Stranger in a mask” midwives’ experiences of providing perinatal bereavement care to parents during the COVID-19 pandemic in Ireland: a qualitative descriptive study

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All participants were female and had practiced midwifery for between 1 and 34 years with a mean experience of 14.5 years.

“All participants were female and had practiced midwifery for between 1 and 34 years with a mean experience of 14.5 years reported.”

May combine two claims.

The sample included participants with experience of providing perinatal bereavement care from antenatal (n = 9) and intranatal (n = 2) clinical areas, enabling a broad exploration of the phenomenon.

“The sample included participants with experience of providing perinatal bereavement care from antenatal (n = 9) and intranatal (n = 2) clinical areas and this enabled a broad exploration of the phenomenon to address the research question.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The theme 'Challenges of providing compassionate bereavement care during a pandemic' appeared to permeate all other themes.

“The theme ‘Challenges of providing compassionate bereavement care during a pandemic’ appeared to permeate all other themes.”

May combine two claims.

Midwives continued to provide the core components of compassionate bereavement care and used various strategies to compensate for the disruption of human connection.

“However, midwives continued to provide the core components of compassionate bereavement care and utilised various strategies to compensate for the disruption of human connection.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Five participants were dual qualified and three of the participants were educated to Masters level.

“Five participants were dual qualified and three of the participants were educated to Masters level.”

May combine two claims.

Facemasks, social distancing and lack of personal touch hindered midwives' communication skills and impacted their ability to engage with bereaved parents.

“Participants described how facemasks, social distancing and lack of personal touch hindered their communication skills and impacted on their ability to engage with bereaved parents.”

• AssumptionRests on an assumption: Non-verbal communication is a factor that contributes to compassionate bereavement care.

May combine two claims.

Analysis of the data revealed two related themes reflecting participants' experience: challenges of providing compassionate bereavement care during a pandemic, and psychological effects and coping strategies utilized by midwives.

“Analysis of the data revealed two related themes that reflect the participant's experience of providing perinatal bereavement care during the COVID-19 pandemic: (1) Challenges of providing compassionate bereavement care during a pandemic. (2) Psychological effects and coping strategies utilized by midwives (Table 3 ).”

May combine two claims.

Visitor restrictions resulted in women not being able to access usual support structures, and midwives were conscious of providing added support to compensate.

“Visitor restrictions resulted in women not being able to access usual support structures and midwives were conscious of providing added support to compensate for this.”

May combine two claims.

Five of the participants had not completed any perinatal bereavement care training, while over half (n = 6) had completed education in perinatal bereavement and loss.

“Five of the participants had not completed any perinatal bereavement care training. Over half of the participants (n = 6) had completed education in perinatal bereavement and loss .”

May combine two claims.

Many midwives considered PPE use affected care provision to bereaved parents and was a significant barrier to compassionate care.

“Many of the midwives considered the use of Personal Protective Equipment (PPE) affected care provision to bereaved parents and suggested that it was a significant barrier to providing compassionate care.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In one case, a colleague arranged a Garda escort for bereaved parents stopped at a checkpoint, and discussing events with colleagues helped identify this solution.

“Anna describes a dilemma she came across where a couple were stopped at a Garda checkpoint on the way to the hospital to give birth to their stillborn baby. On mentioning this to her colleague, they collectively identified a solution to help the bereaved parents on discharge from hospital:”

• Also stated in: § ‘All in it together’ · plain

  “She had been in a similar situation and rang up the Garda station for the parents to get a Garda (policeman) escort home which they did. I really do feel that talking over events with colleagues helps us all. If she hadn't mentioned it, I would never have thought of ringing up the Gardai about getting an escort to prevent further grief to the family” Anna.”

Classified as probably not a substantial claim.

Participants worried that social isolation associated with COVID-19 restrictions may lead to a more complex and prolonged grieving process.

“In addition, participants worried that the social isolation associated with COVID-19 restrictions may lead to a more complex and prolonged grieving process:”

May combine two claims.

With no support person present, midwives felt they needed to bridge the gap and provide emotional support to the bereaved woman, but this was often challenging in busy clinical environments.

“With no support person present midwives felt they needed to bridge the gap and provide emotional support to the bereaved woman. However, this was often challenging in the context of busy clinical environments:”

May combine two claims.

Participants were conscious of the importance of partner support when caring for bereaved parents and found themselves constantly apologising for the visitor restriction.

“Participants were conscious of the importance of partner support when caring for bereaved parents and they found themselves: “constantly apologising for this visitor restriction”.”

May combine two claims.

Before COVID-19, outside professionals visited the hospital to create keepsakes for bereaved parents; during the pandemic, midwives took on this task.

“Prior to the pandemic professionals came into the hospital to make mementos for bereaved parents. The making of memories now fell to midwives, many of whom felt ill prepared for these tasks.”

May combine two claims.

Prior to the pandemic, services such as photographers and professionals who create clay impressions of foot and hand prints were provided by external professionals; during the pandemic non-essential staff such as professionals who created mementoes were not permitted access to the hospital.

“Prior to the pandemic, services such as photographers and professionals who create clay impressions of foot and hand prints were provided by external professionals. However, non-essential staff such as professionals who created mementoes for parents of their baby's life were not permitted access to the hospital.”

May combine two claims.

Midwives felt psychologically vulnerable while working during the pandemic and benefited from colleagues with whom they could share thoughts and concerns.

“The midwives described the psychological vulnerability they felt as they negotiated working in the midst of a pandemic and described benefitting from having colleagues with whom they could share thoughts and concerns.”

May combine two claims.

Midwives worried about unknown effects of COVID-19 on pregnancy and a possible connection between infection and miscarriage or stillbirth.

“The focus of concern extended to the unknown effects of COVID-19 infection for pregnant women and the possible link of infection to miscarriage and stillbirth.”

• Also stated in: § Discussion · hedged

  “Midwives worried about the unpredictable nature of the virus and the unknown effect it could have on pregnancy.”

• Also stated in: § Fear of cross infection · hedged

  “That poor couple were always thinking did COVID in some way contribute to the death of their baby. What could I say to that?” Marie.”

May combine two claims.

Colleague support and mindfulness were the most relied upon coping strategies, and the majority of midwives declined formal psychological supports available to them.

“Colleague support and mindfulness were the most relied upon strategies, with the majority of midwives declining to make use of any formal psychological supports that were available to them.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Midwives felt that social isolation could contribute to the stigma of perinatal bereavement.

“Furthermore, midwives felt that social isolation could contribute to the stigma of perinatal bereavement which acts as a barrier to supporting bereaved parents (Heazell, 2016; Horton and Samarasekera, 2016).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The second theme identified through data analysis reflects the psychological effect on midwives providing bereavement care during a pandemic.

“The second theme identified through data analysis reflects the psychological effect on midwives providing bereavement care during a pandemic.”

May combine two claims.

Making a connection and building rapport with the woman while wearing a facemask was challenging, and many participants felt they had to change their communication approach.

“Making a connection and building rapport with the woman while wearing a facemask was challenging and many of the participants felt that they had to change their communication approach:”

May combine two claims.

An understanding network of colleague support was relied upon and gave several participants a sense of community.

“The presence of an understanding network of support from colleagues was relied upon and described by several participants as providing a sense of community:”

• Also stated in: § ‘All in it together’ · plain

  “My biggest support is the people I work with. We are a great team and all look out for each other.” Gina.”

May combine two claims.

Colleague support and mindfulness were the strategies found most helpful and most used to mitigate challenges of providing bereavement care during the pandemic.

“Although midwives faced added challenges in providing care during pandemic certain strategies were implemented to mitigate against this. Colleague support and mindfulness were found to be helpful and most effective.”

• Also stated in: § Discussion · plain

  “Colleague support and mindfulness were the most relied upon strategies, with the majority of midwives declining to make use of any formal psychological supports that were available to them.”

• Also stated in: § Conclusion · plain

  “A number of strategies were identified which were found to be beneficial including mindfulness and colleague support.”

May combine two claims. The quote only partly states this claim.

Many midwives attended mindfulness sessions during working hours and found them very helpful for self-care.

“Many of the midwives availed of these sessions and found them very helpful in their own self-care:”

• Also stated in: § ‘All in it together’ · plain

  “I think the mindfulness sessions for staff are helpful. It helps you to recharge your batteries” Karin.”

• Also stated in: § Discussion · plain

  “Many of the participants availed of this intervention.”

May combine two claims.

In the case of bereaved parents, partners were permitted to stay with the woman if she was accommodated in a single room; generally women experiencing early pregnancy loss were accommodated in a three-bedded room, therefore partners were unable to stay.

“In the case of bereaved parents, partners were permitted to stay with the woman if she was accommodated in a single room. Generally, women experiencing early pregnancy loss are accommodated in a three-bedded room therefore, partners were unable to stay.”

May combine two claims.

During the pandemic midwives recognised the importance of keepsakes and took on the responsibility of creating mementos for parents.

“During the pandemic midwives recognised the importance of these keepsakes and took on this responsibility of creating mementos for parents.”

May combine two claims.

Social distancing removed midwives' ability to provide therapeutic touch and was viewed as a significant barrier to empathic care.

“Social distancing removed midwives ability to provide therapeutic touch and was viewed as a significant barrier to providing empathic care.”

May combine two claims.

Midwives understood the importance and value of mementos, but undertaking these tasks added to the challenge of providing care.

“While it was clear that midwives understood the importance and value of these mementos, undertaking these tasks also added to the challenge of providing care.”

May combine two claims.

Participants felt the recommended contact time of fifteen minutes with women was not supportive of optimal bereavement care and impacted on emotional support provision.

“Participants felt the recommended contact time of fifteen minutes with women was not supportive of optimal bereavement care and impacted on emotional support provision.”

May combine two claims.

Midwives felt the care they gave was impersonal and harder to engage with the woman and her partner.

“They described how they felt that the care they gave was now impersonal and made it harder to engage with the woman and her partner.”

May combine two claims.

Midwives in the study expressed an in-depth understanding of the core components of quality perinatal bereavement care and used techniques to optimise care while adhering to COVID-19 guidelines.

“Midwives in the study expressed an in-depth understanding of the core components of quality perinatal bereavement care and utilised techniques to optimise care while adhering to COVID-19 guidelines.”

May combine two claims.

In this study, midwives said work gave their lives structure and some normality.

“In previous pandemics healthcare professionals expressed a fear of going to work (Jones et al., 2017; Kollie et al., 2017) however in this study midwives found going to work provided a structure and degree of normality in their lives.”

May combine two claims.

Participants took comfort from working and meeting people, and unlike other healthcare providers during the pandemic, they did not report social isolation.

“Participants found working and meeting people a comfort and did not experience social isolation that other healthcare providers had experienced when providing care during the COVID-19 pandemic (Huang and Zhao, 2020).”

• cites Huang and Zhao, 2020 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Perinatal loss is a complex experience and is widely accepted as one of the most painful forms of bereavement.

“Perinatal loss is a complex experience (Leitao et al., 2021), and is widely accepted as one of the most painful forms of bereavement.”

• cites Leitao et al., 2021 sourceNot checked yet

  Not checked in the free run.

• cites Hughes and Goodall, 2013Not checked yet

  Not checked in the free run.

• cites Coffey, 2016Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

This increases confidence in the credibility of the findings, ensuring that the researchers interpretation of the data is a true reflection of the midwives' experiences and is not inadvertently influenced by the researchers own beliefs and values.

“This increases confidence in the credibility of the findings (Thomas and Magilvy, 2011), ensuring that the researchers interpretation of the data is a true reflection of the midwives’ experiences and is not inadvertently influenced by the researchers own beliefs and values (Johnson et al., 2020).”

• cites Thomas and Magilvy, 2011Not checked yet

  Not checked in the free run.

• cites Johnson et al., 2020 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Midwives are acknowledged as key care providers for bereaved parents and may be the first, last and most frequent contact parents have with healthcare professionals.

“Midwives are acknowledged as key care providers for bereaved parents and may be the first, last and most frequent contact parents have with healthcare professionals (Wallbank and Robertson, 2013; Fernández-Basanta et al., 2021).”

• cites Wallbank and Robertson, 2013Not checked yet

  Not checked in the free run.

• cites Fernández-Basanta et al., 2021 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Maternity care providers are challenged to balance the needs and safety of pregnant women with their own safety.

“In addition, maternity care providers are challenged to balance the needs and safety of pregnant women with their own safety (Pollock et al., 2020).”

• cites Pollock et al., 2020 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

During step four and step five, the generation of themes and sub-themes was discussed and agreed by the authors.

“During step four and step five, the generation of themes and sub-themes was discussed and agreed by the authors.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The research has provided a detailed systematic account of the research process and research setting to aid transferability of the original findings to another context.

“In addition, the research has provided a detailed systematic account of the research process and research setting to aid transferability of the original findings to another context (Morse, 2015; Bradshaw et al., 2017).”

• cites Morse, 2015 sourceNot checked yet

  Not checked in the free run.

• cites Bradshaw et al., 2017Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Data saturation was determined on the basis there was a repetition of concepts and interviews offered no new information.

“Data saturation was determined on the basis there was a repetition of concepts and interviews offered no new information (Gugiu et al., 2020).”

• cites Gugiu et al., 2020 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Prolonged engagement with the data improved credibility of findings.

“Prolonged engagement with the data also improved credibility of findings.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The first author was a clinical midwife practicing in the study site and was known to the informants.

“The first author was a clinical midwife practicing in the study site, known to the informants.”

May combine two claims.

The researcher had established a trusting relationship with the participants before interviewing so there was a willingness of the participants to exchange information which enhanced credibility.

“The researcher had established a trusting relationship with the participants before interviewing so there was a willingness of the participants to exchange information which enhanced credibility (Bradshaw et al., 2017).”

• cites Bradshaw et al., 2017Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Once preliminary findings were identified, these were presented to participants (n = 4) to establish if they fitted with their perceptions and experience of the research topic.

“Once preliminary findings were identified, these were presented to participants (n = 4) to establish if they fitted with their perceptions and experience of the research topic (Prion and Adamson, 2014).”

• cites Prion and Adamson, 2014Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Data collection ceased after eleven interviews as data saturation appeared to occur initially after nine interviews with the final two interviews serving to test the evolving themes.

“Data collection ceased after eleven interviews as data saturation appeared to occur initially after nine interviews with the final two interviews serving to test the evolving themes.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

To ensure an accurate reflection of the participants views, audio recordings and transcripts were analysed using the structured thematic analysis process outlined by Braun and Clarke (2013) which has the potential to reduce bias.

“To ensure an accurate reflection of the participants views, audio recordings and transcripts were analysed using the structured thematic analysis process outlined by Braun and Clarke (2013) which has the potential to reduce bias (Mackieson et al., 2019;Lincoln and Guba, 1985).”

• cites Braun and Clarke, 2013Not checked yet

  Not checked in the free run.

• cites Mackieson et al., 2019 sourceNot checked yet

  Not checked in the free run.

• cites Lincoln and Guba, 1985Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable).

The development of high quality COVID-relevant solutions to optimize care need to be co-created with staff.

“Renfrew et al. (2020) suggests that the development of high quality COVID-relevant solution to optimize care, need to be co- created with staff.”

• cites Renfrew et al., 2020 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants were free to withdraw at any time during the interview and information about accessing employee assistance counselling services was reiterated at the beginning and end of interviews.

“In order to support interviewees, the participants were free to withdraw at any time during the interview and the participant information sheet had information about accessing employee assistance counselling services, which was reiterated at the beginning and end of interviews.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Interviews were guided by a pilot tested interview schedule consisting of open-ended questions and probes developed after a preliminary review of the literature and through discussion with a midwife specializing in bereavement care.

“Interviews were guided by a pilot tested interview schedule consisting of open-ended questions and probes developed after a preliminary review of the literature and through discussion with a midwife specializing in bereavement care.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Confidentiality and anonymity were preserved by assigning pseudonyms to participants and no identifiable information was included in the findings.

“Confidentiality and anonymity were preserved by assigning pseudonyms to participants and no identifiable information was included in the findings.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Purposive sampling was employed to ensure maximum variation in recruitment of midwives with a broad range of experience, practicing across clinical areas including labor ward, antenatal ward and Emergency Maternity Unit who had experience of providing bereavement care during COVID-19.

“In accordance with qualitative research methodology and the intention to recruit information-rich cases purposive sampling was employed to ensure maximum variation in recruitment of midwives with a broad range of experience, practicing across clinical areas including labor ward, antenatal ward and Emergency Maternity Unit who had experience of providing bereavement care during COVID-19 (LoBiondo-W”

• cites LoBiondo-Wood and Haber 2018Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participation in the study was voluntary and informed written consent was obtained prior to data collection.

“Participation in the study was voluntary and informed written consent was obtained prior to data collection.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Two researchers (AMP and MN) reviewed codes, themes and subthemes.

“Furthermore, two researchers (AMP and MN) reviewed codes, themes and subthemes.”

Probably not a substantial claim: may not pass S2 (checkable).

Understanding midwives' experiences in providing bereavement support may inform education, change and quality improvement to perinatal bereavement care provision.

“Understanding midwives’ experiences in providing bereavement support may inform education, change and quality improvement to perinatal bereavement care provision (Shorey and Chan, 2020).”

• cites Shorey and Chan, 2020Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Providing perinatal bereavement support can be an emotional and traumatic time for health care professionals as well as parents.

“It is acknowledged that the provision of perinatal bereavement support can be an emotional and traumatic time for health care professionals as well as parents (Jonas-Simpson et al., 2013; Mulvihill and Walsh, 2014; Health Service Executive, 2016; Nash et al., 2018).”

• cites Jonas-Simpson et al., 2013 sourceNot checked yet

  Not checked in the free run.

• cites Mulvihill and Walsh, 2014 sourceNot checked yet

  Not checked in the free run.

• cites Health Service Executive, 2016Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The conduct and reporting of this study was in line with the consolidated criteria for reporting qualitative research (COREQ).

“The conduct and reporting of this study was in line with the consolidated criteria for reporting qualitative research (COREQ) (Tong et al., 2007).”

• cites Tong et al., 2007 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Providing quality bereavement care can be challenging in both complexity and sensitivity and is potentially heightened in the context of a pandemic such as COVID-19.

“Therefore, providing quality bereavement care can be challenging in both complexity and sensitivity and is potentially heightened in the context of a pandemic, such as COVID-19.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The use of direct quotations support verification of the accuracy of the data.

“and the use of direct quotations support verification of the accuracy of the data (Bradshaw et al., 2017).”

• cites Bradshaw et al., 2017Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Ethical approval was granted in December 2020 from the HSE Mid-Western Area Research Ethics Committee (REC Ref:121/2020).

“Ethical principles were upheld in this study (Gray et al., 2017) and ethical approval was granted in December 2020 from the HSE Mid-Western Area Research Ethics Committee (REC Ref:121/2020).”

• cites Gray et al., 2017Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Interview audio files, transcriptions and field notes were stored in compliance with the Irish General Data Protection Regulation (GDPR) (2018).

“Interview audio files, transcriptions and field notes were stored in compliance with the Irish General Data Protection Regulation (GDPR) (2018).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Once interviews were transcribed the participants viewed the transcripts to ensure accuracy of the data.

“Once interviews were transcribed the participants viewed the transcripts to ensure accuracy of the data.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Emerging data link COVID-19 infection during pregnancy to an increased risk of stillbirths.

“There is emerging data available on the link between COVID-19 infection during pregnancy and an increase risk of stillbirths (Homer et al., 2021).”

• cites Homer et al., 2021 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Because of pandemic restrictions, isolation and altered mourning customs may produce grief that is more complicated and lasts longer.

“It is acknowledged within the literature that social isolation and changes to cultural grieving practices as a result of COVID-19 restrictions may lead to a more complex and prolonged grief reaction (Carr et al., 2020).”

• cites Carr et al., 2020 sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

The COVID-19 pandemic radically changed the basic elements of the midwife-woman relationship due to cross-infection reduction strategies, with unknown impact on the wellbeing of women and families.

“Coxon et al. (2020) acknowledges the radical change the COVID 19 pandemic has had on the basic elements of the midwife woman relationship as a result of cross infection reduction strategies and the unknown impact this will have on the wellbeing of women and their families.”

• cites Coxon et al. (2020) sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Usual supports may be unaware of the pregnancy loss and this could contribute to the overall stigma of bereavement experienced by women.

“These usual supports may also be unaware of the pregnancy loss and this could contribute to the overall stigma of bereavement experienced by women.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health care professionals felt helpless when they could not help patients as they wished while adhering to strict IP&C measures during the Ebola virus outbreak.

“This concurred with a study by Erland and Dahl (2017) in relation to the Ebola virus where health care professionals felt helpless when they could not help patients in the way they wished while adhering to strict IP&C measures.”

• cites Erland and Dahl (2017)Not checked yet

  Not checked in the free run.

May combine two claims.

Mask wearing creates a barrier to effective communication and significantly impacts non-verbal communication.

“A finding supported by Spillane (2020) who found that mask wearing created a barrier to effective communication and significantly impacts on non-verbal communication.”

• cites Spillane (2020)Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Keepsakes like photographs and prints can comfort grieving parents and may assist them in accepting their loss.

“Mementos such as photos and prints are seen to be cathartic to grieving parents and may help parents in coming to terms with their loss (Rådestad et al., 2011; Erlandsson et al., 2013).”

• cites Rådestad et al., 2011 sourceNot checked yet

  Not checked in the free run.

• cites Erlandsson et al., 2013 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Nurses experienced adverse psychological effects due to the COVID-19 pandemic, including higher levels of anxiety compared to the general population.

“It was found that nurses experienced adverse psychological effects due to the COVID-19 pandemic (Aksoy and Koçak, 2020) including higher levels of anxiety compared to the general population (Haung and Zhao, 2020).”

• cites Aksoy and Koçak, 2020Not checked yet

  Not checked in the free run.

• cites Haung and Zhao, 2020Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Providing compassionate bereavement care is challenging for health care professionals.

“There is widespread agreement that the provision of compassionate bereavement care is challenging for health care professionals (Jonas-Simpson et al., 2013; Nash et al., 2018; Laing et al., 2020).”

• cites Jonas-Simpson et al., 2013 sourceNot checked yet

  Not checked in the free run.

• cites Nash et al., 2018 sourceNot checked yet

  Not checked in the free run.

• cites Laing et al., 2020 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A heightened sense of fear and anxiety can dominate care during this time.

“While, Renfrew et al. (2020) found a heightened sense of fear and anxiety can dominate care at this time.”

• cites Renfrew et al. (2020) sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The COVID-19 pandemic created unprecedented additional demands for midwives providing bereavement support and significantly disrupted human connection and communication.

“This research echoed this sentiment however, the COVID-19 pandemic created unprecedented and additional demands for midwives providing bereavement support as it created significant disruption to human connection and communication.”

• Also stated in: § Recommendations and implications for practice · hedged

  “The findings of this research suggest that the COVID-19 pandemic had a significant impact on bereavement care provision.”

• Also stated in: § Conclusion · hedged

  “The findings of this study indicated that the pandemic brought unprecedented challenges to midwives when providing perinatal bereavement care.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Social support can help grieving families.

“Furthermore the literature acknowledges that social support can help grieving families (Cockell, 2020).”

• cites Cockell, 2020Not checked yet

  Not checked in the free run.

May combine two claims.

Communication and touch are key elements in women's experiences of compassionate care.

“These findings are supported by research undertaken by Menage et al. (2020) who found communication and touch were key elements in women's experiences of compassionate care.”

• cites Menage et al. (2020) sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Midwives keep providing care and staying 'with women' even when they fear for their own safety and that of women and families.

“Walton (2020) acknowledges the innovation, imagination and kindness of midwives who continue to be ‘with women’ and provide care despite fears for their own health and safety and that of women and their families.”

• cites Walton (2020) sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interviews were conducted away from the clinical area and a participatory interview was encouraged.

“Although the researcher had a professional relationship with many participants, the interviews were conducted away from the clinical area and a participatory interview was encouraged.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Mindfulness programs during a pandemic might reduce fear and anxiety and could help employees' mental health over time.

“Behan et al. (2020) suggests that mindfulness offered during a pandemic may allay fear and anxiety and potentially benefit employees long-term mental health.”

• cites Behan et al. (2020) sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Organizational stress may be harmful for healthcare professionals' mental and physical health and well-being.

“The literature recognizes that organizational stress maybe harmful for healthcare professionals mental and physical health and well-being (Melnyk et al., 2013; Foster et al., 2020).”

• cites Melnyk et al., 2013 sourceNot checked yet

  Not checked in the free run.

• cites Foster et al., 2020 sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Despite limitations, the aim of the study was achieved.

“Despite the limitations, the aim of the study, which was to capture midwives’ perceptions and experiences of perinatal bereavement care provision during a pandemic, was achieved.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The researcher had a professional relationship with many participants.

“Although the researcher had a professional relationship with many participants, the interviews were conducted away from the clinical area and a participatory interview was encouraged.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A small sample size is consistent with qualitative methodologies that privilege context-rich narrative data.

“This study had a small sample size from one maternity hospital in one country, which is consistent with qualitative methodologies which privilege context rich narrative data (Karanikola, 2019).”

• cites Karanikola, 2019Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

New Zealand midwives showed strong collegiality, which helped them feel safe at work during the pandemic.

“Similarly a high degree of collegiality was found amongst midwives in New Zealand which supported safety in the workplace during the COVID-19 pandemic (Dixon, 2020).”

• cites Dixon, 2020Not checked yet

  Not checked in the free run.

May combine two claims.

The study had a small sample size from one maternity hospital in one country.

“This study had a small sample size from one maternity hospital in one country, which is consistent with qualitative methodologies which privilege context rich narrative data (Karanikola, 2019).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Midwives and nurses might experience heightened stress levels during a public health crisis.

“It has been suggested that midwives and nurses might experience heightened stress levels during a public health crisis (Shorey and Chan, 2020).”

• cites Shorey and Chan, 2020Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

In previous pandemics, healthcare professionals expressed a fear of going to work.

“In previous pandemics healthcare professionals expressed a fear of going to work (Jones et al., 2017; Kollie et al., 2017) however in this study midwives found going to work provided a structure and degree of normality in their lives.”

• cites Jones et al., 2017 sourceNot checked yet

  Not checked in the free run.

• cites Kollie et al., 2017Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

When planning support for pregnant women and families, the psychological wellbeing and physical safety of midwives should also be considered.

“Pollock et al. (2020) suggests that midwives' psychosocial wellbeing and physical protection needs to be considered alongside how best to support pregnant women and their families.”

• cites Pollock et al. (2020) sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants freely and articulately recounted and shared their experiences.

“The participants freely and articulately recounted and shared their experiences.”