I am a new nurse (almost a year) working in a high Risk Ante/Postnatal unit.
Part of our patient population is admitting,monitoring,performing and caring for women/families experiencing 2nd trimester terminations. These are usually wanted pregnancies that are being terminated due to genetic anomalies NOT compatible with life.
The nurses work very hard and do an incredible job on the unit but in regards to this population there seems to be a resistance/need to be as effective. The end result being negativism, signs of burnout.
Are there any of you out there with this same experience? What works as a form of support for your team? What works as a form of support for yourself? How did you get from NOT wanting to working with these patients to wroking with them and feeling good about it?
Any guidance/suggestions are helpful
Apr 12, '02
This is by far the most difficult thing we deal with in OB nursing--I know that my hospital has initiated a bereavement committee. While we are in the planning stages (defining the scope of support, etc) the mission is to help staff deal with ALL stressful and/or traumatic events. For instance, we had a maternal death 2 months ago--undiagnosed cerebral aneurysm--ruptured at 29 weeks. She presented with unwitnessed loss of consciousness and headache--even the doc was working her up for PIH when she began to crash. This led me to pursuing resources and I found out that one of our chaplains is certified in post traumatic stress management--organized a meeting for any/all staff who wanted to attend. The chaplains will be a key interdisciplinary support for the bereavement committee.
Case reviews are a way for the nurses to "tell their story" and pass along information on strategies that worked well for the patients and which ones didn't. Ongoing reassurance and support--they can make the most unbearable experience bearable. There are no magic words--it's as horrible as it can ever be--the loss of a potential life never brought to fruition. There's no sense or logic--it's okay to hurt, to cry, to be angry--nurses will grieve for their inability to "make it better" and what they need to hear over and over is that they can make a difference through their compassion and empathy.
There is a great video--called "At a Loss for Words" that is specifically designed for healthcare professionals dealing with families experiencing fetal demise and neonatal losses. The film encompasses interviews of people who have gone through this process--one who is a nurse, others who are not. It is probably the best film I've ever seen and it was required for all Maternal/Child Services staff to view.
Another strategy is to plan the care prior to admission (whenever possible). I know that we always have several days to weeks of notice when we will be getting a patient in this category--we look ahead at the schedule and ask for volunteers to care for the patient. Pass the responsibility around (if you have a high volume--sounds like you do) and offer training or seminars for the staff caring for these patients--sometimes the frustration is that we don't feel equipped or knowledgeable enough to tend to all their needs--education and training can give them some tools to work with. (More than you asked for, huh?) Oh, and you can get a local bereavement support group to come in and provide an inservice for your staff, as well......okay I'm done--promise
Apr 13, '02
WOW RENEE!! Wonderful ideas! I wish we had had you around when we had to deal with a new MD (perinatologist) who thrust these procedures on us literally overnight with no preperation AT ALL! We simply elected to participate on the basis of our personal convictions when the pts came thru the door!! It was such a stressful mess and the dr could not have cared less! Thank goodness for this site and all it offers for those of us with no alternatives at hand. I am recommending it to every nurse I know! Keep up the good work!!!!!!
Apr 14, '02
thank you both for the reply. Presently, this is how this area of our unit is operating:
-The attempt to have all nurses complete An RTS course (perinatal/newborn bereavement program...and is excellent)
-rotating who does TOPs (termination of Pregnancies) and how often to deter any one person doing too many (whatever that is for them).
-using team meetings to discuss this area openly (easily said than done)
-having inservices of multi-disciplinary nature discussing all areas (i.e.-genetics, Nursing leadership team...)
-oh ya, an orientation with a seasoned/experienced nurse in this area
-there just seems to be that..unsaid....resistance...for lack of a better word.
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