The Meaning, Experiences, and Behaviors of Nurses Caring for Women with a Perinatal Loss

Objective:  The specific aim of this study is to explore the caring experiences of obstetric, post-anesthesia, and emergency nurses in caring for women after a fetal death.   Nurses who are indirectly exposed to trauma through their work are at high risk of developing compassion fatigue.   There is limited research to identify whether nurses in obstetrics, emergency departments, and post-anesthesia units who provide care to women who have experienced fetal death are at increased risk of developing compassion fatigue.  Thus, there is a gap in knowledge regarding 1) the post-loss experiences of nurses after caring for a woman with a fetal death.

Design: Qualitative study using focus group (FG) interviewing

Setting: 2 large acute care hospitals with level 3 nurseries

Sample: Four FGs were conducted involving 24 total participants. Participants were registered nurses currently working in labor and delivery, antepartum, post-anesthesia, and emergency departments who had experience with caring for a patient who has had a fetal loss and had been employed at least one year.

Methods: The FG questions were carefully constructed based on the major concepts of Swanson’s Theory of Caring, open-ended, clear, appropriately sequenced, and supportive of the group process and response maximization.  Participants also completed a brief demographic questionnaire.  Interviews were audiotape recorded, transcribed verbatim, and de-identified.  Transcripts were then uploaded into the software program “Dedoose” for coding by research team members.  Analysis was conducted using a continuously emergent process of data collection, data reduction, data display, and interpretation of data. Team members coded the transcripts which were then compared for agreement. Any discrepancies in coding and theme identification were resolved through discussion and group consensus.

Results:  Nurses in all areas of specialty demonstrated Swanson’s nurse caring behaviors, but used them preferentially according to situational exigencies and level of rapport developed with the patient.  Themes that emerged from the data included Strategies for Coping in the Moment; Making Meaning of the Experience; Situations That Make Care Easier; Situations that Make Care More Difficult; and Priority of Care.Symptoms of compassion fatigue described by nurses included anger, intense sorrow, feeling incompetent, overwhelmed, exhausted, inconsolable, and having a desire to avoid patient care.

Conclusion/Implications for nursing practice: Nurses try very hard to give the best care they can to women after fetal loss.  In doing so, they make themselves vulnerable to compassion fatigue.  Further research is needed to identify ways to support nurses as they provide care to these traumatized patients.

Keywords:  compassion fatigue, secondary traumatic stress, obstetrics, emergency, operating room and recovery room nurses