Training health professionals in caring for dying children and grieving families

In most industrialized countries today, the death of a child is a rare phenomenon. When it occurs, however, it is usually within a hospital setting, after the child has received complex and often long-term medical care aimed at curing or controlling a serious disease. Thus, health professionals are increasingly exposed to the dying process and death of a child with little prior education to help them deal with the particular needs of young patients and minimal preparation in recognizing and handling their personal reactions in the face of death. Comprehensive training programs in pediatric hospice care could help professionals cope with the growing and unique needs of terminally ill children and of their families but these should be differentiated from training programs designed for the terminal care of adult patients. The purpose of this article is to describe and discuss some of the challenges involved in the training of health professionals (pediatricians, nurses, psychologists, social workers, clergy) who wish to provide services to dying children and grieving families. These challenges include (a) definition of educational objectives, (b) selection of teaching methods and content of training, (c) definition and teaching of emotional involvement, (d) support of training participants, (e) promotion of interdisciplinary collaboration, (f) evaluation of the training process and its outcomes, and (g) background and skills of educators. The challenges are discussed and references are made to illustrate how they were met by a 600-hour training program on home-based palliative care for children dying of cancer conducted at the University of Athens.     

The monkey's paw: The role of inheritance in the resolution of grief

Despite the common occurrence of the loss of a parent in adulthood, most research has either focused on the child's loss of a parent or parental loss of an adult child. Yet research has reported that the death of a parent is a stressful loss to adults. However, little research explores circumstances that might complicate loss.

This research considers the role of inheritance in the resolution of grief. It was found that inheritance reflects, and perhaps intensifies, existing problems and conflicts between parents and siblings. When these prior issues are not problematic, inheritances leave a legacy that validates the life of the deceased and affirms relationships with survivors. The study also found a “settlement reaction” similar to anniversary reactions, suggesting that legal events influence the cycle of grief.     

Balance as a key concept in the resolution of grief

The writer analyzes a selection of bereavement studies for a concept of balance. At the same time, she traces the course of her personal experience of grief at the sudden, accidental death of her 13-year-old twin son. Intermingled with the mid-life crisis, other siblings leaving home, and the death of an aged mother, the situation is further complicated by a hysterectomy. The writer shows how the death of one significant person—a son—has affected her own role. Once the incumbent of a key complementary role has been removed, it is difficult to maintain the role identity hierarchy. When a salient role has been changed, the remaining structure must be reorganized. How such restructuring can occur and how the process causes other roles to be questioned, rearranged, and placed in relation to the new roles that have been adopted, is shown.     

A concept analysis: the grieving process for nurses

The concept of the grieving process has been explored extensively in families losing a loved one or in a patient grieving over a terminal diagnosis. The patients and families live through this experience one time. What about the nurse who lives it several times a week by caring for these patients and families? How does a nurse grieve? Little publication and research have been done surrounding the grieving process for nurses. This is a concept analysis that clarifies the grieving process for nurses. Clarifying this process will enable further development of nursing research and education, ultimately benefiting nursing practice and retention.     

Transformation through grieving: art and the bereaved

The literature on grief has focused primarily on the grieving process and individual manifestations of grief. Little has been written, however, about the transformative or growth potential of grief. The article focuses on the use of art therapy in an adult bereavement group and the potential benefits of using expressive art therapy in bereavement work. The art therapy activities provided the group members with occasions to express a full range of feelings and opportunities for them to reflect on their individual views of themselves.     

College and the grieving student: A mixed-methods analysis

The current mixed-methods study examines how college students negotiate the grief process with the competing demands of college. Data were collected from 950 students at a regional comprehensive university and a research intensive institution. Quantitative findings revealed closeness to the deceased as a key positive predictor of mental health and academic difficulties and positive associations between changes in peer relationships and mental health difficulties. Qualitative findings showed that closeness to the deceased was associated with a greater sense of purpose in the college experience and findings suggested that institutions and their faculty encourage and exhibit more sensitivity about grief issues.     

The deceased child in the psychic and social worlds of bereaved parents during the resolution of grief

A core dynamic by which grief is resolved by parents in Bereaved Parents, a selfhelp group, is a series of transformations of the inner representation of the dead child in the parent's inner world and in the parent's social world. As the reality of the child's death as well as the reality of the parent's continuing bond with the child are made part of the socially shared reality, the inner representation of the child can be transformed in the parent's psychic life. The end of grief is not severing the bond with the dead child, but integrating the child into the parent's life in a different way than when the child was alive. This article traces the course of the inner representation of the child in the parent's inner life and social world as the parent progresses through Bereaved Parents. It concludes with some comments on the differences that should be maintained between scholarly and popular understandings of phenomena in the continuing bonds survivors maintain with the dead.