 I am going to introduce our speaker now. So, Jalu Tuan is a Ph.D. nursing student from Zhejiang University in China. She is now an international visiting scholar in the Midwifery Division at the University of British Columbia. For the last six years, she has worked on projects related to perinatal mental health. Her master's project was about providing a psychological intervention for women who experienced pregnancy termination for fetal abnormalities. Her doctoral project mainly focuses on constructing professional training for nurses and midwives to enhance their ability of providing perinatal bereavement care. She has published 16 SCI articles as the first author. Hey, I'm gonna give the presentation over now. Hi, everyone. My name is Jalu Qian. I'm very glad to have the opportunity to give this presentation. In today's presentation, I would like to focus on experiences of prenatal bereavement, of obstetric nurses and midwives receiving a prenatal bereavement care training program, a qualitative study. Before I begin, let me introduce myself briefly. My name is Jalu Qian. I'm a Ph.D. nursing student from Zhejiang University, China. I'm now a visiting scholar in the University of British Columbia. My research mainly focuses on prenatal bereavement care and midwife free education. I have published a relevant articles in this field. My presentation is divided into the following four sections. Let me start with some general information on the introduction. Prenatal wars includes miscarriage, therapeutic abortion, stillbirth or neonatal death. It occurs worldwide in 25% of non-pregnancies. It can cause serials and long-term mental health problems in the bereaved parents. It is reported that the quality of care that bereaved parents receive from nurses and midwives has a major influence on parents' ability to cope with the loss. For parents, they often receive unsatisfactory care, feeling that the care they receive did not meet their expectations. In an online survey, some parents reported disrespect for care. For nurses and midwives, Larkin's sufficient confidence and capability and bearing a heavy emotional burden during provision of prenatal bereavement care were reported. Thus, the gap between parents' need for high-quality care and healthcare professionals' lack of prenatal bereavement care capability has become increasingly prominent. In Chinese clinical practice, ignoring women's needs and using disrespectful words were the main reasons for interactive contradiction. Actually relevant guidelines have addressed the necessity of conducting continuous training for healthcare professionals in the field of prenatal bereavement care. In a scoping review, a series of educational programs in the UK, USA, and Ireland sought to propel nurses and midwives to care for bereaved parents. However, these programs revealed lack of theoretical base and comprehensive training contents. Systematic and comprehensive prenatal bereavement care has not been developed in China. Therefore, there was an urgency to establish and conduct the prenatal bereavement care training program in China. The aim of our study was to understand nursing and midwife professionals' experiences of the prenatal bereavement care training program, PBCTP, after its implementation. Now we come to the methods. This study was used to record and analyze obstetric nurses and midwives' experiences of the PBCTP. The PBCTP intervention was specifically designed for nurses and midwives who provide prenatal bereavement care to parents who experience a prenatal loss. It aimed to meet nursing and midwife professionals' knowledge and skill gaps and emotional support needs. There are five modules in this program. Content was delivered via eight online theoretical courses, which were given every two days. Participants in our study had to submit a journal reflection after each online course to ensure their participation. In this figure, you can see some detailed information of the detailed information of the intervention content. Five modules, including introduction, general knowledge, practical skills, emotional support for nurses and midwives, practices, reflection, and learning were included. This study was conducted in a deliberate room and seven obstetric wards in a tertiary maternity hospital between March and May 2022. The inclusion criteria were nurses or midwives who have provided prenatal bereavement care and who have over one year of clinical experience. In this full diagram, you can see participants' inclusion. There were 127 nurses and 44 midwives participated in this training, and then we interviewed 12 nurses and four midwives in total. Purpose sampling was used to include participants who submitted eight reflective journal entries and gave detailed reflective comments in their journals instead of using a few simple words. Interviews were conducted by our telephone using a semi-structured interview guide and lasted about 30 to 15 minutes. The interviews were conducted in Mandarin. In data analysis, a six-stage semantic analysis was used. Finally, we interviewed 12 hospital obstetric nurses and four midwives. In this table, you can see the themes and sub-themes of our study. I will not explain all the results in detail. I would like to focus on some interesting and important sub-themes. Scene one is about participants' aims of undertaking the training, needs for knowledge and skill enhancement and providing high-quality care were the main reasons for their participation. The lack of prenatal treatment care ability made it difficult to obtain trust and cooperation of the women which hinders their work efficiency. Nurses and midwives also wanted to eliminate women's negative feelings by providing high-quality, emotionally sensitive care. Scene two is personal growth and practice changes after training. After the training, nurses and midwives started to care from viral perspectives. They began to pay attention to viral needs of the briefed women, including emotional, spiritual and other needs. And also they integrate the family psychological needs into their care. Before the training, some nurses and midwives sought women who experienced prenatal loss would have an easier birth than women who experienced a four-term pregnancy with a four-grown baby. After the training, they realized the importance of pain management among this population. The third sub-theme is more effective communication. Nurses and midwives started their communication by giving detailed health education. A nurse said that, I didn't dare to communicate with them before because I thought it would make them feel depressed. I left in a hurry after every word expansion. Now when I see the briefed women and their families, I will tell them the following precautions for labor induction. I have received training and learned many courses so I have certain knowledge reserve. I have the confidence and ability to communicate with them. Seem three is the most valuable training content. Respect for grief care was a very important sub-theme in this part. Nursing and midwife staff found the content about grief care very practical. For example, provision of baby's footprint, dressing the baby, holding or seeing the baby. One midwife said that, I usually don't pay attention to how to name the baby. Maybe sometimes I just call the baby a small corpse. The mother might be very upset to hear that. After we learn the course materials, we would say the baby's name. I will also double check if the mother wants to see the baby, who will clean the baby when the mother needs to see her baby. Increased medical knowledge was also proposed by nurses and midwives. Their basic education didn't prevent for understand chromosomal abnormalities or fatal formation defects. This course provided nurses and midwives with more knowledge about the courses of pregnancy loss. Mindful nurse breathing in our study could help nurses and midwives to relieve their negative emotions in life. Seem four is suggestions for training improvement. Some nurses and midwives suggested that suggested to strengths course interaction. Nurses and midwives saw that online courses in our study lacked communication and interaction between colleagues. They suggested that offline learning would be better to improve the efficiency of the training. And also prenatal law is a solemn topic. Nursing and midwife staff reported that they do not communicate much about it. One nurse reported that the courses are recorded which is one sided. If these courses can be carried out whilst several live broadcasts, the effect would be better. For example, if I don't get any feedback on a certain question, there may be a knowledge point that I don't understand. Enriching clinical courses was also suggested by nurses and midwives. They hope to apply specific theoretical knowledge to clinical practice by learning clinical cases. Slowing the frequency of courses was also suggested. Seem five directions for practice improvement. More appropriate content and form of prenatal breathing care was suggested is a process of understanding women's breathing care needs. It is necessary to ask about women's need in a way that will not cause additional harm. Uniform service conscience would facilitate the provision of consistent and supportive care. The last theme is Influency Factors of Practice Optimization. Visit clinical work and environmental support from the hospital were considered as two main Influency Factors of the practice. Some nurses and midwives were intellectually and emotionally willing to provide high quality breathing care, but their own exhaustion, we can their ability to provide this kind of care. Environmental support from the hospital, some nurses and midwives hope that it would be better if the hospital could provide a private undisturbed space for the prenatal breathing care because post-pattern rooms may be shelled rooms. There is no private room for the farewell ceremony at the hospital. The price of other babies can also affect the mood of the breathing women. In rooms shelled by several women, the women often do not want to share their experiences with professionals. Now we come to the discussion. The findings that nursing and midwife professionals perceive the personal growth and practice changes after training, similar with other studies implementing this kind of training, this positive feedback reflected the effectiveness of the training program. Our training program was established based on a systematic scoping review and the exploration of Chinese prenatal breathing care. It could enhance the evidence-based rigor of the program. Therefore, in the future, wider application and testing of the training program should be conducted with larger sample and in diverse communities to verify its effectiveness. Respect for grief care increased medical knowledge and mindful breathing were considered as the most valuable contents of our study. In China, actually it is a taboo to talk about death, so nurses and midwives were quite unfamiliar with providing respect for grief care. In our study, they found that asking women's desire to see the baby after the delivery, calling a baby by name and keeping baby's footprint in this training as practical breathing skills. In our study, nurses and midwives acknowledged the value of learning more medical knowledge related to pregnancy laws, related to prenatal laws. It is similar with findings in previous study, nurses and midwives recommended training related to physical care issues and knowledge of genetics. For mindfulness breathing, actually it has been widely used for relieving health care professionals traumatic psychological symptoms. And in our study, nurses and midwives are also found it was helpful to relieve negative emotions. Due to the COVID-19 pandemic, our intervention was implemented via online lectures. It reduced the course interactions to some extent. In previous studies, face-to-face meetings in class interaction, offline workshops and debriefing case presentations were suggested to improve the efficiency of the training program. More appropriate content and form of prenatal breathing care was suggested. The key to providing prenatal breathing care is to respect women's preference. Therefore, hospitals could develop tools such as a list of breathing care services so that nurses and midwives could better understand women's breathing care needs in a way of avoiding a courtness. Basic clinical work and environmental support from the hospital were considered factors that limited practice optimization. So improvement of breathing care involves the contribution of individuals, teams, institutions and systems. Hence, hospital managers should optimize human resource allocation and create the necessary conditions to enable the implementation, monitoring and evaluation of the best practice prenatal breathing care. There are some strengths and limitations of our study. The methodology of this study was real. This is the first implementation of PBCTP in China and the results were helpful to provide enlightenment about the future training for healthcare providers in prenatal breathing practice. There are also some limitations of our study. First, the number of participants represent was small. We included nurses and midwives who were expressive in their reflective journals. This purposive sampling may have generated favorable bios interview responses. Secondly, we didn't obtain experiences from families after the training. Any improvement in the prenatal breathing care is recognized only from the perspectives of the nursing and midwife professionals. Last but not least, the PBCTP was only implemented in a single hospital and transferability of the findings to other health systems is unknown. Now I'd like to move on to the conclusion. The PBCTP was described by nurses and midwives as satisfying their training needs and supporting their professional enhancement. It facilitated personal growth and provide changes in providing prenatal breathing care. This intervention should be optimized based on suggestions from nurses and midwives for wider dissemination and application to verify its effectiveness. More efforts from hospitals, managers, obstetric nurses and midwives are needed to form a uniform care pathway and promote prenatal breathing care practice. Here are some references of our studies. This brings me to the end of my presentation. Thanks for your listening. And now if you have any questions and better pleased to answer it. Thank you. Okay. Does anyone have any questions right off? Well, I have a question. This study aimed to understand nursing and midwifery experiences with the perinatal bereavement care training program after its implementation. Can you tell me more about the details about the actual training program and how that was implemented? Okay. Thank you very much for your question. I will move to the one slide. In actually in this figure you can see some detailed information of the program. Actually this part has already been published in BMJ Open. You can check the reference list for more details of the contents. In five modules of our training program, the most important modules are general knowledge, practical skills, emotional support for nurses and midwives. In the beginning, nurses and midwives have to learn the meaning and objectives of the training in the introduction module. And then in the general knowledge module they have to learn something about clinical guidelines, law and ethics, psychological characteristics of the britnum parents. And then communication skills, psychological support strategies were delivered to nurses and midwives in practical skills module. These skills are very useful in clinical practice. Them, emotional support for nurses and midwives module, they have to learn some relaxation techniques. For example, mindfulness training so that it can help them to manage them, manage their own negative emotions. The last module is practices, reflection and learning. We will encourage them to organize group workshop and practical reflection conference to promote experience, sharing and communication. Yeah, so if you want to know more details you can check the reference for number 18 to know more details. Thank you. Okay, thank you. We do have some questions here in the chat. So, Seal Javit says, interesting work. Your work in China is at a similar stage to where we were in the early, I think you mean 1980s seal. Do you have plans to upscale this program and to spread it? Yeah, I think the reason why our work in China is similar stage to the early 19th century 1908 here is because the culture is very different. In China, people are not willing to talk more, much more about that. So, few medical staff will pay attention to the care for this population before. But now we are, there are more and more research in this field and the implementation of the training program is the first step in my research. And we are now in China apply for some grant to support us to spread this training program to other hospitals and for wider implementation of the training program. Yeah. Okay. There's more questions coming in. So, the next one is Susanna asks, what are the steps moving forward from the results of your study? And are you considering obtaining information from service users? Yeah, from my results, in this study, I only obtained some feedback from the nurses and midwives after their training. And in the future, I will also collect some information from the brilliant parents about their experiences of the bereavement care. Actually, in our hospital, we are now changing some principles of bereavement care. And I'm now collecting some information from the bereavement parents about their satisfaction of the bereavement care and their psychological outcomes. And then compel the outcome with previous data I collected before to see if there are any improvements after the training in the practice. Yeah. I will collect more information from the bereavement parents to verify the effectiveness of the program. Okay. Anita says, thanks for the nice presentation. How long was the training and how can you ensure that they practice what they were taught? Thank you for your question. We have about eight theoretical courses and these courses were delivered every two days. So the training is about 16 days through online lectures. Actually, the main aim of the training is to improve their confidence to provide this kind of care. And actually, I can't ensure they practice what we want to practice because the first step is to improve their knowledge and skills. But how can help them to implement their practice, how to implement their practice with their need more efforts from the managers and hospitals. So that's what we need to do in the future. Okay. Susanna has another comment. She says, as an Asian descendant, I know that the death of a baby is seen as a guilt and shame for families. I wonder how do you think you can attract participants? Actually, in this study we, our participants is nurses and wives, but I also do some research about the bereavement parents. In the beginning I also thought that it is, it may be difficult to include the bereavement parents because they may feel very, it's a shame to talk about the baby's death, but actually this kind of participation, it's very willing to share their experience because they are very sad they want to share their experience with the professionals for help and to relieve their negative emotions. So it is not very difficult to attract these participants because they have a great demand for seeking psychological support and professional support from the medical staff. Tara Mati says, very good presentation. Do you think that the study group were a good number? Actually we in our hospital, we have one delivery room and seven obstetric words and after communicating with a leader in these words, we have tried to include as many as participants in our study. So in our hospital, the majority of nurses and midwives all participated in our study. So I think it's a good number for a single hospital. But if I want to spread the training program in China, I think it's still not enough. Maybe in the future we can establish a cooperation with more hospitals to spread the training program and hope that more nurses and midwives can participate in this training. Yeah. Okay, any other questions before we start to wrap up here? All right, and here's Yalu's contact information.