What would you do in this situation?

squeakykitty · Mar 25, 2008

You weren't off the mark, you were right. The shift coordinator was wrong. I hope you documented everything in case there is trouble.

GilaRRT · Mar 25, 2008

First, congrats on realizing that your past situation may effect the way you look and react to the situation at hand.

However, I agree with your assessment. I know we would admit these patients to a medical/surgical unit. I think a general postpartum unit would not be the most therapeutic area for the patient in question IMHO.

mianders, RN · Mar 25, 2008

Although I agree with you that the patient should not be on a unit with all the newborn babies, I do not think that postpartum nurses not being trained in "bereavement care" is sufficient reason not take the patient. Dealing with patients and families after the loss of a loved one is part of being a nurse.

Kristin_collegemom · Mar 25, 2008

Although I agree with you that the patient should not be on a unit with all the newborn babies, I do not think that postpartum nurses not being trained in "bereavement care" is sufficient reason not take the patient. Dealing with patients and families after the loss of a loved one is part of being a nurse.

I agree with the above post... On my unit we give the patient the option to a) stay on with us on L&D, b) go to PP, or c) go to the women's gyn floor. We do what the patient is comfortable with. I too lost a baby (@30 weeks), so I understand being sensitive to this issue... but I am almost appalled that a unit would refuse to take the pt due to lack of "bereavement training".... She is still a PP patient, and sending her to some random med-surg floor because it is assumed she doesn't want to be around babies is cruel as well. After my demise, I was sent to such a place and the nurses avoided coming to my room like I had the plague, and I can only assume it was because they didn't know what to do with a PP patient or one who suffered loss...

You, being someone who has "been there" could possibly be the very best nurse there is to take care of that pt. I know you remember what she feels like...

camay1221_RN · Mar 25, 2008

I agree with the above post... On my unit we give the patient the option to a) stay on with us on L&D, b) go to PP, or c) go to the women's gyn floor. We do what the patient is comfortable with. I too lost a baby (@30 weeks), so I understand being sensitive to this issue... but I am almost appalled that a unit would refuse to take the pt due to lack of "bereavement training".... She is still a PP patient, and sending her to some random med-surg floor because it is assumed she doesn't want to be around babies is cruel as well. After my demise, I was sent to such a place and the nurses avoided coming to my room like I had the plague, and I can only assume it was because they didn't know what to do with a PP patient or one who suffered loss...
You, being someone who has "been there" could possibly be the very best nurse there is to take care of that pt. I know you remember what she feels like...

My intent was for her to stay on L&D, not ship her off to some random med/surg floor. The nurse/patient ratio is lower down there which allows the L&D RN to spend more time with the grieving family. On our postpartum unit we usually take four mom/baby dyads so staffing does not allow for 1:2 or 3. To consider transferring the patient at all is added stress to the patient regardless of where they are being transferred. At least having her stay in L&D will also allow for some continuity of care.

rnheart · Mar 25, 2008

you never know what effect your personal attitude will have on these patients the greater question is labor and delivery they place for a postpartum mom with a demise to be the hear the pains of labor from other moms. I have never worked anywhere that demise/ moms were kept in labor and delivery they were either place on the gyn floor between gyn surg patients or place on another unit. It was extremely unprofessional to refuse to accept a patient that you as a registered nurse with any sense of compassion are more than qualified to care for all they need is some one to say "I am sorry for your loss." that is all that is needed and maybe someone to cry with( which I have also done). Show your empathy and compassion you will never know how much it means to this patient

camay1221_RN · Mar 25, 2008

you never know what effect your personal attitude will have on these patients the greater question is labor and delivery they place for a postpartum mom with a demise to be the hear the pains of labor from other moms. I have never worked anywhere that demise/ moms were kept in labor and delivery they were either place on the gyn floor between gyn surg patients or place on another unit. It was extremely unprofessional to refuse to accept a patient that you as a registered nurse with any sense of compassion are more than qualified to care for all they need is some one to say "I am sorry for your loss." that is all that is needed and maybe someone to cry with( which I have also done). Show your empathy and compassion you will never know how much it means to this patient

How is it anymore professional, compassionate, or ethical to put this woman on a floor with crying babies? And trust me, moms who have lost a baby need more than just someone to say, "I'm sorry for your loss." If that's all that were needed, I'd have no objection to taking any patients who have had a fetal demise. If our staffing allowed for us to do 1:2-3 I'd love to care for this woman, but that isn't the reality. Honestly, I think women with a loss of any kind should be given 1:1 care. As I said in a subsequent post, we have four mom/baby dyads. It hardly seems fair to the grieving family to page me and I'm unable to respond right away because I'm trying to assist another patient with her own care or the care of her newborn.

Elvish, BSN, DNP, RN, NP · Mar 25, 2008

Honestly, and this is just my opinion, women should be given the choice as another poster said. Where I am, moms come to PP after a fetal loss. We try not to put them anywhere close to the nursery, but they still come to us and they know they're on a PP floor. I have had some moms say they prefer not to hear screaming babies etc. because it reminds them of their loss. I have had other moms s/p fetal loss say they prefer to be around other mothers because it validates the notion that they are mothers too. They say they felt like to put them on a GYN med/surg would have taken that notion away.

So, in the end, there doesn't seem to be one way that is 100% right or wrong for 100% of women. That is why it seems like these mamas should be given a choice.

txpixiedust · Mar 25, 2008

Our hospital has a Perinatal Loss Class, that while hard to sit through(I took my own kleenex and cried quite a bit!), it was a awesome class. I'm a PP RN, and I'm so glad the class is mandatory for all L&D, PP, Newborn Nursery, NICU, and Special Care Nursery RN's. Something powerful I learned was that someone whose lost a baby at 18 weeks, 30 weeks, or even months after delivery - can grieve equally, and that's okay.

Part of the four hour class was a video that showed several families who experienced the loss of a child, how they helped their living children to cope, and how we as nurses or chaplains can help these families. The NICU Nurse and Chaplain who taught the class sited several studies/research that showed that moms who can realize and begin accepting their loss while in the hospital, do better long-term. At out hospital, Moms are allowed to keep the baby in their room in the bassinette for their entire length of stay, or have the baby brought back and forth from the morgue (and we place warm blankets around the baby before the family holds the baby).

I'm not looking forward to my first mom with a demise, but I know the day will come and I feel better prepared due to this class and the handouts they've given us, etc. What these moms need is someone to tell them they're sorry, point out characteristics they shared (if possible) with family members (mom's eyes, dad's mouth), ask what the baby's name is, take pictures, help coordinate consults, provide information about funeral homes, and make a box of momentos for the mom to keep - hand and foot prints, a lock of hair, pictures with family & soft blankets/dolls or a ring the mom can wear on a necklace later, etc.

I understand we're all busy, but as PP nurses we are the ones who are more apt to recognize the physical and emotional red flags for these patients. And we celebrate life everyday - we can definitely celebrate the life (although short) of the babies these women longed for and are now grieving over.

I suggest that anyone who has never had a Perinatal Loss Class should ask their Clinical Educator to start one immediately - it will be a blessing to you and your patients.

God Bless!:heartbeat

txpixiedust

LizzyL&DRN · Mar 25, 2008

In our unit we too offer moms the option of going to a med surg floor although I have not seen a mom accept that offer in the 5 years i've been there. If a short hospital stay is expected for a patient that has had a demise we try our best to keep them in Labor and Delivery in the isolation rooms because there is a separate door to those rooms and they are less likely to hear babies or mothers cries. If they do need a c section they are put in PP (we have a busy unit and cannot have a PP pt for 3 days in L&D). We try to place them in rooms far away from couplets or possibly next door to antepartum patients. Their doors are always closed and we have a special picture of a leaf with a tear drop on it that is placed on the outside of the room that the entire hospital staff knows the meaning of. Not having "bereavement training" is not a valid reason for refusing care of this type of patient. We are all offered some type of schooling on this subject in nursing school. It is not our job to heal this patient's/family's pain of losing a child. It is our job to be sensitive to their needs and support whatever stage of grief they are in. A 1:1 ratio for this type of patient is both uneccessary and unrealistic. I can see where a med surg unit's nurses may be uncomfortable with this type of patient. It isn't something they see regularily and i'm not surprised by the previous poster that said she felt neglected on that unit.

babyktchr, BSN, RN · Mar 26, 2008

Being a bereavement facilitator at my facility, I have to say that anytime there is a loss, it is hard for everyone involved. Though there are many sides of this situation, and many positions can be justified, there is really no easy answer. Put a grieving mom with laboring women where they hear cries of the newly born, or in post partum where babies are everywhere with happy parents? Unfortuately for this mom, she is a surgical patient who won't go home after stable (like a vag delivery would most times). She is in for a longer haul than most. Where would this patient be better suited? Did anyone ASK the patient where she might like to be? Some moms feel BETTER when they are around people that know how to care for them, can get answers readily and knowledgeable care when it comes to the post partum period. Let's face it, med/surg nurses are just plain skeered of the dreaded FUNDUS. You must also factor in that they aren't trained to deal with perinatal loss, and usuallly will stay away from these patients for fear of "saying the wrong thing". I have dealt with many moms with losses over the years, and for the most part, I would have to say a large percentage choose to stay on our floor before moving to another. Of course, when possible, they just go home. I think it is important to let the patient have some say in her care, after all...she has lost a great bit of control, and having a bit given back means the world to them.

I have to say that I am surprised that a post partum floor has no training in perinatal loss. I would think at least a basic guide to caring for those who have lost a baby would be prudent. Remember, just because their baby died, doesn't mean they aren't going to go thru normal post partum issues....milk coming in, bleeding, recovering from surgery (when applicable). Sometimes, at first, moms just wanted to be treated like nothing happened, like they are "normal"...even thought their world isn't. You care for them just the same, except you may have to wipe a few more tears, give extra hugs, or just listen for a bit. To me..that is being a nurse.

I agree with the above poster....get a class going...attend one. It is a powerful experience. I love working with these moms. There is strength in these women, though they feel they have none. It is an amazing experience.