Predictors of staff distress in response to professionally experienced miscarriage, stillbirth and neonatal loss: A questionnaire survey

Background: Nursing and medical staff in maternity and gynaecological settings regularly care for patients experiencing miscarriage, neonatal death and stillbirth as part of their work. Qualitative reports have suggested that perinatal death takes a significant emotional toll on staff but to date, reported distress has not been quantified. Objectives: The present study, using Lazarus and Folkman's transactional model of stress, explored the extent of staff distress, and its predictive factors, in a sample of United Kingdom nursing and medical staff. Method: A retrospective, cross-sectional, questionnaire survey was undertaken across five Midlands hospitals, inviting a total of 350 doctors, nurses and midwives to participate. In addition to sociodemographics, the questionnaires assessed staff distress, coping strategies and their perception of working environment via the Impact of Events Scale (IES), Positive And Negative Affect Scale (PANAS), Brief COPE, and Work Environment Scale (WES) respectively. Results: 54% of eligible staff responded. IES scores revealed 55% of participants reporting subjective distress levels indicating a 'high' level of clinical concern. Multiple regression revealed that whilst no socio-demographic variable predicted distress, negative affect experienced at time of care (p=.002; Cl 0.164-0.683) negative appraisal of care given to the family (p=.003; Cl 0.769-3.358), cumulative number of losses experienced (p = 0.004; Cl 0.713-3.778), maladaptive ways of coping (p=.000; Cl 0.482-1.136), and staff perceptions of support outside work significantly predicted distress (p = 0.023; CI -4.818 to -0.355). Working environment, specifically lack of supervisor support, was significantly correlated with negative coping strategies (r=-0.242, p = 0.001). Conclusion: Staff working in these settings appear to experience significant levels of subjective distress, with appraisals of care and coping styles rendering staff more vulnerable. Formal training does not appear to be protective, however opportunity could be given to access support and supervision to mitigate distress and encourage reappraisal of care during which neonatal death has occurred. (C) 2013 Published by Elsevier Ltd.