses cared for women who experienced stillbirth. This preliminary theory included three themes: Experiencing a Spectrum of Emotions, Managing Patient Care in an Ambiguous Context, and Managing Institutional Ambiguity. These themes provided an overview of the creative/protective and avoidant/conflicted behaviors that nurses brought to their work with women whose fetuses died in utero and were stillborn. These interactions were complicated by institutional policies and additional factors, such as workload, that often denied nurses the resources needed to engage in the patient care processes required to address the trauma experienced by women and their families.ConclusionThe preliminary theory Managing Ambiguity provided a perspective on the experiences, behaviors, and social processes involved in caring for women who experience stillbirth. The absence of preparatory education, effective protocols, and institutional support contributed to the ambiguity inherent in caring for these women.     

Scoping Review of Memory Making in Bereavement Care for Parents After the Death of a Newborn

ObjectiveTo summarize and synthesize extant literature on memory making in bereavement care for parents who experience the death of a newborn and to identify opportunities for future research.Data SourcesWe conducted a systematic search of four health-related databases (MEDLINE Complete, CINAHL Complete, Embase, and PsychINFO) for original research in January 2019. We then conducted a manual search of the reference lists of all included articles and a citation search via Scopus.Study SelectionSelection criteria initially included all original research articles available in English that related to parents’ perceptions of perinatal or neonatal palliative care or bereavement care for parents after the death of a newborn. These criteria were refined as we developed familiarity with the available literature. Our initial screening of article titles and abstracts yielded 287 articles for full-text review. After full-text analysis, we included all 25 qualitative or mixed method research articles that met selection criteria.Data ExtractionWe used a spreadsheet modeled on the Joanna Briggs Institute Review Guidelines (2015) for data extraction.Data SynthesisAvailable research was focused primarily on parents’ perceptions of care during and after the death of their newborns. Memory making interventions emerged as significant elements of the experiences of bereaved parent. Several researchers examined parents’ perceptions of specific memory making interventions, such as bereavement photography. Contact with the newborn, opportunities for caregiving, bereavement photography, and the collection or creation of mementos emerged as important elements of memory making. Parents also identified a need for guidance about each of these key strategies for memory making.ConclusionWe identified few studies focused entirely on memory making as an intervention in the context of bereavement care for parents. However, memory making emerged as a recurring theme throughout qualitative and mixed method studies on parents’ perceptions of perinatal or neonatal end-of-life care. Further research is required to provide evidence to guide memory making interventions for bereaved parents who experience the death of a newborn.     

Validity and Reliability of the Modified Attitudes About Drug Use in Pregnancy Scale

ObjectiveTo contemporize the Attitudes About Drug Abuse in Pregnancy questionnaire, keep the length of the modified scale brief to promote use, and test the psychometric properties of the modified scale among perinatal nurses.DesignCross-sectional survey.SettingFour hospitals in the Midwestern United States.ParticipantsRegistered nurses who worked in perinatal units (N = 440).MethodsWe collected data from participants using survey methods. Seven experts in perinatal substance use research and clinical care informed scale modifications. We used a split-sample design involving maternal–newborn units (labor, postpartum) and newborn-focused units (NICU, pediatrics). We evaluated construct validity using factor analysis and reliability using Cronbach’s alpha. We tested for differences between units using analysis of variance and Tukey’s post hoc honest significant difference test of pairwise differences.ResultsThe final modified scale included 13 items that loaded on one factor and showed internal consistency reliability in both samples (α = .88?.91). We found a statistically significant difference in mean score between NICU and pediatric units; however, the absolute difference was small and likely not clinically significant.ConclusionsThe Modified Attitudes About Drug Use in Pregnancy scale has initial evidence for validity and reliability, was updated to reflect current terminology in the field, and is a pragmatic tool for use in research.     

Development and Psychometric Testing of the Nurses’ Confidence Scale: Unique Families

ObjectiveTo develop and evaluate an instrument designed to measure the confidence of nurses in their ability to provide neutral, compassionate care to unique families in perinatal settings: the Nurses’ Confidence Scale: Unique Families.DesignProspective instrument development and psychometric study.SettingHealth system in the U.S. Mountain West region.ParticipantsConvenience sample of 62 perinatal/neonatal nurses.MethodsWe developed a two-part scale to measure the confidence of nurses in their ability to care for complex/nontraditional families, termed unique families. Part A was focused on nursing care behaviors for any unique family; Part B was focused on providing care to seven specific unique family populations. Five experts in perinatal nursing or adoption evaluated the scale’s content validity. To test the psychometric properties of the scale, we used item analysis, reliability analysis, and exploratory factor analysis.ResultsThe content validity index was 0.82. The Cronbach’s alpha coefficient estimate of internal consistency for Part A was .92. Principal component analysis resulted in two factors that explained 64% of the total variance: skills and resources (Cronbach’s alpha coefficient = .89) and awareness and sensitivity (Cronbach’s alpha coefficient = .87). Part B had a Cronbach’s alpha coefficient of .90. Parts A and B showed a strong positive relationship with one another (r = .77). The general self-efficacy measure was strongly and positively correlated with Part A (r = .81) and moderately and positively correlated with Part B (r = .48).ConclusionThe Nurses’ Confidence Scale: Unique Families is a new tool with which to measure the confidence of perinatal/neonatal nurses in providing sensitive, specific care to complex/nontraditional families. Results of our psychometric evaluation supported initial acceptable reliability and validity of the scale.     

Integrative Review of Parents’ Perspectives of the Nursing Role in Neonatal Family-Centered Care

ObjectivesTo identify the perceptions of mothers and fathers of newborns admitted to NICUs regarding the role of neonatal nurses in the provision of family-centered care and how neonatal nurses were able to interpret and meet parents’ needs.Data SourcesWe conducted literature searches in the CINAHL, MEDLINE, Embase, PsycINFO, Dissertations and Theses Global, and Maternity and Infant Care databases.Study SelectionArticles on qualitative and quantitative studies were selected if they were published in English from 2009 to 2018; they were set in countries with similar health care resources in Australasia, Canada, Europe, Scandinavia, the United Kingdom, and the United States; and the data were collected from parents. We identified 31 studies for analysis.Data ExtractionWe used the thematic analysis method of Braun and Clarke to extract data elements that were grouped and coded into themes and subthemes.Data SynthesisThrough ongoing iterative analysis, we generated six themes from the 18 subthemes that in combination presented the experiences of parents in the context of family-centered care provided by neonatal nurses: Process of Becoming a Parent, Neonatal Nurses Supporting Parents, Infant Safety, Communication, Barriers to Parenting, and Parenting Inhibited by Neonatal Nurses.ConclusionThe six themes reflected the contribution made by neonatal nurses to family-centered care in the NICU. The parents’ perspectives of nurses were mostly positive, but some negative aspects attributed to nurses identified in earlier studies persisted.     

Women's lived experience of compassionate midwifery: Human and professional

ObjectiveTo develop an understanding of women's lived experience of compassionate midwiferyDesignA qualitative study using the principles of Interpretive Phenomenological Analysis (IPA). Data was collected during interviews with 17 women who identified themselves as having received compassionate midwifery care.FindingsWomen participants' experience of compassionate care from midwives was experienced through a sense of a midwife Being With them, Being in Relationship with them and Empowerment. Women were also aware of the way midwives were able to Balance potentially conflicting aspects of their work, in order to provide compassionate care.Two other themes which emerged through extensive analysis of the data related to how women set their experience of compassion in the context of their personal suffering and that compassion made a difference. These themes will be reported separately.Conclusion and implications for practiceThe unique contribution of this study was to provide a window into the nature of women's lived experiences of compassionate midwifery and thus building, understanding around the qualities of compassionate midwifery and its impact on women. The findings are important because they challenge assumptions that compassion is ill-defined and therefore difficult to teach. On the contrary, compassionate midwifery was easily identified by women participants and had the features of an effective intervention for relieving their suffering. A dynamic model of Compassionate Midwifery in Balance has been proposed, providing a much-needed tool to inform practice, education and policy. Further research will build on this work by focussing on women in varied circumstances, environments and cultures and on understanding the lived experience of compassionate midwifery from the midwife's perspective.     

Personal Infant Feeding Experiences of Postpartum Nurses Affect How They Provide Breastfeeding Support

Objective

To describe the experiences of postpartum nurses when feeding their own infants and explore how these experiences influence the breastfeeding support they provide to new mothers.

Experiences of Parents Whose Newborns Undergo Hypothermia Treatment Following Perinatal Asphyxia

ObjectiveTo describe and interpret experiences of parents whose newborns are treated with induced hypothermia following perinatal asphyxia.DesignA qualitative exploratory study.SettingData collection in parental home environments (n = 8) and in a study room in a university library (n = 2).ParticipantsA total of 10 parents, seven mothers and three fathers, participated in the study. Their newborns were treated with induced hypothermia 4 to 12 months prior to the interviews.MethodsRecorded open‐ended interviews with the participants lasted from 60 to 90 minutes. Field notes were made after each interview. The interviews were transcribed verbatim and inductive content analysis was used in the analyzing process.ResultsFour main themes emerged from the data: emotional landscapes, adaptation to a new situation (with subthemes creating control, external and internal support in a difficult situation, normalizing the abnormal and reconciling oneself to uncertainty), moments of rebirth, and change in attitude toward life and existence.ConclusionTerm newborns are treated with induced hypothermia treatment due to perinatal asphyxia. During the hospitalization of newborns in neonatal intensive care units (NICUs), parents experience high levels of stress. Parents use several strategies for adapting to this situation, and nurses play a pivotal role in providing individual support and acting as advocates for parents in the NICU. After the infants are rewarmed, parents experience a moment of rebirth that might help them attach to their infants. Further research is warranted in this area to provide holistic care and support to families whose neonates undergo this treatment.