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Objectives: Relatives of patients who died after euthanasia or physician-assisted suicide (EAS) might need (specific) aftercare. We examined if and how physicians provide aftercare to bereaved relatives of patients who died after EAS, and which patient-, physician- and process characteristics are associated with providing aftercare. Methods: A cross-sectional questionnaire study was conducted among 127 physicians (general practitioners, clinical specialists, and elderly care physicians) in the Netherlands. Associations were examined using multivariable logistic regression analyses. Results: Most physicians had had at least one follow-up conversation with bereaved relatives (77.2%). Clinical specialists less often provided aftercare compared to GPs. Also, aftercare was more often provided when the deceased had a cohabiting partner. Topics addressed during aftercare conversations included looking back on practical aspects of the EAS trajectory, the emotional experience of relatives during the EAS trajectory and relatives' current mental wellbeing. A minority of aftercare conversations led to referral to additional care (6.3%). Conclusion: Aftercare conversations with a physician covering a wide-range of topics are likely to be valuable for all bereaved relatives, and not just for "at risk" populations typically targeted by policies and guidelines. [ABSTRACT FROM AUTHOR]

Aim: To explore relatives' needs in terms of bereavement care during euthanasia processes, how healthcare providers respond to these needs, and the degree of commonality between relatives' and healthcare providers' reports. Design: A phenomenological design was employed, utilising reflexive thematic analysis to examine interviews conducted with relatives (N = 19) and healthcare providers (N = 47). Results: Relatives' needs throughout euthanasia processes are presented in five main themes and several subthemes, with similar findings between both sets of participants. Although relatives infrequently communicated their needs explicitly to healthcare providers, they appreciated it when staff proactively met their needs. Healthcare providers aimed to assist with the relatives' grief process by tending to their specific needs. However, aftercare was not consistently offered, but relatives did not have high expectations for professional follow‐up care. Conclusion: Our research offers important directions for healthcare professionals, empowering them to provide needs‐based bereavement care during euthanasia processes. Moreover, it emphasises the importance of recognising the unique needs of relatives and proactively addressing them in the period before the loss to positively contribute to relatives' grief process. Implications for the profession and/or patient care: Insights into relatives' needs in the context of euthanasia. Good practices on how healthcare providers can attend to relatives' needs before, during and after the loss Impact: Current literature and guidelines on needs‐based bereavement care in the context of euthanasia and, more generally, assisted dying, are limited. These findings provide concrete directions for practice in supporting (nearly) bereaved relatives in the context of euthanasia, potentially mitigating adverse health outcomes. Reporting method: Standards for Reporting Qualitative Research (SRQR checklist). Patient or Public contribution: Relatives of deceased cancer patients were involved in the conduct of the study. [ABSTRACT FROM AUTHOR]

Background: The death of a child is one of the most devastating events a family can face, resulting in significant physical and psychosocial morbidity. Bereavement support programs have been developed in high-income contexts to address this need. However, little is known about implementing bereavement programs in low-and middle-income countries (LMICs). Here, we describe the implementation of a bereavement program for parents whose children died due to cancer or other catastrophic illnesses. Methods: We conducted a retrospective analysis to describe the implementation of a hospital-based End of Life (EoL) care and bereavement program. This program was developed in several stages, including an assessment of bereaved families, development program guidelines, staff training, piloting of the program, refinement, and standardization. The program was developed between 2019 and 2021 in a nonprofit, teaching hospital and referral center for southwestern Colombia. Results: Several tools were developed as key components of the bereavement program: a virtual bereavement course; guidance for EoL and bereavement communication and care, memory making, and follow-up calls; a condolence letter template, and group support workshops. A total of 956 healthcare professionals were trained, 258 follow-up calls to bereaved parents were made, 150 individual psychological follow-ups to parents with complicated grief occurred, 79 condolence letters were sent, and 10 support group workshops were carried out. Challenges were identified and overcome, such as limited resources and staff, and cultural perceptions of death. In 2021, this program received an award by the hospital as the Best Strategy to Humanize Healthcare. Conclusions: This study highlights the feasibility of developing and implementing EoL and bereavement care programs for parents and families within hospitals in LMICs. Lack of resources, staff, and training are some of the identified challenges to implementation. Utilizing methodological tools allows us to identify facilitator factors and deliverable outcomes of our EoL and bereavement program. This model provides a valuable framework for resource-limited settings. [ABSTRACT FROM AUTHOR]

Abstract Background The death of a child is one of the most devastating events a family can face, resulting in significant physical and psychosocial morbidity. Bereavement support programs have been developed in high-income contexts to address this need. However, little is known about implementing bereavement programs in low-and middle-income countries (LMICs). Here, we describe the implementation of a bereavement program for parents whose children died due to cancer or other catastrophic illnesses. Methods We conducted a retrospective analysis to describe the implementation of a hospital-based End of Life (EoL) care and bereavement program. This program was developed in several stages, including an assessment of bereaved families, development program guidelines, staff training, piloting of the program, refinement, and standardization. The program was developed between 2019 and 2021 in a nonprofit, teaching hospital and referral center for southwestern Colombia. Results Several tools were developed as key components of the bereavement program: a virtual bereavement course; guidance for EoL and bereavement communication and care, memory making, and follow-up calls; a condolence letter template, and group support workshops. A total of 956 healthcare professionals were trained, 258 follow-up calls to bereaved parents were made, 150 individual psychological follow-ups to parents with complicated grief occurred, 79 condolence letters were sent, and 10 support group workshops were carried out. Challenges were identified and overcome, such as limited resources and staff, and cultural perceptions of death. In 2021, this program received an award by the hospital as the Best Strategy to Humanize Healthcare. Conclusions This study highlights the feasibility of developing and implementing EoL and bereavement care programs for parents and families within hospitals in LMICs. Lack of resources, staff, and training are some of the identified challenges to implementation. Utilizing methodological tools allows us to identify facilitator factors and deliverable outcomes of our EoL and bereavement program. This model provides a valuable framework for resource-limited settings.

AbstractIn light of the COVID-19 pandemic, a pediatric hospice in Ottawa, Ontario, implemented a Virtual Bereavement Group Program, necessitating a reorganization of care delivery during the global crisis. This paper outlines the program and assesses the feedback of families who participated in the program following the death of a child or grandchild. Participants expressed high levels of satisfaction, indicating its potential as an effective approach for pediatric bereavement care beyond the pandemic. [ABSTRACT FROM AUTHOR]

The death of a child may be the most traumatic event a family can experience. Bereavement care for parents is essential for their physical and mental well-being and is a psychosocial standard of care. Childhood mortality is higher in low- or middle-income countries (LMICs); however, little is known regarding bereavement support or interventions for parents in LMICs. To identify programs, services, initiatives, or interventions offered to bereaved parents in LMICs in hospital settings. A systematic search was executed following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles from LMICs describing interventions, programs, or resources provided to parents after the death of a child (0–18 years old) from any cause were included. Extracted data was categorized by demographics, study design, outcomes, and quality assessment using the McGill Mixed Methods Appraisal Tool (MMAT). We retrieved 4428 papers and screened their titles and abstracts, 36 articles were selected for full-text assessment, resulting in nine articles included in the final analysis. Most interventions described support for parents whose child died during the prenatal or neonatal period. The primary interventions included psychological counseling, creating mementos (such as photographs or footprints), and bereavement workshops. Only one paper described a fully established bereavement program for parents. Eight of the papers met high-quality criteria. Although bereavement care is crucial for parents whose child has died, only a few studies have documented bereavement interventions in LMICs. More research may help with bereavement program implementation and improved care for bereaved parents in LMICs. [ABSTRACT FROM AUTHOR]

Introduction Palliative care of children (PCC) is a philosophical and a structured approach to providing tailored care to children with life-threatening diseases. Understanding the role of nurses and empowering them to take up the role of palliative care nurse are imperative to strengthen these services and make the palliative care services more accessible to the patients. Method The literature search was done in two database, PubMed and Scopus, using keyword and Medical Subject Headings (MeSH) terms such as children, palliative care, end of life, hospice, bereavement, and nursing. Records were screened by authors and relevant articles were included in the review. Discussion PCC should start with the diagnosis of the illness continue through all the phases of illness. Bereavement support to the family is also a part of palliative care. Nurses are in a key position to play important role in the PCC team. Nurses play various roles such as direct care provider, communicator, patient advocate, respite nurse, and counselor. Conclusion PCC is aimed to improve the quality of life of the child and family. It is crucial to achieving universal health coverage. Role of nurse is vital in providing PCC. [ABSTRACT FROM AUTHOR]

Objectives: Relatives of patients who died after euthanasia or physician-assisted suicide (EAS) might need (specific) aftercare. We examined if and how physicians provide aftercare to bereaved relatives of patients who died after EAS, and which patient-, physician- and process characteristics are associated with providing aftercare.Methods: A cross-sectional questionnaire study was conducted among 127 physicians (general practitioners, clinical specialists, and elderly care physicians) in the Netherlands. Associations were examined using multivariable logistic regression analyses.Results: Most physicians had had at least one follow-up conversation with bereaved relatives (77.2%). Clinical specialists less often provided aftercare compared to GPs. Also, aftercare was more often provided when the deceased had a cohabiting partner. Topics addressed during aftercare conversations included looking back on practical aspects of the EAS trajectory, the emotional experience of relatives during the EAS trajectory and relatives’ current mental wellbeing. A minority of aftercare conversations led to referral to additional care (6.3%).Conclusion: Aftercare conversations with a physician covering a wide-range of topics are likely to be valuable for all bereaved relatives, and not just for “at risk” populations typically targeted by policies and guidelines.

Perinatal death results in long-lasting intense grief for bereaved mothers with a potential to negatively impact on their short- and long-term outcomes and quality of life if inadequately supported in coping with and managing their experience. This study aimed at exploring the lived experience of women, of care and support following perinatal death in South-Western, Nigeria. A qualitative methodology using Heideggerian phenomenology was used. Fourteen women who had experienced perinatal death in South-Western Nigeria within the last (5) five years were interviewed, and Van Manen's approach to hermeneutic phenomenology was used in data analysis. Four main themes were identified: "they did not tell me the baby died", "response of health care professionals after the baby died", "moving on from hospital", and "support from family". The physical health status of mothers determined how they were informed of perinatal death. Health care professionals were distant, rude, nonempathetic and did not offer emotional support, in some cases. Mothers were given opportunity to see and hold their babies. There was no routine follow-up support in the community, besides a postnatal check-up appointment offered to all mothers regardless of their birth outcome. Family provided emotional support for mothers on discharge. This study was the first to explore the lived experience of women of the care and support following perinatal death in South-Western, Nigeria. There is a need for healthcare systems to review bereavement care and support provisions for women who experience perinatal death. [ABSTRACT FROM AUTHOR]

Introduction: This study describes the end-of-life (EOL) care planning and bereavement practices among adult day services centers (ADSC) when an ADSC participant is dying or has died. Methods: Data are from the 2018 National Study of Long-term Care Providers' biennial survey of ADSCs. Respondents were asked about the following 4 practices: 1) honoring the deceased in some public way in this center; 2) offering bereavement services to staff and participants; 3) documenting in the care plan what is important to the individual at the end of life (EOL), such as the presence of family or religious or cultural practices; and 4) discussing spiritual needs at care planning conferences. ADSC characteristics included US Census region, metropolitan statistical area status, Medicaid authorization, electronic health records (EHR) use, for-profit status, employment of aides, services provision, and model type. Results: About 50% to 30% of ADSCs offered the EOL care planning or bereavement services. Honoring the deceased was the most common practice (53%), followed by bereavement services (37%), discussing spiritual needs (29%), and documenting what is important at EOL (28%). Fewer ADSCs in the West had EOL practices relative to the other regions. The EOL planning and bereavement practices were offered more often in ADSCs that used EHRs, accepted Medicaid, employed an aide, provided nursing, hospice, and palliative care services, and were categorized as medical models, compared with ADSCs without these characteristics. Conclusion: These results highlight the importance of understanding how ADSCs provide EOL and bereavement care to participants who are near EOL. [ABSTRACT FROM AUTHOR]

Objective: The goal of this scoping review was to assess the scope and nature of evidence concerning culturally sensitive grief treatment and support interventions, aiming to provide valuable insights for future research on grief intervention development. Introduction: Prolonged grief disorder (PGD), associated with adverse psychosocial outcomes, requires treatment. The norms of a person's culture influence grief expression, mourning rituals, and perspectives on death. Despite increasing interest in culturally sensitive grief interventions, a comprehensive synthesis of evidence is lacking. A scoping review was deemed fitting to address this gap. Inclusion criteria: This review included studies featuring participants experiencing clinically relevant grief and engaged in culturally sensitive psychosocial grief interventions. It included studies conducted in non-WEIRD contexts or those focusing on sociocultural (sub)groups distinct from the majority (in terms of age, religion, sexual orientation, etc). Methods: Following JBI methodology for scoping reviews, 13 databases were searched (Scopus, Embase, Cochrane, Sociological Abstracts, IBSS, PTSDpubs, PsycINFO, PsycArticles, PSYNDEX, MEDLINE, CINAHL, SocINDEX, and Web of Science). Limits included language (English and German), peer-reviewed articles and publication date (from 2000). The two-step screening process (titles and abstracts, full text) was piloted, and data were extracted and collated. Results: Eighteen studies were included, displaying diversity in geographical location, methodology, and target populations. Interventions targeted various forms of clinically relevant grief, lost relationships, and sociocultural groups. Cultural adaptation processes varied, with seven studies using a top-down approach. Sources of information for formative research involved theoretical models and empirical data, while local experts and qualitative research (e.g., key informant interviews) informed cultural adaptation. Outcome measures were diverse, with 15 studies showing significant pre-post intervention changes, while two did not. Conclusions: The review highlighted the emerging significance of culturally sensitive interventions for PGD, emphasizing the need for standardized approaches and further research. By shedding light on gaps and providing recommendations, it offers insights for future researchers in this field.

Midwifery is not just about life and joy; unfortunately, at times it also involves death, sorrow and grief. The death of a baby and subsequent grief is complex, and involves grieving the baby's life as well as the life that parents have imagined with their child, including their role as parents. Pregnancy and baby loss have devastating effects on women and their families; expecting life and meeting death leave a profound emptiness. Perinatal death can include miscarriage, stillbirth and neonatal death. Lactation in these circumstances has been described by bereaved mothers as a healing therapy, and although there is some published evidence on this topic, further research will be necessary. This article was written based on the author's personal and professional experience, combined with current evidence, following Gibbs' reflective cycle, which provides a structured approach to learning from experiences. The aim is to create awareness of the importance of giving women the opportunity to decide how to manage their lactation and to speak about a topic that, unfortunately, is still taboo. [ABSTRACT FROM AUTHOR]

Sudden unexplained death in childhood (SUDC) is the sudden and unexpected death of a child between 1 and 18 years of age, which remains unexplained after a thorough investigation. Although it is the 4th leading category of death in England and Wales for children aged 1–4 years, there is limited awareness of SUDC and limited research into this field. There are currently no known modifiable risk factors or prevention strategies. SUDC deeply impacts families and is particularly difficult due to the sudden nature, the potential trauma of finding a child, and a lack of any clear reason. For most bereaved families understanding why their child died is very important but this is not possible following SUDC. Parents may have grief complicated by post-traumatic stress disorder (PTSD) and paralysing fear for the survival of any other siblings or pregnancies. This article is written by a professional with personal experience of losing a child to SUDC and both authors have years of experience working with and listening to families. It summarises important considerations and recommendations for any professional who could potentially interact with an affected family. [ABSTRACT FROM AUTHOR]

Abstract Background Stillbirth is a profound emotion-laden event to the mothers and health workers who provide care due to its sudden and unexpected occurrence. Health workers offering support in regions shouldering the highest-burden experience providing support to a stillbirth mother in their professional lifetime. However, their experiences seldom get documented as much of the focus is on mothers causing a dissonance between parental and clinical priorities. This study aimed to explore the health worker’s experiences in the provision of bereavement care to mothers following a stillbirth. Methods An exploratory cross-sectional qualitative study was undertaken on a purposively selected sample of key informants drawn from frontline health workers and health systems managers providing maternal health services at a subnational level health system in Uganda. An interview guide was used to collect data with the audio-recorded interviews transcribed using Microsoft office word. Atlas. ti a qualitative data management software aided in coding with analysis following a thematic content analysis technique. Results There was no specialised bereavement care provided due to inadequate skills, knowledge of content, resources and support supervision for the same. However, health workers improvised within the available resources to comfort mothers upon news of a stillbirth. Disclosure to mothers about the stillbirth loss often took the form of forewarnings, direct and sometimes delayed disclosure. A feeling of unpreparedness to initiate the disclosure process to the mother was common while the whole experience had an emotional effect on the health workers when establishing the cause, particularly for cases without clear risk factors. The emotional breakdown was often a reflexive response from the mothers which equally affected the care providers. Health workers engaged in comforting and rebuilding the mothers to transition through the loss and validate the loss. Efforts to identify the skills and health systems gaps for address were a common response targeted at improving the quality of maternal healthcare services to avert similar occurrences in the future. Conclusion Providing care to mothers after stillbirth was an emotional and challenging experience for health workers requiring different approaches to disclosure and provision of emotional support. The aspect of specialised bereavement care was lacking within the current response. Reflection of unpreparedness to handle the tasks demonstrates a deficit in the required skills. It is a critical gap missing hence calling for dedicated efforts to address it. Targeting efforts to improve health workers’ competencies and preparedness to manage grieving mothers is one way to approach it.

Background: Primary Health Care nurses express deficits in their training in Palliative Care. The purpose of this study is to design a Palliative Care training plan and a bereavement care protocol for Primary Health Care nurses of the Dr. Peset Health Department according to their needs. Methods: Assessment of theoretical and practical training needs and literature review for the design of the training plan. Results: A training plan was elaborated that included a protocol of care for the bereaved. The plan was adjusted to the needs detected in Primary Health Care nurses of the Dr. Peset Health Department. Important training deficits were detected in clinical practice; Conclusions: Improving the care of people with palliative needs in Primary Health Care requires adequate training of the nurses who care for them so their knowledge is the basis of their interventions. This study was not registered.

Shared decision-making (SDM) is included in guidelines for bereavement care after a stillbirth, as it can improve women's long-term health and wellbeing. SDM within the stillbirth context is still not common, and Italy does not yet have standardised guidelines. The ShaDeS (Sha red De cision-Making in S tillbirth) study aims to investigate how Italian women with a stillbirth perceive their own centrality in decision-making processes around bereavement care and how this might impact satisfaction of care. The ShaDeS study is a cross-sectional study based on a web survey consisted of four sections: sociodemographic information and medical history, communication of bad news and bereavement care, decisions about childbirth (SDM-Q-9, SHARED, and DCS), and decisions and communication about autopsy (CPS). 187 women answered the survey. For the 41.1% of women that did not have an emergency childbirth, the SDM-Q-9 median score was 66.6 (0–100 range), and the SHARED median score was 3.5 (1–5 range). 29.4% of participants reached the proposed cutoff of 37.5 in the DCS (0–100 range) suggesting a difficulty in reaching decisions. Satisfaction scores were lower for those with such difficulties (p < 0.0001). Of the 64.5% of women that discussed autopsy, 28.3% were involved in an SDM approach, despite this being associated with higher levels of satisfaction of care (p < 0.05). An SDM approach is only moderately widespread amongst our participants, despite it being significantly related to higher levels of satisfaction. Further studies should investigate the tools that both patients and healthcare professionals need for an SDM approach. [ABSTRACT FROM AUTHOR]

Background: Stillbirth is a profound emotion-laden event to the mothers and health workers who provide care due to its sudden and unexpected occurrence. Health workers offering support in regions shouldering the highest-burden experience providing support to a stillbirth mother in their professional lifetime. However, their experiences seldom get documented as much of the focus is on mothers causing a dissonance between parental and clinical priorities. This study aimed to explore the health worker's experiences in the provision of bereavement care to mothers following a stillbirth. Methods: An exploratory cross-sectional qualitative study was undertaken on a purposively selected sample of key informants drawn from frontline health workers and health systems managers providing maternal health services at a subnational level health system in Uganda. An interview guide was used to collect data with the audio-recorded interviews transcribed using Microsoft office word. Atlas. ti a qualitative data management software aided in coding with analysis following a thematic content analysis technique. Results: There was no specialised bereavement care provided due to inadequate skills, knowledge of content, resources and support supervision for the same. However, health workers improvised within the available resources to comfort mothers upon news of a stillbirth. Disclosure to mothers about the stillbirth loss often took the form of forewarnings, direct and sometimes delayed disclosure. A feeling of unpreparedness to initiate the disclosure process to the mother was common while the whole experience had an emotional effect on the health workers when establishing the cause, particularly for cases without clear risk factors. The emotional breakdown was often a reflexive response from the mothers which equally affected the care providers. Health workers engaged in comforting and rebuilding the mothers to transition through the loss and validate the loss. Efforts to identify the skills and health systems gaps for address were a common response targeted at improving the quality of maternal healthcare services to avert similar occurrences in the future. Conclusion: Providing care to mothers after stillbirth was an emotional and challenging experience for health workers requiring different approaches to disclosure and provision of emotional support. The aspect of specialised bereavement care was lacking within the current response. Reflection of unpreparedness to handle the tasks demonstrates a deficit in the required skills. It is a critical gap missing hence calling for dedicated efforts to address it. Targeting efforts to improve health workers' competencies and preparedness to manage grieving mothers is one way to approach it. [ABSTRACT FROM AUTHOR]

The contagiousness of some illnesses (e.g., COVID-19) limits the ways in which families can interact with their dying loved ones who have been admitted to the hospital, especially in the intensive care unit. As a result, nurses have developed culturally relevant strategies for virtual bereavement care for patients and families predeath, perideath, and postdeath. Specific ways nurses can support, communicate, and facilitate meaningful rituals when patients die in isolation are provided in this article. [ABSTRACT FROM AUTHOR]

Background: Although support for family caregivers is an essential component of palliative care, routine provision of such support is often lacking. To improve support for family caregivers, we assessed current practice and influencing factors as perceived by healthcare professionals. Methods: A two-phase study was conducted including a survey exploring healthcare professionals' practice of supporting family caregivers in Western urbanized Netherlands in 2017, and focus groups exploring facilitators and barriers to supporting family caregivers in 2018. Focus group data were thematically analyzed with deductive coding based on the COM-B system. Results: Of the 379 survey respondents (response 11%), 374 were eligible (physicians, 28%; nurses, 64%; nurse assistants, 9%). The respondents practiced in academic hospitals (52%), general hospitals (31%), nursing homes (11%) and hospices (5%). They reported to always (38%), most of the time (37%), sometimes (21%) or never (5%) provide support to family caregivers during the illness trajectory. Respondents reported to always (28%), sometimes (39%), or never (33%) provide support after death. Four focus group discussions with 22 healthcare professionals elicited motivational facilitators and barriers to supporting family caregivers (e.g., relationship with family caregivers, deriving satisfaction from supporting them), and factors related to capability (e.g., (lacking) conversational skills, knowledge) and opportunity (e.g., (un)availability of protocols and time). Conclusions: Support for family caregivers, especially after the patient's death, is not systematically integrated in working procedures of healthcare professionals. The barriers and facilitators identified in this study can inform the development of an intervention aiming to enhance support for family caregivers. [ABSTRACT FROM AUTHOR]

Background: Primary Health Care nurses express deficits in their training in Palliative Care. The purpose of this study is to design a Palliative Care training plan and a bereavement care protocol for Primary Health Care nurses of the Dr. Peset Health Department according to their needs. Methods: Assessment of theoretical and practical training needs and literature review for the design of the training plan. Results: A training plan was elaborated that included a protocol of care for the bereaved. The plan was adjusted to the needs detected in Primary Health Care nurses of the Dr. Peset Health Department. Important training deficits were detected in clinical practice; Conclusions: Improving the care of people with palliative needs in Primary Health Care requires adequate training of the nurses who care for them so their knowledge is the basis of their interventions. This study was not registered. [ABSTRACT FROM AUTHOR]

Stillbirth is a traumatic life-event for parents. Compassionate care from health workers supports grief and adjustment, alleviating psychological distress and minimising serious adverse health and social consequences. Bereavement support in facilities in LMICs, including in sub-Saharan Africa, often fails to meet parents' needs. However, very few studies have explored health worker's experiences in these settings. To explore the lived experiences of midwives, doctors and others, caring for women after stillbirth in Kenya and Uganda. Qualitative, guided by Heideggerian phenomenology. Sixty-one health workers, including nurse-midwives (N = 37), midwives (N = 12) and doctors (N = 10), working in five facilities in Kenya and Uganda, were interviewed. Data were analysed following Van Manen's reflexive approach. Three main themes summarised participants' experiences: ' In the mud and you learn to swim in it ' reflected a perceived of lack of preparation; skills were gained through experience and often without adequate support. The emotional and psychological impacts including sadness, frustration, guilt and shame were summarised in 'It's bad, it's a sad experience'. Deficiencies in organisational culture and support, which entrenched blame, fear and negative behaviours were encapsulated in Nobody asks 'how are you doing?'. Health workers in Kenya and Uganda were deeply sensitive to the impacts of stillbirth for women and families, and often profoundly and personally affected. Care and psychological support were acknowledged as often inadequate. Interventions to support improved bereavement care in sub-Saharan Africa need to target increasing health worker knowledge and awareness and also embed supportive organisational cultures and processes. [ABSTRACT FROM AUTHOR]

Abstract Background Contradictory interactions between bereaved women who have experienced pregnancy loss and obstetric nursing staff are becoming increasingly prominent. The aim of the present study was to gain an understanding of how women who have experienced pregnancy loss and obstetric nursing staff perceive their interactions, what influencing factors impacted their experiences. Methods A qualitative, exploratory study was conducted in a delivery room and six maternity wards of a tertiary hospital. Semi-structured interviews were performed with six nurses, 13 midwives and seven women who experienced pregnancy loss to collect rich information about how they make sense of their interactions. Thematic analysis was adopted to analyse the data. Results Five overarching themes were identified: (1) interaction characteristics, (2) interactive contradiction, (3) influencing factors of the interaction, (4) training needs and (5) suggestions for benign interactions. Conclusions Healthcare providers should be instructed in adopting a respectful and sympathetic attitude in communication, strengthening information support and offering patient-centred care for benign interactions. Ignoring women’s needs and using disrespectful words should be avoided. Training for preparing nurses and midwives in perinatal bereavement care and addressing heavy emotional burden is necessary. Additional efforts are needed to improve medical services and to facilitate benign interactions in induced abortion care.

AimTo explore obstetric nurses and midwifery professionals’ experiences with the Perinatal Bereavement Care Training Programme (PBCTP) after implementation.DesignA qualitative descriptive design was used.MethodThis qualitative study was conducted at a tertiary level maternity hospital in China. The PBCTP was implemented at Women’s Hospital School of Medicine, Zhejiang University from March to May 2022. A total of 127 nurses and 44 midwives were invited to participate in the training. Obstetric nurses and midwives studied a 5-module training programme comprised of eight online theoretical courses and submitted a reflective journal after each session. Semi-structured interviews were conducted with 12 obstetric nurses and four midwives from May to July 2022 as a post-intervention evaluation. Thematic analysis was used in data analysis.FindingsA total of 16 participants in this study ranged in age from 23 to 40 years [mean age (SD), 30 (4) years]. Six main themes within participants’ experiences of PBCTP intervention were identified: participants’ aims of undertaking the training; personal growth and practice changes after training; the most valuable training content; suggestions for training improvement; directions for practice improvement; influencing factors of practice optimization.ConclusionNursing and midwifery professionals described the PBCTP as satisfying their learning and skills enhancement needs and supporting positive changes in their care providing for bereaved families. The optimized training programme should be widely applied in the future. More efforts from the hospitals, managers, obstetric nurses, and midwives are needed to jointly contribute to forming a uniform care pathway and promoting a supportive perinatal bereavement care practice.

Context: Understanding coping mechanisms adopted by families after the traumatic experience of losing a child to cancer may support health care teams in developing more comprehensive bereavement care. Objective: To synthesise qualitative, quantitative, and mixed methods studies focusing on the coping strategies families adopt after losing a child to cancer. Methods: Five databases were systematically searched (Medline, PsycInfo, Embase, CINAHL, and Scopus). Included studies were published in peer-reviewed journals, used empirical research methods, and focused on the coping strategies of families who lost a child to cancer. Content analysis was used to synthesise the results. Results: From 173 full papers, 34 papers were included in the review. Five overarching coping strategies were identified: continuing bonds; meaning-making; emotional expressions; distraction and refocusing; and taking care of others. Continuing bonds and meaning-making were the most frequently reported ones. Mothers, fathers, and siblings use different strategies to cope and their use varies over time as grief is an ongoing process without closure. We found no paper that addressed coping strategies of grandparents or other family members. Conclusion: Families should be reassured that there is no ideal coping style, and that each grief journey is unique both in expression and duration. Healthcare providers should be mindful of the internal and external factors, such as gender, developmental stage, or relationship with the deceased child, that might influence coping. Awareness of different coping strategies might help to improve bereavement care and communication with bereaved family members.

Perinatal bereavement, the death of a baby before or around the time of birth, is profoundly distressing and associated with significant psychosocial consequences for parents and families. There is a need for diverse support options for bereaved parents that recognises their continuum of needs, preferences and circumstances. Nature-based interventions have potential as a non-clinical approach drawing on “natural assets” within everyday settings. With limited evidence about nature-based interventions for perinatally bereaved parents, a scoping review was undertaken to determine the types of nature-based interventions, theories of change and key elements in the design of bereavement support interventions. A search of eight academic library databases using a combination of terms to represent nature-based interventions and bereaved grief identified 17 papers for review: the 7 qualitative studies, 3 quantitative studies, 4 case studies and 3 mixed method studies included care farming, gardening interventions and animal-assisted therapy. No studies focused solely on perinatally bereaved parents. Studies were underpinned by various theoretical frameworks but none provided explicit explanation of how theory was used for intervention design. The review findings suggest that nature-based interventions offer a promising approach to complement traditional bereavement care interventions. Reported benefits included the capacity to be personalised to suit a person's preferences and needs, their appeal and acceptability, and participant experiences of comfort and calm. Processing of grief and adaptation to loss were supported through the experience of safeness, and the inclusion of natural elements in processes such as memorialisation, rituals, metaphor and mindfulness. Future research should prioritise co-creation of interventions with bereaved parents, rigorous evaluation, and support options that are implemented in healthcare, community organisation and wider community settings.

Background: Addressing stillbirth is a difficult task and becomes more challenging with a huge burden and skewed doctorpatient ratio. There is a lack of data regarding the knowledge about the bereavement care practices following pregnancy loss and practices being followed by the health-care providers in the Indian context. The objective of this study is to describe the experience, views, and practices of health-care professionals while managing women with stillbirths. Design: Internet-based Monkey Survey. Methodology: An on-line self completion questionnaire was shared with various health care providers via emails and whats app groups. Results: A total of 281 responses of health-care providers were analyzed, and the majority of them were obstetricians. Almost 90% had managed women with stillbirth, but just a third (38.1%) had provided bereavement care. The majority of them felt the lack of a uniform and comprehensive training model for providing bereavement care to such women. Out of 281 participants, 258 (91.8%) believed that health-care providers should have a bereavement care training and support system, whereas only 23 (8.2%) rejected this idea. Conclusion: There is no defined protocol or standards for providing bereavement care to women following stillbirth. Most health-care professionals feel an urgent need for professional training to bridge the gap between the expectations of patients and the care provided.

The COVID-19 pandemic hindered access to routine healthcare globally, prompting concerns about possible increases in pregnancy loss and perinatal death. PUDDLES is an international collaboration exploring the impact of the COVID-19 pandemic on parents who experience pregnancy loss and perinatal death in seven countries, including Aotearoa New Zealand. To explore parents' experiences of access to healthcare services and support following baby loss during the COVID-19 pandemic in Aotearoa New Zealand. We conducted in-depth, semi-structured interviews with 26 bereaved parents, including 20 birthing mothers, and six non-birthing parents (one mother and five fathers). Types of loss included 15 stillbirths, four late miscarriages, and one neonatal death. Participant ethnicities were broadly representative of Aotearoa New Zealand's multi-ethnic society. Data were analysed using Template Analysis. Analysis revealed five themes relating to pandemic impact on bereaved parent's experiences. These were: 'Distanced and Impersonal care'; 'Navigating Hospital Rules'; Exclusion of Non-birthing Parents; 'Hindered Access to Social Support'; and 'Continuity of Relational Care'. The COVID-19 pandemic exacerbated isolation of bereaved parents through perceived impersonal care by healthcare professionals and restrictions on movement hindered access to social and cultural support. Compassionate bending of the rules by healthcare professionals and community postnatal visits by continuity of care midwives following the bereavement appeared to be mitigating factors. Social isolation is an added challenge for parents experiencing baby loss during a pandemic, which may be mitigated by flexible and compassionate care from healthcare professionals, especially continuity of care midwives. [ABSTRACT FROM AUTHOR]

Background: At the beginning of 2020, mothers and fathers who experienced perinatal events (from conception to pregnancy and postpartum period) found themselves facing problems related to the emergency caused by the COVID-19 pandemic and the associated difficulties for health care centers in providing care. In the unexpected and negative event of perinatal loss (ie, miscarriage, stillbirth, and neonatal death) more complications occurred. Perinatal loss is a painful and traumatic life experience that causes grief and can cause affective disorders in the parental couple--the baby dies and the couple's plans for a family are abruptly interrupted. During the COVID-19 pandemic, limited access to perinatal bereavement care, due to the lockdown measures imposed on medical health care centers and the social distancing rules to prevent contagion, was an additional risk factor for parental mental health, such as facing a prolonged and complicated grief. Objective: The main aims of this study are as follows: to investigate the impact of COVID-19 on mothers and fathers who experienced perinatal loss during the pandemic, comparing their perceptions; to evaluate their change over time between the first survey administration after bereavement and the second survey after 6 months; to examine the correlations between bereavement and anxiety, depression, couple satisfaction, spirituality, and sociodemographic variables; to investigate which psychosocial factors may negatively affect the mourning process; and to identify the potential predictors of the development of complicated grief. Methods: This longitudinal observational multicenter study is structured according to a mixed methods design, with a quantitative and qualitative section. It will include a sample of parents (mothers and fathers) who experienced perinatal loss during the COVID-19 pandemic from March 2020. There are two phases--a baseline and a follow-up after 6 months. Results: This protocol was approved by the Ethics Committee of Psychological Research, University of Padova, and by the Institutional Ethics Board of the Spedali Civili of Brescia, Italy. We expect to collect data from 34 or more couples, as determined by our sample size calculation. Conclusions: This study will contribute to the understanding of the psychological processes related to perinatal loss and bereavement care during the COVID-19 pandemic. It will provide information useful to prevent the risk of complicated grief and psychopathologies among bereaved parents and to promote perinatal mental health. [ABSTRACT FROM AUTHOR]

To investigate which objective (actions/interventions) and subjective (perceptions of care quality) outcomes of care following stillbirth or termination of pregnancy predict perceived care quality. A cross-sectional descriptive study using an anonymous online survey. The population was women who had experienced a stillbirth or termination of pregnancy from ≥16 weeks of gestation, in the Spanish health system. Multiple sequential regression analysis was used to identify predictors of perceived care quality (satisfaction, willingness to recommend, competence and ability to provide loss-focused care). Results from 610 women were analysed. A significant regression equation (p<0.001) was found in each of the objective only and objective-subjective models. In the case of overall care (satisfaction-recommend composite), 72.0% of variance (adj. R2) was explained. In general, subjective evaluations of care are more potent predictors of perceived care quality than objective care interventions (e.g. autopsy performed). Feeling free to 'express emotions', 'teamwork between doctors and nurses/midwives', and 'being well-informed of all steps and procedures' were the three strongest predictors, followed by perception of 'medical negligence'. Information provision and loss-focused interventions had the weakest influence, except in the specific 'loss-focused' model. The results indicate that the 'atmosphere' of care is a transversal dimension related to the context of loss and trauma and has the single greatest influence on perceptions of care quality. It is necessary to use a specific 'loss-focused' care variable to adequately capture perceptions of the quality of bereavement care and a custom scale to measure the influence of care interventions on perceived quality. [ABSTRACT FROM AUTHOR]

Perinatal bereavement care is a complex area of practice. The COVID-19 pandemic led to reconfiguration of maternity and perinatal bereavement care services. This study explores Australian health care providers' perspectives of the impact of COVID-19 on the provision of respectful and supportive care following stillbirth or neonatal death. Members of a perinatal bereavement care network were consulted at the commencement of the pandemic in Australia using an online feedback form. Respondents provided ratings and free-text comments on the impact of COVID-19 on implementation of 49 recommendations contained in the Perinatal Society of Australia and New Zealand/Stillbirth Centre of Research Clinical Practice Guideline for Respectful and Supportive Perinatal Bereavement Care. Responses were received from 35 health care providers who provided perinatal bereavement care in clinical settings or through support organisations in Australia. Major impacts of COVID-19 were reported for 8 of 49 guideline recommendations. Impacts included reduced: support for mothers due to visitor restrictions; availability of cultural and spiritual support and interpreters; involvement of support people in decision-making; options for memory-making and commemorative rituals; and staff training and supervision. Adaptations to minimise impacts included virtual consultations, online staff training, use of cold cots, and increased staff support for memory-making. Health care providers encounter substantial challenges as they strive to implement best practice perinatal bereavement care in pandemic conditions. Some practice adaptations developed during the COVID-19 pandemic could benefit parents; however, evaluation of their effectiveness and acceptability is needed. [ABSTRACT FROM AUTHOR]

Background: Many people prefer to die at home when the time comes. Hospice at home services aim to support patients to achieve this. A range of hospice at home services exist; some services have been evaluated, but there has been limited evidence synthesis. Objectives: The main objective was to find out what models of hospice at home services work best, for whom and in what circumstances. Other objectives supported this aim, including an analysis of the health economic costs of hospice at home models. Design: The study was an overarching, non-interventional, realist evaluation comprising three phases. Phase 1 was a survey of hospice at home services. Phase 2 involved 12 case studies, grouped into four models on the basis of size and 24 hours per day, 7 days per week (24/7), operations, from which quantitative and health economics data were gathered. Qualitative interview data from bereaved carers, commissioners and providers were analysed to generate context–mechanism–outcome configurations. Phase 3 comprised stakeholder consensus meetings. Setting: Hospice at home services across England. Participants: A total of 70 hospice at home managers responded to the survey. A total of 339 patient and family/informal carer dyads were recruited; 85 hospice at home providers and commissioners were interviewed. A total of 88 stakeholders participated in consensus meetings. Main outcome measures: The quality of dying and death of patients was assessed by bereaved carers (using the Quality of Dying and Death questionnaire). A patient’s use of services was collected using the Ambulatory and Home Care Record. Results: Hospice at home services varied; two-thirds were mainly charitably funded, and not all operated 24/7. Most patients (77%) had cancer. Hospice at home services overall provided care that was likely to deliver ‘a good death’, and 73% of patients died in their preferred place. Six context–mechanism–outcome configurations captured factors relevant to providing optimum hospice at home services: (1) sustainability (of the hospice at home service); (2) volunteers (use of, in the hospice at home service); (3) integration and co-ordination (with the wider health and social care system); (4) marketing and referral (of the hospice at home service); (5) knowledge, skills and ethos (of hospice at home staff); and (6) support directed at the carer at home. Key markers of a good service included staff who had time to care, providing hands-on care; staff whose knowledge and behaviour promoted supportive relationships and confidence through the process of dying; and services attending to the needs of the informal carer. Areas of potential improvement for most hospice at home services were the use of volunteers in hospice at home, and bereavement care. Limitations: The study had the following limitations – heterogeneity of hospice at home services, variations in numbers and patient clinical statuses at recruitment, a low Quality of Dying and Death questionnaire response rate, and missing data. Only patients with an informal carer involved on a daily basis were eligible for the study. Conclusions: Hospice at home services delivered high-quality care and a ‘good death’, with the majority of patients dying in their stated preferred place. Hospice at home providers can improve their impact by focusing on the features identified that deliver the best patient outcomes. Commissioners can facilitate patient preference and reduce the number of hospital deaths by working with hospice at home services to secure their financial sustainability and increase the numbers and range of patients admitted to hospice at home services. Future research: Future research should explore the use of volunteers in the hospice at home setting and evaluate approaches to bereavement support. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 24. See the NIHR Journals Library website for further project information.

Background: Contradictory interactions between bereaved women who have experienced pregnancy loss and obstetric nursing staff are becoming increasingly prominent. The aim of the present study was to gain an understanding of how women who have experienced pregnancy loss and obstetric nursing staff perceive their interactions, what influencing factors impacted their experiences.Methods: A qualitative, exploratory study was conducted in a delivery room and six maternity wards of a tertiary hospital. Semi-structured interviews were performed with six nurses, 13 midwives and seven women who experienced pregnancy loss to collect rich information about how they make sense of their interactions. Thematic analysis was adopted to analyse the data.Results: Five overarching themes were identified: (1) interaction characteristics, (2) interactive contradiction, (3) influencing factors of the interaction, (4) training needs and (5) suggestions for benign interactions.Conclusions: Healthcare providers should be instructed in adopting a respectful and sympathetic attitude in communication, strengthening information support and offering patient-centred care for benign interactions. Ignoring women's needs and using disrespectful words should be avoided. Training for preparing nurses and midwives in perinatal bereavement care and addressing heavy emotional burden is necessary. Additional efforts are needed to improve medical services and to facilitate benign interactions in induced abortion care. [ABSTRACT FROM AUTHOR]

It is widely acknowledged that midwives are essential in providing care for mothers experiencing perinatal death. However, midwifery students lack the knowledge and skills needed to deal with perinatal death, and. There is limited research on perinatal bereavement care training for midwifery students. To investigate undergraduate midwifery students' experiential learning of perinatal bereavement care and serve as a reference for future perinatal bereavement care teaching and training. Qualitative descriptive design. University in Guangzhou, China. Undergraduate midwifery students at a university in Guangzhou, China. This research was conducted at a university in Guangzhou, China. The participants were recruited using purposeful sampling. Semi-structured, in-depth interviews were conducted with 11 midwifery students who participated in perinatal bereavement care training from May to June 2023. The Colalizzi 7-step data analysis method was used for data analysis. From the data, five themes emerged: 1) immersive experience of perinatal bereavement care, 2) formation of perspectives on perinatal bereavement care, 3) clarification of the service boundaries and internalization of the professional service spirit, 4) emotional impact and coping strategies, and 5)) factors influencing practice optimization. Experiential learning is an effective teaching strategy. However, participants continued to feel unprepared to provide perinatal bereavement care. Implementing relevant training, disseminating perinatal bereavement care knowledge and skills, and enhancing the ability of midwifery students to manage and cope with the psychological impact of perinatal death are important. • Undergraduate midwifery (MW) students' perinatal bereavement care (PBC) experience was analyzed. • The first study published regarding MW students' learning experiences in reformed education program in a Chinese university. • Study findings can facilitate MW educators with PBC teaching. [ABSTRACT FROM AUTHOR]

The purpose of this research was to ascertain the availability and depth of services of bereavement care for mothers who live rurally. The specific focus is on those who experienced early losses including pregnancy, stillbirth, neonatal, and young children who were born with fetal anomalies or neonatal disease that resulted in death. The convenience (nonprobability) sample originated from a population of mothers who lived in rural east central Minnesota. Participants were interviewed in a 60-minute interval. All data were coded confidential. Common themes, incidence of resources, or lack of bereavement resources for the participants' lived experiences were considered using a descriptive phenomenological approach. Our appreciation of the continuing bond between mother and child compels us to believe that there is an ethical obligation to reduce and remove these barriers and inequalities in bereavement support services for those who live rurally and have experienced perinatal and infant loss. Results of this study indicate the need for further study and establishment of bereavement resources in rural outreach for perinatal and early childhood loss. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of prolonged grief disorder (PGD), and self-reported resilience among bereaved caregivers within a palliative care program that serves a large region of the Lower Mainland in British Columbia, Canada. Additionally, to discern effective bereavement supports utilized by caregivers following the loss of a loved one. Methods: A descriptive study using both quantitative and qualitative methods. Sociodemographic information (n = 427) was collected from bereaved caregivers 3 months after their loss. PGD and resilience were prospectively assessed 12 months post-loss using the prolonged grief scale (PG-13, n = 212) and brief resilience scale (BRS, n = 215), respectively. A qualitative thematic analysis was conducted on responses to the open-ended question on what bereavement services or activities caregivers found helpful in coping with the loss of a loved one. Results: Of the 212 individuals that completed the PG-13, 4.7% met diagnostic criteria for PGD, 27.4% were moderate risk, and 67.9% were low risk for PGD. Of the 215 caregivers that completed the BRS, 48.4% had low resilience, 51.6% had normal resilience, and 0% had high resilience. The major themes of formal supports, informal supports, and self-care activities emerged from caregiver comments regarding effective bereavement supports. Conclusion: The incidence of PGD in caregivers is low within the Fraser Health Palliative Care program. Bereaved caregivers mainly utilize existing social networks and activities to cope with their loss. Focusing on a community-based approach to supports may improve bereavement experiences and lower rates of prolonged grief. [ABSTRACT FROM AUTHOR]

Background: Cancer caregiving is a distressing experience and loss of a loved one can lead to intense grief and other adverse effects. However, the prevalence of grief disorders among families associated with cancer-related deaths remains unknown. Aim: This study aimed to determine the prevalence of grief disorders among families of patients with cancer to better inform clinicians, researchers, and policymakers. Design: Meta-analysis, PROSPERO number CRD42020209392. Data sources: The databases of CINAHL, Embase, MEDLINE, PubMed, Scopus, PsycINFO, and Web of Science were comprehensively searched with no language restrictions. The quality of included studies was assessed with Hoy's criteria. Results: Among the 3046 records screened, 19 studies were eligible for meta-analysis, with a total of 14,971 participants. The pooled prevalence rate of grief disorders was estimated at 14.2% (95% CI, 11.7%–16.7%), ranging from 7% to 39%. The prevalence was higher in females (10%; 95% CI, 8.2%–12.1%), those who are religious (9.55%; 95% CI, 8.97%–10.16%), spouses of the deceased (7.78%; 95% CI, 6.08%–9.69%), and families of patients with neurological cancers (6.4%; 95% CI, 0.10%–19.9%). Educational levels, study locations, diagnosis tools, time post-after loss, and study methods seemed not to affect the prevalence of grief disorders in families of patients with cancer. Conclusions: As the prevalence of grief disorders in cancer-related bereavement is substantial, therefore, support including palliative care is important to reduce the burden of caregiving. In addition, future studies are needed to identify and explore effective strategies that can help reduce the burden caused by grief disorders after the death of the patient. [ABSTRACT FROM AUTHOR]

Background: Addressing stillbirth is a difficult task and becomes more challenging with a huge burden and skewed doctorpatient ratio. There is a lack of data regarding the knowledge about the bereavement care practices following pregnancy loss and practices being followed by the health-care providers in the Indian context. The objective of this study is to describe the experience, views, and practices of health-care professionals while managing women with stillbirths. Design: Internet-based Monkey Survey. Methodology: An on-line self completion questionnaire was shared with various health care providers via emails and whats app groups. Results: A total of 281 responses of health-care providers were analyzed, and the majority of them were obstetricians. Almost 90% had managed women with stillbirth, but just a third (38.1%) had provided bereavement care. The majority of them felt the lack of a uniform and comprehensive training model for providing bereavement care to such women. Out of 281 participants, 258 (91.8%) believed that health-care providers should have a bereavement care training and support system, whereas only 23 (8.2%) rejected this idea. Conclusion: There is no defined protocol or standards for providing bereavement care to women following stillbirth. Most health-care professionals feel an urgent need for professional training to bridge the gap between the expectations of patients and the care provided. [ABSTRACT FROM AUTHOR]

Purpose: Clinicians face personal barriers that impede the provision of bereavement care and require education in hospice care. This study aims to investigate the effects of an educational bereavement program on emotional and cognitive barriers, self-efficacy, and professional quality of life among clinicians in hospice care. Methods: A pretest–posttest design was implemented. A total of 194 clinicians with working experience in hospice care were recruited. The participants underwent a 12-h workshop. The content included lectures, role-play, and group discussion. Emotional and cognitive barriers, self-efficacy, and professional quality of life were measured before and after the program and at 3-month follow-up. Results: After the educational program, negative emotional barriers (F (2, 386) = 17.07, p < 0.001), lack of ability (F (2, 386) = 20.11, p < 0.001), belief in avoidance (F (2, 386) = 7.10, p = 0.001), outcome expectancy (F (2, 386) = 11.32, p < 0.001), and burnout (F (2, 386) = 5.59, p = 0.005) decreased significantly. Self-efficacy (F (2, 386) = 5.37, p = 0.006) and compassion satisfaction (F (2, 386) = 127.99, p < 0.001) increased significantly. Conclusion: The educational program addressed personal barriers to bereavement care. Role-play and group discussion about emotional and cognitive barriers can reduce barriers and improve self-efficacy in clinicians in hospice care. [ABSTRACT FROM AUTHOR]

This project examined the experiences of healthcare professionals who obtain consent for perinatal post-mortem examination with the aim of using the findings to develop training resources for taking post-mortem consent. [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]

As pediatric palliative care (PPC) became a recognized medical specialty, our developing clinical PPC team longitudinally partnered with bereaved parents to understand the care that their children received as they transitioned towards end of life. Families developed Eight Priorities, shared within, to improve care for children with a poor chance of survival based on their experience of losing a child to cancer. In this paper, we delineate the top eight PPC needs from a parent perspective to offer multi-layered, individually tailored resources for patients and families. One of these Eight Priorities noted that bereavement care for the remaining family members is vital for healing after the death of a child to promote meaning making and resilience in bereaved families. Here, we outline the creation of a bereaved parent-designed bereavement support program as one example of how we have partnered with parents to fulfill their Eight Priorities for quality care. [ABSTRACT FROM AUTHOR]

Ireland has had a reliance on voluntary groups to provide peer-to-peer bereavement support. The aim of this study was to explore volunteers', within these voluntary groups, experiences of supporting parents following a fatal fetal anomaly diagnosis. Purposive sampling was used to recruit volunteers (n = 17) and face-to-face interviews undertaken. NVivo12 was utilized to assist in the thematic analysis of the data. Five themes; "motivation for altruistic acts," "being challenged," "value of education and training," "supporting volunteers to support others," and "it is not a sprint, it is a marathon" were identified. Volunteers felt comfortable in their peer-support role but found the lack of knowledge regarding newly implemented termination of pregnancy (TOP) services challenging. The importance of education/training was identified, emphasizing the need for collaboration with health care professionals and other voluntary organizations for support. The findings illustrate the need for collaborative working between health care professionals and volunteers to assist them in supporting bereaved parents. [ABSTRACT FROM AUTHOR]

Children’s grief, in perinatal loss, can be misunderstood and overlooked. Parental behaviour while mourning infant loss and parental ability to respond to their own grief has a crucial role in the child’s grief. This study aimed to explore parental behaviour as a determining factor in siblings’ grief following perinatal death. Six mothers and two fathers experiencing perinatal loss were interviewed about their perception of the child’s experience of perinatal death. Thematic analysis allowed for identifying of relevant themes. The main themes related to parents’ expression of grief, insight and understanding of their children’s grief and communicating the death/anticipated death with their surviving children. Findings showed that children seek out information on their deceased sibling and need supportive parents to guide them through their grief. Our study highlights that supporting parents in their grief is a key factor for a healthy grieving process in children and must be considered when supporting families in perinatal death. [ABSTRACT FROM AUTHOR]

• Increased understanding of how actor-based simulation can enable students to make sense of the complexities of caring for bereaved parents for the first time. • Addressing the potential of using actor-based simulation in reducing students' anxieties and concerns in communicating and responding to the needs of bereaved parents prior to clinical placement. • Enhanced understanding of how transformational learning theory can illustrate changes in students' perspectives and learning about compassionate holistic care. Student midwives frequently encounter bereaved parents in clinical practice; however, the experience of caring for bereaved parents can be a significant source of traumatic stress. Although the use of simulation to teach bereavement care is considered a powerful experiential form of learning, evidence for its effectiveness as a transformative learning strategy is limited. To explore student midwives' lived experience of caring for bereaved parents experiencing perinatal loss using high-fidelity simulation. Students midwives participated in an actor-based bereavement simulated scenario. Data was collected using semi-structured interviews. Interpretative Phenomenological Analysis was conducted to gain a deep understanding of the meaning of the experience. Mezirow's Transformative Learning Theory was applied as an analytical framework to illustrate how the student midwives made sense of and learned from the experience of caring for bereaved parents experiencing perinatal loss. One BSc (Hons), 156-week undergraduate midwifery programme within a university in the Northwest of England. A purposeful sample of nine first-and second-year student midwives volunteered to participate in the study. One of the superordinate themes that emerged from the analysis (1) ' trying to console and making things easier' and the related subthemes (1a) 'what words can I say', (1b)' my instinct was to console the mum', (1c)'left to sort of pick up the pieces' captured the deep sense of powerlessness and the professional dilemmas experienced as students struggled to emotionally console and communicate the right words to say to the grieving parents. The study highlights the vital role of simulation as a defined model of bereavement education that equips students with the necessary knowledge, skills, and confidence to provide compassionate care to bereaved parents experiencing perinatal loss. The emotional toll of caring for bereaved parents is significant, and higher education institutions should adopt experiential forms of learning using actor-based simulation scenarios to emotionally prepare students to care holistically for parents affected by perinatal loss. [ABSTRACT FROM AUTHOR]

Abstract In recent years, there has been a global call to reduce the numbers of preventable stillbirths and increase public awareness about the incidence and impact of pregnancy loss. The lived experiences of bereaved parents have much to contribute to developing the research agenda and clinical care in pregnancy loss. The multidisciplinary Pregnancy Loss Research Group (PLRG) based at the INFANT Centre at University College Cork and Cork University Maternity Hospital, has an established practice of active engagement and participation of patient members. This partnership provided the catalyst to model a similar collaborative approach between clinicians, researchers and bereaved parents when the PLRG was successful in their bid to host the International Stillbirth Alliance (ISA) annual conference in 2017. Over 400 hundred delegates from around the globe attended the conference, of which one quarter were bereaved parents. Establishing a culture of collaboration, support and mutual respect in the field of pregnancy loss, requires scientists, clinicians and parents to be brought together so each can be informed by the other in the efforts to prevent stillbirth and improve bereavement care. As part of ISA 2017 conference, a sub-committee of staff and parents was established to ensure that the voice of parents could contribute to the research agenda and developments in clinical and bereavement care. A creative workshop specifically for parents, followed by a parent assembly were organised to facilitate this. Remembrance activities, organised by the parent committee, were central to the conference and actively engaged in by parents, clinicians and researchers. This commentary, written collaboratively by a parent, a chaplain, a bereavement and loss specialist midwife and a consultant obstetrician, gives voice to this experience, identifying four key messages that arose from our reflection on the conference. These include; the value of active partnership between clinicians and patients, the use of creativity as a unifying expression of grief and as a means to facilitate learning, the value of collaboration with global stakeholders in raising awareness about stillbirth, and the importance of facilitating meaningful patient/public engagement in scientific research. The potential for education and learning opportunities are also explored, highlighting the connection between parents, researchers and clinicians as central stakeholders in the prevention of stillbirth and in improving bereavement care.

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]