FINDING MEANING IN A CHILD'S VIOLENT DEATH: A FIVE-YEAR PROSPECTIVE ANALYSIS OF PARENTS' PERSONAL NARRATIVES AND EMPIRICAL DATA

Finding meaning in the death of a loved one is thought to be extremely traumatic when the circumstances surrounding the death is perceived to be due to negligence, is intentional, and when the deceased suffered extreme pain and bodily harm immediately prior to death. We addressed this assumption by obtaining personal narratives and empirical data from 138 parents 4, 12, 24, and 60 months after an adolescent's or young adult child's death by accident, suicide, or homicide. Using the Janoff-Bulman and Frantz's(1997) framework ofmeaning-as-comprehensibility and meaning-as-significance, the purposes were to identify the time course to find meaning, present parents' personal narratives describing finding meaning in their experiences, identify predictors of finding meaning, and compare parents who found meaning versus those who did not on five health and adjustment outcomes. The results showed that by 12 months postdeath, only 12% of the study sample had found meaning in a child's death. By 60 months postdeath, 57% of the parents had found meaning but 43% had not. Significant predictors of finding meaning 5 years postdeath were the use of religious coping and support group attendance. Parents who attended abereavement support group were 4 times more likely to find meaning than parents who did not attend. Parents who found meaning in the deaths of their children reported significantly lower scores on mental distress, higher marital satisfaction, and better physical health than parents who were unable to find meaning. Recommendations for future research are made.     

Reply to Manthorpe & Iliffe

Effective interprofessional collaboration is considered essential for optimum healthcare delivery. Studies have investigated interprofessional education (IPE) as a means for improving collaborative practice, and evidence suggests that the clinical setting offers opportunities for interprofessional learning (IPL). Little is known, however, about the aspects of clinical practice that students perceive as meaningful to their IPL. This study explores physiotherapy students' experiences of collaborative working, and identifies their perceptions of the skills used and factors affecting interprofessional interactions in the clinical setting. Twenty second-year physiotherapy students studying in London provided written critical incident reports describing good and poor interprofessional collaborative encounters in the clinical setting. The data were subjected to thematic content analysis. Students identified communication and interprofessional relationships as the main factors affecting collaboration and perceived teamwork in formal contexts (e.g., team meetings) as generally effective with positive outcomes for professionals and patients. Informal collaboration was perceived to be poor and attributed primarily to insufficient direct contact and communication. The wide range of described experiences and learning outcomes indicate that clinical placements provide potentially valuable IPL opportunities. Facilitating the development of informal (ad hoc) collaborative teamwork skills is proposed as an important consideration when planning and implementing IPE in this setting.     

Life Goes On: The Experiences of Wives of Multiply-Deployed National Guard Soldiers

Whether a service member is active duty or part of the National Guard, deployment of these service members is a major issue for most families. There is limited knowledge of the experience of multiple deployments on the family. The purpose of this study was to describe experiences of wives of National Guard soldiers that were deployed more than once. Nine wives were interviewed. An analysis of the interviews revealed four themes: (1) “Life Goes On” (i.e., despite the repeated deployments, life continues at home); (2) the “Guard is a Different Animal” (i.e., life as a National Guard spouse is different from that of an active duty spouse); (3) “It's a Mind-Set” (i.e., how wives cope their husband's deployment); and (4) “Going Back Again” (i.e., wives’ experiences of multiple deployments). Exploring how multiple deployments affects wives of National Guard soldiers is helpful in understanding their experiences and the adjustments that must be made in family life. Knowledge of the experiences of these wives may help in formulating more effective interventions with families who have experienced multiple deployments.     

Predictors of Grief in Bereaved Family Caregivers of Person's With Alzheimer's Disease: A Prospective Study

The purpose of this prospective study was to identify factors in 66 spouses and adult child caregivers of person's with Alzheimer's disease prior to the death that predicted higher levels of grief in bereavement. A hierarchical regression model was tested. Predeath grief, dysfunctional coping, depression, social support, and decreased positive states of mind explained 54.7% of the variance in postdeath grief. Factors that contributed significantly to postdeath grief included predeath grief and depression. Results from this study indicate that risk factors for postdeath grief can be predicted prior to the death.     

Adolescent chronic pain‐related functioning: Concordance and discordance of mother‐proxy and self‐report ratings

Accurate assessment of adolescent chronic pain is critical to guiding treatment decisions. Given the multifaceted role of the parents in their children's lives, parents, and patients often each provide reports of adolescents’ pain‐related functioning. In order to make sense of these data, clinicians should be aware of patterns of discordance in perspectives. In this study, we aimed to examine concordance and discordance in adolescents’ self‐report and mothers’ proxy‐report of adolescents’ chronic pain‐related functioning. Results suggested that although there were high correlations between the raters, there were also significant discordance with mothers rating their adolescents as having greater disability in social functioning, depression, and pain‐specific anxiety. Analyses suggested that high pain and being older predicted greater concordance in ratings. Findings suggest that mothers and adolescents tended to have greater concordance for more observable and shared disability (e.g., physical disability, family functioning) and greater discordance for internal experiences (e.g., pain‐specific anxiety, depression). Awareness of these patterns of concordance and discordance should help clinicians in interpreting mothers’ proxy‐reports and adolescents’ self‐reports of chronic pain‐related functioning.     

Physical activity and implications on well-being in mild Alzheimer's disease: A qualitative case study on two men with dementia and their spouses

To improve the understanding of experiences of people with mild Alzheimer's disease (AD) and their significant others, related to the physical activity of the afflicted persons and its perceived importance. A qualitative case study design was used. The study comprised two men with mild AD and their wives. Data were collected by qualitative interviews and participant observations. Data analysis followed a thematic guideline as described by Braun and Clarke (). Three central themes of experiences related to physical activity in AD were identified: 1) physical activity as health reinforcement; 2) barriers to physical activity; and 3) adaptation strategies. Important motivations for outdoor walks were enjoyable experiences of nature, body movement, and positive attitudes toward physical activity. Several factors were experienced as barriers to physical activity (e.g., tiredness, difficulties in finding one's way, and “peculiar behavior”). Significant others made considerable adjustments in everyday life to enable their partners to retain a physically active lifestyle. The findings indicate that in persons with AD, physical activities such as outdoor walking can play an important part in everyday life by creating meaningful routines and improving experienced well-being and health.     

Find a way out: bereavement support in Taiwan hospice

Goals of work The aim of the study was to explore one of the possibilities to enhance bereavement care in Taiwan hospice due to insufficient attention and resources. Meanwhile, a theoretical assumption about the relationship between anticipatory grief and postdeath grief was made and examined.Patients and methods Through convenience sampling, 109 most bereaved families of terminally ill cancer patients were included. Data were collected by the Anticipatory Grief Scale (Theut SK et al (1991) Caregivers anticipatory grief in dementia: a pilot study. Int J Aging Hum Dev 32:113–118), Perinatal Grief Scale (Potvin L, Lasker J, Toediter T (1989) Measuring grief: a short version of the Perinatal grief scale. J Psychopathol Behav Assess 11:29–45), and a background information sheet.Main results Anticipatory grief was correlated with postdeath grief significantly but mildly. Age was associated with anticipatory grief, not with postdeath grief. However, relationship and gender did not statistically relate to anticipatory grief and postdeath grief.Conclusions Although anticipatory grief could predict postdeath grief, the result was not encouraging enough. Prevention is still the best way not only for the bereaved in theoretical point of view but also for hospice staff in practical application. However, how to screen out high-risk bereaved family in order to provide help in advance require more effort.     

Finding meaning in a child's violent death: a five-year prospective analysis of parents' personal narratives and empirical data

Finding meaning in the death of a loved one is thought to be extremely traumatic when the circumstances surrounding the death is perceived to be due to negligence, is intentional, and when the deceased suffered extreme pain and bodily harm immediately prior to death. We addressed this assumption by obtaining personal narratives and empirical data from 138 parents 4, 12, 24, and 60 months after an adolescent's or young adult child's death by accident, suicide, or homicide. Using the Janoff-Bulman and Frantz's(1997) framework ofmeaning-as-comprehensibility and meaning-as-significance, the purposes were to identify the time course to find meaning, present parents' personal narratives describing finding meaning in their experiences, identify predictors of finding meaning, and compare parents who found meaning versus those who did not on five health and adjustment outcomes. The results showed that by 12 months postdeath, only 12% of the study sample had found meaning in a child's death. By 60 months postdeath, 57% of the parents had found meaning but 43% had not. Significant predictors of finding meaning 5 years postdeath were the use of religious coping and support group attendance. Parents who attended abereavement support group were 4 times more likely to find meaning than parents who did not attend. Parents who found meaning in the deaths of their children reported significantly lower scores on mental distress, higher marital satisfaction, and better physical health than parents who were unable to find meaning. Recommendations for future research are made.     

To regain participation in occupations through human encounters – narratives from women with spinal cord injury

Purpose. To gain an understanding of how women with spinal cord injury (SCI) experienced human encounters in occupations and how these influenced their participation.

Method. The data were collected through two or three in-depth interviews with 13 women (age 25 – 61 years) with SCI. Data analysis was carried out by using a paradigmatic analysis of narrative data, followed by an interpretation based on a narrative theory.

Results. The results showed a complexity where the women's experiences and acting in human encounters changed over time. In these human encounters the women struggled with conflicts, supported other persons that were insecure and revaluated their apprehension about persons in their social network. These multidimensional human encounters thereby enabled them to regain participation in occupations.

Conclusions. This shows that human encounters are important for persons with disabilities so they can restructure their occupational identity and their needs for participation in occupations. The study also showed that the use of narratives as a tool within rehabilitation could lead to an increased understanding of the subjective changes that occur over time for a person with a disability.     

Interoperability—Making Information Systems Work Together

Disaster literature suggests that children's and adolescents’ post-disaster reactions vary according to their developmental levels. Preschool children show less psychological problems as compared to older children and adolescents, but they have a higher incidence of trauma-specific fears and behavioral problems (e.g., dependency, clinging). School-age children's disaster responses include sleep and eating disturbances, behavioral problems, and poor school performance. Adolescents tend to exhibit symptoms such as posttraumatic stress disorder, depression, anxiety, belligerence, and pessimistic views about the future (Korol, Green, &; Gleser, ).     

Communicating with culturally and linguistically diverse patients in an acute care setting: nurses' experiences

Communication with culturally and linguistically diverse (CLD) patients has been shown to be difficult. This study describes nurses' experiences of communicating with CLD patients in an acute care setting. A purposive sample of registered nurses and certified midwives (n=23) were interviewed. Main findings were: interpreters, bilingual health workers and combinations of different strategies were used to communicate with CLD patients; some nurses showed empathy, respect and a willingness to make an effort in the communication process with others showing an ethnocentric orientation. Main recommendations were: prioritising access to appropriate linguistic services, providing nurses with support from health care workers, e.g., bilingual health care workers who are able to provide more in-depth information, increasing nurses' understanding of legal issues within patient encounters, supporting nurses to translate their awareness of cultural diversity into acceptance of, appreciation for and commitment to CLD patients and their families.     

Talking to children: The within-classroom nature of everyday adult language input in the early childhood educational environment

Group-size effects, as changes in the adult language when speaking to individual or multiple children in two- and three-year-olds' Australian childcare centre classrooms were investigated. The language addressed to children by 21 staff members was coded for social (e.g., non-verbal, inferential and pragmatic), and linguistic (e.g., morphological, lexical, syntactic and referential) features. In the two-year-olds' classrooms, minimal differences were found between the language used in dyads (addressed to a single child) and polyads (addressed to more than one child). More extensive group-size effects, particularly in syntactic complexity, were found in the three-year-olds' classrooms. Explanations for the constancy of the adult language input in the younger classrooms, and the changes noted in the older rooms will be discussed in terms of plurality (i.e., more than one listener), methodology, and group-size effects that may be specific to the early childhood educational setting.     

THE USE OF RESEARCH FINDINGS IN BEREAVEMENT PROGRAMS: A CASE STUDY

Violent death is a major public health problem in the United States, yet there is no consensus among bereavement researchers and clinicians regarding a "gold standard" of bereavement services to be offered to family survivors. This article has three purposes: (a) to describe the planning, implementation, and results of a theory-based intervention study involving parents bereaved by the violent deaths of their children; (b) to suggest programmatic elements of bereavement services based on some findings from both the bereavement program and the follow-up data obtained from parents up to 5 years postdeath; and (c) to identify future research and theory development needs. The results of the intervention study involving 261 bereaved parents provide helpful insights regarding parent bereavement program preferences as well as changes in parent outcomes. Some of the most relevant findings pertain to variability in distress levels, gender, and causes of deceased children's deaths. Findings suggest that many different types of services are needed to meet parents' needs. The follow-up data collected from the parents 1, 2, and 5 years postdeath demonstrate that loss accommodation following violent death bereavement is both lengthy and difficult. Recommendations follow for both bereavement services and research studies.     

Nurses' experiences of caring encounters with older people living in Swedish nursing homes

Aim. The aim of the study was to describe and interpret the meaning of nurses' experiences of caring encounters with residents in nursing homes. Background. Life for residents in nursing homes can be characterized as a process of decreased physical and psychological resources. Therefore, encounters with nurses are important activities for providing meaning and security for the residents. Research in this field has previously focused on communication, attitudes and job satisfaction, but gives limited knowledge about what the human encounters in this context mean for the nurses. Method. A hermeneutic method was used in this study. Interviews were conducted with 14 nurses from two nursing homes about their experiences of caring encounters. The transcribed interview texts were interpreted as a whole. Results. In the interpretation of the text concerning the meaning of nurses' experiences of encounters with resident's four themes and 11 subthemes emerged. The comprehensive interpretation mainly showed possible ways available being present, being significant and being aware of opportunities for the nurse to find meaning in the encounter with the resident, but impossible ways as being inadequately were also revealed. Conclusion. This study shows the importance of caring encounters between nurses and residents in nursing homes. The good encounters provide various possible ways for nurses to find meaning and a sense of communion with residents. However, bad encounters, described as being inadequate, were found to inhibit nurses from finding meaning in their encounters with residents. Relevance to clinical practice. Meeting the needs of older people in nursing homes requires special knowledge about the importance of the caring encounter. Therefore, nurses in this care context need supervision and continuous education in order to gain relevant knowledge about the meaning of caring encounters for themselves and residents.     

Community-Dwelling,Older Women's Perspectives on Therapeutic Life Review: A Qualitative Analysis

The purpose of this study was to elicit the participants' perspective of a Therapeutic Life Review intervention program delivered by a home care worker. Following the intervention by the home care worker, 13 of the 14 older women receiving home care services were interviewed to examine their experiences. Qualitative data analysis revealed five themes: (1) Someone was there to listen to my story, (2) It was a special time, (3) A valued interaction with the home care worker developed, (4) Remembering was meaningful and pleasurable, and (5) Integration with one's lived experiences was healing. Three case scenarios illustrate the lives of these older women.     

District nursing--sharing an understanding by being present. Experiences of encounters with people with serious chronic illness and their close relatives in their homes

Background. In the homecare setting, district nurses assume a heavy responsibility and are involved in a variety of care activities. They view themselves as having a central role in care at home that centres on the development of a relationship with those who are ill and their families. Aim. The aim of this study was to elucidate the meaning of district nurses experiences of encounters with people with serious chronic illness and their close relatives in their homes. A purposive sample of 10 district nurses (female) was interviewed using a narrative approach. Method. To achieve the aim, a phenomenological hermeneutic interpretation inspired by the philosophy of Ricoeur was used to interpret the interview text. Results. This study proposes that district nurses’ experiences of encounters with people with serious chronic illness and their close relatives in their homes can be understood as district nurses being welcomed into the ill people's privacy, to share their intimacy and their understanding of being ill. This close relationship enables them to alleviate and to console the suffering and loneliness caused by illness. This is expressed in the three themes: being in a close relationship, sharing an understanding and weaving a web of protection. Conclusion. It seems that by being entirely present, in a close relationship, district nurses share the experiences of illness and through interpretation of the whole persons’ expressions; they share an understanding of this illness experience. In this close relationship, at the home of the ill people and their close relatives, district nurses are available to alleviate people's suffering and loneliness caused by illness. Relevance to clinical practice. This study reveals the need to be entirely present in encounters between the district nurses and people with serious chronic illness and their close relatives. This relation makes it possible to establish a shared understanding of the illness experience. Being aware of the importance of this shared understanding within a relationship, will increase the health care personnel's possibility to alleviate and console those suffering of illness. This proposed interpretation could be useful for reflection of care interventions, in education and supervision of district nurses.     

Globalization: Migrant nurses' acculturation and their healthcare encounters as consumers of healthcare

Globally, one of every eight nurses is a migrant, but few studies have focused on the healthcare experiences of migrant nurses (MNs) as consumers or recipients of healthcare. We address this gap by examining MNs and their acculturation, barriers to healthcare access, and perceptions of healthcare encounters as consumers. For this mixed-methods study, a convenience sample of MNs working in Europe and Israel was recruited. The quantitative component's methods included testing the reliability of scales contained within the questionnaire and using Hayes Process Model #4 to test for mediation. The qualitative component's methods included analyzing interviews with iterative inductive thematic analysis. Quantitative findings on MNs (n = 73) indicated that the association between acculturation and perception of the healthcare encounter, which MNs experienced as healthcare consumers, was mediated by barriers to healthcare access, even after adjusting for age and gender (p = 0.03). Qualitative interviews with MNs (n = 13) provided possible explanations for the quantitative findings. Even after working in the host country's healthcare system for several years, MNs reported difficulties with their healthcare encounters as healthcare consumers, not only due to their limited knowledge about the culture and healthcare resources but also due to the biased responses they received.