Grief Is a Process Some Call a Journey

Abstract

Purpose for the Program The purpose of a Perinatal/Child Loss Bereavement Program is to provide a system-wide standard of care that offers individualized, interdisciplinary, and holistic support to families experiencing the loss of a pregnancy, infant, or child. Proposed Change Develop a standardized process to identify families in the health care system that experience a perinatal loss or loss of a child and provide support, follow-up, and/or referrals to community resources. Most patients with a perinatal or child loss were seen in the emergency and perioperative departments. We realized this was a very large patient population that was not given appropriate resources as inpatients or much needed follow-up as outpatients. Implementation, Outcomes, and Evaluation A multidisciplinary committee was constructed to develop a perinatal/child loss bereavement program. After attending formal training, we developed processes and educated staff in the women and family, emergency, and perioperative departments; chaplains; counseling; and other support staff system-wide. We now also hold monthly multidisciplinary perinatal grand rounds to identify patient cases that may require increased services from the program. We had 438 staff that completed education for the program. As a result of our efforts, we have received 225 referrals since the program began on September 1, 2012. Most of these referrals have been captured through the emergency departments and perioperative departments system-wide via the electronic health record system. Through development of a database, in conjunction with the electronic health record, we are able to track referrals and follow up with patients and families. Prenatal families with a terminal fetal diagnosis can now present in labor with a preconstructed collaborative care plan to help guide staff and family decisions. The fact that most of the bereavement referrals have originated from the emergency and perioperative departments proves that we were initially missing a large number of patients experiencing a perinatal or child loss. It validates the need for further follow-up assessment of those patients entering the health care system for short periods. Future goals are to continue to educate new, incoming staff, create a mainstream resource mailing process, and further collaborate with community resources. Implications for Nursing Practice A standardized, multidisciplinary team approach should be used for these bereavement situations to best support families. Nurses should receive additional training so as to be sensitive to the emotional and individualized needs that may present. The purpose of a Perinatal/Child Loss Bereavement Program is to provide a system-wide standard of care that offers individualized, interdisciplinary, and holistic support to families experiencing the loss of a pregnancy, infant, or child. Develop a standardized process to identify families in the health care system that experience a perinatal loss or loss of a child and provide support, follow-up, and/or referrals to community resources. Most patients with a perinatal or child loss were seen in the emergency and perioperative departments. We realized this was a very large patient population that was not given appropriate resources as inpatients or much needed follow-up as outpatients. A multidisciplinary committee was constructed to develop a perinatal/child loss bereavement program. After attending formal training, we developed processes and educated staff in the women and family, emergency, and perioperative departments; chaplains; counseling; and other support staff system-wide. We now also hold monthly multidisciplinary perinatal grand rounds to identify patient cases that may require increased services from the program. We had 438 staff that completed education for the program. As a result of our efforts, we have received 225 referrals since the program began on September 1, 2012. Most of these referrals have been captured through the emergency departments and perioperative departments system-wide via the electronic health record system. Through development of a database, in conjunction with the electronic health record, we are able to track referrals and follow up with patients and families. Prenatal families with a terminal fetal diagnosis can now present in labor with a preconstructed collaborative care plan to help guide staff and family decisions. The fact that most of the bereavement referrals have originated from the emergency and perioperative departments proves that we were initially missing a large number of patients experiencing a perinatal or child loss. It validates the need for further follow-up assessment of those patients entering the health care system for short periods. Future goals are to continue to educate new, incoming staff, create a mainstream resource mailing process, and further collaborate with community resources. A standardized, multidisciplinary team approach should be used for these bereavement situations to best support families. Nurses should receive additional training so as to be sensitive to the emotional and individualized needs that may present.