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Perinatal

Bereavement

Perinatal BereavementContinuing Education Requirements:

In order to receive continuing education:

• You must attend the entire program. No partial credit can be awarded.

• You must complete an evaluation (it will be emailed to you). It must be completed within 7 business

days after the program date or you will receive an incomplete. Credit cannot be awarded once the

program is closed in 30 days.

• A link to access your certificate will be automatically generated and emailed to you within 24 hours of

completing all requirements. Go to our website: www.methodistcollege.edu/pd, then click “Account

Login” on the top right side of the page. Log in to your account, then click “Certificates.”

• If you have any questions or need assistance, please contact Professional Development at Nebraska

Methodist College at 402-354-7100 or pd@methodistcollege.edu

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www.facebook.com/NMCCenterforProfessionalandContinuingEducation

Tweet us! @nmcProfDev

Did you know we offer CPR, ACLS & PALS classes?

Night, weekend and non-healthcare provider CPR classes are offered, too!

“All content provided herein is for educational, informational and guidance purposes only. It is not intended to serve as a substitute for individualized professional medical advice, diagnosis, or treatment. Nothing contained herein establishes or shall be used to establish a standard of care.”

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Housekeeping

• Any questions on how to access CEUs?

• Bathroom locations

• Please turnoff cellphones or turn them to vibrate

• “Parking Lot”

• Lecture and Interactive

• Explanation of the manuals

• Guest speakers

• Full day

Special Thanks To:

Valerie Anderson, DNP, APRN, FNP-C

Rachel Montagne , MSN, RNC-MNN,C-EFM,CLC

OBJECTIVES

1. Identify participants comfort

level in caring for patients and

or families experiencing

perinatal loss or the loss of a

newborn

2. Identify the classifications of

perinatal loss

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Introductions

• Break into small group of 3- 5 people

Designate one person in the group to be the recorder

Designate one person in the group to be the spoke’s person

Within your small group answer the following questions and record:

• The cumulative number of years of experience

• Various professions and places of employment

• On a scale from 1 (very uncomfortable) to 10 (very comfortable) rate your group’s comfort level in dealing with patients and families experiencing perinatal loss

• What is one thing your group would like to learn or “get” from attending this program?

http://www.pinterest.com/pin/291819250828138789/

Classifications of Perinatal Loss

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Miscarriage

• Is the lay term for spontaneous abortion

• Prior to 20 weeks gestation – Incidence is 15% to 20% of clinically

recognized pregnancies – Risk

• 12% in women < 20yrs • Approximately 26% in women >40yrs

• Threatened abortion – Unexplained bleeding or cramping

• Imminent abortion – Bleeding and cramping increases and the

cervix is dilated

Davidson, (2016) pg. 373-374

– Incomplete abortion

• Products of conception are retained and the cervix is dilated

– Complete abortion

• All products of conception are expelled . Uterus is contracted and the cervix is now closed

– Missed abortion

• Fetus dies in utero but is not expelled

• Molar pregnancy – Condition in which a rapid growth

of trophoblastic cells result in a placenta characterized by hydropic (fluid filled) clusters

– Embryo dies in utero however, the placenta continues to grow

– Remote chance of developing choriocarcinoma

• Blighted ovum• Gestational sac is seen but the

embryo has not developed

Davidson, (2016) pg. 378

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• Recurrent pregnancy loss formerly termed “habitual” abortion – Occurs consecutively in at least three

pregnancies or more • Septic abortion

– Presence of infection • Prolonged rupture of membranes • IUD pregnancy [Intrauterine demise]

• Ectopic pregnancy – Implantation of the fertilized ovum in a

site other than the endometrial lining of the uterus

Davidson, (2016) pg. 374

Stillbirth

• Fetal death

– Early – prior to 20 weeks gestation

– Intermediate 20-27 weeks gestation – rates are unchanged

– Late – after 28 weeks gestation-rate has declined

• Reporting differs from state to state

– Some states have weight requirement – 350 gms to 500 gms

– Some states have gestational age requirements

– Some states have both weight and gestational age requirements

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Nebraska

Iowa

Neonatal Death

• Death of a newborn within the first 28 days of life

Davidson, (2016) pg. 15

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“Grief is not about answers; but learning to live with the questions”.

Brooke Noel

Exploring Grief and Loss

“To Live in the Hearts we leave behind is not to Die”

Thomas Campbell

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“People don't care how much you

know until they know how much

you care”

John C. Maxwell

Care of the Caregiver

Nurses Grieve Too

Discussion

• What did you think of the film?

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Nurse’s Perspective on Caring for

Women Experiencing Perinatal Loss

• Small study qualitative study (9)• Major Theme

•Nurses need support and debriefing

(2019) American Journal of Maternal Child Nursing, 44(1), 46-51

Companioning

As a care giver you are not responsible

for making the patient better or for fixing

them. Your job is to be a partner or

companioning with them during the

process of grief

Heustis and Jenkins (2005)

Companioning You!

Alan D. Wolfelt, PH.D.

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Some Nurses May Be At A Disadvantage

• Experiences of Nurses Who care for Women After Fetal Loss

• Huttei (2016) JOGNN

– Emergency and Operating room nurses primary focus is saving the patient’s life and making the patient more comfortable

– This staff reported less training and mentoring

– Lacked the opportunity to see the families with subsequent healthy neonates

– Had the most difficulty when the fetus resembled a baby

Our Job Can Be Difficult……..

•Because we are compassionate,

there may be times in which our

attempts to assist others are not

beneficial to ourselves.

•We may become a rescuer rather

than a helper………..

Helper or the Rescuer Which One Are You?

• There is a checklist in your handout which may assist you to identify whether you tend to employ “rescuer” or “helper” activities

• When completing this checklist, please be as honest as possible when completing the statements as they applies to you.

• Note the X refers to significant others in your life such as partner, boss, friend or colleague

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Your Score and What it Means

• A score of more than 10 points = rescuing is possible

• A score of more than 20 points = rescuing is probable

Helper or the Rescuer Which One Are You?

Let’s Hypothesize your answers reveal you have a tendency toward being a Rescuer

– Gives when not asked

– Neglects to find out if offer is welcome

– Gives help more and longer than needed

– Omits feedback

– Doesn’t check results and feels good when accepted, bad when turned down

– Does the majority of talking

Used with permission:

Ryan, R.S., & Travis, J.W. (1998). Wellness Handbook. (2nd ed.). Berkley, CA: Ten

Speed Press

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We Should All Strive to Be A Helper

The Helper

– Listens for Request

– Presents an offer

– Gives only what is needed

– Checks periodically with person

– Checks results:

• Functioning better?

• Meeting goals?

• Solving problems independently?

• Using suggestions successfully?

– Talks less and listens more

Compassion Fatigue Versus Burnout

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Be Aware of Compassion Fatigue

What is it?

What it is not?

Compassion Fatigue

• Compassion Fatigue

– Continuous or cumulative exposure to stress or emotional burdens

– Response to the people who are suffering rather than the work situation

– Not a character flaw

– Encompasses emotional, physical, social and spiritual exhaustion

Compassion Fatigue

– Health care professionals

• Nurses, chaplains, social workers……. The list goes on

– Continue to give but can’t maintain a healthy balance between empathy and objectivity

– Results from giving high levels of compassion over an extended period of time

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Burnout

– Sense of frustration and tiredness and is associated more with the work environment versus a particular person

– Stages of Burnout

• Enthusiasm

• Stagnation

• Frustration

• Apathetic

Burnout

– Anyone who works in a difficult environment

– Adapt to exhaustion and become less empathetic and more withdrawn

– Response to work situation

– Results from being busy

– Evolves gradually

Do I Suffer From Compassion Fatigue or Caring Too Much ?

• Feeling tired before you start your workday

• Lack of enjoyment during leisure activities

• Overeating, overdrinking, overspending…

• Excessive blaming

• Minimize or deny your feelings

• Chronic physical ailments:

– Back pain

– Stomach upsets

– Overuse of sick days

• Excessive complaints about your job, peers or assignments

• Feel your own personal relationships are deteriorating

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Ways Some People Use to Cope with Stress

• Please take a moment to look inside the boxes at your table…….

How Do I Combat Compassion Fatigue or Caring too Much???

Personal Awareness is the

KEY!

Compassion Fatigue within the Areas of Loss .……Self Awareness

Three questions you need to ask yourself”

1. Your background related to death and life

losses

2. Your current personal issues surrounding

grief and loss

3. Your motivations as a caregiver

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Strategies You Can Use

Take Care of You First!

Try to Maintain Balance

What Are the Self-Care Activities You Engage In?• Take 5 minutes to list:

– What positive self-care activities you employ

– How often do you make time for yourself, minutes, hours, once a week or once a day etc…………

– At least one positive self-care activity you are committed to do today.

• Start small. Make a promise to yourself that you can keep without breaking. Then gradually expand your time on this activity or the frequency of it.

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Suggestions

Create a Stress-Buster Box

Collect the following to make a fun,

portable stress-buster box

- A picture of a person or place that brings a

smile to your face

- A piece of candy or favorite non-perishable

snack

- A gem stone, a rosary, a piece of soft silky

material

- Your favorite scent or essential oil

- A CD with your favorite music

Evaluate your need for Perfection

I tend to lose patience with people if they

aren’t quick learners

I have a reputation as being someone

who is difficult to please

I tend to want to do things exactly right

every time I do something

I get upset with myself when I don’t do

something well

I tend to think I only have one opportunity

to do things right, so I better not mess up

I get frustrated when I play games and

don’t perform well

Cures for Perfectionism

Strive for imperfection

Take the pressure off yourself – do

something or play a game but allow

yourself to relax, laugh and plan to

lose

Allow yourself to make mistakes

An occasional mistake makes you

human

Remind yourself of your successes,

not your mistakes

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Other Suggestions….. • Take your allotted breaks• Talk to friends and peers and family and

listen to their suggestions • Accept Help!!!!!!• Transition from work to home

– Change clothes or go for a short walk when you get home

• Assess your trauma input • Take care of your physical health

– Get enough sleep– Make healthy food choices– Exercise outside of work on a regular basis

• Learn to set boundaries – Avoid the “Disease to Please”! – Avoid the Debbie Downers!!!

Suggestions • Recognize your limitations

• Recharge and take Charge!

– Make a list of all the things you like to do and place them on your calendar

– Stimulate your brain

• You have a specialty; learn about one new disease/treatment or intervention in that specialty to wake up the cognitive part of your brain and give the emotional centers of your brain a rest!

April 23rd

“ I don’t want to get to the end of my life and find that I have lived just the length of

it. I want to have lived the width of it as well”. Diane Ackerman

You’ve got 24 hours until you turn the next page in your life . Live the width of

them.”

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“Rest and self-care are so important. When you take time to replenish your spirit, it allows

you to serve others from the overflow. You cannot serve from

an empty vessel.” ― Eleanor Brownn

Pastoral Care Representative from Heafey- Heafey-Hoffmann-

Dworak & Cutler Mortuaries and Crematory

INTERDISCIPLINARY TEAM

“Each new life, no matter how brief, forever changes the world.”

Anonymous

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• Lunch is on your own

• Please remember to take your purses

and valuables with you

• Feel free to bring any snacks or drink

items with you for the afternoon

session

Resources and protocols/guidelines

“It is so curious; One can resist tears and behave very well in the hardest hours of grief. But then someone makes you a friendly sign behind a window, or one notices that a flower that was in bud only yesterday has suddenly blossomed, or a letter slips from a drawer… and everything collapses”

Colette

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Parent Panel

“No one can know how much I love you, because you are the only one who knows what my heart sounds like from the inside.”

Anonymous

Parent Panel Debriefing

• What was it like hearing about these experiences

• What was the most satisfying aspect of listening to the parent panel

• Was there anything you found distressing in listening to the parent panel

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Parent Panel Debriefing

• Strategies for Coping

– What strategies will you use to cope with your experience today?

Suggestion……..Participation is encouraged but not mandatory

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Thank You

•For Listening to Our Stories

•For Sharing Your Stories

•Continuing to Care for the Parents

and Families Experiencing

Perinatal Loss