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"Moving Through Miscarriage" Curriculum to Increase Confidence of Providers

In This Article

  • 30 years of scientific research demonstrates that individuals experiencing miscarriage are dissatisfied with the emotional care they receive
  • Providers understand the emotional needs of these patients but do not feel confident caring for individuals experiencing a miscarriage
  • Providers have voiced the desire for more training, (both formal and continuing education), as well as increased organizational support in this area
  • "Moving through Miscarriage" contains modules on miscarriage facts, grief after miscarriage, ecological systems theory, grief intensity, and case studies

Carolyn McDonald, DNP, began her nursing career at Massachusetts General Hospital as a student nurse in 1992. Since receiving a master's degree in nursing in 1995 from the MGH Institute of Health Professions, she has worked as a nurse practitioner specializing in women's health. Carolyn's doctoral studies focused on the psychological care of individuals experiencing a miscarriage. As part of her studies, she developed a novel, web-based curriculum—Moving through Miscarriage—to increase the confidence levels of medical professionals providing care to patients experiencing miscarriages.

Q. What prompted you to select psychological care after miscarriage as a topic for your Doctor of Nursing Practice degree research?

McDonald: I wrote my master's degree thesis on miscarriage management, after which I thought I had a good understanding of how to support a person experiencing a miscarriage. It was after my personal, life-altering experience with a miscarriage that I understood how much more we as a medical community needed to learn and do to better support people experiencing loss through miscarriage. I healed and moved through my loss, knowing that part of my life's work would be dedicated to raising awareness surrounding loss through miscarriage and supporting those individuals experiencing it

Q. What is your project and its goals?

McDonald: This doctoral project was conceptualized as a quality improvement project, aimed at improving the approach to the education of providers related to the psychological care of individuals experiencing a miscarriage. There is much scientific research related to the topic of miscarriage management, but the translation of this research into practice needs improvement. I developed an educational program that is web-based, readily accessible, and easily modified to meet the needs of users. The specific aim of my project is to address the need expressed by healthcare providers for increased education related to perinatal loss, as well as increase the confidence levels of these providers. My project is globally aimed at providing better care, more resources, and ultimately increasing patient satisfaction related to psychological care of miscarriage.

Q. How did you develop this course? Did you collaborate with any researchers or incorporate past research?

McDonald: "Moving through Miscarriage" contains content modules related to miscarriage facts, grief after miscarriage, ecological systems theory, grief intensity, and case studies. This curriculum is intended for anyone caring for a patient experiencing a miscarriage. This includes providers in radiology, ultrasound, emergency services, community health, public health, and OB/GYN settings.

I conducted an extensive review of the literature—over 30 years of scientific research demonstrating that individuals experiencing miscarriage are dissatisfied with the emotional care they receive. Research also revealed that providers understand the emotional needs of these patients, but do not feel confident caring for individuals experiencing a miscarriage. Providers have voiced the desire for more training, both formal and continuing education, as well as increased organizational support in this area.

Bronfenbrenner's Ecological Systems Theory informed this project's development because the intricate web of systems and connections in a person's life (including biological, cultural, spiritual, and socioeconomic factors) affect how a miscarriage is perceived, received, and responded to. The course content was guided by the work of Marianne Hutti, PhD, WHNP-BC, FAANP, FAAN, and the Hutti Perinatal Grief Intensity Framework.

Q. How effective is this course?

McDonald: I used Agwu-Kalu's Perinatal Bereavement Care Confidence Scale (PBCCS) to measure knowledge, skills, confidence, and self-awareness levels pre-and post-intervention. The participants rated themselves on the scales before and after the 1.5-hour course.

Analysis of the data revealed a significant increase in the confidence levels, knowledge, and skills of participants.

Q. What is the future of this work?

McDonald: The curriculum became part of the training of new helpline providers at the Pregnancy & Infant Loss Support Centre. I think this course could benefit clinicians across Mass General, including Psychiatry residents and ED staff (nurses, mental health specialists, and patient care assistants). The course's web-based design makes it easily modifiable into a format for webinars and shorter presentations. I am also presenting at the 36th Annual American Psychiatric Nurses Association Convention in October 2022 and am eager to share this work with others.

I am grateful for my doctoral team of advisors: my content expert Fernando Espi-Forcen, MD, Dr. Ruta Nonacs, MD, PhD, and my project advisor Patrice Nicholas DNSc, DHL (Hon.), MPH, RN, NP-C, FAA.

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