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Anger is
expected parent's reaction and normal way of cope with the
tragic event, what should not be taking personally by
medical staff. When the
parents are on the active stage of grief - the
anger, doctor should not try to do any activity such as an
effort to explain what happened. That will aggravate the
situation, so all important information about of the event
will be mess. The best way at that time is to keep silent
with listening of the parents. This approach is the most
suitable to shrink the gap and achieve of mutual
understanding between the medical staffs and the parents
in grief. This is
naturally that the parents believe what the medical staff
do not care about what happened with them. The parents in
grief are looking for a guilty person and mostly this is
the doctor or midwife, eventually. It is necessary to
express that the doctor and the midwife are also very
sorry what happened, that they are also expected the good
outcome and feel disappointed because the situation could
not be corrected by the medical care. Honest
sorrow and open talking able to establish trustable
contact between doctor and the parents, then they will
calm down and get ready to listen of the professional
explanation about the accident. This is the time to let
the parents know as much as possible details of what
happened. The parents will repeat the same Q gWhy?h for
many times and the doctor needs to explain again and
again. If the
parents keep silence, the medicals have to be in the same
stage (active or passive phase should be
sinchronized) .A nonverbal communication like the keeping
silence together is very important stage what helps
the parents to pass grief and do not live with a permanent
hatred toward the medical staff, include a keeping a
various aggressive actions against to them. The
theory of culture care diversity and universality was
developed by Leininger (1997), and she emphasized that
nurses should expand their thinking from a unicultural
perspective to one that was multicultural, holistic, and
comparative. Hence, because of the increasing need to work
with families of divergent cultures, it is important for
nurses to be families with the traditions and beliefs of
others as well as what loss means to different individuals
(Speck, 1978; Gibson, 1998). One of the culturally aspect
communication practices recommended for nurses when caring
for bereaved family who are from Asia is speaking to the
bereaved parent through a gkey personh (Engler at al.
2004): such as a respected or older person in the bereaved
family. Traditionally in Japan if
some of unexpected situation occurred, doctor had have
discuss with a father first of all. The information about
baby loss in case of perinatal or neonatal death was kept
off mother for several days during she was staying in the
hospital. In fact, most of mothers were appreciated this
approach. They usually wanted and tried to forget about
the unfortunate pregnancy as it never happened with them,
so and they relatives were followed the same way. Usually the parents try
to be calm, gkeep faceh and mostly the mother stays in
numbness, but the father and parents of the mother or her
parents-in-law sometimes can lets their emotions to spill
out. In contrary, non-Japanese patients do not try to
suppress their natural feelings in the triadic situation.
It could be taken as the type of situation what make
doctorfs work more emotionally hard. From the other hand,
quick parentfs response could shrink a gcold gaph between
the medical staff and the parents in grief off. To help nurses and midwifes care for parent whose baby has died and cope with their own feeling it is recommended special education be provided. For medical staffs who work at hospitals what able to provide medical care for international patients an education courses about different religions and religious practices and referral opportunities should be considered. (Chan M. F., Arthur D. G., (2009)). A Story gc She was 28 years old, and pregnant of discordant twins. In 32 weeks of gestation we diagnosed that the small twin as IUGR (intra-uterine growth restriction), but the other twin fine. After I explained twins status to the parents, I showed the decision to end this pregnancy by Cesarean for rescuing the small twin in34 weeks. Because it was only 32 weeks, we had decided to prolong 2 more weeks for fetal maturation. Also I was obligated to have a business trip for 1 week (during 33rd weeks of her pregnancy), so it was an additional reason to delay the Cesarean. Unfortunately, early morning
on just 33 weeks of gestation, I got the phone call from
hospital with bad news: the small twin had suddenly
died. It happened exactly one day before my business
tripcI was really shocked. I was worried if I could make the right decision at that time. I evaluated survived twinfs health and I proposed we could wait till 34 weeks from medical point. If it was possible to wait, I did not want to detach the dead baby soon from mother. butc she was having the dead baby inside and I was obligated to be of city by business. Though, over this discussion we took the risk to wait until 34th weeks for be sure about safe of the alive fetus better. Furthermore, she stopped to talk. From that time on, the hospital staff has been keeping to exam regularly the heart beating of only survived twin, then happened unfortunate accident; one of doctor who was not familiar with the situation make an effort to exam the second fetusfs heart beating. It has unpredictable effect; she felt revive and start to communicate. She realize that she is caring on still two her babies inside even on of them is not alive any more. In contrary to the mother, this accident had
made the father very mad. From this moment they went by
the different roads. Then it was the time to come out of the dead baby. In the delivery room, there were mother in labor, nurse and me only. It was proper company of people who wanted to meet this baby and share own sad feeling. The mother had enough time with dead baby to hold, to cry and to say goodbye. The father was keeping his anger and avoided spending time with dead baby. By this reason we had a lot of time to communicate with the bereavement mother. This kind and supportive treat helped to the mother passed relatively smooth the anger stage of her grief via mostly asking a questions and taking about the event. But the father escaped to
talk in a normal way with us, did not visit the hospital
during the mother was staying there and, did not
emotionally support her. They lost communication way, so
about two year after got divorce. c" (By Dr. Takeuchi
Masato).
Medical
staff
copes with the event The
death of a patient is a profound event for most of
physicians. Unfortunately, although medical training in
medical school has increased, students, and practicing
physicians often still report feeling unprepared for
bereavement issues in patient care. Approximately 15% of
pregnancies end in early losses (before 20 weeks
gestation). In the US, 1.3% of pregnancies end in either
stillbirth or infant death. This means that on average,
the typical obstetrician delivering 140 neonates a year
could encounter nearly two dozed women with a
miscarriage and one to two with stillbirth or infant
death. (Golg K. J., Kuzina A. L., Hayward R. D., (2008) The two most
common coping method are 1) talking informally with
colleagues (87% of respondents) and 2) talking about the
death with friends or family (56%). Only 9% of physicians
uses of any substances (alcohol, tobacco and so on). (Golg
K. J., Kuzina A. L., Hayward R. D., (2008)). Only 77% of
obstetricians felt somewhat or very prepared to counsel
patients about palliative care or end-of life issues,
compared with about 89% in internal medicine. With
stillbirth, families and physicians may experience complex
emotions from simultaneous birth and death. In addition,
because the cause of death is often not identified,
physicians may blame themselves even for unpreventable
losses. Stillbirth is number two reason for lawsuit
against obstetricians in the US, preceded only by
allegations for births with adverse neurologic outcomes.
(Golg K. J., Kuzina A. L., Hayward R. D., (2008) What do a medical staffs fear in these situations? Firs of all, we
are afraid to be criticized by a people around us:
bereavement patients and our colleagues as well. Another common
feeling is medical staff mentally cannot accept the fact
of the babyfs death, because it was not detected any
obstetrical pathology during antenatal checks up: gI did
everything right, there was no single reason to kill the
baby!h. Some nurses
reported feeling uncomfortable with various aspects of
bereavement care: gWhat make me uncomfortable was not
knowing what to say at a time like this and how I could
be the best resource for this family being that I hade
never had this type of assignment in my nursing career?h
gI feel uncomfortable with the parent especially if
they have just found out that they have a fetal loss as
it is an emotional time for themh gI always
dread the job but only because I have a hard time
maintaining my distance with people who are
suffering I want to cry with themh. Comfort
level with parinatal bereavement care is important because
increased comfort will support better care: gIf you
are not comfortable with a situation, if does show with
the patient and they do not receives all they need from
their nurse during this difficult timeh. (Roehrs
C., Masterson A., Alles R., Witt C., and Rutt Ph.,
(2008)). Japanese Ob/Gyns
and midwifes attitudes and believes. We can be in panic. Panic because such thing should not have happened. Sometimes, right after the babyfs death is detected, we cannot say anything in front of the patients. It can happen sometimes. It is important to know that this reaction is not inappropriate; it is normal humanfs reaction on unexpected situation. If doctor cannot say any word in the situation, better do not try to give a professional speech: talk, when you will be ready, gDo not harm!h by wrong way of communication with your patients. Though, the word
of gobstetricsh means gstand byh in Latin
language. Usually we have no chance to change the fact,
but can support, encourage and help for natural process. Medicals need to avoid such common way of cope as a creation of gthe physiological shieldh. That seems help to be a good professional with easy overcoming of unnecessary sensitivity and tears. In reality such approach makes more problems then seem could be. Absence of understanding the parentfs feeling, loss of humane care on the bereavement parents, desire to protect only own feelings; finally turn the parents to be an enemy of medical staffs. The best way is to learn the situation from the parentfs point of view as well. Undoubtedly, the
best professional approach implicates appropriate balance
between |
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