Emotional Responses of Neonatal Intensive Care Nurses to Neonatal Death

Abstract

The study was planned as a descriptive qualitative study to determine the emotional responses of neonatal intensive care nurses to work in the neonatal unit and to neonatal deaths. The sample of the study consisted of 7 nurses who work at the neonatal intensive care unit since data saturation was achieved. The data were collected using the “Semi-Structured In-Depth Interview Guide for Nurses”. The data were analyzed using the content analysis method. Following codes were reached as a result of the study: ‘happiness-sadness’, ‘professional satisfaction-exhaustion’, ‘empathy’, ‘responsibility-guilt’, ‘hope-despair’ under the theme of being a nurse at neonatal unit’; ‘unforgettable first loss’, ‘professionalism in intervention-and then: sadness, ‘mature-premature difference’, ‘difficulty in giving hurtful news-inability to associate with death’ and ‘attachment-burnout’ under the theme of experiencing neonatal loss.It was seen that nurses’ emotions about working at neonatal intensive care unit were generally positive; however, these emotions changed to negative after neonate’s relapsing and death.

Keywords

nurse neonatal intensive care dying baby death emotions

Introduction

Death, simply, is the end of the livingness of a cell, organ, or organism by losing its vital functions (Uysal et al., 2019). Death is a phenomenon that exists in every person’s life; however, health professionals encounter death at a higher rate (Kain, 2013). Although people accept mortality, they have difficulty accepting death. Today, health workers are educated to improve humans’ bodies; thus, death is perceived as a medical failure (İnce, 2014). Giving care to a dying patient is a source of stress for nurses, causing feelings of disappointment, fear, anxiety, and guilt (Zheng et al., 2017). In particular, the death of an infant becomes a difficult source of stress that creates anxiety and feelings of discomfort and failure for nurses who give care to the infant. It is reported in the literature that nurses experience different emotions varying from grief to burnout when they encounter an infant’s death (Bloomer et al., 2014; Kain, 2013). The most important factors for neonatal intensive care nurses to experience these emotions are that the individuals nurses give care to are vulnerable and that nurses establish special bonds with their patients and their families (Adwan, 2014). According to the literature, nurses who give care to dying infants may experience burnout, stress, and moral distress (Cook et al., 2012; Nurse & Price, 2017).

The study was planned as a descriptive qualitative study to determine the emotional responses of neonatal intensive care nurses to work in the neonatal unit and to neonatal deaths.

Materials and Methods

Research Type and Design

The research was planned as a descriptive study with a qualitative research design to determine the experiences of nurses working at the neonatal intensive care unit of a maternity hospital in the face of death events. The in-depth interview method, one of the qualitative research methods, was used in the research.

Research Questions

What are the emotions of nurses about working at the neonatal unit?

What do nurses feel when they witness the death of a neonate?

Population and Sample of Research

The population of the research consisted of nurses working at the neonatal intensive care unit of a city hospital in Turkey. It has been reported that there is no limit for the sample size for qualitative research and that the sample size can be determined in line with the research question and purpose. What is important in a qualitative study is to examine the phenomenon in depth rather than generalize the results. For this reason, the criterion for data collection is “reaching theoretical saturation”. Theoretical saturation is achieved when data start to repeat and no new data are reached. In light of this information, the population of the study consisted of 14 nurses working at the neo (İnce, 2014) natal intensive care unit of a hospital and the sample consisted of 7 nurses (Erdoğan et al., 2014; Kümbetoğlu, 2017).

Data Collection

The data were collected using the ‘Semi-Structured In-Depth Interview Guide for Nurses’ prepared in line with studies on ethics ( Almedia et al., 2016; Fortney & Steward, 2014, 2017; Hasanpour et al., 2016 ).

The interview form questions the emotions of nurses about working at neonatal intensive care and their feelings in the face of neonatal deaths they encounter. The interviews lasted 15.37 minutes on average.

Ethical Consideration

Permission was taken from the Clinical Research Ethics Committee of Bursa Higher Specialization Training and Research Hospital (Decision number: 2011-KAEK-25 2019/05-16) and the Provincial Health Directorate. The interviews were held after the nurses were informed about the purpose of the study and signed the “Voluntary Consent Form”. Attention was paid that the data obtained from voice records were evaluated only by the researchers.

Data Evaluation

The content analysis method was used for the evaluation of the data. All the interview records were deciphered by the researchers and transferred to the computer environment. In line with the interview forms, first, the main themes and then the sub-themes were determined. The analysis stages of this study were as follows: (1) transcribing the data, (2) coding the data, (3) creating categories and themes, (4) organizing categories and themes, and (5) writing and interpreting the findings. After the researchers read the obtained categories and themes and reached a consensus, opinions of 3 experts were taken. Themes were finalized after expert opinions.

Results

The personal characteristics of the nurses are given in Table 1.

Table 1.

Personal Characteristics of Nurses.

Order	Gender	Age	Education	Neonatal unit experience (years)
1	Female	30	Bachelor degree	6
2	Female	27	Bachelor degree	7
3	Female	26	Bachelor degree	5
4	Female	34	Bachelor degree	10
5	Female	35	Bachelor degree	9
6	Female	33	Bachelor degree	5
7	Female	42	Bachelor degree	18

The findings of this study, in which nurses’ emotions about neonatal death were examined, were presented under two main themes. (Table 2).

Table 2.

Themes and Codes Regarding Being a Nurse in Neonatal Intensive Care Unit and Encountering Death at Neonatal Unit.

Theme	Code
Being a nurse at neonatal unit	Happiness-sadness
	Professional satisfaction-exhaustion
	Empathy
	Responsibility-guilt
	Hope-despair
Experiencing neonatal loss	Unforgettable first loss
	Professionalism in intervention-and then: sadness
	Mature-premature difference
	Difficulty in giving hurtful news-Inability to associate with death
	Attachment-burnout

Theme 1: Being a Nurse at Neonatal Unit: Dilemmas and Empathy

Nurses working at the neonatal intensive care unit mostly stated that they had a dilemma between two emotions about working at the neonatal unit.

Happiness-Sadness

Interviewed nurses stated that they were happy to work at the neonatal unit and that they worked willingly and fondly at this unit. They expressed that witnessing and contributing to the recovery of an infant gave them happiness, but seeing relapsing infants made them sad.

“Sometimes I think that this a different emotion: You recover a baby who is about to die. Now the baby is in its mother's arms and going home. You like this a lot. Seeing a baby returning to its normal life again is great. One should really experience it.” (F,34,10)

“In general, seeing a baby's recovery and witnessing a miracle makes me very happy.” (F,35,9)

“Frankly, it satisfies me very much. When we were in Istanbul, we used to invite babies, who were discharged, on the premature day, which was November 17. You know, to see them. It makes me very happy to come and see them healthy.” (F,26,5)

“I give care to infants willingly, nicely and kindly, talking to them nicely. I also implement their treatment. You know, I feel really happy to work here. Yes, of course, we sometimes have relapsing babies, we feel very sad for them. I wish we could do something and fix some things, but you know, we do everything we can within the framework of education we received.” (F,27,7)

Professional Satisfaction-Exhaustion

The majority of the interviewed nurses stated that working at the neonatal intensive care unit satisfied them professionally whereas some nurses stated that they were both satisfied and got agonized. It was seen that the nurses, who stated that they got agonized, expressed these emotions due to situations such as an infant's relapsing and death.

“It satisfies people. They are really tiny and then they grow up. After that, they come in the premature week, you seem them grow very much.” (F,33,5)

“It makes me very happy to see them recover, but it really tires you. Although it satisfies you, you get agonized.” (F,26,5)

Empathy

The interviewed nurses stated that they gave care to infants by showing empathy towards the families of infants.

“Today, we have patient relatives who are looking forward to hearing that the baby started to breathe on its own. I have always empathized, approached by putting myself in their positions. I’m still doing that.” (F,35,9)

“So now I have no children, but I can become a mother in the future, and I try to put myself in those families’ positions. Sometimes I have difficulty in this respect. Yes, if such things happen to me, I would be very sorry.” (F, 27,7)

Responsibility-Guilt

The majority of the interviewed nurses stated that working at the neonatal intensive care unit brought them responsibility. They expressed that they thought that the small size of babies, their critical condition, and the fear of harming them brought them this responsibility. After the statements of the nurses regarding their responsibilities, it was seen that they mostly questioned themselves about the negative changes in the baby’s condition, reviewed their own actions whether they did something wrong, and felt guilty because of baby’s relapsing.

“You know, I ask everything and do everything step by step. Although I am a 10-year nurse, I ask if there is something on my mind about medication or anything since our patient is a little baby. I don’t want to damage the baby. I like to work here” (F,34,10)

“The child had problems, had pulmonary edema. We got really sad because he/she was re-intubated when there was nothing. We question why this happened. Because everything was good.” (F,33,5)

“When a baby has nothing but is aspirated and then dies, I cannot do anything. I become unresponsive; I question myself if I could do something. I feel very many different emotions. But I mean, if a baby has a severe condition, I try to consider it normal.” (F,27,7).

Hope-Despair

The majority of the interviewed nurses stated that they accompanied the hopes of the infant’s family and that the family’s hopes raised nurses’ hopes. However, they stated that they felt desperate for infants with critical condition and infants with congenital anomaly.

“Of course, our physicians give information; they always tell the worst thing when the baby is premature, but mothers do not think that much. When you see that hope in mothers, you become a little hopeful, but you know that it will end soon.’’ (F,33,5)

“You make interventions but it feels like they do not work. You’re doing everything you can … My evening shift ended. I heard that the baby died around 10 in the evening.” (F,27,7)

Theme 2: Experiencing Neonatal Loss

Unforgettable First Loss

It was a very remarkable finding that all the nurses told about the first infant loss they experienced. While explaining the first loss they experienced, their sadness was reflected in their tones, and some of the nurses’ eyes filled with tears. The most important common statement of the nurses was that they would never forget their first loss.

“I remember my first infant loss very well. My eyes still fill with tears (Participant gets emotional). We had resuscitated the baby and we lost it. (Participant cries) I even had cried near the case at that time. You really cannot forget it.” (F,35,9)

“My first loss. Once, my shift had just started, I was going to work 16 hours. The baby had heart disease. It had Down syndrome and was a baby we gave care for a very long time. But there was still hope since we had discharged a similar baby with heart disease before and got a good outcome. I was waiting for the baby to recover and be discharged. There is always a hope for all babies. I started my shift. They said this baby was mine to give care. All of its functions suddenly stopped. And we could not return it. We tried so hard that he would live. As I said, we didn’t expect its death. We tried very hard. Of course, we started resuscitation for hours, but unfortunately … You know, it made me very sad to see this as soon as I started the shift. Of course, it is a very backbreaking process. I can’t forget that baby. It will remain in my mind after years.” (F,26,5)

Professionalism in Intervention-and Then: Sadness

The nurses stated that when a baby started to relapse, they left their emotions behind and tried to be as professional as possible during the intervention. It was an important finding in terms of the professionalism that the nurses stated that their only aim at that time was to keep the baby alive and that they had to act professionally for this.

“Frankly, you start to display professionalism after 10 years compared to the past. Of course, you cannot get emotional to keep the baby alive at that moment, that is, you are trying hard to prevent its death or you cannot enter that mood at that moment.” (F,34,10)

It was seen that the professional behaviors of the nurses during the intervention were replaced by emotions such as uneasiness, unhappiness, and sadness after the death of an infant. Some nurses experienced this sadness immediately after the loss of a baby whereas the majority reported that they thought about the baby and its family and felt sorry when they went home at the end of the shift.

“Do I have emotional difficulties? Yes, I do. So, I get sad.” (F,35,9)

“Frankly, of course, you cannot get much emotional while doing the first intervention at that stage. Because your only concern is to keep the baby alive at that moment. But you think afterwards when you go home … You feel really uneasy and bad. I don’t know … I feel weird and very sad. I cannot easily overcome.” (F,26,5)

“Losses are really upsetting, inevitably, it tires people. You don’t understand what happened here because of a hurry. When a baby dies, you pick it up and you have to put yourself together very quickly because there are babies that you need to care. You have to adapt psychologically immediately. When you go home and lie on your bed, you start to think about the baby and its family … You really think about it. I think everyone thinks.” (F,26,5)

Mature-Premature Difference

It was seen that the emotions of the nurses differed according to the term of the infant. Nurses experienced more sadness after the death of mature infants but less sadness for premature infants. It was determined that variables such as higher life expectancy of mature infants and increased attachment with the mother affected nurses’ emotions. In particular, the death of term babies with no intensive care history affected nurses more.

“I experienced two losses. One was a big baby and the other was premature. I was more affected by the loss of the bigger baby. It was a cooling case but the cooling could not be performed. Because it came from Bandırma, it was too late. I was very affected. If the baby is older, you are affected. It grows up in its mother’s womb; the mother spends time with and attaches to it. It has a life expectancy. I don’t know why but you hope that it will recover. Maybe because of its volume … But when it is premature, it cannot make a head start. Even it is premature, it has an immaturity. You are doing your best but you know that the possibility of sequelae is much higher. No matter how much you do, oxygen and other applications, the possibility of sequelae is higher. However, bigger babies are not like that. You know those feelings.” (F,33,5)

“Because the baby was discharged, went healthy but came aspirated. It was a big baby … a very beautiful baby. Then, it was very upsetting after it was discharged. It went home with good health; it had no intensive care history. Its return made me sad.” (F,26,5)

“The mood after every death is not the same. Sometimes we give care to a baby for a very long time and it is very difficult to recover. In front of your eyes. You come every day; you look after it. But recovery is not really possible for some. Of course, I am not happy about their death. But sometimes, to see them suffer a lot, frankly, hurts me.” (F,26,5)

Difficulty in Giving Hurtful News

The majority of the nurses stated that they felt the pain while sharing the death news with the family. They stated that it was difficult for them to show the baby’s body to the family and give the death news. Moreover, the majority of the interviewed nurses stated that the death of an adult intensive care patient or an elderly patient was more acceptable. They stated that they cannot associate a baby with death, that they should not die, and that they should hold on to life. One of the important factors was the baby’s family. The nurses expressed that families expected a miracle from them and thought that those babies had to live. One of the difficulties for the nurses was placing the baby in the death bag.

“When a baby dies, it is especially bad to inform its parents … That moment is very bad. I mean, inviting parents, showing the body … You understand and get sad.” (F,34,10)

‘We are always with the physician while informing parents about death. You are with the father when the attendant delivers the baby’s body. It is very sad to put them in those little body bags and deliver them to their family like that … May God not let anyone live.” (F,35,9)

“We wish the baby was healthy, that is, everything went better. You empathize with its family. I think, no pain can affect you as much as one who owns that pain.” (F,30,6)

“As I mentioned, all parents want to hold their baby in good health. Most of the parents prepare baby clothes and baby beds at home. I feel very sad when I put myself in their position.” (F,27,7)

“Adult patients are different. My friends tell me that an elderly patient is now expected to die and they are not affected that much. But it is not for us. I think babies should not die. It is really hard to lose a baby.” (F,34,10)

Attachment-Burnout

Some of the nurses were found to excessively attach to the babies that they looked after for a long time and to experience more intense emotions for the loss of these babies. One nurse, in particular, explained this with expressions such as losing a piece of him/herself, losing his/her own child.

“I can’t remember the average hospitalization right now, but it is at least 40 days. If the baby is very small, very premature, the hospitalization can last 60 days. So, we unavoidably attach to the babies. There is definitely a bond.” (F,33,5)

All nurses stated that they felt much sadder for the loss of the infants they followed up at intensive care for the long-term. It was found that they thought this was a more difficult process not only for them but also for the family. The nurses stated that working at the neonatal unit satisfied them whereas the majority of them stated that neonatal death tired them and caused burnout.

“When we hear that a premature baby who has been given care for a long time is dead, we feel sadder for them.” (F,34,10)

“You look after a baby for a long-time, then it dies. This is a very backbreaking process both for you and for the family. Because there are many babies we look after for 3 months and 4 months.” (F,26,5)

“If a baby who was born premature and who has been hospitalized for a long time, for 25, 26 weeks dies close to discharge, I get very sad. I think I cannot receive recompense for my work. It gets very destructive.” (F,42,18)

“The number of deaths is decreasing but our weariness is really increasing. It is difficult, I mean, emotionally. As I said, I need to be professional, so I do not get emotional at that time. But then, of course, I get sad. It is tiring.” (F,34,10)

Discussion

Nursing is a stressful and challenging profession that provides care to many different individuals and witnesses individuals’ pain. It is not possible for nurses to completely eliminate their emotions while providing care (Gountas & Gountas, 2015). This study was conducted to examine the emotions of nurses in the face of neonatal death and the findings were discussed under the themes of “Being a Nurse at Neonatal Unit” and “Experiencing Neonatal Loss”.

The emotions of the nurses regarding the theme of being a nurse at the neonatal unit were examined, it was determined that they expressed the following emotions: happiness-sadness, professional satisfaction-exhaustion, empathy, responsibility-guilt, hope-despair.

It was found that the most important emotion felt by the nurses while working at the neonatal intensive care unit was the happiness-sadness dilemma. Although the nurses stated that working at the neonatal intensive care unit made them happy, they stated that situations such as the relapsing of the neonate made them sad. Likewise, in the study conducted by Günay and Coşkun (2019), neonatal intensive care nurses stated that they were happy when they saw the mother and infant happy. According to some literature information, the nursing profession brings happiness as a source of satisfaction (Pisaniello et al., 2012).

Another dilemma felt by nurses while working at the neonatal unit was professional satisfaction and exhaustion. The nurses stated that witnessing a little baby grow and recover made them professionally satisfied. Similarly, Archibald (2006) reported that nurses working at the neonatal intensive care unit were professionally satisfied because they encounter a decent number of satisfactory events. Soroush et al. (2016) reported in their study that nurses experienced a moderate level of burnout in terms of emotional exhaustion and depersonalization whereas they experienced high levels of burnout in terms of personal performances.

The nurses working at the neonatal unit stated that they frequently had an empathetic approach while working. Empathy is a vital element of communication in care. In particular, the fact that all nurses working at neonatal intensive care units are women and some of them have experienced motherhood may be effective on relevant empathetic approaches of nurses. Furthermore, the death of a neonate is a devastating event that causes endless pain, disappointment, and uncertainty for the family (Amorim Almeida et al., 2016). In the study, it was seen that nurses had an empathetic approach during care practices and in supporting the family in the grief process.

The interviewed nurses stated that they experienced a responsibility-guilt dilemma at neonatal intensive care. Health professionals have complex emotions in the care of a neonate, especially during and after its death (Amorim Almeida et al., 2016). Death reflects the mortality of human beings and also imposes different occupational and conscientious duties to individuals who take care responsibility. These emotions of nurses are thought to arise from the ethical dimension of care. Infants whose treatment continues at neonatal intensive care unit are in a sensitive, vulnerable, and abusable position. Due to its nature, the nursing profession imposes different responsibilities on nurses working in every field; however, the responsibility felt due to this special position of neonatal intensive care and the accompanying sense of guilt are much higher (Dinç, 2009; Hall et al., 2012). Likewise, Kim et al. (2019) (Kümbetoğlu, 2017) reported that neonatal nurses experience emotions such as sadness, guilt, and regret after the death of an infant.

Another dilemma reported by the neonatal intensive care nurses was hope-despair. The nurses stated that they shared families’ hopes; however, in some cases, they felt desperate since they could not do anything. Neonatal intensive care units are one of the settings where hope and despair can be intensely experienced. Green (2015) discussed the difficulties encountered by nurses in the care of a premature baby at the intensive care unit. The nurses knew that believing that every infant could be saved was unrealistic, they felt unsuccessful when they failed to meet parents’ expectations. In the same study, it was expressed that hope decreased and despair was experienced knowing that the neonate would not survive.

The emotions of the nurses regarding the theme of experiencing a neonatal loss and it was seen that they expressed the following emotions: unforgettable first loss, professionalism in the intervention-sadness, mature-premature difference, difficulty in giving hurtful news-inability to associate with death and attachment-burnout.

All nurses stated that they could not forget their first neonatal loss experience. Khalaf et al. (2018) examined the death and grief experiences of nurses and found that nurses experienced complex emotions such as sadness, crying, anger, shock, denial, patience, belief, fear, guilt, and powerlessness in their first death experience. Most participants stated that they did not know what to do in their first grief experience. They also expressed the contradictions they experienced between life-saving nursing values and the death of a patient. The study stated that the nurses had experiences such as not being able to go to the patient’s room and thinking about life after death after their first death experience. Nurses experience death for the first time during their undergraduate years or in the first years of the profession and this event affects their professional and personal lives. In the study, it was seen that the nurses could not forget their first death experiences and still felt different emotions they experienced during that period. It was thought that death is a reminder of the mortality for human beings and that such an ending for infants who are at the very beginning of life is effective in nurses’ remembrance.

It was determined that the nurses put their emotions aside during the intervention to a neonate and behaved professionally, but expressed that they experienced sadness after its death. Nurses need to balance different emotions such as responsibility/guilt, fear/courage, hope/despair during the death process. During this process, nurses can grow both professionally and humanistically (Karlsson & Kasén 2017). Sadness, on the other hand, is an emotion involved in the nature of death. People experience sadness at different stages after their losses and nurses may experience sadness due to the loss of individuals they take care of (Uysal et al., 2019). Neonatal intensive care patients are more vulnerable than other patient groups, their risk of injury is higher, and their care needs are complex. For this reason, it was reported that sadness experienced by nurses in neonatal intensive care units may be different and more intense than nurses working in other units (Rodriguez et al., 2020).

Another point reported by the nurses regarding neonatal loss was the difference between the loss of mature and premature infants. Nurses stated that they experienced less sadness for premature deaths; however, they felt sadder for mature babies. Dombrect et al. (2020) (Erdoğan et al., 2014) reported that the decision to end life support in term infants was much more difficult than in preterm infants. The reason for this difference may be that the life chances of mature infants are much higher, that families do not expect the loss of their babies, that the life chance of premature infants is lower and the rate of anomaly is higher, and that the families of premature infants are prepared for the bad news. Green et al. (2016) conducted a study to examine the opinions of neonatal nurses about the quality of life and ethical problems in premature infants. It was found that nurses believed that quality of life was an important issue, but they had important inner conflicts and uncertainty when they were asked to identify certain elements of quality of life or suggest how it could be determined. Likewise, regarding the quality of life, the majority of the nurses stated that they felt less sad about the death of infants with severe anomaly and organ failure problems. Razeq (2019) reported that one of the criteria for ending life support at the neonatal intensive care unit was the presence of anomalies that can affect the quality of life. It was suggested that the nurses empathized with infants who would have poor quality and dependent life and thus felt less sad about their deaths.

The nurses reported that they had difficulty when communicating with the family after their loss at the neonatal intensive care unit and informing the family about their loss. It was seen from nurses’ statements that they empathized with the family. After long-term hospitalizations, the relationship between nurses and parents improves; nurses support the family on many issues and provide emotional support (Rodriguez et al., 2020). As a result, emotions experienced by nurses while giving bad news to the family were expected. Confrontation with the loss of a baby expected in hope is a challenging situation not only for the family but also for the nurses who are a part of this process. Razeq (2019) emphasized that not only the infant’s but also the family’s condition should be evaluated for ending life support at neonatal intensive care. Almedia et al. (2016) stated that they gave time to the family to say goodbye to their baby after its death and prepared a suitable environment for them. Differently, in this study, none of the nurses included statements about the care provided to the family of an infant that was thought to die. Another frequently expressed situation by the nurses was that they could not associate a baby with death. Another situation frequently expressed by the nurses was that they could not associate an infant with death. Although death is a part of life, it is difficult to cope with and face death, especially in a neonate (Silva et al., 2010). It was seen that families considered neonates as hope and could not associate neonates with death since they were at the very beginning of life. The nurses stated that the deaths of elderly individuals were more easily acceptable. Likewise, Almedia et al. (2016) reported that nurses experience much more difficulties during neonatal death; however, coping with the death of an adult or elderly is easier. Nurses stated that they felt pain in the face of neonatal death and had more difficulty accepting the death of a neonate compared to an adult (Silva et al., 2010). It was thought that all these emotions could have resulted from the empathy of the nurses.

The nurses reported that they were attached to the infants they gave care to at the neonatal unit and experienced emotions such as burnout, sadness in the face of their deaths. Emotional attachment is inevitable for nurses since they follow up on the neonate from its admission to the unit until discharge or death (Almedia et al., 2016). This bond that brings health professionals closer also makes them suffer during and after the death of the neonate (Silva et al., 2015). In a study conducted with oncology nurses, similarly, it was reported that nurses experienced burnout after loss (Collins & Tan, 2017).

Conclusion and Recommendations

In conclusion, it was seen that nurses’ emotions about working at the neonatal intensive care unit were positive and they were satisfied by working at the neonatal intensive care unit; however, the neonate’s relapsing and death negatively affected the emotions of nurses and revealed different emotions ranging from sadness to burnout.

In line with these results, it was recommended to develop strategies for nurses to manage these negative emotions and to provide environments where nurses can share their emotions after an infant loss. Furthermore, it was recommended to conduct the study with different sample groups.

Footnotes

Acknowledgments

The authors thank all the nurses who participated in the study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Berna Köktürk Dalcalı

Author Biographies

Berna Köktürk Dalcalı , PhD, BSN, assistant professor. She was born in 1987, in Zonguldak and graduated Ege University Nusing Faculty in 2009. She completed master degree in Istanbul Üniversity in 2013 and PhD at the İstanbul University in 2018. She is working as an assistant professor in Bandırma Onyedi Eylül Unıversity Health Science Faculty Fundamentals of Department. She has an interest in qualitative research, end of life care, nursing ethic and spiritual care in nursing education.

Şeyda Can, PhD, BSN, assistant professor. She was born in 1988, in Bursa and graduated Bursa Uludağ University Nusing Faculty in 2010. She completed master degree in Istanbul Üniversity in 2013 and PhD at the İstanbul University in 2018. She is working as an assistant professor in Yalova Onyedi Eylül Unıversity Health Science Faculty Fundamentals of Department. She has an interest in educational and clinical research.

Hanife Durgun,PhD, BSN, assistant professor. She was born in 1987, in İstanbul and graduated Dokuz Eylül University Nusing Faculty in 2011. She completed master degree in Istanbul Üniversity in 2014 and PhD at the İstanbul University-Cerrahpasa in 2018. She is working as an assistant professor in Ordu University Health Science Faculty Fundamentals of Department. She has an interest in educational and clinical research.

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