Expert nursing care: perinatal palliative care during labor, delivery, and the recovery period
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It is a tragic reality that some infants are anticipated to be stillborn or only live minutes to hours after birth. Nurses providing care during labor, delivery, and recovery (LDR) are in a key position to support families who experience such perinatal losses, and the quality of the care they provide can have an enduring impact on families’ healing and bereavement. Limited empirical work has been conducted examining the behaviors nurses engage in to provide perinatal palliative care (PPC) during the LDR period. Thus, nurses have little by way of evidence to support them in providing care. To address this gap in the scientific literature, this study examined and described: the critical behaviors required for expert nursing care of families receiving PPC during LDR; the factors promoting or hindering their ability to do so; and the consequences of achieving or not achieving these behaviours. Interpretive description, a qualitative methodology placing emphasis on yielding knowledge for clinical practice, was utilized and Benner’s From Novice to Expert model served as the foundation for the theoretical forestructure of this study. A purposive sample of seven registered nurses deemed as experts by their colleagues were identified through a peer nomination process at two urban tertiary care centres on their respective LDR units. A total of 12 semi-structured face-to-face audio recorded interviews were conducted and transcribed verbatim for thematic analysis. A conceptual model illuminating how nurses cultivate expertise in PPC in the LDR setting emerged from the data and is inclusive of a description of the actions and considerations expert nurses engage in while providing care for families experiencing perinatal loss during the distinct stages of LDR. The outcomes of providing expert nursing care during perinatal loss have also been identified. Laboring patients and their families can be best served during this delicate time of life by equipping nurses with evidence to inform their practice. By understanding how nurses cultivate expertise in PPC during LDR, educators, administrators, and managers can better support nurses to hone their ability to care for families experiencing perinatal loss.