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PROJECT TITLE: Caring for Bereaved Parents: Competency, Beliefs About Perinatal Loss, and Coping Strategies of Nurses and Physicians

The purpose of this form is to provide you with information that may affect your decision whether to say YES or NO to participation in this research. The research will be conducted within the state of Virginia.

Principal Investigator:
Anisa L. Glowczak, MSEd, NCC
Fort Norfolk Plaza
301 Riverview Dr, Suite 710
Norfolk, VA 23510

This study seeks to identify trends in the competency, beliefs, coping strategies and experience of nurses and physicians who regularly work with patients who have experienced a perinatal loss. Information will only be gathered from you by the following survey. If you say YES, then your participation will last approximately 5-10 minutes.

RISKS:  If you decide to participate in this study, you may face a risk of some emotional discomfort as you recall the events, thoughts and feelings associated with your work. The researchers strive to reduce this risk by expressing the voluntary nature of participation and the option to withdraw from this study at any time without penalty. The survey does not ask identifying information (e.g. names or locations) so your responses will be anonymous.

BENEFITS:  Although there are no direct benefits for participating in the study, you may gain personal insight or benefit from reflecting on your experiences, thoughts, and feelings. The researchers hope that the information gathered within this research study will contribute to the overall knowledge and understanding of how to best support hospital staff who care for bereaved parents.  If you would like, the researchers will offer you a copy of the results of this study once it is completed.

There are no costs to participate. The researchers are unable to give you any payment for participating in this study.

All data collected will be pooled and de-identified. NO identifying information will be collected, including IP addresses. All information you provide for this study is strictly confidential. The survey and all data on this website will be retained for the required amount of time, and then deleted/destroyed. The results of this study may be used in reports, presentations, and publications.

It is OK for you to say NO to participating in this study, and you are free to withdraw from the study at any time without penalty.

 Researchers will not provide free medical care for any illness or injury resulting from participating in this study. Financial compensation for research related injury or illness, lost wages, disability, or discomfort is not available. However, you do not waive any legal rights by signing this consent form.

By clicking below, you are agreeing that you are an adult (age 18 or older), have read this form (or have had it read to you) and that you are satisfied that you understand this consent, the research study, and its risks and benefits. If you have any questions now or in the future, you can contact the research team at the address listed above.

By continuing, you are telling the researchers "YES, I understand this informed consent document, I am an adult age 18 or older, and I agree to participate in this study."

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* 1. In which area do you work?

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* 2. In which hospital system do you work?

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* 3. I am a...

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* 4. How comfortable are you with...(check all that apply)

  I am comfortable I am NOT comfortable I am knowledgeable and/or experienced I need more training and/or experience
Multicultural aspects (i.e. religious beliefs and practices, culture, etc.)
Caring for a bereaved family
Dressing/wrapping the baby
Taking photos of the baby
Obtaining hand and/or footprints
Understanding and completing the appropriate forms
Expressing my natural emotions (i.e. crying) with the patient/family
Reviewing the contents of the bereavement packet with the patient/family
Expressing yourself verbally (naturally knowing what to say, no inappropriate comments, etc)
Empathizing with and understanding the patient's experiences
Recognizing appropriate grief responses
Understanding how the hospital-provided cremation service works
Encouraging patient to talk about her loss
Dealing with my own thoughts/feelings about death and loss

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* 5. AFTER caring for a bereaved patient how often do you....(check all that apply)

  Never Seldom/Occasionally Always
Practice self-care (i.e. exercise, relax, hobby, meditation etc.)
Believe that your own thoughts/feelings about death/loss interfered with the care you provided the bereaved patient
Believe that you provided competent care
Carry the patient/family "home" with you mentally
Believe it was a rewarding or meaningful experience, professionally and/or personally
Feel angry
Feel anxious
Have upsetting, intrusive thoughts about the baby or patient
Believe that your care made a positive difference to the patient/family
Need time to reflect
Need to share (talk, vent, discuss) your experience with another
Engage in a "feel good" or "checking out" behavior (i.e. drinking alcohol, going out with friends, eating, etc)

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* 6. Please answer honestly.

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* 7. Do you have emotional difficulty working with bereaved parents who fall into any of these categories (check all that apply)...

  Yes No Sometimes
Mother used drugs or alcohol
Parents chose to terminate pregnancy (for genetic D/O, anomaly, etc)
Mother chose not to obtain prenatal care
Mother was non-compliant with prescribed meds or treatment for medical condition
Mother is very young
Parents in abusive relationship
A family whose cultural, religious, familial beliefs and values differ from yours
A family whose values and/or beliefs about life, or what constitutes person-hood, differs from yours

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* 8. How do you perceive a miscarriage (less than 20 weeks)? (check any that apply)

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* 9. How do you perceive a stillbirth (20+ weeks)? (Check all that  apply)

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* 10. Thinking of just grief-related and perinatal loss issues, in what areas are you competent? In what areas would you like/need to have additional training or support?

  I'm fully competent I need more experience I'd like more training & support
Multicultural aspects
Completion of paperwork
Information about the hospital-provided cremation service
How to prepare a baby to be viewed by the family (tips & tricks)
What to say, or not say, to bereaved families
Working through my own thoughts/feelings about death/grief/loss
Working through my own thoughts/feelings about patients in difficult situations (i.e. substance abusing, non-compliant, very young, etc)
Identifying and addressing situations that challenge my own biases, values, and beliefs

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* 11. Click on all statements that you agree with

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* 12. Do you have any other comments, questions, or concerns?