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Aim: To explore critical care nurses' perceptions of bereavement nursing care in critical care settings at a tertiary hospital in Singapore. Background: Grief and bereavement are stressful life experiences associated with significant health problems. Critical care nurses play important roles in supporting bereaved family members, and their self‐competence affects the quality of the care they deliver. Exploring critical care nurses' perceptions of bereavement nursing care is thus essential. Methods: An exploratory descriptive qualitative study design was adopted. A total of 16 nurses were recruited. One‐on‐one interviews were conducted using a semi‐structured interview guide and were audio‐recorded. The data collected were analysed using thematic analysis. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. Findings: Five themes surfaced in the study, namely, family responses, holistic care, psychological impact, self‐competence and organisational dynamics. Conclusion: This study highlighted the key roles of critical care nurses in providing bereavement care, how their self‐competence impacts care delivery and the significant impacts of organisational policies on their capacity to provide care. Implications for nursing and nursing policy: Nursing administrators should provide enhanced organisational support to critical care nurses who provide bereavement nursing care, and implement training work plans to ensure nurses are adequately prepared to provide culturally appropriate care. Strategies should be introduced to reduce administrative burden, expand the role of critical care nurses in providing bereavement nursing care, and establish and enlist role models as drivers of bereavement nursing care. [ABSTRACT FROM AUTHOR]

Bereavement care practice guidelines assist in delivering high-quality bereavement care. However, the quality of published guidelines is unknown. A systematic review was conducted to identify and evaluate the quality of the process used to develop bereavement care practice guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. A keyword search was conducted in MEDLINE-Complete, CINAHL-Complete, Health-Source (Nursing/Academic Edition), Psychology and Behavioral Sciences Collection, and an internet search engine in October 2017. Sixteen guidelines with differing scope and purpose but similar core values were identified from the grey literature and then appraised at high quality (n = 1), moderate quality (n = 4), or low quality (n = 11). The domains "clarity of presentation" and "scope and purpose" achieved the highest scores (mean ± SD 71.0 ± 27.6% and 64.4 ± 37.5%, respectively), while "editorial independence" showed the lowest mean score (9.2 ± 13.3%). While few of the bereavement care practice guidelines met the AGREE II quality standards related to their development process, neither the quality of the content of each guideline nor the in-context application was assessed by the AGREE II instrument. Ongoing development of practice guidelines may benefit from consideration and application of the framework outlined in the AGREE II or similar appraisal instrument., (© 2019 John Wiley & Sons, Ltd.)

People bereaved through road traffic accidents (RTAs) are at risk for severe and disabling grief (i.e., pathological grief). Knowledge about needs and use of bereavement care, including psychotherapy, pharmacotherapy, and support groups, is limited. This study charted (correlates of) the needs and use of bereavement care in RTA bereaved people. Furthermore, although online grief treatment seems effective, it is unknown whether it is perceived as acceptable. Accordingly, we examined the acceptability of online treatment. Dutch RTA bereaved adults (N = 273) completed self‐report measures about needs and use of bereavement care, acceptability of online grief treatment, and pathological grief. Regression analyses were used to identify correlates of care needs and use and acceptability of online treatment. The majority (63%) had received help from psychotherapy, pharmacotherapy, and/or support groups. One in five participants had not used bereavement care services, despite reporting elevated pathological grief levels and/or expressing a need for care, pointing to a treatment gap. Use of psychological support before the loss was the strongest predictor of bereavement care needs and use following the loss. A minority (35%) reported being inclined to use online grief treatment if in need of support. More openness towards online services was related to greater acceptability of online treatment. In conclusion, 20% of RTA bereaved people with pathological grief or care needs had not received care. This treatment gap may be reduced by improving accessibility of online treatments. However, as only 35% was open to using online treatments, increasing the acceptability of (online) treatments appears important. [ABSTRACT FROM AUTHOR]

Purpose: To understand the lived experience of mothers surrounding the time of being informed of neonatal deaths in intensive care units. Design: A phenomenological qualitative approach was employed. Methods: Twelve mothers (age 24–41 years) were identified from the neonatal mortality records of two large neonatal intensive care units with high neonate turnover rates in Amman, Jordan. Data were collected using semistructured interviews with the participants. Interpretive phenomenology was used to generate themes regarding the essence of the mother's experience. Results: Critical analyses of mothers' accounts revealed three major themes: (a) Minimize the hurt, which described how mothers intuited overprotection by their families while the news was conveyed indirectly to them; (b) The striking reality of death, which captured mothers' distressing experiences while realizing the loss of their neonates; and (c) Farwell my baby, which accentuated mothers' needs and experiences while neonates' bodies were honored and prepared for burial per the cultural norms in Jordan. Practice Implications: Our findings highlighted the complex dynamics of familial interactions and cultural influences on mothers' bereavement experiences at the time of neonatal death. The grieving mothers expressed unfulfilled needs of receiving professional bereavement support at the time of neonatal death. Strategies are needed to optimize the supportive role of specialized nurses in providing family‐centered bereavement care to mothers and their families who experience neonatal death. [ABSTRACT FROM AUTHOR]

Background: Despite technological advances and specialist training of neonatal teams, perinatal deaths still occur. Such events are traumatic experiences for the parents and increase the risk of pathological grieving. Nursing is one of the main sources of support. However, the important work of nurses in these situations is made more difficult by the lack of recognized strategies that can be implemented to assist parents and family members in the bereavement process. Aim: Identify nursing interventions to help parents of neonates admitted to neonatal intensive care units cope with perinatal loss. Methods: A scoping review based on the methodological framework established by Arksey and O'Malley was used. A total of 327 relevant studies were identified through a bibliographic search in Pubmed, CINAHL Plus, APA PsycNET and Scopus between 2000 and 2019. The screening process included an initial analysis of the relevance of the abstract and, when required, an extensive review of the full paper. Results: A total of 9 papers were finally selected which responded to the research question. All nine papers are from the USA and have different methodological characteristics. A number of effective interventions were identified, including legacy creation, support groups, family‐centred accompaniment and follow‐up, parental involvement in pre‐mortem care, intergenerational bereavement programmes, and the use of technological and spiritual resources. Conclusion: In general, the scant evidence that is available about nursing interventions around perinatal bereavement care underlines the requirement to thoroughly assess the effectiveness of those that have already been designed and implemented. Implications for nursing practice and policy: This scoping review contributes to the potential implementation of effective interventions to deal with and help parents and family members cope with perinatal bereavement, with nursing staff as the main source of support and leading interventions which have family members in the care team. This review also makes a substantial contribution to the development of a practical and evidence‐based clinical guide for nursing, with recommendations that can be adapted to effective quality care criteria. It is additionally intended to encourage visibility in health policies of care and attention to perinatal grief in neonatal intensive care units. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objectives Search Strategy and Selection Criteria Data Collection and Analysis Main Results Conclusions Ninety‐eight percent of neonatal deaths worldwide occur in low‐ and middle‐income countries (LMICs), yet there is little bereavement care guidance available for these settings.To explore parents', families' and healthcare professionals' experiences of care after neonatal death in healthcare facilities in LMICs.Four databases were searched for peer‐reviewed literature, meeting the inclusion criteria of qualitative studies exploring the experiences of people who provided or received bereavement care following neonatal death in a LMIC healthcare setting.Data were collected by two independent reviewers, collated through line‐by‐line coding and then reciprocal and refutational translation, and analysed through Noblit and Hare's seven‐step meta‐ethnography approach to create first‐, second‐ and third‐order themes.Seven first‐order themes extracted from the literature included emotional responses, social relationships, staff and systems, religion, connecting with the baby, coping strategies and economic concerns. From these data, three third‐order themes arose: The individual, the healthcare setting and the community/context.Overarching themes in bereavement care shape grief responses and are often similar across geographical locations. Analysing these similarities allows a deeper understanding of the important elements of bereavement care and may be helpful to inform the creation of high‐quality, bereavement care guidelines suitable for use in LMIC settings. [ABSTRACT FROM AUTHOR]

Background: A child's death affects not only family members but also the health‐care professionals involved in patient care. The education system for bereavement care in Japan, however, is not set up in a systematic way, and the care provided is based on the individual experience of the health‐care professional. The aim of this study was to investigate pediatrician awareness of and actual circumstances involved in bereavement care in Japan. Methods: A qualitative descriptive study was conducted at four facilities in Japan. Data collected using semi‐structured interviews of 11 pediatricians were assessed using inductive qualitative analysis. Results: Pediatrician recognition of the elements of bereavement care was categorized as follows: (i) developing relationships with families before a child's death is important in bereavement care; (ii) after the child dies, family involvement is left to the doctor's discretion; (iii) coping with a child's death myself through past experience is essential; (iv) doctors involved in a child's death also experience mental burden; and (v) a system for the family's bereavement care must be established. Two categories were established according to actual circumstances involved in bereavement care: (i) attention must be given to the emotions of the families who lost a child; and (ii) doctor involvement with bereaved families depends on doctor awareness and expertise. Conclusion: Japanese pediatricians provided bereavement care to families who lost their children in a non‐systematic manner. This is necessitates improvement of the self‐care of health‐care professionals with regard to grief by improving bereavement care‐related education. Additionally, health‐care professionals must be trained, and a national‐level provision system must be established to provide high‐quality bereavement care to families who lose a child. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to assess the effectiveness of professional training in bereavement care. Method We mailed a questionnaire to 554 Japanese pediatricians. It asked about demographic characteristics, personal support experiences, professional training, psychological distress, recognition of high risk after a child's death, and eight items relating to awareness in bereavement care. We divided the subjects into two groups based on the presence or absence of professional training and compared them on the basis of each item (χ2 test), and conducted logistic regression analysis. Results Of the 239 respondents, 193 (80.8%) had performed bereavement care. The final number included in the analysis was 175, after excluding responses with missing data. A total of 46 respondents (26.3%) had attended bereavement care training. The subjects who had had training were more likely to recognize those at high risk for poor psychological recovery, have information about support groups, have a desire to study bereavement care, and understand the necessity of cooperation with mental health specialists. Conclusion Many pediatricians had personally provided support for the bereaved. On logistic analysis, it was considered that four factors (recognition of high risk for poor recovery, information about support, desire to study, and cooperation with professionals) were significantly associated with the professional training. There were no significant differences, however, in psychological distress, helplessness, and fatigue. Training programs related to stress management must be improved for pediatricians who feel high levels of psychological distress. [ABSTRACT FROM AUTHOR]

Background: Critical care consensus groups recommend providing bereavement support; however, little is known about what cardiac intensive care patients' families would find useful and beneficial in their grieving process. Aim and objectives: To describe cardiac intensive care unit (ICU) patients' families' opinions on six common components of a bereavement programme. Design: Qualitative, exploratory and descriptive. Methods: Families were recruited from a cardiac ICU 13‐15 months after their loved one's death. Families were interviewed using a semi‐structured questionnaire. The research team analysed interview transcripts to assess and categorize families' opinions on six bereavement components. Results: Twelve family members were interviewed. Most were female (n = 8, 67%), spouses (n = 10, 83%) and white (n = 10, 83%), with a mean age (SD) of 58.4 years (16.7). Families' overall opinions of the bereavement brochure were positive, stating it was helpful in providing information about the grieving process. Families described the sympathy card as "meaningful" and "touching," although they rated it neutral in providing comfort. Most participants felt that a follow‐up telephone call was unnecessary except to answer lingering questions they had. Many participants favoured the unit offering counselling services because they found therapy helpful in their grieving process. Participants had mixed feelings about a memory box; they believed it was an individual preference and should be handled in a sensitive manner. Most would not have attended a memorial service if offered because of traffic, distance, concerns about stressful feelings on returning to the hospital or because they already honoured their loved ones through a personalized memorial service. Conclusions: Participants varied in their opinions about what bereavement services may be useful; however, this study provides insight about services that cardiac critical care units may consider when adding bereavement support. Relevance to clinical practice: Family perspectives about bereavement needs can help structure services offered by critical care units. [ABSTRACT FROM AUTHOR]

Objective: To develop global consensus on a set of evidence-based core principles for bereavement care after stillbirth.Methods: A modified policy-Delphi methodology was used to consult international stakeholders and healthcare workers with experience in stillbirth between September 2017 and October 2018. Five sequential rounds involved two expert stakeholder meetings and three internet-based surveys, including a global internet-based survey targeted at healthcare workers in a wide range of settings.Results: Initially, 23 expert stakeholders considered 43 evidence-based themes derived from systematic reviews, identifying 10 core principles. The global survey received 236 responses from participants in 26 countries, after which nine principles met a priori criteria for inclusion. The final stakeholder meeting and internet-based survey of all participants confirmed consensus on eight core principles. Highest quality bereavement care should be enabled through training of healthcare staff to reduce stigma and establish respectful care, including acknowledgement and support for grief responses, and provision for physical and psychologic needs. Women and families should be supported to make informed choices, including those concerning their future reproductive health.Conclusion: Consensus was established for eight principles for stillbirth bereavement care. Further work should explore implementation and involve the voices of women and families globally. [ABSTRACT FROM AUTHOR]

Aims. To explore nurses’ attitudes towards perinatal bereavement care and to identify factors associated with these attitudes. Background. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and that nurses with positive attitudes to bereavement care can help bereaved parents to cope during their grieving period. Design. Survey. Method. Data were collected through a structured questionnaire; 657 nurses were recruited from Obstetrics and Gynaecology units in Hong Kong and Shandong during 2006. Outcome measures included attitudes towards perinatal bereavement care, importance of hospital policy and training support for bereavement care. Results. The majority of nurses in this study had a positive attitude to bereavement care. Results show that only 21·6% ( n = 141) of the nurses surveyed had bereavement-related training. In contrast, about 89·8% ( n = 300) believed they needed to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·5% ( n = 592) would share their experiences with their colleagues and seek support when feeling under stress. A regression model showed that age, past experience in handling grieving parents, recent ranking and nurses’ perceived attitudes to hospital policy and training provided for bereavement care were the factors associated with nurses’ attitudes to perinatal bereavement care. Conclusions. Nurses in both cities emphasised their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used by nursing educators to educate their students on issues related to delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula. [ABSTRACT FROM AUTHOR]

The article offers information on the challenges and opportunities in bereavement care and research in the intensive care unit (ICU). It mentions major concern towards providing appropriate support and care for end-of-life (EOL) patients and their family members for clinicians working in the highly technological environment of intensive care and also highlights the high risks of developing complicated grief symptoms after the death of a loved one in the ICU.

The article discusses about the aspect of bereavement care in intensive care unit (ICU) practice and critical care nursing. It looks at the importance of care to bereaved family members following patient death in ICUs, providing support to the families and helping them recover from bereavement, and the role of ICU nurses in bereavement care.

Objective: Bereaved patients are often seen in primary care settings. Although most do not require formal support, physicians may be called upon to provide support to some bereaved, particularly those with bereavement-related mental health disorders like complicated grief and bereavement-related depression. Research evidence on physician bereavement care is scant. We make recommendations for future research in this area. Design: Literature review focuses on studies conducted between 1996 and 2013 in the United States. Searches of Medline and PsychInfo, along with hand searches of reference sections, were conducted. Results: The limited existing research indicates substantial gaps in the research literature, especially in the areas of primary care physician skill and capacity, patient-level outcomes, and the quality of research methodology. No US studies have focused specifically on care for bereavement-related mental health disorders. We provide recommendations about how to improve research about primary care bereavement care. Conclusions: The primary care sector offers ample opportunities for research on bereavement care. With greater research efforts, there may be improvements to quality of bereavement care in primary care, in general, and also to the accurate detection and appropriate referral for bereavement-related mental health conditions. [ABSTRACT FROM AUTHOR]

Title. Nurses’ attitudes towards perinatal bereavement care. Aim. This paper is a report of a study conducted to explore the factors associated with nurses and midwives’ attitudes towards perinatal bereavement care. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. In some situations nurses may experience personal failure, feel helpless, and need to distance themselves from bereaved parents because they feel unable to deal with the enormity of the parental feelings of loss. Method. A correlational questionnaire study using convenience sampling was carried out in Singapore in 2007 with 185 nurses/midwives in one obstetrics and gynaecology unit. Results. Regression models showed that nurses/midwives with religious beliefs and those with more positive attitudes to the importance of hospital policy and training for bereavement care were statistically significantly more likely to have a positive attitude towards perinatal bereavement care. Nurses emphasized their need for increased knowledge and training on how to cope with bereaved parents and requested greater support from team members and the hospital. Conclusion. Bereavement counselling education and preceptorship supervision are recommended to reduce this stressful experience, increase the confidence and expertise of novices, and lead to increased quality of care for bereaved parents. [ABSTRACT FROM AUTHOR]

Aim. The purpose of this study was to explore nurses’ attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. Method. Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May–August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. Results. Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39·3% ( n = 130) of nurses had bereavement related training. By contrast, about 89·8% of nurses ( n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·0% ( n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses’ perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses’ attitudes towards perinatal bereavement care. Conclusions. Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively. [ABSTRACT FROM AUTHOR]

Linked article: This is a mini commentary on Bethany Atkins et al., pp. 1731–1739 in this issue. To view this article visit https://doi.org/10.1111/1471‐0528.17138 [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to explore the factors associated with nurses and midwives' attitudes towards perinatal bereavement care. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. In some situations nurses may experience personal failure, feel helpless, and need to distance themselves from bereaved parents because they feel unable to deal with the enormity of the parental feelings of loss. Method. A correlational questionnaire study using convenience sampling was carried out in Singapore in 2007 with 185 nurses/midwives in one obstetrics and gynaecology unit. Results. Regression models showed that nurses/midwives with religious beliefs and those with more positive attitudes to the importance of hospital policy and training for bereavement care were statistically significantly more likely to have a positive attitude towards perinatal bereavement care. Nurses emphasized their need for increased knowledge and training on how to cope with bereaved parents and requested greater support from team members and the hospital. Conclusion. Bereavement counselling education and preceptorship supervision are recommended to reduce this stressful experience, increase the confidence and expertise of novices, and lead to increased quality of care for bereaved parents. [ABSTRACT FROM AUTHOR]

Aim. The purpose of this study was to explore nurses' attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. Method. Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May-August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. Results. Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39.3% (n = 130) of nurses had bereavement related training. By contrast, about 89.8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88.0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses' perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses' attitudes towards perinatal bereavement care. Conclusions. Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively. [ABSTRACT FROM AUTHOR]

The needs of cancer patients' bereaved carers require attention. Although the majority of bereaved individuals manage to cope with their loss, a minority remain distressed and suffer serious prolonged disruption of their lives. The Yale Bereavement Study has revealed a specific syndrome, prolonged grief disorder. The diagnostic criteria of this disorder are outlined and several clinical illustrations are presented. Preliminary evidence suggests that cognitive-behaviour therapy (CBT) can be effective in the management of prolonged grief disorder. An example of the use of CBT is provided together with some useful clinical guidelines. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Stillbirth, the death of a baby before birth, is associated with significant psychological and social consequences that can be mitigated by respectful and supportive bereavement care. The absence of high‐level evidence to support the broad scope of perinatal bereavement practices means that offering a range of options identified as valued by parents has become an important indicator of care quality. This study aimed to describe bereavement care practices offered to parents across different high‐income and middle‐income countries. Methods: An online survey of parents of stillborn babies was conducted between December 2014 and February 2015. Frequencies of nine practices were compared between high‐income and middle‐income countries. Differences in proportions of reported practices and their associated odds ratios were calculated to compare high‐income and middle‐income countries. Results: Over three thousand parents (3041) with a self‐reported stillbirth in the preceding five years from 40 countries responded. Fifteen countries had atleast 40 responses. Significant differences in the prevalence of offering nine bereavement care practices were reported by women in high‐income countries (HICs) compared with women in middle‐income countries (MICs). All nine practices were reported to occur significantly more frequently by women in HICs, including opportunity to see and hold their baby (OR = 4.8, 95% CI 4.0‐5.9). The widespread occurrence of all nine practices was reported only for The Netherlands. Conclusions: Bereavement care after stillbirth varies between countries. Future research should look at why these differences occur, their impact on parents, and whether differences should be addressed, particularly how to support effective communication, decision‐making, and follow‐up care. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore nurses' attitudes towards perinatal bereavement care and to identify required support and training needs for nurses on bereavement care in Hong Kong. Data were collected through a structured questionnaire, and 110 nurses were recruited from the obstetrics and gynaecology unit in one of the largest public hospitals in Hong Kong. The majority of nurses held a positive attitude towards bereavement care. A significant difference in nurses' attitudes towards bereavement support was found in terms of demographics, practical experiences and training factors. The results showed that only 25.5% (n = 28) of nurses had bereavement-related training. In contrast, 90.9% of nurses showed a positive response to grief training and 90.0% would share experiences with colleagues and seek support when feeling under stress. The findings also suggest that nurses' attitudes towards bereavement care are positively correlated with bereavement care training needs (r = 0.53) and hospital policy support (r = 0.55). Hong Kong nurses' attitudes towards perinatal care emphasized their need for increased knowledge and experience, improved communication skills, and greater support from team members and the hospital. These findings may be used for Hong Kong health care professionals to improve support of nurses, to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula. [ABSTRACT FROM AUTHOR]

Objective: To explore the healthcare experiences of parents whose baby died either before, during or shortly after birth between 20+0 and 23+6  weeks of gestation in order to identify practical ways to improve healthcare provision.Design: Qualitative interview study.Setting: England through two parent support organisations and four NHS Trusts.Sample: A purposive sample of parents.Methods: Thematic analysis of semi-structured in-depth narrative interviews.Main Outcome Measures: Parents' healthcare experiences.Results: The key overarching theme to emerge from interviews with 38 parents was the importance of the terminology used to refer to the death of their baby. Parents who were told they were 'losing a baby' rather than 'having a miscarriage' were more prepared for the realities of labour, the birth experience and for making decisions around seeing and holding their baby. Appropriate terminology validated their loss, and impacted on parents' health and wellbeing immediately following bereavement and in the longer term.Conclusion: For parents experiencing the death of their baby at the margins between miscarriage, stillbirth and neonatal death, ensuring the use of appropriate terminology that reflects parents' preferences is vital. This helps to validate their loss and prepare them for the experiences of labour and birth. Reflecting parents' language preferences combined with compassionate bereavement care is likely to have a positive impact on parents' experiences and improve longer-term outcomes.Tweetable Abstract: Describing baby loss shortly before 24 weeks of gestation as a 'miscarriage' does not prepare parents for labour and birth, seeing their baby and making memories. [ABSTRACT FROM AUTHOR]

Background: Evidence to guide intrapartum care when an unborn baby has died is limited. Aims: To explore parents' experiences of care during labour of an antepartum stillbirth. Materials and Methods: Semi‐structured interviews with 18 bereaved parents from across Australia. Content analysis was conducted. Findings: Two broad themes were identified: 'explaining every step' and 'helping us feel like parents.' Sub‐themes under the first broad theme, 'explaining every step', were 'how and when information was given' and 'what happens next.' 'Like any other parent', 'feeling the pain' and 'everything is clouded' were sub‐themes of the second broad theme. These findings mapped to current Australian clinical practice guidelines for bereavement care around stillbirth and neonatal death, ie good communication, recognition of parenthood, shared decision making and effective support. Conclusions: This study on parents' experiences of labour with a fetal death in utero brings an important perspective to intrapartum care for this group. As far as we are aware, this study is the first to focus solely on this aspect of care. Our findings could be readily mapped to the four perinatal bereavement care goals. Parents wanted care providers to facilitate their choices, their sense of control, their autonomy and their agency. They wanted to feel that they had received the 'best' care available. [ABSTRACT FROM AUTHOR]

An introduction is presented which topics including bereavement care in the intensive care unit (ICU); exploring the elements, organisational model and evaluation of critical care bereavement services in countries in Europe ; and descriptive qualitative study among non-Muslim nurses working in ICU.

Objective: Parent engagement in perinatal mortality review meetings following stillbirth may benefit parents and improve patient safety. We investigated perinatal mortality review meeting practices, including the extent of parent engagement, based on self‐reports from healthcare professionals from maternity care facilities in six high‐income countries. Design: Cross‐sectional online survey. Setting: Australia, Canada, Ireland, New Zealand, UK and USA. Population: A total of 1104 healthcare professionals, comprising mainly obstetricians, gynaecologists, midwives and nurses. Methods: Data were drawn from responses to a survey covering stillbirth‐related topics. Open‐ and closed‐items that focused on 'Data quality on causes of stillbirth' were analysed. Main outcome measures: Healthcare professionals' self‐reported practices around perinatal mortality review meetings following stillbirth. Results: Most clinicians (81.0%) were aware of regular audit meetings to review stillbirth at their maternity facility, although this was true for only 35.5% of US respondents. For the 854 respondents whose facility held regular meetings, less than a third (31.1%) reported some form of parent engagement, and this was usually in the form of one‐way post‐meeting feedback. Across all six countries, only 17.1% of respondents described an explicit approach where parents provided input, received feedback and were represented at meetings. Conclusions: We found no established practice of involving parents in the perinatal mortality review process in six high‐income countries. Parent engagement may hold the key to important lessons for stillbirth prevention and care. Further understanding of approaches, barriers and enablers is warranted. Parent engagement in mortality review after stillbirth is rare, based on data from six countries. We need to understand the barriers. Parent engagement in mortality review after stillbirth is rare, based on data from six countries. We need to understand the barriers. [ABSTRACT FROM AUTHOR]

Objective: This qualitative study sought to obtain feedback from stakeholder cancer caregivers and bereaved family members on the implementation of bereavement risk screening in oncology. Methods: Semi‐structured interviews were conducted with 38 family members of patients with advanced cancer (n = 12) and bereaved family members (n = 26) on when and how to effectively implement bereavement risk screening. Data were analyzed using thematic analysis. Results: Many participants indicated that they would be open to completing a self‐report screening measure before and after the patient's death. Several suggested screening at multiple timepoints and the importance of follow‐up. Participants viewed screening as an opportunity to connect to psychosocial support. Conclusions: The findings suggest that family members appear supportive of sensitively approached bereavement risk screening before and after a patient's death as an important component of quality psychosocial care. To optimize implementation, bereavement risk screening would involve screening at multiple timepoints and include follow‐up. Findings suggest standardized risk screening using a brief, validated self‐report tool would be a pragmatic approach to increasing access to bereavement care. [ABSTRACT FROM AUTHOR]

Introduction: Perinatal loss can be a devastating experience for parents that can result in complicated grief symptoms that include depression, anxiety, and posttraumatic stress. Perinatal bereavement care pathways have been developed internationally within health care services; however, there is an apparent lack of recommendations and guidance on grief‐focused interventions specifically for complicated perinatal grief. Studies have analyzed the effectiveness of cognitive behavioral therapy (CBT) for perinatal grief, and more recent research has emerged on the use of mindfulness‐based interventions (MBIs) for perinatal grief symptoms. The purpose of this study was to conduct a systematic review and present the effectiveness of CBT and MBIs for perinatal grief, to report patient experiences of the interventions, and to determine which intervention can be more effective in managing symptoms of complicated perinatal grief. Methods: A systematic search was conducted of 5 academic databases: PsycINFO, CINAHL, MEDLINE, Social Science, and ASSIA. No limits on publication date, language, or geographic location were set because of the paucity of research published on this subject. Quality appraisal was conducted for each included study. Findings are reported in accordance with the PRISMA statement. Results: This systematic review identified 8 eligible studies with a total of 681 bereaved participants. The results were examined for effectiveness of CBT and MBIs for grief; effectiveness of CBT and MBIs for depression, anxiety, and posttraumatic stress; and participant experiences. Both interventions produced favorable reductions of perinatal grief symptoms, depression, and posttraumatic stress. However, a true comparison between the 2 interventions' effect on complicated perinatal grief symptoms could not be made because of the limited studies in this area and the heterogeneity of the included studies' methods and outcomes. Discussion: Both MBIs and CBT interventions can be effective in reducing symptoms of complicated perinatal grief. The findings of this review are heavily weighted in quantitative outcome measurements. More qualitative research and randomized controlled trials with larger sample sizes are needed in this area of perinatal bereavement care. [ABSTRACT FROM AUTHOR]

Millions of people worldwide are mourning the loss of loved ones due to the COVID‐19 epidemic, which may adversely impact their mental health. This meta‐analysis aimed to investigate pandemic grief symptoms and disorders for developing policy, practice, and research priorities. The databases of Cochrane, Embase, Ovid‐MEDLINE, WHO COVID‐19, NCBI SARS‐CoV‐2, Scopus, Web of Science, CINAHL, and Science Direct were comprehensively searched until July 31, 2022. The Joanna Briggs Institute's and Hoy's criteria were used to evaluate the studies. A pooled prevalence was presented in a forest plot figure with a corresponding 95% confidence interval (CI) and prediction interval. Between‐study heterogeneity was measured using the I2 and Q statistics. Variations in the prevalence estimates in different subgroups were examined by moderator meta‐analysis. The search identified 3677 citations, of which 15 studies involving 9289 participants were included in the meta‐analysis. The pooled prevalence rate of grief symptoms was 45.1% (95%CI: 32.6%–57.5%), and grief disorder was 46.4% (95%CI: 37.4%–55.5%). Grief symptoms were significantly higher in <6 months (45.8%; 95%CI: 26.3%–65.3%) compared to the period of more than 6 months. Unfortunately, moderator analyses for grief disorders could not be performed due to limited studies. The prevalence of grief problems during the pandemic was substantially higher than in non‐pandemic conditions; therefore, it is crucial to strengthen bereavement support to reduce psychological distress. The results provide a foundation for nurses and healthcare workers to anticipate a heightened need for support and provision of bereavement care in the post‐pandemic era. [ABSTRACT FROM AUTHOR]

Background: A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which have been identified as an important research priority. Objectives: To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. Search strategy: Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. Selection criteria: Randomised and non‐randomised comparative or non‐comparative studies reporting a stillbirth care intervention. Data collection and analysis: Interventions, outcomes reported, definitions and outcome measurement tools were extracted. Main results: Forty randomised and 200 non‐randomised studies were included. Fifty‐eight different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). A total of 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. A total of 242 outcome measurement instruments were used, with 0–22 tools per outcome. Conclusions: Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research. [ABSTRACT FROM AUTHOR]

Background: Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement.Objective: To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs.Search Strategy: Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL.Selection Criteria: Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs.Data Collection and Analysis: Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES).Main Results: In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth.Conclusions: Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately.Tweetable Abstract: Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs. [ABSTRACT FROM AUTHOR]

Objective To explore the personal and professional impact of stillbirth on consultant obstetrician gynaecologists. Design Semi-structured in-depth qualitative interviews. Setting A tertiary university maternity hospital in Ireland with a birth rate of c. 9000 per annum and a stillbirth rate of 4.6/1000. Sample Purposive sample of eight consultant obstetrician gynaecologists (50% of consultant obstetrician gynaecologists in the hospital). Methods Semi-structured in-depth interviews analysed by Interpretative Phenomenological Analysis. ( IPA) IPA is a methodology for exploring human experience and its meaning for the individual. Main outcome measures The lived experiences, personal feelings and professional impact of stillbirth on consultant obstetrician gynaecologists. Results Stillbirth was identified as amongst the most difficult experiences for consultants. Two superordinate themes emerged: the human response to stillbirth and the weight of responsibility. The human response to stillbirth was characterised by the personal impact of stillbirth for consultants and, in turn, how that shapes the care they provide. The weight of professional responsibility was characterised by the sense of professional burden and the possibility of a medico-legal challenge-mostly for those who are primarily gynaecologists resulting in the question 'what have I missed?'. Conclusions Despite the impact of stillbirth, no consultant has received formal training in perinatal bereavement care. This study highlights a gap in training and the significant impact of stillbirth on obstetricians, professionally and personally. The provision of support, ongoing education, bereavement training and self-care is recommended. Medico-legal concerns following stillbirth potentially impact on care, warranting further research. [ABSTRACT FROM AUTHOR]

A combination of mifepristone and a prostaglandin preparation should usually be recommended as the first-line intervention for induction of labour (Grade B). A single 200 milligram dose of mifepristone is appropriate for this indication, followed by: 24 +0 -24 +6 weeks of gestation - 400 micrograms buccal/sublingual/vaginal/oral of misoprostol every 3 hours; 25 +0 -27 +6 weeks of gestation - 200 micrograms buccal/sublingual/vaginal/oral of misoprostol every 4 hours; from 28 +0 weeks of gestation - 25-50 micrograms vaginal every 4 hours, or 50-100 micrograms oral every 2 hours [Grade C]. There is insufficient evidence available to recommend a specific regimen of misoprostol for use at more than 28 +0  weeks of gestation in women who have had a previous caesarean birth or transmural uterine scar [Grade D]. Women with more than two lower segment caesarean births or atypical scars should be advised that the safety of induction of labour is unknown [Grade D]. Staff should be educated in discussing mode of birth with bereaved parents. Vaginal birth is recommended for most women, but caesarean birth will need to be considered for some [Grade D]. A detailed informed discussion should be undertaken with parents of both physical and psychological aspects of a vaginal birth versus a caesarean birth [Grade C]. Parents should be cared for in an environment that provides adequate safety according to individual clinical circumstance, while meeting their needs to grieve and feel supported in doing so (GPP). Clinical and laboratory tests should be recommended to assess maternal wellbeing (including coagulopathy) and to determine the cause of fetal death, the chance of recurrence and possible means of avoiding future pregnancy complications [Grade D]. Parents should be advised that with full investigation (including postmortem and placental histology) a possible or probable cause can be found in up to three-quarters of late intrauterine fetal deaths [Grade B]. All parents should be offered cytogenetic testing of their baby, which should be performed after written consent is given (GPP). Parents should be advised that postmortem examination can provide information that can sometimes be crucial to the management of future pregnancy [Grade B]., (© 2024 Royal College of Obstetricians and Gynaecologists.)

Background We examined factors associated with positive consequences for family members who served as caregivers of terminal cancer patients. Methods We conducted a nationwide cross-sectional survey of 501 bereaved family members who served as caregivers for terminal cancer patients . The main outcomes were measured by the previously developed Caregiving Consequences Inventory, which assesses perceived rewards and burdens of caregiving. Results Bereaved family caregivers reported high levels of perceived rewards and burden. Among the characteristics of bereaved family members, older age, female gender, and having a religion were associated with some domains of perceived rewards, but being a spouse of a patient was negatively associated with some domains of perceived rewards. Caregiver depression or perceived burden did not affect positive consequences of caregiving. However, receiving bereavement care was significantly associated with positive outcome in all four perceived reward domains (sense of mastery [adjusted odds ratio {aOR} = 1.69; 95% CI, 1.05-2.70]; appreciation for others [aOR = 2.19; 95% CI, 1.27−3.76]; meaning in life [aOR = 1.80; 95% CI, 1.13-2.89]; and reprioritization about his/her life [aOR = 2.02; 95% CI, 1.27-3.19]). Conclusions Family caregivers of terminal cancer patients experience burdens, but caregiving also has positive consequences. This study has important implications for the development of bereavement interventions that aim to encourage positive outcomes and reduce negative outcomes for caregivers. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Despite stillbirth being identified as one of the most traumatic events a woman can experience, there is a lack of evidence on which to inform best practice in hospital and follow‐up care. Aims: The aim of this study was to identify which strategies are most valued by parents regarding care following stillbirth in order to improve the support and management of grieving families. Method: Mixed methods questionnaires were sent to bereaved participants of the Sydney Stillbirth Study. Questionnaires included a combination of fixed and open‐ended responses regarding two critical areas: the participant's hospital stay and their follow‐up care. We analysed the qualitative data using thematic analysis. Results: Of the 103 women who experienced a stillbirth, 36 responded to the questionnaire. Responders were more likely to have private obstetric care (odds ratio (OR) 4.7, 95% CI 1.7–12.7) and be tertiary educated (OR 6.2, 95% CI 2.3–16.8). Three key themes relating to hospital management of stillbirth were identified: the emotional response to grief, the educational importance of being guided through the grief process, and the environmental aspects of adequate time and appropriate physical space. Families preferred not to be seen in an antenatal setting for follow‐up. Conclusions: Simple key components of care including a sensitive and respectful approach, offering guidance as to creating memories, and arranging follow‐up care in a quiet and private environment are valued by families experiencing a stillbirth. Incorporating these into practice is achievable and could benefit both families and caregivers. [ABSTRACT FROM AUTHOR]

Objectives: Head and neck cancer surgeons frequently interact with dying patients with advanced disease and their families, but little is known about their bereavement practices after a patient's death. The aim of this study is to elucidate the frequency of common bereavement practices, cited barriers to bereavement, and predictive physician factors that lead to an increase in bereavement practices among head and neck cancer surgeons. Methods: A 20‐item survey was sent to 827 active surgeons of the American Head and Neck Society. Approval was obtained and the survey was distributed through the American Head and Neck Society. Demographics, frequency of common bereavement practices, empathy, and barriers were assessed. Multiple linear regression was performed to determine physician factors associated with more frequent bereavement follow‐up. Results: There were 156 respondents (18.9% response rate). Overall, surgeons were more likely to usually/always call (48.5%) or send a letter (42.4%) compared with other practices such as attending funerals (0%), offering family meetings (18.6%), or referring family members to counseling (7.7%). Many barriers were cited as being at least somewhat important: being unaware about a patient's death (67.3%) was the most cited, whereas 51.3% cited a lack of mentorship/training in this area. Scoring higher on empathy questions (P ≤.001) was associated with more frequent surgeon bereavement follow‐up with the family of deceased patients. Conclusion: There is substantial practice variation among surgeons suggesting a lack of consensus on their roles in bereavement follow‐up. Having higher empathy was predictive of higher engagement. Level of Evidence: NA Laryngoscope, 132:1971–1975, 2022 [ABSTRACT FROM AUTHOR]

Objective: To quantify parents' experiences of respectful care around stillbirth globally. Design: Multi‐country, online, cross‐sectional survey. Setting and population: Self‐identified bereaved parents (n = 3769) of stillborn babies from 44 high‐ and middle‐income countries. Methods: Parents' perspectives of seven aspects of care quality, factors associated with respectful care and seven bereavement care practices were compared across geographical regions using descriptive statistics. Respectful care was compared between country‐income groups using multivariable logistic regression. Main outcome measures: Self‐reported experience of care around the time of stillbirth. Results: A quarter (25.4%) of 3769 respondents reported disrespectful care after stillbirth and 23.5% reported disrespectful care of their baby. Gestation less than 30 weeks and primiparity were associated with disrespect. Reported respectful care was lower in middle‐income countries than in high‐income countries (adjusted odds ratio 0.35, 95% CI 0.29–0.42, p < 0.01). In many countries, aspects of care quality need improvement, such as ensuring families have enough time with providers. Participating respondents from Latin America and southern Europe reported lower satisfaction across all aspects of care quality compared with northern Europe. Unmet need for memory‐making activities in middle‐income countries was high. Conclusions: Many parents experience disrespectful care around stillbirth. Provider training and system‐level support to address practical barriers are urgently needed. However, some practices (which are important to parents) can be readily implemented such as memory‐making activities and referring to the baby by name. One in four experience disrespectful care after stillbirth. Parents want more time with providers and their babies, to talk and memory‐make. One in four experience disrespectful care after stillbirth. Parents want more time with providers and their babies, to talk and memory‐make. Linked article: This article is commented on by Mehali Patel, pp. 1740 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17146. Linked article: This article is commented on by Susannah H. Leisher, pp. 1741‐1742 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17157. [ABSTRACT FROM AUTHOR]

There is growing interest in psychological factors maintaining healthy functioning following adverse events. One such variable is a sense of coherence (SOC), an orientation to life comprising manageability, comprehensibility, and meaningfulness. Little research has examined the role of SOC in adjustment to bereavement. The present longitudinal study examined the role of SOC in recovery from loss, in a Danish sample (N = 221) of elderly spousally bereaved people. The aim was twofold. First, we aimed to establish the optimal measurement model of SOC, evaluating the fit of different factor solutions for the 29‐item SOC‐29 scale and 13‐item SOC‐13 scale, using confirmatory factor analysis. Second, we sought to examine associations of emerging SOC factors with symptoms levels of prolonged grief disorder (PGD) and depression, and with satisfaction with life, assessed concurrently (at 6 months post‐loss) and at two consecutive time points, 13 and 18 months post‐loss. Results showed that the three‐factor model of the SOC‐13 (with distinct manageability, comprehensibility, and meaningfulness factors) provided a good fit to our data. With respect to our second aim, analyses showed that the three SOC factors were associated with concurrently assessed PGD, depression, and satisfaction with life. In the analyses predicting outcomes at Wave 2 and Wave 3, meaningfulness (but not manageability and comprehensibility) predicted some of the outcomes, above and beyond baseline scores of the outcomes. Findings suggest that meaningfulness may increase healthy and attenuate unhealthy responses to loss. Helping bereaved people to experience life's demands as worthy of investment and engagement is likely an important target for bereavement care. [ABSTRACT FROM AUTHOR]

The International Classification of Diseases Eleventh Edition (ICD‐11), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM‐5‐TR), now include prolonged grief disorder (PGD). Since criteria for PGD in both classification systems differ from prior proposed grief disorders and each other, the validation of a single instrument to screen for prolonged grief (PG) symptoms of both new diagnoses is critical for bereavement research and care. Therefore, we evaluated the psychometric properties of the Swedish version of the Traumatic Grief Inventory Self‐Report Plus (TGI‐SR+). Two‐hundred and forty‐eight bereaved parents completed questions about sociodemographic and loss‐related variables, the TGI‐SR+, and symptom measures of post‐traumatic stress (PTS), depression and an older measure of PG symptoms, the Prolonged Grief Disorder‐13 (PG‐13). Confirmatory factor analyses showed that a one‐factor model best fit DSM‐5‐TR and ICD‐11 PG symptoms and the analyses of the internal consistency and inter‐item correlations showed that these symptoms could be reliably assessed. In support of convergent validity, DSM‐5‐TR and ICD‐11 PG symptoms correlated with symptoms of PTS, depression and PG assessed with the PG‐13. In support of known‐groups validity, DSM‐5‐TR and ICD‐11 PG symptoms were higher among lower educated (vs. higher educated) participants and related negatively to time since loss. ROC analyses showed optimal cut‐off score of ≥71 and ≥72 to determine probable caseness for DSM‐5‐TR and ICD‐11 PGD, respectively. Results support the reliability and validity of the Swedish TGI‐SR+ as a screening instrument for PG in research and bereavement care. [ABSTRACT FROM AUTHOR]

Objective: The PARENTS 1 study (Parents' Active Role and ENgagement in The review of their Stillbirth/perinatal death) found that parents would endorse the opportunity to give feedback into the perinatal mortality review (PNMR) process. In subsequent focus groups, healthcare professionals were positive about parental engagement, although they considered that there may be significant challenges. The objective of this study was to develop core principles and recommendations for parental engagement in PNMR in the UK.Methods: A two-round Delphi technique was followed to reach consensus on core principles for parental engagement in the PNMR process; Round 1 included a national consensus workshop and Round 2 an online questionnaire. The consensus meeting was attended by a national panel of stakeholders (clinical and academic experts, parent advocates, managers and commissioners) in stillbirth and neonatal and bereavement care. To develop recommendations for parental engagement, participants discussed four key areas comprising: communication with parents, including receiving feedback; the format of the PNMR meeting; the parental engagement pathway; and challenging aspects of engaging with parents in reviews. Content analysis was conducted to generate recommendations from the meeting for a subsequent anonymous web-based survey. Attendees of the consensus workshop and members of the PARENTS 2 Project Advisory Board were asked to rank recommendations using a 9-point Likert scale from 1 (not important) to 9 (critically important). It had been agreed a priori, in compliance with established Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria, that 'consensus' would be achieved if over 70% of participants scored the principle as 'critical' (score of 7-9) and fewer than 15% scored the principle as 'not important' (score of 1-3). Principles for which consensus was achieved were included in the core recommendations.Results: Of the 29 invited stakeholders, 22 participated in the consensus meeting and 25 (86% response rate) in the subsequent online questionnaire in June 2017. Consensus was agreed on 12 core principles. Of the 25 participants, 96% agreed that a face-to-face explanation of the PNMR process was of critical importance, 72% considered that parents should be offered the opportunity to nominate a suitable advocate, 92% believed that responses to parents' comments should be formally documented, 96% indicated that it was vital for action plans to be translated into lessons learnt and that this process should be monitored, and 100% of stakeholders voted that a plain-English summary should be produced for the parents following the meeting. There was good agreement on a further seven principles.Conclusions: Key national stakeholders were unanimously supportive of parental engagement in the PNMR process and agreed on core principles to make this process feasible, meaningful and robust. A 6-month pilot of parental engagement in the PNMR process (PARENTS 2 study) in two UK units took place after the consensus on core principles. In collaboration with the National Perinatal Epidemiology Unit, the findings will inform the national standardized PNMR tool. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

BACKGROUND: District nurses are frequently involved in the care of patients immediately prior to death and could therefore provide support to bereaved relatives. However, little is known about nurses' views on bereavement support or their actual involvement. AIMS OF THE STUDY: To survey a representative sample of district nurses to ascertain their current practice and perceived role in supporting bereaved people and to identify factors that influence their practice. DESIGN AND METHOD: A self-completed postal questionnaire was distributed anonymously to 522 district nurses in the central southern coastal area of Britain. It comprised five sections: interest in and education about bereavement; a Likert scale to measure nurses' views about bereavement care; information about the practice with which the nurse had links; bereavement care provided by the practice; and demographics. RESULTS: A 62% response rate was achieved following two reminders. Sixty-nine per cent reported having an interest in bereavement support. Logistic regression modelling identified older age of the nurse and district of employment as the best predictors of interest in bereavement, and older age of the nurse, district of employment and higher level of academic qualification (having a diploma or degree) as the best predictors of active follow-up bereavement visiting. Ninety five percent of district nurses believed their role should involve visiting bereaved relatives/carers of patients they have nursed, but only 19% believed they should visit bereaved people when the deceased was not their patient. CONCLUSIONS: Older age, higher qualifications and district of employment among district nurses were associated with greater interest in bereavement and more proactive care of bereaved people. The findings of this survey have important implications for the training, continued education and the extended role of the nurse in bereavement support. [ABSTRACT FROM AUTHOR]

Background Stillbirth is a profoundly distressing event. Little evidence exists to guide best practice bereavement care in the perinatal setting. Aims To document parents' experiences and outcomes in relation to seeing and holding a stillborn baby at a hospital with a specialist perinatal bereavement service. Materials and Methods Prospective cohort study of 26 mothers and 11 fathers who experienced a stillbirth at the Mater Mothers' Hospital, Brisbane from September 2007-December 2008. Mailed self-report questionnaires were completed at 6-8 weeks and 6 and 13 months postloss. Validated measures assessed regret regarding the decision to see and hold the baby, parental grief and mental health. Results Of 78 fetal deaths, 26 mothers and 11 fathers participated. Most (20 mothers; 9 fathers) chose to see and hold their stillborn infant. Little regret was reported, irrespective of the decision. For mothers, seeing and holding was associated with higher 'active grief' at 6-8 weeks (mean difference ( MD) = 10.5; 95% CI = 3.3-17.8; P < 0.01), 6 months ( MD = 8.0; 95% CI = 0.6-15.4; P = 0.03) and 13 months ( MD = 9.9; 95% CI = 1.8-17.9; P = 0.01), but not with 'not coping' or 'despair', or mental health. Fathers reported poorer mental health but small numbers mean estimates are imprecise. Conclusions More intense grief does not equate with poorer mental health for mothers who choose to see and hold a stillborn infant. Fathers' experiences warrant further study. Supported decision-making is important for bereaved parents, and rigorous evaluation of bereavement care is essential. [ABSTRACT FROM AUTHOR]

The article reviews the periodical "Bereavement Care."

I Sir i , We welcome the recent I BJOG i Perspectives article from Ravi and colleagues advocating for universal inclusion of stillbirth in UK medical school curricula and their thoughtful discussion about opportunities for medical students to contribute to perinatal bereavement care.[1] We support their conclusions and provide additional emphasis on two particular aspects of care after stillbirth: first, ensuring that care is culturally appropriate, and second, acknowledging the specific needs of fathers. Why stillbirth deserves a place on the medical school curriculum: Stillbirth-related teaching in UK medical schools. [Extracted from the article]

Objective: The aim of this study was to explore parents' experiences of their relationships and interactions with healthcare professionals (HCPs) during care related to prenatal diagnosis and termination of pregnancy for foetal anomaly (TOPFA). Methods: A qualitative approach was used. Participants included 33 parents (23 women and 10 men) from Northern Ireland (n = 11) and Ireland (n = 22) who had a TOPFA. Data collection methods included semi‐structured interviews and written narrative accounts. Data were analysed using thematic analysis. Results: Findings confirmed that TOPFA was a traumatic, life‐altering experience for parents, impacting their health and well‐being. The actions, behaviours and words of HCPs impacted how parents perceived and interpreted their healthcare experiences and their access to services and supports. In relation to this, five themes are presented: (1) the importance of compassionate and non‐judgemental care, (2) the value of effective information and communication, (3) the desire for compassionate care for baby and facilitation of memory making, (4) the need for continuity of care and (5) parents' experiences of healthcare relationships during times of legislative change. Conclusion: This research reveals the important role HCPs play in helping parents cope with prenatal testing and TOPFA. Parents who had a positive relationship with an HCP, in which information was communicated effectively and compassionate and non‐judgmental care was provided, felt more supported and more able to accept and adapt to their loss. Patient and Public Contribution: An advisory group composed of parents who had experienced TOPFA and HCPs with experience in caring for such families were involved in the study from the outset, contributing to the design and development of data collection materials, interpretation of the findings and design of dissemination materials. [ABSTRACT FROM AUTHOR]