Bereavement Support for Underserved Women with Perinatal Loss: Effects on Maternal Coping



ABSTRACT

Purpose: The purpose of this study is to explore the bereavement support experiences of underserved women with perinatal loss and the effects on maternal coping. Psychosocial support is an important determinant of healing for bereaved mothers who experience pregnancy loss and early infant death. These mothers may receive psychosocial support either from formal or informal sources with each offering a different quality of care. Women who receive formal psychosocial support are more likely to report better outcomes than those who receive support from other bereavement support sources. Underserved women have increased risks of adverse bereavement outcomes and often cannot access formal support programs that are not publicly funded.



Theoretical Framework: Roy's Model of adaptation (Roy & Andrew, 1991) is a holistic systems theory, which will be used to guide this study. Roy looks at individuals and groups of people as biopsychosocial and spiritual beings who interact with their environment. The theory is relevant to this study because, it shows how the management of stimuli, (type of bereavement support received) may influence adaptive or ineffective responses to perinatal bereavement. Roy uses the feedback mechanism to illustrate this by relating the person or group of people with concepts from her theory, such as, the human environment, health and nursing. According to Roy, unity of the human system is achieved by a conscious process of organizing and integrating complex stimuli to achieve efficacy and adaptation. This theorist looks at nursing science and practice as a transformational process, by which health needs are met and the adaptive abilities of individuals expanded and enhanced. Roy also views health as a process of being and becoming, which is reflected in the mutuality between the person and the environment. The concepts in Roy's theory are parallel with the variables explored among bereaved mothers in the process of adapting to their loss.



Methods: A retrospective cross-sectional design will be used in this study. Positive bereavement support outcomes to be explored include adaptation to loss, decrease in grief symptoms, a hopeful outlook at life and a general sense of well-being. Negative bereavement support outcomes, on the other hand, include ineffective coping, chronic grief, functional difficulties or adjustment problems, health morbidities and despair. Bereavement support outcomes will be compared between women, who obtained psychosocial support from hospital bereavement programs, support groups and grief counselors, as opposed to those who received grief support from family, friends and spiritual leaders. The differences in grief expression among women who experience miscarriage, stillbirth and neonatal death will also be observed. One hundred and twenty women of diverse ethnic origin from two hospitals in New York City (Queens Hospital Center and Jacobi Medical Center) will be enrolled in the study. Potential participants for this study include patients and employees from the participating institutions who have experienced perinatal loss. The type and access to psychosocial support, used by participants ,will be explored.

Data collection will be conducted by using three de-identified self-reported survey ...