Nurses Caring for the Mother of a Stillborn Baby

City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 2-2018 Managing Ambiguity: Nurses Caring for the Mother of a Stillborn Baby Natasha J. Nurse The Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/2483 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] Running head: MANAGING AMBIGUITY i MANAGING AMBIGUITY: NURSES CARING FOR THE MOTHER OF A STILLBORN BABY by Natasha J. Nurse, RN, MS, CNS A dissertation submitted to the Graduate Faculty in Nursing in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York 2018 MANAGING AMBIGUITY ii © 2018 NATASHA J. NURSE, RN, MS, CNS All Rights Reserved MANAGING AMBIGUITY iii MANAGING AMBIGUITY: NURSES CARING FOR THE MOTHER OF A STILLBORN BABY by Natasha J. Nurse, RN, MS, CNS This manuscript has been read and accepted for the Graduate Faculty in Nursing in satisfaction of the dissertation requirement for the degree of Doctor of Philosophy. Barbara DiCicco-Bloom Date Chair of Examining Committee Donna M. Nickitas Date Executive Officer Supervisory Committee: Arlene T. Farren, RN; PhD; AOCN, CTN-A, CNE Rana Limbo, PhD, RN, CPLC, FAAN Barbara Gail Montero, PhD Donna Nickitas, RN, PhD, NEA-BC, CNE THE CITY UNIVERSITY OF NEW YORK MANAGING AMBIGUITY iv Abstract MANAGING AMBIGUITY: NURSES CARING FOR THE MOTHER OF A STILLBORN BABY by Natasha J. Nurse, RN, MS, CNS Advisor: Barbara DiCicco-Bloom, Ph.D., RN Purpose: The aim of this study was to describe and conceptualize the experiences and processes involved when labor and delivery nurses provide care to women experiencing a stillbirth. Background: The care of a woman experiencing a stillbirth is an important topic that requires attention, however, there is a paucity of literature on the specifics of a nurse’s experience as she or he cares for a grieving mother. These experiences may shed light on gaps in care that may exist as well as gaps in the resources, education and support needed to appropriately prepare nurses for providing care to a mother at such a difficult and vulnerable time. Stillbirth is increasingly referred to in the literature as a traumatic death, unexpected and unplanned, resulting in post- traumatic stress responses. Understanding what the bedside nurse does, thinks, and feels during these moments of traumatic bereavement will contribute to a greater understanding of the nurse’s experience of providing care to a patient. Method: This study used a grounded theory approach. Data were collected via in-depth interviews with 20 labor and delivery nurses. Each interview session was recorded, transcribed verbatim, and analyzed using the constant comparative method of analysis. MANAGING AMBIGUITY v Results: Based on the inductive method of grounded theory and a thorough comparative analysis of the data, the theory Managing Ambiguity emerged as the basic social process of how nurses struggle to care for a mother whose baby was stillborn. This theoretical underpinning summed up the substance of what was occurring when nurses cared from a mother experiencing a stillbirth and was characterized in three different categories by labor and delivery nurses as Experiencing a spectrum of emotions, Managing the ambiguous patient, and Managing institutional ambiguity. These factors contributed to the overall ambiguity the nurse had to manage when providing care for the patient whose baby was stillborn and became the three main categories of the overall theory: Conclusions: This theory of Managing Ambiguity provided a perspective on the experiences, behaviors, and social processes involved in caring for a woman delivering a stillborn baby. This theory also provided insights into how the interactions between the nurse and herself, the nurse and the patient, and the nurse and her environment impacted the process and the meaning of the event. The importance of this study is the resulting understanding of factors that impede and enhance the process of providing care to a mother whose baby was stillborn. Feelings of uncertainty, ambiguity, and discomfort must be addressed at the nursing education and nursing leadership levels. MANAGING AMBIGUITY vi Acknowledgements There are no words that could describe what an extraordinary task and undertaking this has been. I could not have accomplished this feat had it not been for some very special people in my life. I want to acknowledge all of my friends and family members who encouraged and provided unending inspiration to me, especially my husband Andrew, my sister Nikki, my aunt Yolanda, cousin Cristina and best friend Kerona. I couldn’t have asked for a better cheerleading squad! I am also grateful to my mentors Dr. Catherine Alicia Georges, Dr. Cassandra Dobson and Dr. Martha Whetsell. You ladies show me what true compassion and dedication is. I want to also acknowledge my dissertation committee for all of your feedback, encouragement, dedication and guidance through this process. You have each made a unique and essential contribution to my study. To my faculty advisor and chair of my dissertation committee, Dr. Barbara DiCicco-Bloom, I am truly indebted to you for all of the time and support you have offered me. You have made me into a strong researcher and have taught me so much more than I thought was possible to learn. To Dr. Rana Limbo, your kind and encouraging words, along with your longstanding work and expertise in the area of perinatal bereavement were an unparalleled source of comfort and inspiration to me throughout this process. To Dr. Donna Nickitas, to whom I am indebted to for both my Undergraduate and Doctoral level studies, thank you for your encouragement and support along the way. To Dr. Arlene Farren and Dr. Barbara Montero, your unique specialties and talents have helped me in areas where I was weak and helped me to view my research in a different light. I also want to thank all the nurses who volunteered to participate in this study and all the families that brought this important issue to my attention, as well as Marline Laurent-Nicolas who MANAGING AMBIGUITY vii taught me how to support these families in need. Most of all, I want to thank my beautiful mother, Kathleen Nurse who shows me what true courage is every day. This work was truly a labor of love and I am grateful to the PhD program at the CUNY Graduate Center and all the faculty and my fellow colleagues, especially cohort 6, who have supported me every step of the way. MANAGING AMBIGUITY viii Table of Contents Abstract…………………………………………………iv Acknowledgments…………………………………….. vi Table of Contents……………………………………… viii List of figures……………………………..…………… xii Chapter 1: Introduction…………………….……………………. 1 Aim of the study …………………………………..... 2 Research question…………………………………… 2 Definitions………………………………………....... 3 Background…………………………………………. 3 Justification for the study…………….…………........5 Method……………………………………...……..….7 Implications for nursing……………………………... 9 Assumptions and biases……………………………….9 Summary…………………………………………….. 10 Chapter 2: Review of literature…………..……………………... 12 Death and dying in hospital settings…………….……13 Nurses and death……………………………......…….14 Stillbirth………………………………………...…… 17 History of stillbirth management………...….. 17 Parents’ experiences with stillbirth……………20 Experiences of nurses with stillbirth…………..23 Summary………………….………………………….. 30 Chapter 3: Methodology…………………………………………. 31 Research plan……………………………….... 33 MANAGING AMBIGUITY ix Sampling plan………………………………… 33 Inclusion and exclusion criteria……………… 34 Interview process……………………………... 35 Data analysis plan.……………………………. 35 Trustworthiness of findings …………………………...36 Summary……………………………………………… 37 Chapter 4: Introduction.…………………………………………… 38 Demographic characteristics of patients………………...38 Participant recruitment and study setting ………………40 Description of interview process ……………………….40 Data Analysis …………………………………………. 42 Findings ……………………………………………….. 44 Experiencing a spectrum of emotions ………………… 47 Acknowledging the emotional difficulty ……… 47 Suffering while acting professionally …………. 50 Becoming inured ……………………………… 52 Feeling appreciated/rewarded …………………. 54 Summary of experiencing a spectrum of emotions.. 55 Managing the ambiguous patient ………………………. 56 Avoiding the patient ……………………………57 Stigmatizing the patient ………………………. 61 Learning to provide care ……………………… 61 Protecting the patient …………………………. 66 Summary of managing the ambiguous patient …70 Managing institutional ambiguity ……………………... 71 MANAGING AMBIGUITY x Managing barriers to care ……………………… 71 Managing alone ………………………………… 75 Fighting institutional policies and procedures …. 78 Getting support or not getting support …………. 83 Summary of managing institutional ambiguity … 86 Summary of Chapter ……………………………………. 86 Chapter 5: Discussion ………………………………………...… 88 Discussion of findings ………………………………….. 88 Managing ambiguity …………………………………… 90 Ambiguity in nursing care ……………………... 92 The theory of ambiguous loss …………………. 94 Death and dying in hospital settings …………... 96 Summary of managing ambiguity ……………... 100 Experiencing a spectrum of emotions …………………. 100 Acknowledging the emotional difficulty ………. 101 Suffering while acting professionally ………….. 103 Becoming inured ………………………………. 105 Feeling rewarded ………………………………. 107 Managing

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