Many Voices to Mend a Broken Heart

Purpose:

Perinatal bereavement care requires collaboration across multiple disciplines, services and care settings. A perinatal bereavement program, initiated as a “grassroots” effort by two perinatal nurses, evolved into a multidisplinary, hospital-wide team effort to assure compassionate bereavement support for families in any care setting within this 750 bed, Level I trauma center. The team includes perinatal, emergency, and trauma care providers, social workers, case managers, chaplains, and family members, as well as, staff from support services such as dietary and the laundry.

Program Description and Outcomes:

Three staff nurses, after attending a “Resolve through Sharing” workshop, initiated comprehensive training for over 300 colleagues. The bereavement program developed was based on the “Resolve through Sharing” model and includes ongoing sensitivity training for care providers and ancillary staff, education resource materials to assist caregivers in all areas, a “yellow rose” alert system, and facilitation of family bereavement throughout hospitalization and after discharge. Sensitivity training and education resource materials address cultural diversity, alternative family systems, surrogacy and adoption families, and awareness of family bereavement support needs. The yellow rose alert system communicates perinatal loss to all staff and helps to assure compassionate care for patients and families who have suffered a perinatal loss. Support in the immediate bereavement period includes providing private areas for families to grieve, facilitating bonding between the parents and infant, chaplaincy and social services support to meet the spiritual and emotional needs of family members, dressing and positioning of the infant for family viewing and memory photographs, and presentation of infant memory records and bags, hand-sewn by hospital staff, to parents. Nurses guide parents through decision-making by offering options. Bereavement care is planned to meet the culturally diverse needs of both traditional and non-traditional families. Perinatal caregivers created and publish a booklet for parents entitled “As You Begin to Heal,” which provides information about the process of grieving for all family members, suggestions for how families and friends can offer support, ideas for creating memories and commemorating special days, and community resources to support parents and siblings. Post hospitalization care also includes follow-up phone calls and cards to families, contact with primary care providers, referrals for support group services, and an annual Day of Remembrance ceremony.

Relevance

This collaborative bereavement program has significantly improved the quality of perinatal bereavement support provided throughout the organization. Support has extended into the community with plans to strengthen communications with primary care providers and family support groups. Future directions will be guided by ongoing advisement from former patients and families, who are now represented on the bereavement team.

Implications for practice, education, and research

Perinatal nurses play a critical role in fostering collaborative practice and promoting caregiver sensitivity education, two components which are essential for optimal perinatal bereavement support. Potential research opportunities related to this program that are being explored include: Born Alive:  Preparing parents for end of life care in the delivery room and Emergency room nurses beliefs about bereavement support for first trimester losses.____________________________________________________________________.