Mills Tracey A, Ayebare Elizabeth, Mweteise Jonan, Nabisere Allen, Mukhwana Raheli, Nendela Anne, Omoni Grace, Wakasiaka Sabina, Lavender Tina
Centre for Childbirth, Women's and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda.
Women Birth. 2023 Feb;36(1):56-62. doi: 10.1016/j.wombi.2022.02.012. Epub 2022 Mar 16.
Stillbirth is a traumatic life-event for parents. Compassionate care from health workers supports grief and adjustment, alleviating psychological distress and minimising serious adverse health and social consequences. Bereavement support in facilities in LMICs, including in sub-Saharan Africa, often fails to meet parents' needs. However, very few studies have explored health worker's experiences in these settings.
To explore the lived experiences of midwives, doctors and others, caring for women after stillbirth in Kenya and Uganda.
Qualitative, guided by Heideggerian phenomenology. Sixty-one health workers, including nurse-midwives (N = 37), midwives (N = 12) and doctors (N = 10), working in five facilities in Kenya and Uganda, were interviewed. Data were analysed following Van Manen's reflexive approach.
Three main themes summarised participants' experiences: 'In the mud and you learn to swim in it' reflected a perceived of lack of preparation; skills were gained through experience and often without adequate support. The emotional and psychological impacts including sadness, frustration, guilt and shame were summarised in 'It's bad, it's a sad experience'. Deficiencies in organisational culture and support, which entrenched blame, fear and negative behaviours were encapsulated in Nobody asks 'how are you doing?'.
Health workers in Kenya and Uganda were deeply sensitive to the impacts of stillbirth for women and families, and often profoundly and personally affected. Care and psychological support were acknowledged as often inadequate. Interventions to support improved bereavement care in sub-Saharan Africa need to target increasing health worker knowledge and awareness and also embed supportive organisational cultures and processes.
死产对父母来说是一场痛苦的人生事件。医护人员给予的关怀照料有助于缓解悲伤情绪并促进适应过程，减轻心理困扰，同时尽量减少严重的不良健康和社会后果。在包括撒哈拉以南非洲在内的低收入和中等收入国家的医疗机构中，丧亲之痛支持服务往往无法满足父母的需求。然而，很少有研究探讨这些环境中医护人员的经历。
探讨肯尼亚和乌干达的助产士、医生及其他人员在死产后照料妇女的实际经历。
采用以海德格尔现象学为指导的定性研究方法。对在肯尼亚和乌干达五家医疗机构工作的61名医护人员进行了访谈，其中包括助产护士（N = 37）、助产士（N = 12）和医生（N = 10）。数据按照范曼恩的反思性方法进行分析。
三个主要主题概括了参与者的经历：“身处泥沼，学会在其中游泳”反映出一种准备不足的感觉；技能是通过经验获得的，而且往往缺乏足够的支持。“这很糟糕，是一段悲伤的经历”总结了包括悲伤、沮丧、内疚和羞耻在内的情感和心理影响。“没人问‘你怎么样？’”则概括了组织文化和支持方面的不足，这些不足加剧了指责、恐惧和消极行为。
肯尼亚和乌干达的医护人员对死产给妇女和家庭带来的影响深感敏感，而且常常受到深刻的个人影响。人们认识到关怀和心理支持往往不足。在撒哈拉以南非洲，为改善丧亲之痛护理而开展的干预措施需要旨在提高医护人员的知识和意识，同时营造支持性的组织文化和流程。
