Grief Is a Process Some Call a Journey
Title: Grief Is a Process Some Call a Journey
- To identify all families within the health care system who are experiencing the loss of a pregnancy or child utilizing the electronic health record.
- To provide support, education, and resources to families from the time of identification of a potential loss through outpatient follow-up and connection to appropriate community resources.
- To provide the healthcare worker with education to enhance their awareness and practice surrounding grief and loss.
The purpose of a Perinatal/Child Loss Bereavement Program is to provide a system-wide standard of care which offers individualized, interdisciplinary, and holistic support to families experiencing the loss of a pregnancy, infant, or child.
• Proposed change:
Develop a standardized process to identify families, within the health care system, who are experiencing a perinatal or child loss, and provide support, follow-up, and/or referrals to community resources. The majority of patients with a perinatal or child loss were seen in the Emergency and Perioperative Departments. We realized this was a very large patient population that was not being provided appropriate resources as inpatients or much needed follow-up as outpatients.
• Implementation, outcomes and evaluation:
A multidisciplinary committee was constructed to develop a Perinatal/Child Loss Bereavement Program. After attending formal training, we developed processes and educated staff of the Women & Family Department, Emergency and Perioperative Departments, chaplains, counseling, and other support staff system-wide. We now also hold monthly multidisciplinary Perinatal Grand Rounds to identify patient cases that may require increased services from the program.
We had 438 staff complete education for the program. As a result of our efforts, we have received 225 referrals since the program began on September 1st, 2012. The majority of these referrals have been captured through the Emergency Departments and Perioperative Departments system-wide via the electronic health record system. Through development of a database, in conjunction with the electronic health record, we are able to track referrals and follow-up with patients and families. Prenatal families with a terminal fetal diagnosis can now present in labor with a pre-constructed collaborative care plan to help guide staff and family decisions.
The fact that the majority of the bereavement referrals have originated from the Emergency and Perioperative Departments proves that we were initially missing a large number of patients experiencing a perinatal or child loss. It validates the need for further follow-up assessment of those patients entering the health care system for short periods of time. Future goals are to continue to educate new, incoming staff, create a mainstream resource mailing process, and further collaborate with community resources.
• Implications for nursing practice:
A standardized, multidisciplinary team approach should be utilized for these bereavement situations to best support families. Nurses should receive additional training so as to be sensitive to the emotional and individualized needs that may present.
• Keywords: Perinatal, Bereavement, Loss, Emergency Department