Nursing care plan for dealing with perinatal bereavement according to the theory of dysfunctional bereavement. Clinical case.

We present the clinical case report on a 33-year-old woman who, after a perinatal death, presented a complicated grieving process. The aim was to apply an individualised care plan that enabled reestablishment of the woman's emotional balance and environment after an experience of perinatal death. During the first visit to her midwife, the Athens Insomnia, Continuity Bonds and Goldberg Anxiety and Depression scales were applied. Focussed assessment was made using the Gordon patterns and based on the nursing approach described in the Dysfunctional Bereavement Theory. Six International NANDA diagnostic labels were identified (maladaptative grieving, insomnia, hopelessness, ineffective mothering process, moral distress and anxiety), and these were prioritised using clinical network reasoning, using the Outcome Present State Test (OPT) model, observing the relationships between the labels, diagnoses and identifying how they affected the rest. For each International NANDA diagnostic labels, the nursing outcomes were planned, along with the planned nursing interventions. The expected results included the description of the evaluation indicators using the Likert scales. Both results and interventions were agreed between the professional and the mother. The care plan raises the difficulty that nursing professionals face when attending to situations of complicated grief, and specifically, those associated with perinatal death. This situation makes key competencies necessary in training, as well as the need to find out about new nursing approaches.

Plan de cuidados de enfermería para el abordaje del duelo perinatal según la teoría del duelo disfuncional. Caso clínico / Nursing care plan for dealing with perinatal bereavement according to the theory of dysfunctional bereavement. Clinical case

Se presenta el caso clínico de una mujer de 33 años que, tras una muerte perinatal, presenta un proceso de duelo complicado.El objetivo es aplicar un plan de cuidados individualizado que permita un restablecimiento del equilibrio de la mujer y su entorno tras una vivencia de muerte perinatal.La valoración se inició durante la primera visita a su matrona en la que se aplicaron las escalas de insomnio de Atenas, de continuidad de vínculos y de ansiedad y depresión de Goldberg. Se realizó una valoración focalizada mediante los patrones de Gordon y desde el enfoque descrito en la teoría del duelo disfuncional.Se identificaron 6 etiquetas diagnósticas NANDA Internacional (duelo inadaptado, insomnio, desesperanza, proceso de maternidad ineficaz, sufrimiento moral y ansiedad), y se procedió a la priorización utilizando razonamiento clínico en red mediante el modelo análisis de resultados del estado actual, observando las relaciones entre las etiquetas diagnósticas e identificando cómo incidían sobre el resto.Para cada una de las etiquetas diagnósticas NANDA Internacional se planificaron los resultados esperados junto con las intervenciones enfermeras planificadas. Los resultados esperados contaron con la descripción de los indicadores de evaluación utilizando las escalas de Likert. Tanto resultados como intervenciones fueron consensuados entre el profesional y la mujer.El plan de cuidado plantea la dificultad que para los profesionales de enfermería supone la asistencia de situaciones de duelo complicado, y concretamente, las asociadas a una muerte perinatal. Esta situación hace necesarias competencias clave en la formación, así como la necesidad de conocer nuevos enfoques enfermeros.(AU)

We present the clinical case report of a 33-year-old woman who, after a perinatal death, presents a complicated grieving process.The aim is to apply an individualized care plan that allows a reestablishment of the balance of the woman and her environment after an experience of perinatal death.During the first visit to her midwife, the Athens Insomnia, Continuituing Bonds and Goldberg Anxiety and Depression scales were applied. Focused assessment was made using the Gordon patterns and based on the nursing approach described in Dysfunctional Grief Theory.Six International NANDA diagnostic labels were identified (maladaptative grieving, insomnia, hopelessness, ineffective motherhood process, moral distress and anxiety), and they were prioritized using clinical network reasoning using the Outcome Present State (OPT) model, observing the relationships between the labels, diagnoses and identifying how they affected the rest.For each International NANDA diagnostic labels, the nursing outcomes were planned nursing interventions. The expected results included the description of the evaluation indicators using the Likert scales. Both results and interventions were agreed between the professional and the woman.The care plan raises the difficulty that nursing professionals pose in assisting in situations of complicated grief, and specifically, associated with perinatal death. This situation makes key competencies necessary in training as well as the need to know new nursing approaches.(AU)