Randomized controlled trial of combined caring vs nurse caring, self -caring, or no treatment on how partners perceived themselves, their couple relationship, and their partner's caring during the first year after miscarriage. Kristen M. Swanson, RN, PhD, FAAN George Knafl, PhD School of Nursing University of North Carolina at Chapel Hill
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Randomized controlled trial of combined caring vs nurse caring, self-caring, or no treatment on how partners perceived themselves, their couple relationship,
Are there differences in how partners perceive themselves, their couple relationship, and their partner's caring during the first year after miscarriage based on whether couples received Nurse Caring, Self Caring, Combined Caring, or no treatment? RESEARCH QUESTION
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Randomized controlled trial of combined caring vs nurse caring, self-caring, or no treatment on how partners perceived themselves, their couple relationship, and their partner's caring during the first year after miscarriage.
Kristen M. Swanson, RN, PhD, FAANGeorge Knafl, PhDSchool of NursingUniversity of North Carolina at Chapel Hill
BACKGROUND
• At least 1 in 6 pregnancies end in miscarriage: the unplanned, unexpected loss of pregnancy prior to 20 weeks gestation (Ventura et al, 1999).
• Both men and women grieve after loss, with depth and duration of women’s grief tending to be greater (Swanson et al, 2009).
• When asked what was lost, typically mothers say their baby; spouses say their partner (Wojnar et al, 2011).
• One year after loss approx. One-third of women claim their couple and / or sexual relationships are more distant than before their miscarriage (Swanson et al, 2003).
Are there differences in how partners perceive themselves, their couple relationship, and their partner's caring during the first year after miscarriage based on whether couples received Nurse Caring, Self Caring, Combined Caring, or no treatment?
RESEARCH QUESTION
Couples Miscarriage Healing Project
Kristen M. Swanson, RN, PhD, FAANGeorge Knafl, PhD
RECRUITED• Posters, ads (newspaper, radio), provider referral SELECTION CRITERIA• Miscarried w/in last 3 mos.• In a committed relationship• Speak / write English• If not married, both must be 18• Both parents consent and return baseline data
RECRUITMENT
ENROLLMENT(January, 2003 to June, 2006)
Screened• 418 volunteers
Eligible• 393 couples
Enrolled• 341 couples
Retained• 324 couples
Women Men
Age 32.4 33.9 *
College Education 91% 87%
Caucasian 84% 86%
Employed 69% 87% *
Mental Health Tx 49% 26% *
DEMOGRAPHICS
• Together (M = 6.9 yrs; SD = 4.5)• Children (range = 0 to 6)
(0 = 53%; 1 = 31%)• Miscarriages (range = 1 to 6) (1 = 68%)• Pregnancy planned 72%• Pregnancy wanted 98%• Ges. age at loss (M = 9.8 wks; SD = 3.1)
COUPLES
• PROCESS (Swanson Caring Theory)• CONTENT (Meaning of Miscarriage Model)• Four Arms
Growth: CMHP findings for RelationshipsCC > (NC, SC, control)
1. During the first year after miscarriage, compared to those receiving NC, SC, or no treatment, men and women receiving CC rated their partner as more caring and they experienced less decline in their relational intimacy and perception of self.
2. Findings suggest that CC empowered couples to turn to each other as they resolved their miscarriage.
CONCLUSIONS
References
Shaefer, M. T. & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. J of Marital and Family Therapy, 7, 47-60.
Swanson, K. M. (1991). Empirical Development of a middle range theory of caring. Nursing Research, 40, 161-166.
Swanson, K. M., Chen, H. T., Graham, J. C., Wojnar, D. M.. & Petras, A. (2009). Resolution of depression and grief during the first year after miscarriage: A randomized controlled clinical trial of couples-focused interventions. J Women’s Health and Gender-based Medicine, 18(8), 1245-1257.
Swanson, KM, Karmali, Z, Powell, S. & Pulvermahker, F. (2003). Miscarriage effects on interpersonal and sexual relationships during the first year after loss: Women's perceptions. J of Psychosomatic Medicine, 65(5), 902-10.
Ventura, S. J., Mosher, W. D., Curtin, M. A., Abma, J. C., Henshaw, S. (1999). Highlights of trends in pregnancies and pregnancy rates by outcome: Estimates for the United States, 1976-96. USDHHS National Vital Statistics Report 47(29).
Wojnar, D., Swanson, K. M., Adolfsson, A. (2011). Confronting the inevitable: A conceptual model of miscarriage for use in clinical practice and research. Death Studies, 35(6), 536-558(23).
• Model selection was independent of p-values• Based on cross validation (CV) scores
– Data randomly partitioned into subsets– Subsets predicted using parameter estimates
based on the rest of the data– Predictions combined into a score– With larger CV scores indicating better models