Parental grieving after a child dies from cancer: is stress from stem cell transplant a factor?

AIM: to investigate psychological distress, family functioning and complicated grieving in parents whose child had died from cancer, and as a function of whether: (a) the deceased child had also received stem cell transplant (SCT) any time during curative treatment; and (b) the place of the child's death (home or hospital). DESIGN: a cross-sectional case-match design. SAMPLE: Fifty-six Australian bereaved parents in two groups: 28 whose child had also received SCT, matched with 28 (on deceased patient variables) whose child had not received SCT. RESULTS: parents in the 'SCT group' (n = 28) reported relatively higher levels of depression, anxiety and stress, and - for those whose child had also died in hospital - a greater likelihood of meeting the criteria for traumatic grief than those parents whose deceased child had not received SCT. There were no significant group differences in family functioning. CONCLUSION: routine psychosocial screening, especially for families undergoing SCT, may contribute usefully to a proactive model of palliative care in identifying parents at risk for complicated bereavement outcomes.     

Emotional symptoms and physical health in bereaved parents

The purpose of this study was to compare the emotional symptoms and physical health of parents whose children had died suddenly in an accident, parents whose children had died following a chronic disease, and nonbereaved parents. Data for this retrospective survey were collected by mailed questionnaires: the Hopkins Symptom Checklist (HSCL), Bereavement Health Assessment Scale, Review of Life Experiences Scale, and a personal-situation questionnaire. Subjects were 30 bereaved parents who had experienced the death of a child following a chronic disease; 31 bereaved parents whose children died in an accident; and 81 nonbereaved parents. Findings indicated significant differences between the bereaved groups and the control group on the total scale score of the HSCL and on the subscales measuring Depression, Anxiety, Somatization, Obsession-Compulsion, and Interpersonal Sensitivity. However, there were no differences on these variables between the two bereaved groups. Bereaved parents with higher concurrent life stresses and parents from a lower socioeconomic background were at higher risk for emotional symptomatology. There were no significant differences among the three groups on the number of physician/nurse visits, number of hospital admissions, number of new or recurrent illnesses, or drug usage. Bereaved parents, however, more frequently reported appetite and sleep problems.     

The aging of grief in Israel: a perspective of bereaved parents

This article focuses on long - term grief of older bereaved parents within the context of the Israeli society. The themes that emerged in a group discussion with 29 elderly bereaved parents whose sons were killed during military service support previous findings that the passage of time has no diminishing effect on parents' grief or on relinquishing attachment to the deceased. Aging appears to increase internalized involvement with the long - lost child, fears of fading memories, and the need to eternalize the deceased. In reviewing the past, parents reevaluate their coping with the loss and their relationship with the surviving children. The strong attachment seems to continue in external and inner representations of the lost child. In Israel, this preoccupation is enhanced due to society's attitude to dead soldiers, creating thereby an interface between society and bereaved families. The authors conclude that grief is a central theme in aging parents, and the term "aging of grief" is suggested to describe the course that grief and its many aspects may take with the passage of time.     

Death and Dying Anxiety Among Bereaved and Nonbereaved Elderly Parents

This study examines differences in death and dying anxiety between bereaved and nonbereaved elderly Israeli parents, as well as correlates of these factors among bereaved parents. A total of 97 parents (49 bereaved, 48 nonbereaved) completed measures of death and dying anxiety and religiosity. Bereaved parents reported significantly higher dying anxiety scores than nonbereaved parents, but there were no significant differences between the 2 groups in death anxiety. Religiosity was unrelated to death and dying anxiety. Dying anxiety was higher among bereaved mothers than bereaved fathers. Death and dying anxiety were not associated with the length of time since the loss of the child or the nature of the child's death. Results are discussed in light of the difficulties that bereaved parents experience after the loss of their child. Implications for theory, for health and welfare professionals, and for policy are suggested.     

PREDICTORS OF BEREAVED PARENTS' SATISFACTION WITH GROUP SUPPORT: AN ISRAELI PERSPECTIVE

This study evaluates various aspects of groupwork with bereaved parents who lost a child during military service. More specifically, it assesses the unique and cumulative contributions of various features of groupwork to the participants' satisfaction with the group support. One hundred and thirty-eight bereaved parents, who participated in 16 support groups, answered a battery of questionnaires tapping 3 aspects of the groupwork: their motives for joining the group, the interpersonal relations among the group members, and the group leadership style. In addition, the participants were asked to evaluate the contribution of the intervention to their adjustment. The findings indicate that the supportive elements of the intervention were associated with the groups' perceived contribution. The clinical implications of these results are discussed.     

Associations Among Mother–Child Communication Quality,Childhood Maladaptive Grief,and Depressive Symptoms

Mother–child communication may be an important factor in determining children's grief reactions following the death of the father. Using observational methods, the current study suggests that mothers' warm, sensitive, and engaged communication is associated with lower levels of maladaptive grief and depressive symptoms in children whose fathers have recently died. Further, mothers who showed a blunted emotional response to the loss, illustrated by unusually few depressive symptoms, were less effective at using these strategies than mothers with a more “normative” reaction. Findings suggest that mother–child communication may be an important intervention target for bereaved families.     

THE MYTH OF THE REPLACEMENT CHILD: PARENTS' STORIES AND PRACTICES AFTER PERINATAL DEATH

Parents bereaved by perinatal death adapt to their losses in different ways. When bereaved parents give birth to a child or children subsequent to a perinatal death, their constructions of the family necessarily change. The subsequent child is thought to be at risk of psychopathology (the replacement child syndrome) if parents have not sufficiently grieved their losses. This qualitative interview study examines the family stories told by bereaved parents, with particular attention to how parents represent the dead child and subsequent children in the current family structure. We categorized parents' stories as those which suggested that parents replaced the loss by an emphasis on parenting subsequent children, or maintained a connection to the dead child through storytelling and ritual behavior. The two ways in which parents maintained the connection were to preserve the space in the family that the dead child would have inhabited, or to create an on-going relationship with the dead child for themselves and their subsequent children. There seem to be multiple paths to parenting through bereavement. The place of rituals and memorial behavior is also examined.     

儿童死亡后居丧父母悲伤护理研究现状

儿童死亡是父母生活中遇到的严重负性生活事件。相对于成人死亡而言,父母悲伤反应强烈,不仅影响到其身心健康和彼此之间的关系,还会进一步影响到整个家庭乃至社会。该文从儿童死亡对家庭产生的应激和影响,父母悲伤反应的影响因素及相应的干预措施三方面进行了综述。     

Bereaved parents' perception of the grandparents' reactions to perinatal loss and the pregnancy that follows

This article presents bereaved parents' perceptions of their parents' (the grandparents) reactions at the time of loss and in the pregnancy that follows. Data originated from two phenomenological studies conducted to understand bereaved parents' experiences during their loss and subsequent pregnancy. However, this article reports a secondary thematic analysis focused on bereaved parents perceptions of the grandparents' support (or lack of) at the time of loss and during the pregnancy following loss. Our findings illustrate some families found the means to share their grief at the time of loss in a constructive manner, while in others the intergenerational relationship was strained. Most important to parents was intergenerational acknowledgment of the ongoing relationship to the deceased child as an important, though absent family member, especially during the pregnancy that followed. Those supporting bereaved families can play an important role in helping intergenerational communication around perinatal loss and the subsequent pregnancy.     

Exploring parental grief: combining quantitative and qualitative measures

PURPOSE: This study explores parental grief on the death of a child of any age. STUDY DESIGN: The sampling frame for the study consisted of 74 respondents reporting that they experienced the death of a living child. With the exception of standard demographic measures, the quantitative and qualitative items in the instrument were designed specifically for this project. The content validity of the instrument was assessed by a panel of experts on grief. Key quantitative items related to child loss and grief were formatted with between three- and five-point ordinal answer categories. Two types of qualitative items were developed by the authors. The reliability of the instrument designed for this study was not determined. RESULTS: This survey of parents who experienced the death of a child during their lifetime explores and extends current understanding of the complex emotional response of grief. The study offers empirical support for the notion of grief as ongoing in the life of a parent whose child had died. The findings have significant implications for further clinical research supporting studies to explore commonalities in the experience of grieving families regardless of the cause of and time since the death of their child. In addition, the findings may serve to inform the development and provision of services for bereaved parents.     

Preventive Intervention Following Accidental Death of a Child

This paper describes the development and pilot testing of an empirically and theoretically based preventive intervention program for bereaved parents whose adolescent and young adult children died suddenly folloxving an accident. The parents were assigned to either an early (2-6 months postloss) or a later (7-13 months postloss) transition group (N=15) in which they received two-dimensional preventive intervention: informational support and emotional support. A comparison group (N=l 9) received no intervention. Weekly and summative evaluations completed by bereaved parents and group leaders showed the therapeutic benefits of the preventive intervention for both treated groups. However, the two groups responded differently to the interventions, suggesting that timing and type of support might both be important factors to consider.     

Parental Grief Following the Brain Death of a Child: Does Consent or Refusal to Organ Donation Affect Their Grief?

The purpose of this study was to investigate the grieving process of parents who were faced with the dilemma of donating organs and tissues of their underage brain dead child, and to explore the impact of their decision on their grief process. A grounded theory methodology was adopted and a semi-structured interview was conducted with 11 bereaved parents who consented to, and 11 parents who declined organ donation. Findings suggest that the core themes that characterize their grief and the main variables that affect their grieving process are similar for both donor and non-donor parents. Consent or refusal of organ donation per se does not seem to affect the overall grieving process. It is the meaning attributed to the act of donation that affects how parents perceive the child's death and subsequently facilitate or hinder their adjustment to loss.     

Nurses’ attitudes towards perinatal bereavement care

Title. Nurses’ attitudes towards perinatal bereavement care. Aim. This paper is a report of a study conducted to explore the factors associated with nurses and midwives’ attitudes towards perinatal bereavement care. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. In some situations nurses may experience personal failure, feel helpless, and need to distance themselves from bereaved parents because they feel unable to deal with the enormity of the parental feelings of loss. Method. A correlational questionnaire study using convenience sampling was carried out in Singapore in 2007 with 185 nurses/midwives in one obstetrics and gynaecology unit. Results. Regression models showed that nurses/midwives with religious beliefs and those with more positive attitudes to the importance of hospital policy and training for bereavement care were statistically significantly more likely to have a positive attitude towards perinatal bereavement care. Nurses emphasized their need for increased knowledge and training on how to cope with bereaved parents and requested greater support from team members and the hospital. Conclusion. Bereavement counselling education and preceptorship supervision are recommended to reduce this stressful experience, increase the confidence and expertise of novices, and lead to increased quality of care for bereaved parents.     

Investigating factors associate to nurses' attitudes towards perinatal bereavement care

Aim. The purpose of this study was to explore nurses’ attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. Method. Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May–August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. Results. Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39·3% (n = 130) of nurses had bereavement related training. By contrast, about 89·8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses’ perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses’ attitudes towards perinatal bereavement care. Conclusions. Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively.     

The myth of the replacement child: parents' stories and practices after perinatal death

Parents bereaved by perinatal death adapt to their losses in different ways. When bereaved parents give birth to a child or children subsequent to a perinatal death, their constructions of the family necessarily change. The subsequent child is thought to be at risk of psychopathology (the replacement child syndrome) if parents have not sufficiently grieved their losses. This qualitative interview study examines the family stories told by bereaved parents, with particular attention to how parents represent the dead child and subsequent children in the current family structure. We categorized parents' stories as those which suggested that parents replaced the loss by an emphasis on parenting subsequent children, or maintained a connection to the dead child through storytelling and ritual behavior. The two ways in which parents maintained the connection were to preserve the space in the family that the dead child would have inhabited, or to create an on-going relationship with the dead child for themselves and their subsequent children. There seem to be multiple paths to parenting through bereavement. The place of rituals and memorial behavior is also examined.     

Supporting bereaved parents: a phenomenological study of a telephone intervention programme in a paediatric oncology unit

Aims and objectives. This study sought to discover bereaved parents’ perspectives and experiences of a nurse‐led, ward‐based, telephone support programme in a children’s oncology unit. Background. Parental grief is especially intense and long‐lasting, and many parents can experience serious psychological problems. The oncology team learned that some parents felt ‘forgotten’ or ‘abandoned’ following their child’s death and addressed this concern by initiating and subsequently evaluating a telephone bereavement support programme. Design. An interpretive phenomenological investigation of the experiences of six parents who participated in the programme. Methods. Parents shared their experiences and perceptions of the programme in individual interviews. Interpretive phenomenology and thematic analysis guided the interviews’ interpretation to ascertain both the parents’ experiences of the programme and their understandings of everyday clinical terms such as ‘support’ or ‘reassurance’. Results. Parents found the programme supportive, especially valuing ongoing contact with a nurse who ‘knew them’. Telephone contact was preferred to visiting the hospital, which brought back painful memories. Calls were important elements in helping parents create meaning and memory around their deceased child. Conclusions. Regular telephone contact over an agreed period from a familiar member of the child’s treating team can create a more positive and supportive bereavement experience for parents in the year following their child’s death. The specific findings are discussed in the context of the death of a child as a crisis of meaning. Relevance to clinical practice. Clinical nurses are ideally placed to use existing close relationships to extend care and support to bereaved parents. This study shows how nurses can identify service gaps, work with interdisciplinary team colleagues to initiate appropriate actions and participate in the essential evaluation subsequently required.