Childbirth is usually a joyful experience for most families. However, women who have experienced the death of a baby during pregnancy often view subsequent pregnancies with fear and apprehension. It is estimated that 59% – 86% of women with previous perinatal loss will become pregnant again (O’Leary, 2004). There is limited research on what bereaved parents perceive as caring behaviors by nurses following the human experience of perinatal loss. The purpose of this research study was to determine if nurse caring behaviors (NCB) during the perinatal loss event affect pregnancy-specific anxiety (PSA) and maternal-fetal attachment (MFA) in women who are pregnant following a perinatal loss while controlling for socio-demographic and general anxiety influences. The study was guided by a theoretical framework drawn from Swanson’s Caring model and middle range theory of caring. The research design was correlational, non-experimental using surveys with established scales applied to a non-probability, non-randomized, convenience sample. Nurse caring was measured using the 24-item Caring Behaviors Inventory-24 (CBI-24). Pregnancy specific anxiety was measured using the 9-item Pregnancy Anxiety Scale (PAS). Maternal fetal attachment was measured using the 19-item Maternal Antenatal Attachment Scale (MAAS). General anxiety (GA) was measured using the 10-item questionnaire, International Personality Item Pool (IPIP). A final sample size of 33 pregnant women with a history of perinatal loss completed the surveys. In addition to descriptive statistics of sample demographics, correlational analysis was conducted to study the interrelationships between the study variables, and multiple regressions were used to predict pregnancy specific anxiety and maternal fetal attachment. The results showed a significant relationship between NCB and PSA at p = .005. Also, NCB significantly contributed in predicting PSA at p = .008 after controlling for maternal demographic variables and generalized anxiety. NCB was not a statistically significant predictor for MFA. This study provides information to improve individualized and meaningful patient care interventions for pregnant women following a previous loss. As front line health care providers, nurses have the greatest opportunity to directly affect the patient’s perception of the caring experience.

LLU Discipline





School of Nursing

First Advisor

Bossert, Elizabeth A.

Second Advisor

Haviland, Mark G.

Third Advisor

Lloyd, Susan

Degree Name

Doctor of Philosophy (PhD)

Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Pregnancy Complications; Infant Mortality; Maternal Behavior; Object Attachment; Anxiety; Nursing Care; Maternal-Child Nursing; Evidence-Based Nursing

Subject - Local

Childbirth; Fear of Pregnancy; Pregnancy-specific Anxiety; Maternal-fetal Attachment; Maternal Antenatal Attachment Scale



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives