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Nursing Interventions to Facilitate the Grieving Process After Perinatal Death: a Systematic Review

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Nursing Interventions to Facilitate the Grieving Process After Perinatal Death: a Systematic Review International Journal of Environmental Research and Public Health Review Nursing Interventions to Facilitate the Grieving Process after Perinatal Death: A Systematic Review Alba Fernández-Férez 1, Maria Isabel Ventura-Miranda 2,* , Marcos Camacho-Ávila 3, Antonio Fernández-Caballero 4,5, José Granero-Molina 2,6 , Isabel María Fernández-Medina 2 and María del Mar Requena-Mullor 2 1 Faculty of Health Sciences, University of Granada, Distrito Sanitario Almería, 04009 Almería, Spain; [email protected] 2 Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; [email protected] (J.G.-M.); [email protected] (I.M.F.-M.); [email protected] (M.d.M.R.-M.) 3 Obstetrics Service, Hospital La Inmaculada, 04600 Huércal-Overa, Spain; [email protected] 4 Faculty of Nursing, Univesity of Cádiz, 11207 Algeciras, Spain; [email protected] 5 Gynecology, Obstetrics and Delivery Service of the Hospital Punta Europa, 11207 Algeciras, Spain 6 Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago 7500000, Chile * Correspondence: [email protected] Abstract: Citation: Fernández-Férez, A.; Perinatal death is the death of a baby that occurs between the 22nd week of pregnancy (or Ventura-Miranda, M.I.; when the baby weighs more than 500 g) and 7 days after birth. After perinatal death, parents experi- Camacho-Ávila, M.; ence the process of perinatal grief. Midwives and nurses can develop interventions to improve the Fernández-Caballero, A.; perinatal grief process. The aim of this review was to determine the efficacy of nursing interventions Granero-Molina, J.; to facilitate the process of grief as a result of perinatal death. A systematic review of the literature was Fernández-Medina, I.M.; carried out. Studies that met the selection criteria underwent a quality assessment using the Joanna Requena-Mullor, M.d.M. Nursing Briggs Institute critical appraisal tool. Four articles were selected out of the 640 found. Two are Interventions to Facilitate the quasi-experimental studies, and two are randomized controlled clinical studies. The interventions Grieving Process after Perinatal that were analyzed positively improve psychological self-concept and role functions, as well as Death: A Systematic Review. Int. J. mutual commitment, depression, post-traumatic stress and symptoms of grief. These interventions Environ. Res. Public Health 2021, 18, are effective if they are carried out both before perinatal loss and after it has occurred. The support 5587. https://doi.org/10.3390/ of health professionals for affected parents, their participation in the loss, expressing feelings and ijerph18115587 emotions, using distraction methods, group sessions, social support, physical activity, and family Academic Editors: Stefan Nilsson and education are some of the effective interventions. Paul B. Tchounwou Keywords: perinatal death; perinatal loss; perinatal grief; nursing; midwifery Received: 7 May 2021 Accepted: 20 May 2021 Published: 24 May 2021 1. Introduction Publisher’s Note: MDPI stays neutral Perinatal death (PD) is the death of a baby that occurs between the 22nd week of with regard to jurisdictional claims in pregnancy (or more than 500 g of weight) and seven days after birth [1]. PD is a global published maps and institutional affil- health problem, and although it has been reduced, 2.6 million perinatal deaths occurred iations. in the world in 2017 [2]. In Europe, there were between 4 and 6 deaths per 1000 births [3]. In Spain, perinatal deaths have decreased from 20 deaths per 1000 births in 1975 to 4.37 deaths per 1000 births in 2019 [4]. PD can occur as a result of maternal conditions [5] such as high blood pressure [6], anemia [7], diabetes, bacterial infections; fetal conditions Copyright: © 2021 by the authors. such as congenital anomalies, intrauterine growth retardation, or multiple pregnancy; Licensee MDPI, Basel, Switzerland. placental conditions such as premature detachment of the placenta or bleeding; uterine This article is an open access article conditions such as uterine malformation; delivery conditions such as asphyxia during distributed under the terms and delivery hypoxia [8], umbilical cord prolapse [9], or complications of caesarean section [10] conditions of the Creative Commons and other unclassifiable or unclear conditions [11,12]. Attribution (CC BY) license (https:// After PD, parents experience the perinatal grief process [13], which affects them creativecommons.org/licenses/by/ on biopsychosocial and spiritual levels [14]. Thus, parents may experience depression, 4.0/). Int. J. Environ. Res. Public Health 2021, 18, 5587. https://doi.org/10.3390/ijerph18115587 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 5587 2 of 11 anxiety, post-traumatic stress disorder [13], eating and sleeping disorders [15], isolation and loss of faith [16], among other symptoms. The incidence of PD, as well as its important consequences, suggests the need to train nurses in this area [17]. Such training is essential in order to offer the highest possible quality of care based on the needs of the affected fathers and mothers [18]. Furthermore, good professional care based on empathy and emotional support has been shown to help families in the grieving process [19]. Professionals can also suggest practical measures to help the bereaved to cope with and overcome grief, such as holding the baby, and taking a photograph of the moment. Support groups are also effective in dealing with a loss of this type [20]. Nurses and midwives often perform interventions to help parents who have suffered a perinatal death, in fact, nurses are one of the main sources of support. However, the im- portant work of nurses in these situations is hampered by the lack of recognized strategies that can be implemented to assist parents and family members in the grieving process [21]. Additionally, are these interventions effective in helping fathers and mothers who have suffered a perinatal loss to deal with or resolve grief? Although there was a recent review of the literature on the efficacy of interventions on grief after an abortion [22], perinatal grief (between 22 weeks and one week of life) has not been well studied. A specific review on this topic (PD) published in 2013 did not find studies of interventions specifically focused on perinatal bereavement [23]. Therefore, eight years later, a systematic review can be justified; the aim of this review was to analyze the available evidence on the efficacy of nursing interventions to facilitate the process of grief as a result of perinatal death. 2. Materials and Methods 2.1. Design We conducted a systematic review of studies of interventions by following the Cochrane Handbooks [24] and the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, [25]. 2.2. Search Methods A literature search was conducted using four electronic data bases (PubMed, Scopus, Web of Science and Cochrane Library) between January and June 2020. The PICO question was used as a search strategy to identify possible studies, using a combination of natural and structured language, and Medical Subject Headings (MeSH). The keywords were systematically combined in order to conduct the literature search: “perinatal bereavement” AND “nursing care”; “perinatal death” AND “nursing”; “perina- tal loss” AND “nurse”; “perinatal grief” AND “nurse”. The databases were queried using titles, abstracts, and the keywords. In addition to searching the cited databases for studies, specific searches were made in a number of specialized journals such as Advanced Neonatal Care, and BMC Pregnancy and Childbirth. The reference lists of included articles were also reviewed for additional sources. The document selection was carried out independently by two researchers, and disagreements between them were settled by consensus. First, previously unidentified duplicates were eliminated. Then the titles and abstracts of the remaining articles were screened to identify eligible papers reviewed in full text. 2.3. Selection Criteria The criteria for inclusion of studies in this review were: (1) studies published in the last 5 years; (2) studies published in English or Spanish; (3) quasi-experimental studies or randomized clinical trials (RCTs). The criteria for exclusion were: (1) studies on interventions in women who are less than 14 weeks pregnant; (2) studies that do not describe specific interventions in a group of women. Int. J. Environ. Res. Public Health 2021, 18, x 3 of 11 2.3. Selection Criteria The criteria for inclusion of studies in this review were: (1) studies published in the last 5 years; (2) studies published in English or Spanish; (3) quasi-experimental studies or randomized clinical trials (RCTs). The criteria for exclusion were: (1) studies on interventions in women who are less Int. J. Environ. Res. Public Health 2021, 18, 5587 3 of 11 than 14 weeks pregnant; (2) studies that do not describe specific interventions in a group of women. 2.4.2.4. Search Search Outcomes Outcomes InIn the the identification identification phase, phase, the the search search of ofthe the data data bases bases yielded yielded 590 590articles articles and 50 and articles50 articles from from other other previously previously mentioned mentioned sour sources,ces, for for a total a total of of640 640 articles. articles. We We checked checked howhow many many of of them them were were duplicates duplicates (270), (270), which resulted in a total of 370 articles. InIn the the screening phase,phase, afterafter readingreading the the title, title, 329 329 studies studies were were discarded, discarded, with with 41 41 arti- articlescles remaining remaining after after the eligibilitythe eligibility phase. phase. After readingAfter reading the abstract, the abstract, 31 were eliminated,31 were eliminated,and another and 6 were another discarded 6 were for discarded other reasons for other as shown reasons in Figureas shown1. There in Figure were 1. 4 articlesThere wereleft in 4 thearticles inclusion left in phase the inclusion (Figure1 phase). (Figure 1). FigureFigure 1. 1. PRISMAPRISMA study study flowchart.
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