Date of Award


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Selected Creative Commons License

Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Degree Name

Doctor of Philosophy (Ph.D.) Nursing




School of Nursing and Health Sciences



The labor and delivery unit is a place where new life begins, and families are made. Perinatal loss is a traumatic event for families and those that provide care to expectant families. In providing care to patients and families experiencing perinatal loss, nurses are at risk for secondary traumatic stress, which could be harmful to their physical and emotional state leading to compassion fatigue and burnout. Perinatal loss represents a stressful and emotionally demanding event for healthcare professionals, as they must deal with the additional burden of managing their own emotions while caring for the patients. Self-efficacy is a factor that can help to ease secondary traumatic symptoms. Limited research has been done to explore relationships on secondary traumatic stress, the ability to cope and quality of life of obstetric nurses caring for patients, and families experiencing perinatal loss.


The purpose of this study was to explore relationships between Secondary Traumatic Stress (STS), Secondary Trauma Self-Efficacy (STSE), and Professional Quality of Life (ProQOL) of obstetric nurses in caring for patients and families with perinatal loss. This study also describes what nurses state help them cope and feel supported when caring for patients experiencing perinatal loss. The relationship between obstetric nurses’ descriptive characteristics, secondary traumatic stress, self-efficacy and quality of life were explored to correlate any definitive characteristic to decreasing secondary traumatic stress symptoms, increased secondary trauma self-efficacy, decreasing compassion fatigue and increasing compassion satisfaction.


This study employed a quantitative descriptive correlational design with an additional qualitative component. The Secondary Traumatic Stress Scale (STSS), Secondary Trauma SelfEfficacy Scale (STSE), Professional Quality of Life Scale (ProQOL) were used to measure secondary traumatic stress, the ability to cope, compassion satisfaction, and burnout among obstetric nurses caring for patients and families experiencing perinatal loss. Inferential statistics were used to show relationships between obstetric nurses’ demographic characteristics, secondary traumatic stress, secondary trauma self-efficacy and professional quality of life. Concurrent qualitative and quantitative data collection were conducted by incorporating three open-ended questions at the end of the three instrument scales. The qualitative data were analyzed to explore the content and identify what in the participants words provided information to support and expand the quantitative findings.


Study participants included a national sample of registered nurses who identified as obstetric nurses with experience in caring for patients and families who have had a perinatal loss. There were 1178 participants in this study of which more than half responded to each openended question. The results for this population of obstetric nurses in this study demonstrated positive findings such as higher percentages having less STS (on either the STSS or ProQOL STS), less Burnout, higher ability to cope and higher Compassion Satisfaction when exploring relationships with some demographic variables of age, having taken a perinatal bereavement course, being a parent, religious or spiritual beliefs, and the ability to share work related perinatal loss experiences. A negative correlation was shown between the ability to cope and secondary traumatic stress (r=-.484, n=1104, p

Summary and Recommendations

Through this research, identification of what affects nurses’ ability to cope with perinatal loss as well as what supports are impactful can inform policy and practice recommendations to best support care practices for obstetric nurses. Implications for nursing practice include supporting protocols, formal perinatal bereavement programs, certification in an obstetric specialty, religious or spiritual coping mechanisms, creating safe areas for debriefing and mentoring newer obstetric nurses caring for patients and families experiencing a perinatal loss. Further research is recommended to assist in policy development or changes to provide operational support for obstetric nurses. Further investigation on debriefs and other interventions need to be developed to help obstetric nurses deal with the effects of secondary traumatic stress during perinatal loss to further support what helps nurses cope during these events.

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Nursing Commons