# Professional grief experience and psychological detachment of pregnant emergency nurses after the death of pediatric patients: a longitudinal mixed-methods study

## TL;DR

Pregnant emergency nurses experience significant grief and emotional distress after pediatric deaths, with late pregnancy being a high-risk period for poor recovery.

## Contribution

This study longitudinally examines how pregnancy stage influences emotional recovery and psychological detachment in emergency nurses after pediatric deaths.

## Key findings

- Late-pregnancy nurses showed minimal emotional improvement compared to early- and mid-pregnancy nurses.
- Guilt and self-blame were central barriers to psychological detachment.
- Postpartum nurses showed marked emotional improvement compared to those still in late pregnancy.

## Abstract

Emergency nurses are frequently exposed to pediatric death events, which trigger professional grief and impair psychological detachment. Pregnant nurses, due to heightened physiological and psychological sensitivity, may exhibit unique emotional responses, yet evidence remains scarce.

This study adopted a longitudinal mixed-methods design, combining semi-structured qualitative interviews with quantitative assessment using the DASS-21 scale at three time points. Data were analyzed using Colaizzi’s seven-step method to extract themes and depict temporal trajectories.

Five core themes were identified: (1) emotional shock—within 1 week, participants reported intense grief, anxiety, and guilt, with mean DASS-21 stress scores >15; (2) guilt and self-blame—nurses attributed death to their own limitations, prolonging recovery; (3) emotional fluctuation—by 1 month, early- and mid-pregnancy nurses showed ~30% reduction in DASS-21 scores, whereas late-pregnancy participants exhibited minimal improvement; (4) emotional support—family and peer support facilitated partial recovery; (5) physiological factors—late-pregnancy nurses maintained high anxiety (>12) and depression (>15) at 3 months, while those who had delivered showed marked emotional improvement. The overall trajectory followed shock–guilt/self-blame–impaired detachment–gradual recovery.

Pregnancy stage markedly shapes emotional recovery after pediatric death events, with late pregnancy identified as a high-risk period. Guilt is the central barrier to psychological detachment, while social support and postpartum transitions act as protective factors. Tiered psychological interventions tailored to pregnancy stage are recommended to promote recovery and resilience among emergency nurses.