dc.description.abstract | Fetal death is often sudden and unpredictable, and is devastating to a family expecting a newborn. Fetal death has an impact on anyone involved in this event, including the woman’s family and nursing personnel. In the culture in Taiwan, fetal death is still regarded as an ineffable taboo. Many medical and nursing personnel do not perceive their own sorrow, neither do they know how to adjust themselves or use appropriate approaches to guide women to express sorrow. Therefore, there is an urgent need to develop a nursing program suitable for the culture in Taiwan. However, in order to develop an appropriate nursing program, it is necessary to understand women’s experiences of fetal death events, as well as adjustments and expectations regarding nursing care. In addition, it is necessary to understand the feelings, self-adjustments, and care content of the nursing personnel providing care to these women, as well as how to improve care quality as perceived by them. Therefore, this study is divided into 3 parts: Part 1 is the in-depth investigation of women’s experiences, self-adjustments, and expectations towards nursing care. This study used participant observations as “obser-view” to collect the data of 10 women, and documented the interactive process as process recordings. This study invited 2 subjects to inspect whether the research results are consistent with their feelings, and confirm that people with similar experiences can resonate themselves with the research results. Regarding the data scoring, the intra-rater reliability is 88.7%, and the inter-rater reliability is 81.2%. The results of content analysis are as follows: women’s experiences of fetal death events are: “impact of sudden fetal death,” “heartbreak for the loss,” “accidental experience of postpartum lactation suppression,” and “letting go of the past and looking forward to the reborn.” Their self-adjustments are, as follows: “multi-confirmation of the evidences of the fetus death,” “interpreting the meaning of the death of a fetus,” “making sure that the fetal remains are properly handled,” and “regaining normal life.” Their expectations towards nursing care has two aspects: “provision of related information” and “providing a environment with caring ,” including the provision of independent space to avoid recalling sorrow, notification of information on examinations and handling of fetal remains, provision of information on prevention of a similar event, and follow-up on women’s postpartum lactation suppression and uterine involution. Part 2 is the investigation of the feelings, self-adjustments, nursing care providing to the women, and suggestions for the ideal care of nursing personnel in fetal death events. This study used interview guidelines to perform individual or group interviews, which were all recorded. After the interviews, this study converted the interview content into transcripts, and used content analysis to extract the themes. The intra-rater reliability is 87.8%, and the inter-rater reliability is 80.8%. The content credibility, transferability, confirmability, and dependability of Lincoln and Guba (1985) were used to improve the reliability of the data. The research results showed that: nursing personnel’s feelings about fetal death are mainly divided into two parts: sorrow and fear. They feel sorrow for the fetus and mother. They feel fear because of their “existing attitude towards death,” or because they are “afraid of fetal remains,” “worried about saying anything wrong,” and their feel “helplessness.” Their self-adjustments include: “endeavoring to separate themselves from the event” and “seeking support.” They usually use their own approaches to provide care measures, including “providing the woman with a healing space” and “trying to provide care.” The nursing personnel suggest that the approaches to improve care quality are: “early intervention of care” and “strengthening nursing personnel’s care ability.” Part 3 is the action research conducted according to the information of the women and nursing personnel to confirm that the developed care model can be provided by nursing personnel, and it meets the care needs of women. The start time of care should be as early as the moment when women come to the outpatient clinic to confirm fetal status. The cycles of each action research were developed according to the suggestions of women and their family members. After the reflections and discussions of the head nurse, nurse practitioners, and team members who actually provide care, this study modified the care model according to hospital policy and the feasibility of implementation to develop the next model content. After 4 cycles, the direction was ascertained. The nursing personnel provided care to women from contact at delivery in order to ensure that this care model applies to women starting to receive care at the delivery room. After the confirmation of the care model by the team, nurse practitioners operated it in person. This research results showed that, primary caregivers can use the concepts of navigator nurse to listen to the feelings and expectations of specific populations, provide health education, and implement inter-sectoral or inter-unit communications to provide continuous and consistent nursing care. The suggestions on clinical practice generated from the research results include: to understand women’s feelings, to provide more care to women and family members who feel sorrow, to provide companionship and understanding when they are in emotional chaos, to explain the procedures of labor and processing of fetal remains, to provide choices, and to provide the information of postpartum lactation suppression and physiological changes according to individual conditions. The said measures all are beneficial to the improvement of women’s negative emotions. In terms of nursing education, it is advised to include the experiences, feelings, adjustments, and expectations towards care of women and nursing personnel into general education and in-service education. In this way, nursing personnel’s care ability can be improved through the understanding of others and selves, as well as specific handling methods. This research contribution is the development of a nursing program for fetal death events, which not only meets the needs of women and their family members, but also provides the Division of Obstetrics of various hospitals with feasible professional care procedures. Moreover, this study used “obser-view” to collect interview data, and found that this method only applies to populations in sorrow who are short-spoken and passive, and cannot be contacted afterwards. Although only one woman agreed to participate in the narrative method, her feelings could be understood through her story. In addition, the story-telling process enabled her to vent the emotion of sorrow. The research results showed the importance of the role of navigator nurse in this population, and can be provided as reference for future expansion spaces of nursing professionals. | en |