1. Running head: THE FORGOTTEN GRIEVERS
The Forgotten Grievers In Labor and Delivery: An Annotated Bibliography
Annette Evangelista
California Baptist University
NUR 471-Chirstian Leadership Nursing Practicum
Dr. Deborah Bobst

2. THE FORGOTTEN GRIEVERS 2
Chen, F., & Hu, W. (2013). [The impact of perinatal death on nurses and their coping
strategies]. Hu Li Za Zhi The Journal Of Nursing, 60(1), 87-91. doi:10.6224/JN.60.1.87
The research conducted for this article focused on the impact perinatal loss has on the nurses as
they tend to the needs of the family that suffered the loss. The articles focuses on the internal
perceptions and the external stresses that occur with nurses as the experience a loss and attempt
to cope as they care for their patients. It is apparent in the study that nurses tend to grieve in a
similar way as the family. They feel sadness, helplessness but yet feel reserved about being able
to cry. Nurses stated that crying could be seen as incompetence and they felt it could damage
their professional credibility. The coping mechanisms that were used by the nurses were talking
to colleagues, emotional escape and limiting their emotional connections with their patients.
According to this study it is recommended that hospitals offer support networks and training
programs to help address the emotional strains that nurses are experience with perinatal losses.
Cricco-Lizza, R. (2014). The need to nurse the nurse: emotional labor in neonatal
intensive care. Qualitative Health Research, 24(5), 615-628.
doi:10.1177/1049732314528810
In this 14-month ethnographic study researchers reviewed the coping mechanisms utilized by
level IV neonatal intensive care unit nurses (NICU), 114 participants discussed what helped them
survive the psychological strain of their position. The study identified nine successful coping
strategies; talking with the sisterhood of nurses, being a super nurse, using social talk and humor,
taking breaks, offering flexible aid, withdrawing from emotional pain, transferring out of the
NICU, attending memorial services, and reframing loss to find meaning in work. It suggests that
these strategies can be helpful in any and all healthcare departments that often present a high

3. THE FORGOTTEN GRIEVERS 3
stress work environment. The nurses that responded to this study did not incorporate all of the
mentioned strategies but agreed that they were aware of nurses that fit into each one of these
coping mechanism realms. All of which lead to improved job satisfaction, quality of care, and
lessened burnout cases within the NICU.
Friedman, T. C., & Bloom, A. M. (2012). When death precedes birth: experience of a
palliative care team on a labor and delivery unit. Journal Of Palliative Medicine, 15(3),
274-276. doi:10.1089/jpm.2011.0269
In the article it discusses the importance of needing an inter-disciplinary palliative care team on
staff at every hospital. There was a found deficit on the labor and delivery unit that was
originally not anticipated. The purpose this type of care team would be to offer help and support
to the staff while caring for a case that involves any sort of death. With the teams advanced
knowledge of palliative cases, they carry along with them higher levels of assessment,
interventions and follow-up care. All of which can enhance the care for patients and staff. The
team is equipped to provide exemplary care that involves grief, loss and bereavement educational
support. Further research needs to be done to support the conclusion of this article but the
recommendation still stands to be beneficial and assists in providing competent care in demise
cases.
Heazell, A. P., Leisher, S., Cregan, M., Flenady, V., Frøen, J. F., Gravensteen, I. K., & ...
Erwich, J. M. (2013). Sharing experiences to improve bereavement support and clinical
care after stillbirth: report of the 7th annual meeting of the International Stillbirth

4. THE FORGOTTEN GRIEVERS 4
Alliance. Acta Obstetricia Et Gynecologica Scandinavica, 92(3), 352-361.
doi:10.1111/aogs.12042
While this article investigates the need for bereavement support for every party involved with a
stillbirth, the part of the article that focuses on the impact on the healthcare providers is what is
vital for the study. Referenced in the article is a training package that has shown to be highly
successful that is offered at King Edward Memorial Hospital in Western Australia and is
sponsored by the Greif and Loss Advisory Council. There are various modules taught
throughout the program including, family, physical, cultural, psychosocial, and most importantly
self care. The self-care portion teaches healthcare professionals the importance of recognizing
the signs of “burn-out,” and how to properly balance both personal and work stressors. In
closing the article suggests that the along with the training packages, it is imperative to have
continued education on how to cope with the emotional burden of being a provider to such a
vulnerable population.
Kelley, M. C., & Trinidad, S. B. (2012). Silent loss and the clinical encounter: Parents'
and physicians' experiences of stillbirth-a qualitative analysis. BMC Pregnancy And
Childbirth, 12137. doi:10.1186/1471-2393-12-137
This study is a qualitative analysis that gathered data from three semi-structured focus groups.
One group represented the parents who experienced a stillbirth in a hospital and the other two
groups were obstetrician-gynecologists (OB) that assisted in a stillbirth delivery. The results of
the analysis revealed the need for improvement of how care is managed in stillbirth cases.
According to the study, an estimated 70 stillbirths occur each day, which equates to an average
of 25,000 per year in the United States alone. This represents a population in healthcare that is

5. THE FORGOTTEN GRIEVERS 5
being underserved. It was identified that the hospital environment for stillbirth deliveries may
need to be diverted to a semi-solo unit that is not attached to labor and delivery. Also there
needs to be a greater push toward education for medical professionals on the management of
stillbirth cases because as of now the majority of OB physicians feel ill prepared to support their
patients and their families. Mental health support is another critical field that needs attention
during a crisis such as this for both the healthcare team and the families they serve.
Muliira, R. S., & Bezuidenhout, M. C. (2015). Occupational exposure to maternal death:
psychological outcomes and coping methods used by midwives working in rural areas.
Midwifery, 31(1), 184-190. doi:10.1016/j.midw.2014.08.005
Midwives’ occupational exposure to maternal death is the subject that this article focused on. In
this study over 94% of the participants had witnessed a maternal demise, and through the use of
the Death Distress Scale it was determined that their experiences caused significant
psychological effects to their psyche. Of the 238 midwives that were surveyed, it was found that
93% of them had moderate to high death anxiety and more than 53% experienced some type of
mild death depression. The recommendation that came from this study was the need to offer
respite care, education on coping and counseling after the exposure to death to the healthcare
team assigned to the case. According to the study, if the midwives do not get the psychological
support they needed, it could cause a negative effect on their well being and in turn be
detrimental to their professional quality of life and clinical practice.
Noizet-Yverneau, O., Deschamps, C., Lempp, F., Daligaut, I., Delebarre, G., David, A.,

6. THE FORGOTTEN GRIEVERS 6
&Bednarek-Weirauch, N. (2013). [Memory boxes in the neonatal period: caregivers'
opinions after 1 year of practice]. Archives De Pédiatrie: Organe Officiel De La Sociéte
Française De Pédiatrie, 20(9), 921-927. doi:10.1016/j.arcped.2013.06.003
This study investigated the benefits of memory boxes that hospitals provide to families who have
experienced neonatal death. The hospital staff puts the boxes together, and individuals that have
no affiliation with the hospital normally donate the supplies for the boxes. A survey containing
fourteen questions was the tool used to collect the data for the study. The healthcare
professionals and families that were involved with neonatal death were the participants of the
study. It was determined by the results of this study that the memory boxes were much more
therapeutic for the families but were not that beneficial for the healthcare professionals or
caregivers. It also needs to be understood that this is the first study of its kind; further research
needs to be conducted to solidify the findings.
Padrón Acosta, L. (2014). [Different ways of coping the death of nursing students and
professionals]. Revista De Enfermería (Barcelona, Spain), 37(1), 26-29.
This article compared over eighty-four different studies on the primary exposure to death as a
student nurse versus being exposed as a nursing professional. They were in search of evidence to
confirm that being exposed to patient death was beneficial for student nurses and would only
strengthening their future practice in nursing. Of the original studies only sixteen were selected
to be reviewed in this analysis. The results showed that there was a positive correlation between
student nurse exposure to patient death and the ability to handle and cope more effectively as a
licensed nurse in the future. In addition they also found that there was a disconnect at the
university level and it was apparent that the education surrounding patient death was insufficient.

7. THE FORGOTTEN GRIEVERS 7
Wallbank, S., & Robertson, N. (2013). Predictors of staff distress in response to
professionally experienced miscarriage, stillbirth and neonatal loss: a questionnaire
survey. International Journal Of Nursing Studies, 50(8), 1090-1097.
doi:10.1016/j.ijnurstu.2012.11.022
A questionnaire survey was offered to over 189 various healthcare providers who had met the
requirements of the study. The requirements were that they needed to be currently working in an
obstetric and gynecologic healthcare setting and have had to been involved with a neonatal
demise case within eighteen months from the survey date. 161 of the selected participants
responded and their responses were evaluated according to the Impact of Event Scale (IES). The
IES is a clinical tool that is used to measure subjective distress in patients after a specific
stressful event. Prior to this study the IES was mainly used for patients who were suffering from
PTSD. The results of the IES revealed that 55% of the participants reported “high” levels of
distress and an additional 24% were reported to have “moderate” levels after their experience
related to fetal loss. The results of the study showed that formal training on coping does not
appear to be very protective and that more attention needs to be put towards acknowledging the
stressors and the focus need to be more towards restorative measures almost immediately after
the sentinel event. The study also indicated that the more experience a healthcare professional
has with loss the more adapted their coping skills are apt to be.
Wool, C. (2015). Clinician perspectives of barriers in perinatal palliative care. MCN. The
American Journal Of Maternal Child Nursing, 40(1), 44-50.
doi:10.1097/NMC.0000000000000093

8. THE FORGOTTEN GRIEVERS 8
The American Journal of Maternal/Child Nursing published this article that focused on the
barriers in perinatal palliative care (PPC). The study surveyed a total of two hundred and twelve
clinicians who had had experience with caring for at least one family’s fetal lose. The study
concluded that the largest barriers in PPC were education and support that’s offered for the
physicians, certified nurse midwifes, and nurses alike. It is thought that if a PPC team was built
with all three types of providers, they could be trained and better prepared to assist with
palliative care. With each team there would be an assigned coordinator of care who would be in
charge of arranging team meetings, manage referrals, and optimize the continuity of care that
surpasses far beyond discharge. A model of care such as this appears to be a more suitable
solution that benefits both the families and the healthcare providers.

9. THE FORGOTTEN GRIEVERS 9
References
Chen, F., & Hu, W. (2013). [The impact of perinatal death on nurses and their coping
strategies]. Hu Li Za Zhi The Journal Of Nursing, 60(1), 87-91. doi:10.6224/JN.60.1.87
Cricco-Lizza, R. (2014). The need to nurse the nurse: emotional labor in neonatal
intensive care. Qualitative Health Research, 24(5), 615-628.
doi:10.1177/1049732314528810
Friedman, T. C., & Bloom, A. M. (2012). When death precedes birth: experience of a
palliative care team on a labor and delivery unit. Journal Of Palliative Medicine, 15(3),
274-276. doi:10.1089/jpm.2011.0269
Heazell, A. P., Leisher, S., Cregan, M., Flenady, V., Frøen, J. F., Gravensteen, I. K., & ...
Erwich, J. M. (2013). Sharing experiences to improve bereavement support and clinical
care after stillbirth: report of the 7th annual meeting of the International Stillbirth
Alliance. Acta Obstetricia Et Gynecologica Scandinavica, 92(3), 352-361.
doi:10.1111/aogs.12042
Kelley, M. C., & Trinidad, S. B. (2012). Silent loss and the clinical encounter: Parents'
and physicians' experiences of stillbirth-a qualitative analysis. BMC Pregnancy And
Childbirth, 12137. doi:10.1186/1471-2393-12-137
Muliira, R. S., & Bezuidenhout, M. C. (2015). Occupational exposure to maternal death:
psychological outcomes and coping methods used by midwives working in rural areas.
Midwifery, 31(1), 184-190. doi:10.1016/j.midw.2014.08.005
Noizet-Yverneau, O., Deschamps, C., Lempp, F., Daligaut, I., Delebarre, G., David, A.,

10. THE FORGOTTEN GRIEVERS 10
&Bednarek-Weirauch, N. (2013). [Memory boxes in the neonatal period: caregivers'
opinions after 1 year of practice]. Archives De Pédiatrie: Organe Officiel De La Sociéte
Française De Pédiatrie, 20(9), 921-927. doi:10.1016/j.arcped.2013.06.003
Padrón Acosta, L. (2014). [Different ways of coping the death of nursing students and
professionals]. Revista De Enfermería (Barcelona, Spain), 37(1), 26-29.
Wallbank, S., & Robertson, N. (2013). Predictors of staff distress in response to
professionally experienced miscarriage, stillbirth and neonatal loss: a questionnaire
survey. International Journal Of Nursing Studies, 50(8), 1090-1097.
doi:10.1016/j.ijnurstu.2012.11.022
Wool, C. (2015). Clinician perspectives of barriers in perinatal palliative care. MCN. The
American Journal Of Maternal Child Nursing, 40(1), 44-50.
doi:10.1097/NMC.0000000000000093