Table 4 Staff thematic sentences
Staff thematic sentence | FES | Sample quotes from extracted findings |
|---|---|---|
1. There are challenges that may prevent staff from providing effective bereavement care; Emotion, Knowledge and System based | 100 % | "Midwives found it challenging and ‘emotionally draining’ to deal with their own ‘shock’ and ‘confusion’ at having to provide perinatal loss care…at times they felt ‘uncomfortable’ providing perinatal loss care. Providing perinatal loss care had the potential to become ‘all consuming and exhausting’" (Fenwick 2007) [20] |
"Feelings of inadequacy" (Fenwick 2007) [20] | ||
"There was ample time to talk with these women but many staff still avoided them, with the excuse that there was ‘no time’" (Begley 2003) [67] | ||
"Postpartum support was perceived as the hardest situation" (Rivaldi 2010) [75] | ||
"Some nurses tried to distance themselves in order to provide care" (Puia 2013) [74] | ||
"Nurses expressed the sentiment of holding it together until later" (Puia 2013) [74] | ||
"Shaken to the core; physically the nurses reported feeling stressed, muscle tension, headache, and pressure. Other nurses described difficulties eating and sleeping. Other nurses had consuming thoughts while awake" (Puia 2013) [74] | ||
"Never forget; holding onto grief. The nurses all noted that they could still vividly remember the fetal deaths (Puia 2013) [74] | ||
"Admitted to fear of further upsetting grief stricken parents" (Downe 2012) [70] | ||
"A number of students expressed the view that they did not receive enough education on this topic before being faced with a situation on the wards. Because the students didn’t feel confident in this area the students often tried to avoid women who had lost babies" (Begley 2003) [67] | ||
"The physicians in the focus groups would not routinely offer an autopsy to the parents, but would conduct one if requested" (Kelley 2012) [37] | ||
"Stillbirth has become a protocol driven tick box exercise" (Curtis 2000) [69] | ||
2. Staff want improved training and a supportive working environment | 57 % | "None of the students sourced professional support readily available to them through their university" (McKenna 2011) [19] |
"Clinicians discussed the importance of improving education on the data surrounding the prevalence of stillbirth and causes" (Kelley 2012) [37] | ||
"General agreement that targeted training and support were required to ensure the essential processes are effectively undertaken, and that empathetic attitudes are developed" (Downe 2012) [70] | ||
"There was evidence of positive innovation and good practice" (Downe 2012) [70] | ||
3. Emotional support and acknowledging the birth and death of a baby is an important part of bereavement care | 43 % | "Role recognition – midwives describe a generalized role in bereavement support with a consensus that ‘being there’ may be more important than doing" (Nallen 2006) [73] |
"Several of the physicians were less inclined to encourage mothers or parents to talk about their feelings unless initiated by the patient, out of concern that they may make the parents feel worse" (Kelley 2012) [37] | ||
4. Continuity of care is important to staff | 36 % | "Providing continuity of care was important" (Fenwick 2007) [20] |
"Rapport, friendships and close emotional bonds…essential in providing satisfying quality of care" (Fenwick 2007) [20] | ||
"Meet the individual needs of the women" (Fenwick 2007) [20] | ||
"Participants frequently raised the importance of liaison between midwives, health visitors and general practitioners as being crucial to the ability to provide quality continuing care for bereaved parents" (Cartwright 2005) [68] | ||
5. Caring for bereaved parents can be rewarding for staff | 29 % | "Being able to share this experience was viewed as an important positive was to honour and respect the baby’s life and existence" (Fenwick 2007) [20] |
"Receiving ‘positive’ feedback was important and provided midwives with a sense of achievement" (Fenwick 2007) [20] | ||
6. Verbal and non-verbal communication skills are important | 21 % | "Particular emphasis was placed on knowing what to say, when to say it and knowing when was inappropriate" (Nallen 2006) [73] |
"Listening was identified as an important communication skill" (Nallen 2006) [73] | ||
"All physicians acknowledged that they struggle with what to say and what not to say following a stillbirth" (Kelley 2012) [37] | ||
7. Providing parents with information, enabling them to be actively involved in decision making, is a staff priority | 21 % | "While midwives recognized that women and partners were often in a state of shock they also acknowledged that it was important for them to be active participants in what was happening to them" (Fenwick 2007) [20] |
"Midwives considered sharing information and knowledge with families a way of relieving anxiety and assisting women to ‘gain control’" (Fenwick 2007) [20] | ||
8. Experience and knowledge may ease the provision of bereavement care but can increase the emotional burden felt by staff | 21 % | "Midwives refer to experience as a valuable commodity and a resource that should be used to ease a woman's distress when she gives birth to a stillborn baby" (Curtis 2000) [69] |
"participants developed significantly from their initial experiences to positions where they reported such situations as rewarding and feeling they had something substantial to offer" (McKenna 2011) [19] | ||
"If physicians rated their training as comprehensive, and as self-rated performance increased, they were more likely to experience symptoms of depression" (Farrow 2013) [71] |