Karla Fabiola Gamboa-Molina,1 Angélica María Armendáriz-Ortega1
1Unidad de Investigación y Posgrado, Maestría Profesional en Enfermería, Facultad de Enfermería y Nutriología, Universidad Autónoma de Chihuahua, Chihuahua, México
Correspondence: Karla Fabiola Gamboa-Molina
Received: September 10th 2015
Judged: January 20th 2016
Accepted: March 10th 2016
Introduction: the teachable moment to gaze focused professionals who may be exposed to care for women suffering a spontaneous abortion. These women have a duel to lose a baby who could not come, the nurse should take care from his soul, understand their sadness and shock. This need for careful planning led to this teaching learning time student’s graduate nursing degree in nursing in the seminar class of higher education in the Autonomous University of Chihuahua.
Development: a time of learning by strengthening knowledge about the abortion, adding tools for comprehensive care to women in mourning abortion, allowing analysis and reflection of experiences of mothers treated in a health facility was performed. Presenting constructive way and ended problem-based learning, students participated actively reflecting on humane care they need these women.
Conclusions: helping students understand this dynamic based on constructivism student can create a reflective practice to make sense of their actions and improve human nursing care in post abortion.
Keywords: Teaching; Nursing care; Grief; Spontaneous abortion; Problem based learning
Nurses must learn to understand the person whom they care for with love, and perceive the needs that they have. For that reason nursing professors should be a guide for the student to identify these needs and be sensitized through a proper teaching and learning process, in order to achieve the most rewarding task of teaching, which is, as Paulo Freire describes, helping the learners as teachers to build the intelligibility of things, to help them learn, to understand and communicate that understanding to others.1
It is the need to learn to understand the other person to communicate understanding to others, which led us to plan this teaching-learning moment for nursing graduates who were pursuing their studies in the Masters of Nursing, in the higher education class-seminar at the Universidad Autónoma de Chihuahua.
As health professionals in the clinical hospital area, we are in constant motion in the areas of care for people. One of these areas is Gynecology, where women are admitted for different diseases. One of the most common problems is miscarriage. When facing this health problem, women experience grief at losing a baby who could not come to term; however, nurses are not yet able to identify this process as grief.
For that reason, the objective of this teaching-learning moment is for nurses to learn to see women not only for their physical appearance and injuries after a miscarriage, but to see their soul and understand their feelings of deep sadness and shock at not being able to hold in their arms this so anticipated creature who, more than just anticipated, is a loved one; therefore, the title of this teaching-learning moment is "Bereavement care of an unborn loved one".
In addition to truncating the woman’s expectations of motherhood, miscarriage interrupts the vital project that the mother has for their child, because in the first months of pregnancy the child already lives in the mother’s mind, already has a psychic presence in it: in her feelings, her fantasies, her desires, her projections. And all this is suspended with the termination of pregnancy, which many women experience as the loss of a child, an unborn child, but a child after all. It is natural, therefore, for bereavement to occur as a result of miscarriage. And it is also natural for this bereavement reaction to show psychopathological symptoms predominantly of depression and anxiety.2
This teaching-learning moment is not just for nurses to get to know and analyze care for women after miscarriage, it is also a humane care for the person or persons who accompany their spouse, parents, siblings, or friends, as different people may be with her and, like the mother, they were also part of waiting for this cherished new being.
As a professional discipline, nursing is based on humane care as an act of love and understanding of the other. The process of educating through the humane care of nursing is manifested in the caritas process of Jean Watson’s theory, "addressing the genuine teaching-learning experience that accompanies the unity of being and the subjective meaning, trying to stay within the other’s frame of reference".3
Educating nurses who are part of the care of the being is fundamental to the development of the profession. Educating through care of the being is not a simple transmission of knowledge from one group of people to another, rather a transpersonal teaching is formed, i.e., a contact that goes beyond the teacher to the student, a contact that goes beyond the classroom where experiences are analyzed and reflected, to improve humane care for another being found outside: in the community, on the street, and in hospitals.
The teaching-learning moment is part of a relationship of sensitivity with the other, linking efforts, hopes, deepest longings, and concerns and needs that arise in nurse-learners at the time of care.
This process of awareness and education used as a guide the constructivist model with help from problem-based learning. The constructivist model allows the student to think independently and significantly understand their world, in this case the learner understands what emerges in the Gynecology area with women who suffer from the painful process of miscarriage. The student must engage in an activity with experiences written by women who were treated by the nurse in their miscarriage process. These writings must be analyzed and reflected upon by the student to generate understanding, autonomy of thought, and problem-resolution.4,5
Problem-based learning is an apt methodology to acquire knowledge and skills in nursing.5 This is done based on real practice situations. Reflection is necessary to make sense of professional experience, including events of daily practice, such as contact with patients treated for miscarriage. The teacher becomes the organizer and mediator of the student’ encounter with the knowledge, and the student becomes a builder of knowledge, distancing themselves from their former role that required them to be a mere recipient of information.
Reflection at this teaching-learning moment is valuable and fruitful enough to strengthen the teacher’s and student’s perspectives and knowledge by creating learning links; also in the background it has a positive impact on the subject of care when the learner faces care for women who have undergone fetal loss.
The care of these women has a fully humanist dimension. This humanistic nursing practice requires critical and self-directed thinking from professionals for the best strategies to deal with a situation that arises in a given context. This kind of thinking is one they seek to develop at this teaching-learning moment in the care of a woman grieving the loss of a fetus, and the woman’s partner who may also be affected by the loss. It is important for them to work together to express their feelings and emotions, as there is nothing better than listening and offering a shoulder and an understanding look, offering oneself for if they need anything, and not trying to help them jump the stages of grief or minimize the problems saying that things could be better.6,7
Dynamic strategy implemented
A moment of genuine teaching-learning experience was implemented, which strengthened knowledge about miscarriage and tools for understanding and loving care for grieving women and their companions in fetal loss, through analysis and reflection on actual written experiences of mothers treated at a hospital.
This teaching-learning moment was practiced with first-semester students of the Masters in Nursing from the Universidad Autónoma de Chihuahua; the students had undergraduate degrees in nursing.
The teaching-learning moment consisted of three phases including the following dynamic strategies:8-10
Introductory phase: this intended to make a first approach to build trust among students and teachers by presenting this and the reasons why the need arises to implement this theme for their knowledge in clinical practice. Then the free response question was posed, "Who has had the experience of caring for patients with miscarriages?", emphasizing what they saw and perceived. A video was shown using a laptop and a projector as a summary that would serve as a review of previous knowledge of what a miscarriage is, and the teacher asked students to reflect on the lyrics of the song from the video.
Development phase: two teams of six people each were formed to facilitate communication between professionals, teamwork, tolerance, brainstorming, and collaborative reflection in working groups. A leader was appointed who was asked to read their team a letter containing the actual expressions of women in situations of miscarriage, and the nursing care received in that context. Each team reflected on the experience of nursing care, how this was experienced, and when analyzing each letter each team had to create and plan actions that should have been taken for the humane care of these women. Upon completing the analysis, the leader of each team went to the opposing team and there gave a brief overview of the experience and the solutions that their former team came up with for the resolution of the experience of nursing care for women in the miscarriage process. This was in order to give feedback if there were new ideas and solutions for the experience. At all times the teacher accompanied the teams to actively participate with their students.
Closing phase: they were given tools for care for women in their grief for an unborn loved one, this time by a quick PowerPoint presentation, called "Look at me! I'm here! Care for me", which contained the actual responses of women who had received care after a miscarriage. In this presentation the women mentioned how they would like to be cared for by nurses. In this way the students reflected, analyzed, and compared the previous actual experiences from the two letters.
The actual experiences of women in situations of miscarriage were taken from the thesis Perception of nursing care in post- (spontaneous) miscarriage care in women between 17 and 25 years in Bogota, prepared by Carreño Hernández and Henao Santana in 2009.7 Part of these interviews was taken from these experiences of in-depth interviews with several participants.
At the end of this teaching-learning moment, the students had the opportunity to reflect on and analyze a real experience that some have already experienced in their clinical practices.
Most of the time we teachers tell the learners what care interventions should be done with the person cared for, but rarely do we give people the opportunity to express how they want to be cared for. Thanks to this dynamic based on constructivism, the student is able to create a practice reflective of their actions to make sense of and improve humane nursing care for patients who have had a miscarriage. The presentation of the teaching-learning moment was finished constructively and based on problem-based learning, as students participated in the activity efficiently.
Students were able to identify the problem, give it the value required to resolve such situations, and, above all, realize women’s need for humane care after having a miscarriage.
The students' attention was drawn by the fact that the answers were taken from a thesis and that the answers to the questions reflected in the letters were real; this captivated them, and their curiosity made the reflection deeper.
This teaching-learning moment and its strategies give nursing as a discipline the possibility of growing humane care in hospital practice, taking the root of our training in education. If education and teaching practices in this discipline manage to make a turn towards constructivism and freedom of critical analysis, our profession can be empowered, which will give us skilled humane nursing care and will, at the same time, dignify our work.
Significant and personal learning from this teaching-learning moment is the satisfaction that the objective has been achieved, that our students will analyze the situation and see that is a reality that takes place in hospitals, in the community, population, and family. After carrying out this activity we will be assured that the day when students are faced with a woman who has suffered the loss of an unborn loved one, they can offer a comforting shoulder and an ear to hear them, offering humane care.