Abstract
Perinatal loss can be one of the most traumatic and painful experience a mother and family can go through. The aim of this paper is to explore Swanson’s Middle Range caring theory and its application in family centered care when dealing with clients experiencing a perinatal loss.
Introduction
Having a baby die, whether in the womb or during birth can be the most tragic and heart breaking experience parents and nurses’ face. A nurse’s knowledge of the best way to respond to each unique situation of perinatal loss to help the mother and family cope effectively is critical to provide a holistic family centered care. Perinatal death is defined as the combination of stillbirth and neonatal fatalities in the first week of life (WHO). Nurses
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Often, when thinking about a labor and delivery unit, excitement and joy are the first things that come to mind; nurses are familiar with this aspect of care; however, in the case of perinatal death providing care to the mother and families can be challenging and an emotional role for nurses. This paper will be describing the five processes of Kristin Swanson’s Middle- Range Theory of care when dealing with families that have experienced a perinatal loss, the importance of care and compassion when dealing with families experiencing perinatal loss and the application of Kristin Swanson’s Middle Range Theory in nursing Practice to provide a safe competent family centered care.
Swanson’s Middle Range Theory of caring suggests five therapeutic processes that define caring: Knowing, being with, doing for and making belief (Swanson, 1991). Swanson’s theory explores the concept of caring both from the mother and the nurses’ perspective (Swanson, 1991). The first therapeutic process in Swanson’s Middle Range caring theory is
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Establishing a relationship with the mother and the family is key in this process (Jansson & Adolfsson, 2011). One of the way’s nurses can build relationship with the mother and family is through Relational practice, this requires the nurse’s ability to integrate both the patient’s healthcare and personal needs and an understanding of a patient’s personality, values, culture, religion and past medical and emotional history (Doane & Varcoe, 2007). During the traumatic and painful experience of perinatal loss mothers and family often feel powerless and often do not take care of themselves. A nurse can help the mother and the family by providing basic physical needs such as food and drink. In a study conducted by Jansson & Adolfsson (2011) one of the mothers that participated in the study stated that she appreciated the simple gestures provided by the health care team. Furthermore, in a study conducted by Rini and Loriz (2007) parents who experienced displays of caring had a profound long lasting positive effect on their experience surrounding perinatal loss indicating the positive after effect caring has on families experiencing perinatal loss. In Swanson’s Middle Range Caring Theory, the “enabling” process emphasizes the importance of maintaining confidence in the ability of the mother and family to survive and get through the event; the nurse’s appreciation of the difficulty of coping for
Including the client as an expert member of the team creates an enhanced quality of care (Coad, Patel & Murray, 2014). In pediatrics, parents are often at the center of the child’s care. When asked to define what made the client care experience positive, parents stated that sensitivity, empathy and honesty were key factors (Coad, Patel & Murray, 2014). Working in healthcare, nurses can become desensitized to difficult experiences because they deal with them daily. Integrating the client and family as part of the healthcare team, allows the nurse to see the patient and family as a people first. By avoiding using illness as context, and instead using person as context, care will be more holistic (Coad, Patel & Murray, 2014). A family-focused approach helps to ensure that the whole family feels a part of the experience and is valued. In the case of bereavement, family centered care is particularly important. If the family is not included in the care from the start, it can provide barriers for grieving and impact how the family deals with loss (Jones, Contro & Koch, 2014). Nurses have an opportunity to help support the family through the grief process (Jones, Contro & Koch, 2014). Families have a significant impact on how the client heals, so by caring for the family’s needs, the nurse is indirectly caring for the patient. It is in the client’s best interest for the care to be holistic for the patient as well as the family (Jones, Contro & Koch, 2014). All
This means recognizing each woman’s social, emotional, physical, spiritual and cultural needs. It also acknowledge that a woman and her newborn baby does not exist independently of the woman’s social and emotional environment. This includes incorporating an understanding in assessment and provision of health care (Yanti et al., 2015). The fundamental principles of women-centred care ensures a focus on pregnancy and childbirth as the start of family life, not just as isolated clinical episodes. These motherhood phases take into complete account the meaning and the values of each woman. Providing women centred care helps women make an informed choices, being involved in and having control over their own care, this also includes their relationship with their midwives (Johnson et al., 2003). This demonstrates that midwives are able to attend for women during pregnancy, childbirth and in early parenting years. In addition to this, midwives also provide education for women in order to have a healthy lifestyle (Woods et al.,
On reading this article and identifying the study, there was a clear insight on how death and dying, and even improved health, impacted those nurses (Conte, 2014). Nurses, who worked closely with their patients, through the perils and suffering, culminating of death and losses, had grief not readily explored to enable that comfort zone (Conte, 2014).
This situation has made me grateful to be alive since I was able to be brought back to health due to these wonderful neonatal nurses who helped me recover, but not many newborn babies are fortunate enough to survive just like me as newborn babies have died and suffered due to the lack of supervision that neonatal nurses are incapable of providing.
Historically perinatal loss such as stillborn is rarely a topic of discussion. (Avelin, Erlandsson, Hildingsson, & Rådestad, 2011). Stillborn loss was not viewed as an problem, and was expected for mothers to forget about the baby, and have another one, while siblings were told to forget about the baby and not talk about the loss (Avelin et al., 2011). Perinatal loss responses can be vary widely as it covers variety of loss from pregnancy to birth within a few weeks, but most often it is an unexpected loss for many families who typically do not know what to do, what to expect and how to handle grief (O’leary & Warland, 2013). Furthermore, there is very little information on Stillbirth experiences especially about men who lose their child(Bonnette & Broom, 2012). Experiencing the loss of a child can be very difficult and often complicate grief which can affect parents social well being (Kersting & Wagner, 2012). In pregnancies that follows a loss such as perinatal loss, it has been found that parents experience high levels of psychological distress, anxiety, depression and post-traumatic stress. (O’leary & Warland, 2013; Kersting & Wagner, 2012)
The caring theory was grounded on a humanitarian perspective and is found on a humanistic approach toward human caring programs and experiences. It acknowledges that life with individuals and their community to the surrounding environment are somehow connect and affects wellbeing of everything involved. The nature of the theory caring implies that it embraces reflective investigations as well subjective and interpretative inquiries. The nursing profession uses nursing theories as the framework and foundation for practice. Many people find nursing theories to be meaningless and of no use to the
According to Erlingsson and Brysiewicz (2015), family is considered a core, social institution and is our first interaction with human beings. When viewing the family as a context, the nurse assesses the patient that is in need of care while in the background, there are the family members of the patient. According to Kaakinen, Coehlo, Steel, Tabacco & Hanson (2015), the source of support to the patient is his or her family members. Usually family members are in attendance with the patient. This approach is used when a mother is admitted to the intensive care unit after falling and sustaining head trauma. The patient is the mother. The nurse is focused on the mother and care was directed
Cumulative grief is known as a caregiver’s emotional response to many episodes of grief (Shorter & Stayt). The multiple encounters with death give a nurse no opportunity to grieve adequately or completely for each individual patient that has died (Shorter & Stay, 2010). The unresolved grief accumulates and can lead to emotional and physicals problems which can then effect a nurse professionally and personally (Shorter & Stayt, 2010). The effects of cumulative grief include denial, feelings of decreased personal competency, overwhelming grief, low self-esteem, and pre-occupation with death (Shorter & Stayt,
Kristen M. Swanson’s Caring Theory is the solution in bridging the gap between nursing practice and theory. It offers an explanation of the links between patient well-being and the caring process (Tonges & Ray, 2011). Swanson explained that nurses should be able to demonstrate that they care about their patients, and that caring about their wellbeing is as important as their patients’ current medical problem (Tonges & Ray, 2011).
The purpose of this paper is to analyze and summarize the philosophy of nursing and how nursing theory guides this nurse’s practice. Information used to do this paper was retrieved from the online database, Nursing and Allied Health Source and CINAHL through the SJR State Library. Our textbook, The Conceptual Foundations and the Merriam- Webster Dictionary website was also used. Some of the search phrases used were Jean Watson theory of human caring, philosophy of nursing, and Watson’s philosophy and theory of human caring in nursing on the online database. The word philosophy was also searched on the Merriam- Webster Dictionary website. There was an abundance information throughout my research on
It is evident that nursing theorists, scholars and health care professions have varying interpretations of what caring is or should be. In the middle of all these disparity, caring is a vital component of the nursing practice and the key to choosing the concept of caring is because it is very essential when it comes to health care. This paper tries to make clear the concept of caring in the field of nursing and it makes use of the Walker and Avant outline to support the concept. It starts with recognizing the concept and its functions. It then identifies three emerging attributes of caring will be identified and a description of each will be given. At last, the paper will recognize antecedents, the effects or consequences and
Training in palliative and end of life care has been shown to decrease moral distress in nurses who provide care. This training and education needs to be provided by experts in the field in order to help nurses gain confidence in the provision of palliative care as part of the neonatal healthcare team. Targeted education helps build confidence through building communication skills, therapeutic practice with role playing, as well with increased knowledge through information on current research and community resources (Wool, 2013).
Overview: University of Kansas, article entitled: Creating a curtain of protection: nurses’ experiences of grief following patient death. This title was clear and unambiguous suggesting the key phenomenon under study. Too long or too short titles can be confusing or misleading (Parahoo, 2006), however, this title contained few words which adequately described the contents and purpose of the paper being studied. The abstract provided a succinct overview of the research, it brought out the main features of the report and included relevant information. It captivated my interest which motivated me to continue reading. This paper is a qualitative research written by L. Gerow and colleagues. In this study eleven registered nurses were interviewed using semi-structured interviews and phenomenology concepts. Audio-tapes and demographic questionnaires were also used. The data was analysed using methods of Heideggerian hermeneutical analysis and Van Manen’s progression. The purpose was to describe the lived experiences of nurses surrounding patient’s death. It entails how nurses deal with such situation differently by creating a curtain of protection to mitigate the grieving process allowing them to continue providing supportive nursing care. The aim was to investigate nurses’ grief to develop
Part of the caregiver or nurse's duty is to provide emotional support and understanding to the patient. Swanson (1993) proclaims that being with assures patients that their reality is appreciated and that the nurse is ready and willing to provide emotional support. Emotional support can come in many forms, such as providing a shoulder to lean on and listening attentively. By using the process of 'being with', nursing professionals can convey messages such as, "you are not alone, what happens to you matters and that we are here for you" (Swanson, 1993). Conveying these messages can help with the healing process and overall well-being of the patient by decreasing anxiety and providing the patient with a caring relationship when family support is unavailable.
This theory explains, describes, guides, and supports nursing practice. It gives language to the unspoken beliefs and perspectives of the nursing profession. This allows the nursing professionals to better envision, realize, and articulate their unique role in healthcare (Green & Robichaux, 2009). Human caring is the basis of therapeutic relationships between human beings (Wade & Kasper, 2006)