Healthcare professionals' needs when providing perinatal bereavement care: A qualitative study.

BACKGROUND: Caring for and supporting bereaved parents with fetal loss requires preparation, training, and attention to a set of needs of health workers to provide optimal services. This is although it has been less addressed in the educational curriculum and in-service training. This study aims to investigate the experiences of Iranian healthcare professionals regarding the needs related to the care of bereaved parents with perinatal loss. MATERIALS AND METHODS: This research was a qualitative study conducted in Shahroud City, Iran, to explore healthcare professionals' needs from June 2021 to December 2022. Semi-structured in-depth interviews on purposive sample of 14 participants were conducted. The participants were care providers who worked in OB-GYN ward, general midwifery clinics, and a private office. The interviews were recorded verbatim, transcribed, and analyzed using an inductive content analysis. MAXQDA software version 10 was used for data analysis. Granheim and Lundman's approach was used to analyze the data. RESULTS: Two major themes, four categories, and nine subcategories emerged. The themes included the "existence of protective laws and policies" and "skill and training needs." Protective laws and policies included "Government Rules and guidelines" and "organizational Rules protecting the individual." Skills and training needs consisted of two categories: "communication skills" and "Self-Care needs." CONCLUSIONS: Educational policies, development of guidelines for the care of bereaved mothers based on culture, training programs for dealing with bereaved parents, providing self-care programs for employees, and improving the physical and emotional conditions of the workplace were among the needs expressed by the participants. Meeting the needs of healthcare professionals is effective in job satisfaction, feeling of value, and high quality of services for bereaved parents.

Parents', Families', Communities' and Healthcare Professionals' Experiences of Care Following Neonatal Death in Healthcare Facilities in LMICs: A Systematic Review and Meta-Ethnography.

BACKGROUND: Ninety-eight percent of neonatal deaths worldwide occur in low- and middle-income countries (LMICs), yet there is little bereavement care guidance available for these settings. OBJECTIVES: To explore parents', families' and healthcare professionals' experiences of care after neonatal death in healthcare facilities in LMICs. SEARCH STRATEGY AND SELECTION CRITERIA: Four databases were searched for peer-reviewed literature, meeting the inclusion criteria of qualitative studies exploring the experiences of people who provided or received bereavement care following neonatal death in a LMIC healthcare setting. DATA COLLECTION AND ANALYSIS: Data were collected by two independent reviewers, collated through line-by-line coding and then reciprocal and refutational translation, and analysed through Noblit and Hare's seven-step meta-ethnography approach to create first-, second- and third-order themes. MAIN RESULTS: Seven first-order themes extracted from the literature included emotional responses, social relationships, staff and systems, religion, connecting with the baby, coping strategies and economic concerns. From these data, three third-order themes arose: The individual, the healthcare setting and the community/context. CONCLUSIONS: Overarching themes in bereavement care shape grief responses and are often similar across geographical locations. Analysing these similarities allows a deeper understanding of the important elements of bereavement care and may be helpful to inform the creation of high-quality, bereavement care guidelines suitable for use in LMIC settings.

Undergraduate midwifery students' experiential learning of perinatal bereavement care: A qualitative analysis.

BACKGROUND: It is widely acknowledged that midwives are essential in providing care for mothers experiencing perinatal death. However, midwifery students lack the knowledge and skills needed to deal with perinatal death, and. There is limited research on perinatal bereavement care training for midwifery students. AIM: To investigate undergraduate midwifery students' experiential learning of perinatal bereavement care and serve as a reference for future perinatal bereavement care teaching and training. DESIGN: Qualitative descriptive design. SETTING: University in Guangzhou, China. PARTICIPANTS: Undergraduate midwifery students at a university in Guangzhou, China. METHOD: This research was conducted at a university in Guangzhou, China. The participants were recruited using purposeful sampling. Semi-structured, in-depth interviews were conducted with 11 midwifery students who participated in perinatal bereavement care training from May to June 2023. The Colalizzi 7-step data analysis method was used for data analysis. RESULTS: From the data, five themes emerged: 1) immersive experience of perinatal bereavement care, 2) formation of perspectives on perinatal bereavement care, 3) clarification of the service boundaries and internalization of the professional service spirit, 4) emotional impact and coping strategies, and 5)) factors influencing practice optimization. CONCLUSIONS: Experiential learning is an effective teaching strategy. However, participants continued to feel unprepared to provide perinatal bereavement care. Implementing relevant training, disseminating perinatal bereavement care knowledge and skills, and enhancing the ability of midwifery students to manage and cope with the psychological impact of perinatal death are important.

Aftercare Provision for Bereaved Relatives Following Euthanasia or Physician-Assisted Suicide: A Cross-Sectional Questionnaire Study Among Physicians.

Objectives: Relatives of patients who died after euthanasia or physician-assisted suicide (EAS) might need (specific) aftercare. We examined if and how physicians provide aftercare to bereaved relatives of patients who died after EAS, and which patient-, physician- and process characteristics are associated with providing aftercare. Methods: A cross-sectional questionnaire study was conducted among 127 physicians (general practitioners, clinical specialists, and elderly care physicians) in the Netherlands. Associations were examined using multivariable logistic regression analyses. Results: Most physicians had had at least one follow-up conversation with bereaved relatives (77.2%). Clinical specialists less often provided aftercare compared to GPs. Also, aftercare was more often provided when the deceased had a cohabiting partner. Topics addressed during aftercare conversations included looking back on practical aspects of the EAS trajectory, the emotional experience of relatives during the EAS trajectory and relatives' current mental wellbeing. A minority of aftercare conversations led to referral to additional care (6.3%). Conclusion: Aftercare conversations with a physician covering a wide-range of topics are likely to be valuable for all bereaved relatives, and not just for "at risk" populations typically targeted by policies and guidelines.

Implementation of a hospital-based end-of-life and bereavement care program in a latin American middle-income country. A source of light and compassion in the midst of cloudy times.

BACKGROUND: The death of a child is one of the most devastating events a family can face, resulting in significant physical and psychosocial morbidity. Bereavement support programs have been developed in high-income contexts to address this need. However, little is known about implementing bereavement programs in low-and middle-income countries (LMICs). Here, we describe the implementation of a bereavement program for parents whose children died due to cancer or other catastrophic illnesses. METHODS: We conducted a retrospective analysis to describe the implementation of a hospital-based End of Life (EoL) care and bereavement program. This program was developed in several stages, including an assessment of bereaved families, development program guidelines, staff training, piloting of the program, refinement, and standardization. The program was developed between 2019 and 2021 in a nonprofit, teaching hospital and referral center for southwestern Colombia. RESULTS: Several tools were developed as key components of the bereavement program: a virtual bereavement course; guidance for EoL and bereavement communication and care, memory making, and follow-up calls; a condolence letter template, and group support workshops. A total of 956 healthcare professionals were trained, 258 follow-up calls to bereaved parents were made, 150 individual psychological follow-ups to parents with complicated grief occurred, 79 condolence letters were sent, and 10 support group workshops were carried out. Challenges were identified and overcome, such as limited resources and staff, and cultural perceptions of death. In 2021, this program received an award by the hospital as the Best Strategy to Humanize Healthcare. CONCLUSIONS: This study highlights the feasibility of developing and implementing EoL and bereavement care programs for parents and families within hospitals in LMICs. Lack of resources, staff, and training are some of the identified challenges to implementation. Utilizing methodological tools allows us to identify facilitator factors and deliverable outcomes of our EoL and bereavement program. This model provides a valuable framework for resource-limited settings.

Virtual Bereavement Support Program in a Children's Hospice Care Center During COVID-19 Pandemic and Beyond.

In light of the COVID-19 pandemic, a pediatric hospice in Ottawa, Ontario, implemented a Virtual Bereavement Group Program, necessitating a reorganization of care delivery during the global crisis. This paper outlines the program and assesses the feedback of families who participated in the program following the death of a child or grandchild. Participants expressed high levels of satisfaction, indicating its potential as an effective approach for pediatric bereavement care beyond the pandemic.

Care, connection, and social distancing: The challenges of baby loss during the COVID-19 pandemic in Aotearoa New Zealand.

PROBLEM: The COVID-19 pandemic hindered access to routine healthcare globally, prompting concerns about possible increases in pregnancy loss and perinatal death. BACKGROUND: PUDDLES is an international collaboration exploring the impact of the COVID-19 pandemic on parents who experience pregnancy loss and perinatal death in seven countries, including Aotearoa New Zealand. AIM: To explore parents' experiences of access to healthcare services and support following baby loss during the COVID-19 pandemic in Aotearoa New Zealand. METHODS: We conducted in-depth, semi-structured interviews with 26 bereaved parents, including 20 birthing mothers, and six non-birthing parents (one mother and five fathers). Types of loss included 15 stillbirths, four late miscarriages, and one neonatal death. Participant ethnicities were broadly representative of Aotearoa New Zealand's multi-ethnic society. Data were analysed using Template Analysis. FINDINGS: Analysis revealed five themes relating to pandemic impact on bereaved parent's experiences. These were: 'Distanced and Impersonal care'; 'Navigating Hospital Rules'; Exclusion of Non-birthing Parents; 'Hindered Access to Social Support'; and 'Continuity of Relational Care'. DISCUSSION: The COVID-19 pandemic exacerbated isolation of bereaved parents through perceived impersonal care by healthcare professionals and restrictions on movement hindered access to social and cultural support. Compassionate bending of the rules by healthcare professionals and community postnatal visits by continuity of care midwives following the bereavement appeared to be mitigating factors. CONCLUSION: Social isolation is an added challenge for parents experiencing baby loss during a pandemic, which may be mitigated by flexible and compassionate care from healthcare professionals, especially continuity of care midwives.

Relatives' needs in terms of bereavement care throughout euthanasia processes: A qualitative study.

AIM: To explore relatives' needs in terms of bereavement care during euthanasia processes, how healthcare providers respond to these needs, and the degree of commonality between relatives' and healthcare providers' reports. DESIGN: A phenomenological design was employed, utilising reflexive thematic analysis to examine interviews conducted with relatives (N = 19) and healthcare providers (N = 47). RESULTS: Relatives' needs throughout euthanasia processes are presented in five main themes and several subthemes, with similar findings between both sets of participants. Although relatives infrequently communicated their needs explicitly to healthcare providers, they appreciated it when staff proactively met their needs. Healthcare providers aimed to assist with the relatives' grief process by tending to their specific needs. However, aftercare was not consistently offered, but relatives did not have high expectations for professional follow-up care. CONCLUSION: Our research offers important directions for healthcare professionals, empowering them to provide needs-based bereavement care during euthanasia processes. Moreover, it emphasises the importance of recognising the unique needs of relatives and proactively addressing them in the period before the loss to positively contribute to relatives' grief process. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Insights into relatives' needs in the context of euthanasia. Good practices on how healthcare providers can attend to relatives' needs before, during and after the loss IMPACT: Current literature and guidelines on needs-based bereavement care in the context of euthanasia and, more generally, assisted dying, are limited. These findings provide concrete directions for practice in supporting (nearly) bereaved relatives in the context of euthanasia, potentially mitigating adverse health outcomes. REPORTING METHOD: Standards for Reporting Qualitative Research (SRQR checklist). PATIENT OR PUBLIC CONTRIBUTION: Relatives of deceased cancer patients were involved in the conduct of the study.

Spiritual Support to Improve Women's Mental Health after Miscarriage and Stillbirth: A Qualitative Study in Japan.

PROBLEM: Miscarriage and stillbirth can severely impact maternal mental well-being. BACKGROUND: In Japan, local municipalities must prepare systems to provide mental and social-spiritual support to women after miscarriage or stillbirth. OBJECTIVE: To elucidate what spiritually supports the mental health of women who have experienced miscarriages and stillbirths. METHODS: This analysis included 25 women who had experienced miscarriage or stillbirth at least one month previously and participated in self-help group meetings at least twice. Data were collected from March 2020 to March 2021 using two narrative interviews and questionnaires. FINDINGS: The mothers led their lives "together" with their children. They derived spiritual support from others, such as "the presence of someone who is living now after having experienced anguish" and "others who acknowledge the presence of my child and me as a mother. " Further elements of the support included "resigning myself to face my grief" and "strong links to deceased children. " While facing their grief by accepting that this anguish cannot be replaced [with anything else] and resigning themselves to reality, their bond to their child is strengthened. CONCLUSION: What women perceive as support after a miscarriage or stillbirth will be an important clue to care.

Mind Yourself So You Can Mind Me; The Role of Parental Behaviour in Perinatal Death on the Surviving Sibling's Grief.

Children's grief, in perinatal loss, can be misunderstood and overlooked. Parental behaviour while mourning infant loss and parental ability to respond to their own grief has a crucial role in the child's grief. This study aimed to explore parental behaviour as a determining factor in siblings' grief following perinatal death. Six mothers and two fathers experiencing perinatal loss were interviewed about their perception of the child's experience of perinatal death. Thematic analysis allowed for identifying of relevant themes. The main themes related to parents' expression of grief, insight and understanding of their children's grief and communicating the death/anticipated death with their surviving children. Findings showed that children seek out information on their deceased sibling and need supportive parents to guide them through their grief. Our study highlights that supporting parents in their grief is a key factor for a healthy grieving process in children and must be considered when supporting families in perinatal death.

Grief and Bereavement Support for Parents in Low- or Middle-Income Countries: A Systematic Review.

INTRODUCTION: The death of a child may be the most traumatic event a family can experience. Bereavement care for parents is essential for their physical and mental well-being and is a psychosocial standard of care. Childhood mortality is higher in low- or middle-income countries (LMICs); however, little is known regarding bereavement support or interventions for parents in LMICs. AIM: To identify programs, services, initiatives, or interventions offered to bereaved parents in LMICs in hospital settings. METHODS: A systematic search was executed following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles from LMICs describing interventions, programs, or resources provided to parents after the death of a child (0-18 years old) from any cause were included. Extracted data was categorized by demographics, study design, outcomes, and quality assessment using the McGill Mixed Methods Appraisal Tool (MMAT). RESULTS: We retrieved 4428 papers and screened their titles and abstracts, 36 articles were selected for full-text assessment, resulting in nine articles included in the final analysis. Most interventions described support for parents whose child died during the prenatal or neonatal period. The primary interventions included psychological counseling, creating mementos (such as photographs or footprints), and bereavement workshops. Only one paper described a fully established bereavement program for parents. Eight of the papers met high-quality criteria. DISCUSSION: Although bereavement care is crucial for parents whose child has died, only a few studies have documented bereavement interventions in LMICs. More research may help with bereavement program implementation and improved care for bereaved parents in LMICs.

Student midwives' lived experiences of caring for bereaved parents following perinatal loss using actor-based simulation: A phenomenological study.

BACKGROUND: Student midwives frequently encounter bereaved parents in clinical practice; however, the experience of caring for bereaved parents can be a significant source of traumatic stress. Although the use of simulation to teach bereavement care is considered a powerful experiential form of learning, evidence for its effectiveness as a transformative learning strategy is limited. AIM: To explore student midwives' lived experience of caring for bereaved parents experiencing perinatal loss using high-fidelity simulation. DESIGN: Students midwives participated in an actor-based bereavement simulated scenario. Data was collected using semi-structured interviews. Interpretative Phenomenological Analysis was conducted to gain a deep understanding of the meaning of the experience. Mezirow's Transformative Learning Theory was applied as an analytical framework to illustrate how the student midwives made sense of and learned from the experience of caring for bereaved parents experiencing perinatal loss. SETTING: One BSc (Hons), 156-week undergraduate midwifery programme within a university in the Northwest of England. PARTICIPANTS: A purposeful sample of nine first-and second-year student midwives volunteered to participate in the study. FINDINGS: One of the superordinate themes that emerged from the analysis (1) 'trying to console and making things easier' and the related subthemes (1a)'what words can I say', (1b)'my instinct was to console the mum', (1c)'left to sort of pick up the pieces' captured the deep sense of powerlessness and the professional dilemmas experienced as students struggled to emotionally console and communicate the right words to say to the grieving parents. CONCLUSION: The study highlights the vital role of simulation as a defined model of bereavement education that equips students with the necessary knowledge, skills, and confidence to provide compassionate care to bereaved parents experiencing perinatal loss. IMPLICATIONS FOR PRACTICE: The emotional toll of caring for bereaved parents is significant, and higher education institutions should adopt experiential forms of learning using actor-based simulation scenarios to emotionally prepare students to care holistically for parents affected by perinatal loss.

Psychological pathway to emotional exhaustion among nurses and midwives who provide perinatal bereavement care in China: a path analysis.

BACKGROUND: A lack of confidence in perinatal bereavement care (PBC) and the psychological trauma experienced by nurses and midwives during bereavement care leads to their strong need for sufficient organisational support. The current study intended to test a hypothesised model of the specific impact paths among organisational support, confidence in PBC, secondary traumatic stress, and emotional exhaustion among nurses and midwives. METHODS: A descriptive, cross-sectional survey was conducted in sixteen maternity hospitals in Zhejiang Province, China, from August to October 2021. The sample (n = 779) consisted of obstetric nurses and midwives. A path analysis was used to test the relationships among study variables and assess model fit. RESULTS: Organisational support directly and positively predicted confidence in PBC and demonstrated a direct, negative, and significant association with secondary traumatic stress and emotional exhaustion. Confidence in PBC had a positive direct effect on secondary traumatic stress and a positive indirect effect on emotional exhaustion via secondary traumatic stress. Secondary traumatic stress exhibited a significant, direct effect on emotional exhaustion. CONCLUSIONS: This study shows that nurses' and midwives' confidence in PBC and mental health were leadingly influenced by organisational support in perinatal bereavement practice. It is worth noting that higher confidence in PBC may lead to more serious psychological trauma symptoms in nurses and midwives. Secondary traumatic stress plays an essential role in contributing to emotional exhaustion. The findings suggest that support from organisations and self-care interventions were required to improve confidence in PBC and reduce negative psychological outcomes among those providing PBC. The development of objective measures for assessing competence in PBC and organizational support are essential.

End-Of-Life Care Planning and Bereavement Practices Among Adult Day Services Centers, 2018.

Introduction: This study describes the end-of-life (EOL) care planning and bereavement practices among adult day services centers (ADSC) when an ADSC participant is dying or has died. Methods: Data are from the 2018 National Study of Long-term Care Providers' biennial survey of ADSCs. Respondents were asked about the following 4 practices: 1) honoring the deceased in some public way in this center; 2) offering bereavement services to staff and participants; 3) documenting in the care plan what is important to the individual at the end of life (EOL), such as the presence of family or religious or cultural practices; and 4) discussing spiritual needs at care planning conferences. ADSC characteristics included US Census region, metropolitan statistical area status, Medicaid authorization, electronic health records (EHR) use, for-profit status, employment of aides, services provision, and model type. Results: About 50% to 30% of ADSCs offered the EOL care planning or bereavement services. Honoring the deceased was the most common practice (53%), followed by bereavement services (37%), discussing spiritual needs (29%), and documenting what is important at EOL (28%). Fewer ADSCs in the West had EOL practices relative to the other regions. The EOL planning and bereavement practices were offered more often in ADSCs that used EHRs, accepted Medicaid, employed an aide, provided nursing, hospice, and palliative care services, and were categorized as medical models, compared with ADSCs without these characteristics. Conclusion: These results highlight the importance of understanding how ADSCs provide EOL and bereavement care to participants who are near EOL.

An exploration of women's lived experiences of care and support following perinatal death in South-Western Nigeria: A hermeneutic phenomenological study.

BACKGROUND: Perinatal death results in long-lasting intense grief for bereaved mothers with a potential to negatively impact on their short- and long-term outcomes and quality of life if inadequately supported in coping with and managing their experience. AIM: This study aimed at exploring the lived experience of women, of care and support following perinatal death in South-Western, Nigeria. METHODS: A qualitative methodology using Heideggerian phenomenology was used. Fourteen women who had experienced perinatal death in South-Western Nigeria within the last (5) five years were interviewed, and Van Manen's approach to hermeneutic phenomenology was used in data analysis. FINDINGS: Four main themes were identified: "they did not tell me the baby died", "response of health care professionals after the baby died", "moving on from hospital", and "support from family". The physical health status of mothers determined how they were informed of perinatal death. Health care professionals were distant, rude, nonempathetic and did not offer emotional support, in some cases. Mothers were given opportunity to see and hold their babies. There was no routine follow-up support in the community, besides a postnatal check-up appointment offered to all mothers regardless of their birth outcome. Family provided emotional support for mothers on discharge. CONCLUSION: This study was the first to explore the lived experience of women of the care and support following perinatal death in South-Western, Nigeria. There is a need for healthcare systems to review bereavement care and support provisions for women who experience perinatal death.

The Current Status of Bereavement Care in Chinese Emergency Departments: A Multicenter Cross-Sectional Study.

Understanding the current status and challenges of bereavement care will help facilitate the development of bereavement care in the emergency department. However, little is known about the status of bereavement care in Chinese emergency departments and nurses' perceptions of bereavement care. We used a self-made questionnaire to survey 124 head nurses and 870 emergency nurses in 21 hospitals in Jiangsu Province in September 2023. Among 124 emergency departments, 78 (62.90%) emergency departments provided bereavement care strategies, and the most frequent strategy was a waiting room, relevant information on funeral arrangements and the establishment of a relatively secluded environment conducive to the solace of the patient's family, or the provision of a dedicated farewell chamber. Emergency nurses believed that bereavement care is important but difficult to implement, with support resources, environment and human resources being the main challenges. In the future, further attention should be paid to the development of bereavement care in the emergency department, and the implementation of bereavement care should be supported in terms of policies, funds, resources and personnel.

[When the diagnosis came in Bereavement care in Germany in 2020/2021: Where do we stand?] / Als die Diagnose kam Wo steht die deutsche Trauerversorgung im Jahr 2020/2021?

BACKGROUND: In Germany, numerous health care providers work in the field of bereavement care. An epidemiological study of the field immediately after the introduction of the ICD-11 diagnosis "Prolonged Grief Disorder" (PGD) is pending. METHODS: The second survey of the trend study, which is designed over a total of three measurement points at intervals of one decade each, explores whether and to what extent the field of bereavement care has evolved after the introduction of the grief-specific diagnosis PGD. For this purpose, providers of bereavement care at various organizational levels were asked to participate in an online survey. The survey was conducted from October 2020 to January 2021. RESULTS: 456 questionnaires were included in the study. Data analysis was descriptive. 80.5% of the participants have an additional grief-specific qualification, 59.4% base their work on a grief-specific concept. In view of the PGD diagnosis, only a few respondents have participated in a PGD-related advanced training. Most are afraid that the topic of grief will increasingly be subsumed in the medical-psychological-therapeutic field. An increase in bereavement research and the number and quality of continuing education is also expected. DISCUSSION: Some positive trends in German bereavement care can be identified. However, there is a need for further development in the areas "designation of the activity", "diagnostics", and "intervention". Also, there is a need for training with regard to PGD. CONCLUSION: After the introduction of PGD, the field of bereavement care in Germany turns out to be slightly different. The diagnosis is viewed skeptically.

Innovation in Bereavement Care: Research Circles as a Framework for Translation of Research-Based Knowledge.

This article aims to contribute to the research-practice gap in bereavement care by exploring Research Circles as a collaborative approach to implementation of research-based knowledge into bereavement care. Particularly the article discusses key dimensions for translating research concerning bereaved after drug-related deaths into practice-relevant knowledge, as a first step of implementation. This co-created knowledge translation took place in the first phase of a Research Circle including bereaved mothers, practitioners and researchers. Data were collected via semi-structured interviews with Research Circle participants and field notes. Data were analyzed using reflexive thematic analysis. Results showed two key dimensions with the Research Circle approach influencing the translation process: (1) multiple and long-lasting arenas for translation: (2) multiple stakeholders and perspectives. Research Circles appear to be a promising framework for translating research-based knowledge in bereavement care, but there are some barriers to fully realizing the democratic ideal that underlines the Research Circle framework.

An exploration of health workers' experiences in providing bereavement care to mothers following a stillbirth: results from a subnational level health system in Uganda.

BACKGROUND: Stillbirth is a profound emotion-laden event to the mothers and health workers who provide care due to its sudden and unexpected occurrence. Health workers offering support in regions shouldering the highest-burden experience providing support to a stillbirth mother in their professional lifetime. However, their experiences seldom get documented as much of the focus is on mothers causing a dissonance between parental and clinical priorities. This study aimed to explore the health worker's experiences in the provision of bereavement care to mothers following a stillbirth. METHODS: An exploratory cross-sectional qualitative study was undertaken on a purposively selected sample of key informants drawn from frontline health workers and health systems managers providing maternal health services at a subnational level health system in Uganda. An interview guide was used to collect data with the audio-recorded interviews transcribed using Microsoft office word. Atlas. ti a qualitative data management software aided in coding with analysis following a thematic content analysis technique. RESULTS: There was no specialised bereavement care provided due to inadequate skills, knowledge of content, resources and support supervision for the same. However, health workers improvised within the available resources to comfort mothers upon news of a stillbirth. Disclosure to mothers about the stillbirth loss often took the form of forewarnings, direct and sometimes delayed disclosure. A feeling of unpreparedness to initiate the disclosure process to the mother was common while the whole experience had an emotional effect on the health workers when establishing the cause, particularly for cases without clear risk factors. The emotional breakdown was often a reflexive response from the mothers which equally affected the care providers. Health workers engaged in comforting and rebuilding the mothers to transition through the loss and validate the loss. Efforts to identify the skills and health systems gaps for address were a common response targeted at improving the quality of maternal healthcare services to avert similar occurrences in the future. CONCLUSION: Providing care to mothers after stillbirth was an emotional and challenging experience for health workers requiring different approaches to disclosure and provision of emotional support. The aspect of specialised bereavement care was lacking within the current response. Reflection of unpreparedness to handle the tasks demonstrates a deficit in the required skills. It is a critical gap missing hence calling for dedicated efforts to address it. Targeting efforts to improve health workers' competencies and preparedness to manage grieving mothers is one way to approach it.

Training Proposal in Palliative Care for Primary Care Nurses in a Health Area in Spain.

BACKGROUND: Primary Health Care nurses express deficits in their training in Palliative Care. The purpose of this study is to design a Palliative Care training plan and a bereavement care protocol for Primary Health Care nurses of the Dr. Peset Health Department according to their needs. METHODS: Assessment of theoretical and practical training needs and literature review for the design of the training plan. RESULTS: A training plan was elaborated that included a protocol of care for the bereaved. The plan was adjusted to the needs detected in Primary Health Care nurses of the Dr. Peset Health Department. Important training deficits were detected in clinical practice; Conclusions: Improving the care of people with palliative needs in Primary Health Care requires adequate training of the nurses who care for them so their knowledge is the basis of their interventions. This study was not registered.