Unfinished Business in Bereavement

Unfinished business (incomplete, unexpressed or unresolved relationship issues with the deceased) is frequently discussed as a risk factor for chronic and severe grief reactions. However, few empirical studies have examined this construct. The present study aimed to address this gap in the literature by examining the presence and severity of unfinished business as well as common themes of unfinished business reported in open-ended qualitative narratives among a sample of 224 bereaved individuals. In bivariate analyses, self-reported presence of unfinished business and the severity of distress due to unfinished business were both found to be associated with poorer bereavement outcomes. However, after controlling for potential confounds, distress related to unresolved issues with the deceased emerged as a more robust correlate of these outcomes. Qualitative responses were categorized, and the type of reported unfinished business was not significantly related to the degree of unfinished business distress or other bereavement outcomes. These findings provide preliminary justification for bereavement interventions that aim to ameliorate distress related to unresolved relational issues with the deceased.     

Bereavement care for older people in healthcare settings: qualitative study of experiences

Aim. This study aimed to explore the experiences of healthcare staff of caring for bereaved older people, and older people’s experiences of bereavement care. Background. Loss through death of close family members, partners and friends inhibits the physical, emotional and social well being of older people. The rising population of older people and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence. Design. A qualitative design drawing on phenomenological methodology was used to understand interactions between healthcare staff and bereaved older people. The study was set in hospital wards, general practice and community nursing teams, and care homes. Healthcare staff and a sample of recently bereaved older people participated. Methods. Purposive sampling took place to recruit staff with a range of roles, and older people who were 65 years of age or more, and bereaved of a family member or friend for between 6 months and 5 years. Participants took part in in‐depth interviews, and data were analysed systematically. Results. Thirty‐nine participants were recruited, and three key themes arose from the data: (i) Bereavement care depends on an established relationship between healthcare staff and the patient’s relatives; (ii) Preparation for the relative’s death may not equate to being prepared for bereavement; (iii) The ‘Open Door’ to bereavement care is only slightly ajar. Conclusions. The study identified the interactions of healthcare staff with bereaved older people in terms of the bereavement journey. Staff demonstrated awareness of difficulties the bereaved person may encounter and showed commitment to providing support. However, lack of flexibility in services restricts meaningful interactions. Implications for Practice. (i) Healthcare staff may identify gaps in services in terms of preparing relatives and follow‐up post‐bereavement; (ii) Therapeutic relationships between staff and relatives enable ongoing support; (iii) Development of practice guidelines is a key consideration.     

Bereavement related to the death of a close relative. Nursing care

The authors publish a consensus document designed to assist nursing professionals to recognize and work with bereavement related to the death of an intimate family member or friend, inside the conceptual framework for nursing treatment and care. This project exposes bereavement in a fashion similar to that used by "NANDA" for its distinct diagnostic categories: title, definition and distinguishing characteristics. Furthermore, the authors include an evaluation guide which may facilitate making a diagnosis between normal and dysfunctional bereavement; the authors propose objectives and activities which a nurse can perform to help to complete the bereavement process in a healthy and adaptive manner. In order to deal with these situations, a consensus document may be useful; at the same time this can become a professional development aide which includes theoretical knowledge about bereavement, adroitness in relation to helpful measures and which facilitates a conscious awareness by health professionals regarding their own personal attitudes and difficulties in the face of death and bereavement. Adequate nursing care during the first phases of this process, which helps the individual or family to mobilize all their resources, may lead to a better evolution of this process and to a recuperation of the affective loss.     

Adjustment Disorder Related to Bereavement

Adjustment disorder related to bereavement (ADRB) is a condition that may develop after a loss, does not resolve over time, and requires clinician intervention. This article investigates the personal factors that influence response to loss and explores the relationship between coping mechanisms and the development of ADRB. Clinical features, diagnosis, and treatment options are discussed for use in primary care.     

Find Me the Evidence: Connecting the Practitioner With the Evidence on Bereavement Care

Care practices change as knowledge emerges and research findings challenge current approaches. Access to evidence has challenges. Bereavement care is diverse: practitioners often work alone or in small teams, terminology can be diffuse, and practitioners may not have time and skills for effective search strategies. CareSearch, an online palliative care resource, is hosting the Bereavement Search Filter, a validated search strategy to facilitate access to bereavement care evidence. The service connects practitioners to global best practice evidence; it is free and trustworthy. This article outlines the development of the Medline Bereavement Search Filter, translating it for PubMed and deploying it online.     

The Meaning of Loss Codebook: Construction of a System for Analyzing Meanings Made in Bereavement

Recent research on grieving populations has emphasized the role of meaning making in adaptation to bereavement, typically relying on simple self-reports of the extent to which respondents have been able to find sense or benefit in their loss. The present article reports the development of a reliable and comprehensive coding system for analyzing meanings made in the wake of the death of a loved one, yielding a 30-category codebook demonstrating excellent reliability, and comprising both negative and positive themes that arise as grievers attempt to make sense of loss. Based on an intensive qualitative analysis of a diverse sample of 162 adults mourning the natural or violent death of a variety of loved ones, the Meaning of Loss Codebook could prove useful in process-outcome studies of grief therapy, analysis of naturalistic first-person writing about bereavement experiences in grief diaries and blogs, and clinical assessment of meanings made in the course of bereavement support or professional intervention.     

The Economic Cost of Bereavement in Scotland

Aspects of the socioeconomic costs of bereavement in Scotland were estimated using 3 sets of data. Spousal bereavement was associated with increased mortality and longer hospital stays, with additional annual cost of around £20 million. Cost of bereavement coded consultations in primary care was estimated at around £2.0 million annually. In addition, bereaved people were significantly less likely to be employed in the year of and 2 years after bereavement than non-bereaved matched controls, but there were no significant differences in income between bereaved people and matched controls before and after bereavement.     

助产士对围产儿死亡产妇进行哀伤辅导体验的质性研究

目的 深入了解助产士对围产儿死亡产妇进行哀伤辅导的内心感受及护理经验。 方法 采用目的抽样法,于2019年10月—12月选取广东省11所三级甲等医院的18名助产士进行半结构式深入访谈,运用Colaizzi 7步分析法分析访谈资料,提炼主题。 结果 助产士对围产儿死亡产妇进行哀伤辅导的体验可归纳为3个主题：助产士存在多种负性情绪、积极与消极应对并存和期望更多的组织支持。 结论 助产士在护理围产儿死亡产妇时存在消极情感反应,消极的应对方式不利于保证产妇的护理质量。建议医院和科室为助产士提供情感支持和培训,鼓励助产士积极应对,与此同时,制订循证护理路径,组建多领域专业团队,促进围产期哀伤辅导服务的发展。     

The Religious Life During Suicide Bereavement: A Description

This exploratory study gathered narratives from 10 female suicide survivors, exploring 3 dimensions of their religious life during bereavement: (a) the function of the survivor's personal religion, (b) the function of religious support from family and friends, and (c) the function of established religious communities. Ten themes emerged from the narratives: afterlife destiny of the loved one, a more spiritual perspective, the impact on religious beliefs, support from family and friends, survivors' contribution to emotionally distant relationships, long-term and in-depth spiritual support, religious support from congregants, the ministry of clergy, the funeral service, and the return to public worship services. The participants believed that religion played an important role in their bereavement process. The results suggest future research questions, including (a) what is the perceived role of God in the suicide and the bereavement, (b) what is the relationship between the survivor's participation in a religious community and the care received from that community, and (c) what postvention do survivors wish from clergy?     

Experiencing Missing Contact With Professionals and Long Term Bereavement Outcome

ContextThe Danish health care system provides palliative care for terminally ill patients and their family caregivers. However, initiatives to support family caregivers are not systematically organized.ObjectivesWe aimed to examine the association between self-reported experience of missing contact to health care professionals involved in palliative care, and symptoms of grief and depression three years post-loss.MethodsWe conducted a prospective population-based survey of 3635 family caregivers to terminally ill patients. At six months follow-up, the caregivers reported whether they missed contact to the general practitioner, home care nurse, hospital staff, and/or palliative care team. Associations between missing contact and symptoms of prolonged grief (Prolonged-Grief-13) and depression (Beck Depression Inventory-II) three years after bereavement were analyzed with multivariable logistic regression analysis.ResultsWe found that an experience of missing contact with health care professionals six months after bereavement was significantly associated with symptoms indicative of prolonged grief disorder and depression after three years. The strongest association was found for missing contact with the general practitioner with an adjusted OR = 4.0 (95%CI: 1.9;8.3) for prolonged grief and an adjusted OR = 5.2 (95% CI: 3.4;7.9) for depression.ConclusionExperiencing missing contact with health care professionals shortly after bereavement was associated with adverse psychological reactions. Family caregivers may benefit from bereavement support to prevent further complications. A proactive approach with assessment of support needs and risk of complications early during the patient's illness trajectory may target support at those who needs it.     

The perceptions and experiences of nurses and bereaved families towards bereavement care in an oncology unit

Background

Existing bereavement literature focuses on the care provided in palliative care units or community settings. However, nurses in oncology units are in a unique position to provide bereavement care, which is care extended to the families after the death of cancer patients. This study aimed to explore the perceptions and experiences of bereavement care among nurses and bereaved family members in an oncology unit in Hong Kong.

Method

Semi-structured qualitative interviews were carried out in one oncology unit in Hong Kong with 15 nurses and ten bereaved family members. All interviews were audiotaped, transcribed verbatim and analysed by using qualitative content analysis.

Results

Among the bereaved family members, three themes emerged: being informed, being supported and being with the patient before and after the patient’s death. Among the oncology nurses, however, the three identified themes were: elements of good bereavement care, emotional response in providing bereavement care and educational needs in the provision of bereavement care. Comparatively, the experiences of and the opinions on bereavement care identified by the bereaved were more specific than those identified by the nurses.

Conclusion

The findings revealed that there is room for improvement in current bereavement care. Family members were committed to patient care and they expressed their need for more involvement in the patient care, which could result in a positive impact on their grief and loss experience. Nurses were committed to quality care, and they expressed their need for more training on knowledge, skills and attitudes to improve their readiness and competencies in the provision of bereavement care.     

Literary Resources for Bereavement

The bereavement process can be aided by multiple resources. Hospice counselors and related therapeutic professionals turn most easily to their own disciplines and training. In this article, complementary or ancillary resources from literature have been offered. If healing includes the “storying” and “restorying” of lives, then literature can enrich and facilitate the mourning process. Suggestions of resources and some of their connections to hospice care have been offered. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com]     

Bereavement care to minimize bereaved parents' suffering in their lifelong journey towards healing

This article presents select findings from an interpretive phenomenological study which aimed to describe the lived experience of parental bereavement. Six parents, each of whom experienced the death of a child due to cancer at least one year prior, participated in conversational interviews to share what it has been like for them since their child's death. Heideggerian (1962) phenomenology provided the philosophical underpinnings of the study, while van Manen's (1997) phenomenological method guided data collection and analysis. From this methodological approach, a structure of the meaning of parental bereavement experience was revealed. Profound suffering emerged as one essential theme. Pertinent findings related to this theme are discussed. Parents share ways others might minimize their suffering and provide support in their lifelong journey towards healing. Findings will enhance nurses' practice of providing bereavement care, which is an expectation of quality palliative care.     

How Adults With an Intellectual Disability Experience Bereavement and Grief: A Qualitative Exploration

This qualitative study explored the lived experiences of bereavement of 13 adults with an intellectual disability and found that their experiences could be situated within the concept of disenfranchised grief. The latter mediated participants' meaning making of the grieving process illustrated in the themes of intra- and interpersonal bereavement experiences, core beliefs about life and death, level of inclusion, and maintaining a continuing relationship with the deceased. The results suggest that participants experience bereavement and grief in a manner similar to that of the general population and suggest the need for open communication, facilitation of informed choice, and a culture of inclusion.     

Bereavement support in an acute hospital: an Irish model

In the first Irish study to examine a hospital-based bereavement care program, 1 year's cohort of bereaved people was surveyed. A response rate of over 40% provided 339 completed questionnaires from bereaved next-of-kin. The findings suggest that a tiered pyramid model of bereavement care (the Beaumont model) may be functional in a number of ways. The outreach aspect of the service is successful in providing additional support and information through telephone and postal contact to people at a distance or with mobility difficulties. Those bereaved by sudden death are twice as likely to access the service as those for whom death was expected. These, and other findings, are discussed.     

Bereavement Support in an Acute Hospital: An Irish Model

In the first Irish study to examine a hospital-based bereavement care program, 1 year's cohort of bereaved people was surveyed. A response rate of over 40% provided 339 completed questionnaires from bereaved next-of-kin. The findings suggest that a tiered pyramid model of bereavement care (the Beaumont model) may be functional in a number of ways. The outreach aspect of the service is successful in providing additional support and information through telephone and postal contact to people at a distance or with mobility difficulties. Those bereaved by sudden death are twice as likely to access the service as those for whom death was expected. These, and other findings, are discussed.     

Attitudes to Bereavement and Intellectual Disabilities in an Irish Context

Background The influence of grief and bereavement on the lives of people with intellectual disabilities is currently receiving much interest. Many of the long‐standing rituals associated with bereavement are still practised in Ireland, probably more than in many other Western countries. The present authors were interested in studying the experience of bereavement for people with intellectual disabilities in Ireland, and in making international comparisons. Method This mixed method study was carried out using two questionnaires. The first was used to study national service and organisational approaches to bereavement. The second questionnaire (based on Murray et al. 2000 ) was used to study a staff group working in Ireland, assessing staff knowledge and understanding of the grieving process. The results were compared with a UK staff group who were assessed using the same questionnaire ( Murray et al. 2000 ). Results Staff and service attitudes were found to be very positive in supporting people with intellectual disabilities who have been bereaved. There is considerable understanding of the needs of bereaved individuals, and there is a high level of support in the participation in grief rituals. When compared with a UK staff group, Irish staffs were more inclined to encourage individuals to take part in bereavement rituals, though they had less actual experience in supporting bereaved people. Only one service had written bereavement guidelines. Conclusions There appears to be cultural differences in the experience of bereavement for people with intellectual disabilities. This is important in the context of staff training and policy development in grief and bereavement.     

Bereavement and the elderly: a critical review with implications for nursing practice and research

Loss is a common occurrence in the lives of the elderly. One of the most profound losses is the death of a spouse. Yet, frequent and predictable as this event is for older adults, we know very little about the grieving process or the resolution of grief among this age group. For nurses who care for older clients an understanding of loss and bereavement is important in order to provide appropriate and timely support.
In this paper the nature of grief and bereavement behaviour is discussed beginning with the earliest empirical work done in 1930 and including a synopsis of six major variations of grief. A comprehensive review and critique of current investigations provides the basis for suggesting that, because of flaws in conceptualization and design, there are substantial limits on the relevance of existing knowledge of grief for an understanding of this phenomenon among the aged bereaved.
A beginning theoretical integration and discussion of key concepts related to bereavement and the elderly is provided. This discussion is summarized in a proposed model. The paper concludes with suggestions for nursing research and practice.     

Bereavement care for families part 1: a review of a paediatric follow-up programme

The World Health Organization suggests that palliative care needs to offer a support system to the family during the patient's illness as well as during his/her bereavement. Bereavement follow-up services in paediatrics offer families an additional source of support in their grieving process. This article reviews the development of a bereavement follow-up programme delivered by the paediatric palliative care team and explores the lessons learnt and challenges faced in developing the programme.