Comforting Patients through Perinatal Loss

In 2015, Cleveland Clinic’s Medina Hospital discontinued outsourcing perinatal bereavement services to a religious community-based organization. Nurses in the Family Birthing Center were asked to handle those services.

“Perinatal loss is a delicate time for patients and caregivers,” says Ashley Hawkins, BSN, RN, a staff nurse in Medina’s Family Birthing Center. “We were challenged to recreate our bereavement program.” During a staff meeting, Hawkins offered to help develop those in-house services, implementing several practices she learned while working at another hospital. Hawkins teamed up with Ann Roach, MSN, RN, RNC-OB, RNC-MNN, ACNS-BC, clinical nurse manager of Medina’s Family Birthing Center, to create the perinatal bereavement program and educate nurses on the 15-bed unit.

Mobile cart brings comfort to the bedside

When nurses in the Family Birthing Center discovered that perinatal bereavement services were being brought in-house, many were apprehensive. “They were accustomed to coming in, managing the induction and making sure the paperwork was filled out,” says Hawkins. “They weren’t as in tune with the messy, emotional part of perinatal loss because someone else was handling it. A lot of nurses were uncomfortable because they didn’t know what to say or how to act.”

To help them, Hawkins and Roach devised a mobile bereavement cart with all the supplies needed to provide both physical and emotional support to patients. When needed, the cart on wheels is easily moved right outside the patient’s room. The mobile bereavement cart includes several items, including the following:

• A perinatal loss guide for nurses – A binder created by Hawkins includes a script and pointers for nurses to talk to grieving patients and families, an explanation of memory boxes offered to patients, a list of resources for funeral homes, support groups, etc. and more. “I tried to compile everything in the binder in a straightforward manner because when nurses are in a stressful situation they are not comfortable with, knowing what to do can slip their minds,” says Hawkins.
• Personal supplies for nurses – When nurses are caring for a patient experiencing perinatal loss, they are encouraged to stay by the bedside. The top drawer of the mobile bereavement cart is filled with small items to help provide comfort, such as tissues, lotion, mints, tea bags and lip balm.
• A caregiver journal – Nurses who have tended a patient are asked to share tips and words of wisdom in the journal afterward for peers to read. “For new nurses, this is especially helpful,” says Hawkins. “It sends the message that others have been in the same situation.”
• Memory boxes – These boxes for patients hold mementos of their lost babies. The mobile bereavement cart also contains items to place in the boxes, such as beads to make a bracelet with the baby’s name, heart-shapes stones, forget-me-not seeds to plant in the spring and footprint and handprint making kits.

In addition, the nurses at Medina Family Birthing Center offer photography services so families can have photos of their babies. Hawkins has arranged for the area coordinator of Now I Lay Me Down to Sleep, a nonprofit organization that specializes in remembrance photography, to hold a class for nurses on how to pose babies and families and how to skillfully edit photos to provide the families a flash drive with images upon discharge.

The Birthing Center also has a CuddleCot™, donated by a former patient who experienced fetal loss. CuddleCot cooling pads are placed in a basket and connected to a cooling unit. Cooling the baby allows families a few more precious moments of time with their infants.

The right tools empower nurses, comfort families

Nurses are glad to have the mobile bereavement cart and other tools, and ultimately that benefits patients. A young woman pregnant for the first time recently experienced perinatal loss and was a patient at Medina Hospital. During her first night in the Family Birthing Center, a novice nurse cared for her. The nurse was nervous and unsure how to act, but she reviewed the binder then spent the evening reassuring the patient.

The following evening, the nurse was floated to another unit. “The family actually asked for her to come back and take care of this patient because she was so comforted by the nurse,” recalls Hawkins. “The nurse was flabbergasted because she had never done this before.” The tools in the cart empowered the new nurse, who in turn provided quality care and comfort to the patient.