Anticipatory mourning: processes of expected loss in palliative care

This qualitative study explored the retrospective perceptions of the anticipatory mourning experience of caregivers who had not received hospice services. Data revealed five major processes that were consistently described by informants: realization; caretaking; presence; finding meaning; and transitioning. Characteristics of each of these processes are described. Study informants provided information about what was helpful to them. The implications for health care providers include: an awareness of changed family roles and relationship attachments that can cause strain on family systems; familiarity with the complex demands on caregivers and their need for accurate information, anticipatory guidance and support resources; professional expertise especially in regard to education about what to expect; a caring presence; and pain and symptom management.     

The lament of a broken heart: mourning and grieving in different cultures. How acceptance of difference creates a bridge for healing and hope

Abstract

Working in palliative care with other cultures in the domain of grief, loss, and bereavement, the challenge for practitioners is to be open to difference and remain conscious of their own cultural beliefs, while being aware of their perceptions and interpretations of another's culture. This paper explores some of the requirements that need to be in place to develop collaboration and sharing of knowledge, wisdom, and experience when working in palliative care on the interface between individual focussed and community focussed cultures and countries.     

Health care personnel's experiences of a bereavement follow-up intervention for grieving parents

The aim of this study is to investigate the experiences of health care personnel of a bereavement follow-up intervention for grieving parents and of the ways to develop it. The intervention included three components: a support package for grieving parents, peer supporters' and health care personnel's contact with parents. The sample included 29 health professionals. Data were collected via open-format questionnaires and telephone interviews from health care personnel. Content analysis was used as a means of data analysis. The support package for grieving parents was considered important and versatile. Health care personnel perceived the intervention and its viability as mostly good. Parents' willingness to receive support, health care personnel's good resources and organizational preconditions were important for the follow-up contact. The intervention clarified the policy related to supporting grieving parents. It was enabled by a good attitude, shift arrangements and co-worker support. However, the implementation was considered difficult because of scarce resources. Parental support engendered negative feelings in health care personnel and they desired systematic supervision to deal with these. Follow-up care of grieving parents is a demanding task. Continuous education about bereavement follow-up care and systematic supervision to health care personnel is needed. Family-focused care in supporting grieving families after leaving from hospital should be increased. Inter-organizational cooperation in supporting parents is important and feasible.     

Jewish practices in death and mourning

This article describes the traditional Jewish practices surrounding death and mourning, and the principles that underlie these practices, as may be found among those Jews who take the biblical account of the events on Mt. Sinai more or less literally. It is characteristic of these Jews that 'practice' is an amalgam of (a) biblical commandments (mitzvot), (b) rabbinic law (halachah), and (c) traditions, or cultural habits of popular origins. This article, however, does not go to great length to enumerate the origins of each act or belief. The historical roots of these practices are not discussed, nor are the extreme departures from tradition that can be witnessed today. For treatments of these topics, the reader is referred to the bibliography.     

Bereavement and mourning in pediatric rehabilitation settings

Developmental changes in children's acquisition of death concepts and in their emotional reactions are reviewed. Moderating variables that may affect the nature of grieving processes after parental or sibling death are discussed, including circumstances of the loss, prior experience with death, and the child's cognitive functioning. Pragmatic issues (such as when and how to inform children of parental or sibling death) regarding bereavement and mourning in children with acquired brain injuries are reviewed and illustrated by means of case studies. Special challenges to rehabilitation professionals who must deal with these issues (including the concurrent treatment of secondary losses, cognitive deficits, and organic personality changes) are discussed.     

The Butajira rural health project in Ethiopia: epidemiological surveillance for research and intervention in primary health care.

Ten study populations sampled from a total of 86 communities in a rural Ethiopian area, have been registered and followed for a period of four years. A baseline census revealed a median age of 15 years, a literacy rate of 24%, poor housing and environmental conditions, and low utilization of the existing health care facilities. A surveillance system was established which made it possible to estimate the occurrence of vital events. This showed a crude birth rate of 40.3/1000, a crude death rate of 16.4/1000, a life-expectancy at birth of 48 years, an infant mortality rate of 114/1000, a yearly child (1-4 years) mortality rate of 36/1000, and an under-five mortality rate of 210/1000. The implications of these data in terms of the planning and operations of research and health services are discussed, and on-going and projected studies are outlined emphasizing the methodological potentials of this epidemiological study base.     

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.     

Visions of the dead: imagination and mourning

Contemporary research recognizes the existence of an ongoing attachment between the mourner and the deceased. This research tends to focus on the subjective aspects of the attachment--the mourner's memory and emotions. A complementary perspective is offeredby archetypal psychology, which considers the deceased to exist outside the mourner'ssubjectivity as an autonomous image. This approach is illustrated by an exemplary case: a woman named Verda who experienced the death of her twin sister, Vera. Their account suggests that Verda's mourning derives from her encounters with Vera's continuing imaginal presence.     

The effect of a support group on grieving individuals' levels of perceived support and stress.

This study examined the effects of support group participation on bereaved individuals' levels of perceived support and stress. Using a single group pretest/posttest design, data were collected from a convenience sample of 21 grieving individuals who participated in 10 weekly support group sessions. Perceived stress decreased significantly (P less than .002) following support group participation. However, although perceived support increased, the change was not statistically significant. These findings indicate that a support group can be an effective intervention to decrease feelings of stress in bereaved individuals.