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Larsson AL, Beck I, Janlöv AC, Einberg EL. Nurse assistants' experiences of encountering patients in grief due to the death of a loved one - a qualitative study in municipal health and social care. Int J Qual Stud Health Well-being 2024; 19:2330116. [PMID: 38493488 PMCID: PMC10946262 DOI: 10.1080/17482631.2024.2330116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE The aim was to explore nurse assistants´ experiences of paying attention to and encountering patients receiving municipal health and social care, who are in grief due to the death of a loved one. METHODS A qualitative study with focus group interviews (n = 6) was conducted with nurse assistants (NAs) (n = 28) in municipal health and social care (n = 5) in southern Sweden. The data were analysed inductively using qualitative content analysis. RESULTS Three categories (1) Noticing changes in the patient, (2) Using different strategies to create a dialogue with the patient, (3) Experiencing challenges when encountering patients in grief, included eight sub-categories were identified. The result is captured in the theme of Having to be attentive to signs of grief after patients´ loss of loved ones, sensing the right time to approach and comfort, while having to cope with emotional challenges. CONCLUSIONS The NAs encountered expressions of strong emotions from patients in grief, and even expressions of a desire to end their lives. Additionally, the NAs had to deal with their own emotions that were evoked when meeting patients in grief. These challenges indicate the need for enhanced conditions in the work culture, and improved training and supervision in health and social care.
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Affiliation(s)
- Anne-Lie Larsson
- The Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Ingela Beck
- The Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Ann-Christin Janlöv
- The Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Eva-Lena Einberg
- The Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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Ergün-Başak B. Surviving after the Death of a Spouse: A Phenomenological Study of Young and Low-Income Mothers in Turkey. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241257375. [PMID: 38809150 DOI: 10.1177/00302228241257375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
The aim of this study is to examine psychosocial adjustment of low-income mothers who lost their spouses at a young age. The study was conducted using a qualitative research method with a phenomenological approach. The data was collected through focus group interviews. Thirteen women between the ages of 26 and 43 participated in the study. In this study, manifest content analysis was carried out with an inductive perspective. In this scope, five interrelated themes emerged as loss, initial reactions, difficulties, coping ways, and change. For the participants, the death of their spouse was perceived as the loss of a loved one, the loss of their children's father, a loss of security, and the loss of an abusive spouse. The initial reactions that emerged as a result were shock, helplessness, anxiety, and ambivalence. Participants faced social pressure, exclusion, parenting an orphaned child, insufficient basic life skills, and economic difficulties after their spouses' deaths. In order to cope with these difficulties, they sought social support, applied for social assistance funds, focused on their motherhood roles, used religious coping mechanisms, and set boundaries. It was determined that participants learned new skills, gained self-confidence, and developed helping behaviors toward others during the post-loss change process. Findings revealed that participants are unable to access adequate social, economic, and psychological resources in society. This circumstance caused them to withdraw from their social environment and reevaluate their existential goals. The new identity created by these women could be interpreted as a challenge to the culture that marginalizes them.
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Affiliation(s)
- Bircan Ergün-Başak
- Guidance and Counseling Department of Educational Faculty, Anadolu University, Eskişehir, Turkey
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Waddington C, Flanagan K, Clements H, Harding E, van der Byl Williams M, Walton J, Crutch S, Stott J. Grief and loss in people living with dementia: a review and metasynthesis of qualitative studies. Aging Ment Health 2024; 28:408-421. [PMID: 37970882 DOI: 10.1080/13607863.2023.2280925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES This review seeks to synthesise qualitative studies that focus on the experience of grief and loss in people living with dementia. METHODS Included studies were quality appraised, synthesised and analysed using inductive thematic analysis. RESULTS 19 studies were selected for inclusion in the final review and metasynthesis, including 486 participants (115 participants living with dementia, 152 family carers, 219 professionals). Five key dimensions of grief in people living with dementia were identified during the analysis process: grieving for the person I used to be, grieving for how others see me, grieving for the person I will become, grieving for those who have died and what helps me with my grief. CONCLUSION It is evident that people living with dementia can experience grief related to a range of previous, current and anticipated losses. Many of the studies included in this review did not directly include people living with dementia in their research and did not ask participants directly about their experience of grief and loss. As grief is a highly personal and individual experience, further research addressing the experience of grief that directly includes participants living with dementia is required, in order to improve awareness of grief-related needs and to develop and deliver support to meet these needs.
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Affiliation(s)
- Claire Waddington
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Katie Flanagan
- Centre for Ageing Population Studies, Primary Care and Population Health, University College London, London, UK
| | - Henry Clements
- Clinical Education and Health Psychology, University College London, London, UK
| | - Emma Harding
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | | | - Jill Walton
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Sebastian Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Joshua Stott
- ADAPT Lab, Clinical Education and Health Psychology, University College London, London, UK
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4
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Willi N, Pancoast A, Drikaki I, Gu X, Gillanders D, Finucane A. Practitioner perspectives on the use of acceptance and commitment therapy for bereavement support: a qualitative study. BMC Palliat Care 2024; 23:59. [PMID: 38418964 PMCID: PMC10900636 DOI: 10.1186/s12904-024-01390-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND There is currently a high demand for bereavement support coupled with inconclusive findings as to the efficacy of existing approaches. Acceptance and Commitment Therapy (ACT) aims to improve human functioning and has shown efficacy across a wide range of conditions. ACT may be a promising means of supporting bereaved people, yet evidence on the use of ACT for bereavement support is lacking. The aim of this study is to explore how ACT is currently used for bereavement support and practitioner perspectives of how it helps following bereavement. METHODS Semi-structured interviews were conducted online via MS Teams with practitioners experienced in using ACT for bereavement support. Data were analysed thematically guided by a framework approach. RESULTS Nine participants were recruited. Three themes were identified: (i) creating psychological space around grief; (ii) using psychological space for value-directed action in the midst of grieving, and (iii) adapting ACT for bereavement support. Practitioners indicated that ACT improves clients' relationship with distressing internal experiences. Metaphors and mindfulness techniques were used to encourage acceptance of grief responses, taking perspective on distressing thoughts and images, and contact with the present moment. Better relationships with distressing experiences were regarded as less psychologically taxing, improving coping and well-being, while providing the psychological space to engage in value-directed action. Values exploration, sometimes using metaphors and exercises, was seen as supporting the bereaved person to rediscover a sense of purpose and engage in meaningful activities alongside their grief. Practitioners used ACT flexibly, integrating other interventions, and adapted ACT to the perceived sensitivities of bereaved people, and age-related and developmental factors. CONCLUSION ACT is used to support people who have been bereaved to live effectively with the difficult thoughts and feelings associated with grieving and to enable them to gradually identify, reconnect with, and act in line with their values after loss.
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Affiliation(s)
- Nikolaus Willi
- Clinical Psychology, University of Edinburgh, Edinburgh, UK.
| | - Anna Pancoast
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Ioanna Drikaki
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Xueying Gu
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | | | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
- Marie Curie Hospice Edinburgh, Edinburgh, UK
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Palitsky R, Chen ZJ, Rentscher KE, Friedman SE, Wilson DMT, Ruiz JM, Sullivan D, Grant GH, O'Connor M. Associations of religious and existential variables with psychosocial factors and biomarkers of cardiovascular risk in bereavement. Aging Cell 2024; 23:e14014. [PMID: 37840393 PMCID: PMC10776136 DOI: 10.1111/acel.14014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023] Open
Abstract
Bereavement increases in prevalence as people age and is associated with multiple psychological and health risks, including cardiovascular risk. Religious and existential variables may play an important role in the health impacts of bereavement. Theorized pathways linking religious and existential variables with health have suggested these associations are due to intermediary psychosocial variables, but have not been tested in bereavement. This research empirically tested these pathways in a bereaved population. In N = 73 adults within 1 year of bereavement (mean age = 64.36), this study examined associations between (1) religious and existential characteristics (religious and spiritual struggles, intrinsic religiosity, and existential quest) and intermediary psychosocial variables (depression, loneliness, and difficulties in emotion regulation), and between (2) intermediary psychosocial variables and bereavement-relevant health outcomes (self-reported health, change in health since last year, grief severity, and cardiovascular biomarkers). Cardiovascular biomarkers (heart rate, heart rate variability, and blood pressure) were collected before, during, and after a laboratory grief recall emotion elicitation. Anticipated associations between self-reported religious and existential characteristics and intermediary variables, and between intermediary variables and self-reported bereavement-relevant outcomes, were consistently observed. However, associations between intermediary variables and cardiovascular biomarkers were largely unobserved. This study examined the role of religious and existential variables in whole-person health after bereavement and is among the first to include biomarkers of cardiovascular risk. Results suggest that although religious and existential variables are associated with important bereavement-related outcomes, these associations may be "skin-deep," and extensions to cardiovascular functioning should be re-examined.
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Affiliation(s)
- Roman Palitsky
- Department of PsychologyUniversity of ArizonaTucsonArizonaUSA
- Emory UniversitySpiritual Health, Woodruff Health Sciences CenterAtlantaGeorgiaUSA
| | - Zhuo Job Chen
- School of NursingUniversity of North Carolina, CharlotteCharlotteNorth CarolinaUSA
| | - Kelly E. Rentscher
- Department of Psychiatry and Behavioral MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | | | | | - John M. Ruiz
- Department of PsychologyUniversity of ArizonaTucsonArizonaUSA
| | - Daniel Sullivan
- Department of PsychologyUniversity of ArizonaTucsonArizonaUSA
| | - George H. Grant
- Emory UniversitySpiritual Health, Woodruff Health Sciences CenterAtlantaGeorgiaUSA
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Rolbiecki AJ, Washington KT, Holman JG, Lee JE. Sense making in the wake of familial death: "I continue to work through those feelings". DEATH STUDIES 2023:1-8. [PMID: 37725580 DOI: 10.1080/07481187.2023.2258509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Sense making is especially common in bereavement when a death challenges an individual's existing worldview. Thus, it is often discussed in the context of statistically atypical deaths, such as the death of a child or death by suicide, that are apt to create a crisis of meaning. Less understood is the process of sense making following more statistically normative deaths, such as those that occur in old age following prolonged illness. In this descriptive phenomenological study, researchers analyzed qualitative interviews and digital narratives created by six individuals who had experienced the death of an older family member with dementia, seeking to identify the essential nature of sense making during bereavement following so-called "normal" losses. Three themes (memorializing the whole person, reflecting on the caregiving experience, and emotional sense making) were identified, shedding light on this specific meaning making process among individuals representing a large and growing segment of the population.
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Affiliation(s)
- Abigail J Rolbiecki
- Department of Family Medicine and Division of Geriatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Karla T Washington
- Division of Palliative Medicine, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jason G Holman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jonathan E Lee
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
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Roaquin L. Participatory Grieving: A Concept Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231184744. [PMID: 37338900 DOI: 10.1177/00302228231184744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Grief is a psychobiological response to loss as manifested by intense feeling of sadness, along with thoughts, mental images and memories of the deceased loved one. In order for the patient to attain successful grieving process, it is fundamental among nurses to recognize and understand the loss or impending loss experienced by the patient and/or its significant others. With the use of Walker and Avant's concept analysis, together with thorough literature review pertaining to bereavement and grieving, the defining attributes, antecedents and consequences of participatory grieving were determined. Furthermore, the results of this concept analysis provide a better view on the significant roles and responsibilities of nurses during the grieving process.
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Affiliation(s)
- Lucky Roaquin
- Master of Arts in Nursing spec, Medical-Surgical Nursing, College of Nursing, Saint Tonis College Inc Dean
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Li C, Tang N, Yang L, Zeng Q, Yu T, Pu X, Wang J, Zhang H. Effect of caregiver burden on anticipatory grief among caregivers of elderly cancer patients: Chain mediation role of family functioning and resilience. Front Psychol 2023; 13:1020517. [PMID: 36704702 PMCID: PMC9872027 DOI: 10.3389/fpsyg.2022.1020517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
This study aimed to explore the relationship between caregiver burden and anticipatory grief among caregivers of elderly cancer patients, and to examine the chain mediation effects of family functioning and resilience. A total of 624 valid questionnaires were collected. The Structural Equation Model was established to test the mediating effects of family functioning and resilience. Results showed that caregiver burden has a direct positive effect on anticipatory grief, both family functioning and resilience have negative effects on caregiver burden and anticipatory grief, and that resilience moderates the mediating effect of family functioning. Our findings suggest that reducing the caregiver burden among caregivers of elderly cancer patients, improving family functioning, and enhancing resilience have important effects in alleviating the anticipatory grief of caregivers. Our findings provide some references for further research. Medical staff should better understand the grief experience of caregivers and implement interventions to enable caregivers to better cope with anticipatory grief and psychological stress, so as to promote the quality of care for elderly cancer patients.
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Affiliation(s)
- Caiyue Li
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Nan Tang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Lili Yang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Qing Zeng
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Tana Yu
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiaojin Pu
- Lanzhou University First Hospital, Lanzhou, China
| | - Juan Wang
- Lanzhou University Second Hospital, Lanzhou, China
| | - Hongchen Zhang
- School of Nursing, Lanzhou University, Lanzhou, China,*Correspondence: Hongchen Zhang,
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Asadollahi A, Karimpoor L, Kaveh MH, Ghahremani L. Effectiveness of resilience training intervention on psychological capital of the underprivileged widowed women of Fasa City, Iran. BMC Womens Health 2022; 22:302. [PMID: 35864493 PMCID: PMC9302561 DOI: 10.1186/s12905-022-01886-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Women heads of households (widows or divorcees) are vulnerable groups in society who face various psychological problems and have less resilience than other women. Therefore, the present study was conducted to determine the effectiveness of resilience educational intervention on the psychological capital of poor widows in Fasa city, south Iran. Materials and Methods In this quasi-experimental study, 120 widows covered by Imam Khomeini Relief Foundation were selected by a simple random sampling method based on a random Efron algorithm (Efron coin) and randomly assigned into two interventions and control groups (60 people each) in the second half of 2021. About 8 training sessions on resilience and psychological capital were held for the experimental group through training clips, audio transmissions, and podcasts. Data were collected using demographic characteristics forms, widowers' resilience assessment questionnaires, and Luten's psychological capital scale for testing and control before and two months after the intervention. Data were analyzed with Chi-square test, independent and paired t-test using SPSS V. 26 software. Results There were differences between the two groups at pretest in demographic variables and psychological capital and its subscales, and resilience and its subscales (P ≥ 0.05).. But two months after the educational intervention, a statistically significant increase was observed in the experimental group in these variables compared to the control group (p < 0.05). It indicates that there was an improvement in the outcomes from pretest to post-test within the intervention and no change in the outcomes over time within the control group. Discussion and Conclusion Using a resilience-based educational approach as a novelty of this research to promote psychological capital and resilience can increase resilience and psychological capital in widows. Then, considering the positive effect of this educational approach and the low cost of this intervention, it seems that the implementation of such interventions should be included in the plans related to widows. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01886-9.
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Suttle M, Hall MW, Pollack MM, Berg RA, McQuillen PS, Mourani PM, Sapru A, Carcillo JA, Startup E, Holubkov R, Dean JM, Notterman DA, Meert KL. The Association between Therapeutic Alliance and Parental Health Outcomes following a Child's Death in the Pediatric Intensive Care Unit. J Pediatr Intensive Care 2021; 12:3-11. [PMID: 36742250 PMCID: PMC9894698 DOI: 10.1055/s-0041-1727179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/20/2021] [Indexed: 02/07/2023] Open
Abstract
Therapeutic alliance reflects the strength and quality of the physician-patient/family relationship. We investigated the association between therapeutic alliance and bereaved parents' mental health and perceived overall health following their child's death in a pediatric intensive care unit (PICU). Bereaved parents were surveyed 6 months after their child's death in a PICU affiliated with the Collaborative Pediatric Critical Care Research Network. Parents were evaluated for complicated grief, depression, and post-traumatic stress using the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire (PHQ-8), and the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), respectively. Overall health was evaluated using a single item. Therapeutic alliance between parents and their deceased child's PICU physicians was assessed using the Human Connection scale (HCS). Two hundred and thirty-five parents of 158 deceased children completed surveys. Mean ICG score was 34.4 ± 14.9 with 142 (60.4%) parents screening positive for complicated grief. Mean PHQ-8 score was 9.1 ± 6.2 with 102 (43.4%) screening positive for at least moderate depression. Mean SPRINT score was 14.6 ± 8.2 with 122 (51.9%) screening positive for post-traumatic stress disorder. Overall health was perceived as fair for 47 (20.0%) parents and poor for 10 (4.3%). Using multivariable modeling, higher HCS score (greater therapeutic alliance) was significantly associated with lower (better) ICG score (-0.23, 95% CI -0.42, -0.04, p = 0.018). HCS score was not significantly associated with PHQ-8, SPRINT, or overall health scores. We conclude that bereaved parents experience a high level of adverse mental health symptoms including complicated grief, depression, and post-traumatic stress symptoms. Greater therapeutic alliance with PICU physicians may lessen symptoms of complicated grief during bereavement.
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Affiliation(s)
- Markita Suttle
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Mark W. Hall
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Murray M. Pollack
- Department of Pediatrics, Children's National Hospital, Washington, United States
| | - Robert A. Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Patrick S. McQuillen
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California, United States
| | - Peter M. Mourani
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado School of Medicine, Colorado, United States
| | - Anil Sapru
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, California, United States
| | - Joseph A. Carcillo
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pennsylvania, United States
| | - Emily Startup
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | | | - Daniel A. Notterman
- Department of Molecular Biology, Princeton University, New Jersey, United States
| | - Kathleen L. Meert
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, Central Michigan University, Mt. Pleasant, Michigan, United States,Address for correspondence Kathleen L. Meert, MD Division of Pediatric Critical Care Medicine, Children's Hospital of Michigan3901 Beaubien, Detroit, MI 48201United States
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Suttle M, Hall MW, Pollack MM, Berg RA, McQuillen PS, Mourani PM, Sapru A, Carcillo JA, Startup E, Holubkov R, Dean JM, Notterman DA, Meert KL. Complicated Grief, Depression and Post-Traumatic Stress Symptoms Among Bereaved Parents following their Child's Death in the Pediatric Intensive Care Unit: A Follow-Up Study. Am J Hosp Palliat Care 2021; 39:228-236. [PMID: 33949217 PMCID: PMC10184266 DOI: 10.1177/10499091211015913] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Parents often suffer reduced mental health after their child's death; however, the trajectory and risk factors are not well described. OBJECTIVE Describe the change in complicated grief, depression, and post-traumatic stress symptoms among parents between 6 and 13 months after their child's death in a pediatric intensive care unit (PICU), and factors associated with 13-month symptoms. METHODS Parents whose children died in 1 of 8 PICUs affiliated with the Collaborative Pediatric Critical Care Research Network completed surveys 6 and 13 months after their child's death. Surveys included the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire-8 (PHQ-8) for depression, and the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT). Parents provided sociodemographics. Charts were reviewed for child characteristics. RESULTS One-hundred and fifty seven parents of 104 deceased children completed surveys at both time points. Mental health symptoms declined over time (mean (SD)): ICG (33.8 (15.4) vs. 30.5 (15.2), p < 0.001), PHQ-8 (9.0 (6.4) vs. 7.3 (5.8), p < 0.001), and SPRINT (14.1 (8.3) vs. 12.0 (8.2), p < 0.001). After controlling for 6-month scores, higher 13-month ICG was independently associated with sudden unexpected death; higher PHQ-8 with Black race, insecure attachment style, and sudden unexpected death; and higher SPRINT with having a high school level of education (compared to college degree or higher). CONCLUSION Mental health symptoms improve among parents during the first 13 months after their child's death; however, symptoms persist for many. Black parents and those whose children die suddenly may be high risk for poor adjustment during bereavement.
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Affiliation(s)
- Markita Suttle
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA)
| | - Mark W Hall
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA)
| | - Murray M Pollack
- Department of Pediatrics, Children's National Hospital, Washington DC, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick S McQuillen
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Peter M Mourani
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anil Sapru
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph A Carcillo
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Emily Startup
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - J Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Daniel A Notterman
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Kathleen L Meert
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, Central Michigan University, Mt. Pleasant, MI, USA
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12
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Fox R, McHugh Power J, Coogan AN, Beekman ATF, van Tilburg TG, Hyland P. Posttraumatic stress disorder and loneliness are associated over time: A longitudinal study on PTSD symptoms and loneliness, among older adults. Psychiatry Res 2021; 299:113846. [PMID: 33706195 DOI: 10.1016/j.psychres.2021.113846] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
Loneliness has a pernicious effect on mental health in later life and is likely to have a bidirectional relationship with psychopathology. However, longitudinal research examining loneliness and posttraumatic stress symptoms among older adults is scarce. This study aimed to examine the longitudinal relationship between different types of loneliness (social and emotional) and posttraumatic stress symptoms. Using two waves of an older adult sample (n = 1,276) from the Longitudinal Aging Study Amsterdam (LASA), this longitudinal relationship was examined using a multivariate two wave-latent change score (2W-LCS) model. There were significant, however, very small increases in both posttraumatic stress symptoms and emotional loneliness over time, whereas, average social loneliness scores did not significantly increase/decrease over time. Changes in both social (β = .16) and emotional loneliness (β = .15) were associated with small changes in posttraumatic stress symptoms, consistent with the existence of a longitudinal association between the constructs, net of covariate effects. Results provide evidence of the existence of a longitudinal association between subtypes of loneliness and posttraumatic stress symptoms, among older adults. Results have implications for clinicians who should identify individuals at risk of developing posttraumatic stress symptoms, and for the theory of both posttraumatic stress disorder and loneliness.
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Affiliation(s)
- Robert Fox
- Department of Psychology, Maynooth University, Kildare, Ireland; Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin.
| | - Joanna McHugh Power
- Department of Psychology, Maynooth University, Kildare, Ireland; UK CRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; GGZ inGeest, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Theo G van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
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Increased Amygdala Activations during the Emotional Experience of Death-Related Pictures in Complicated Grief: An fMRI Study. J Clin Med 2020; 9:jcm9030851. [PMID: 32245009 PMCID: PMC7141501 DOI: 10.3390/jcm9030851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 01/20/2023] Open
Abstract
Complicated grief (CG) is associated with alterations in various components of emotional processing. The main aim of this study was to identify brain activations in individuals diagnosed with CG while they were observing positive, negative, and death-related pictures. The participants included 19 individuals with CG and 19 healthy non-bereaved (NB) individuals. Functional magnetic resonance imaging (fMRI) scans were obtained during an emotional experience task. The perception of death-related pictures differed between the CG group and the NB group, with a greater activation in the former of the amygdala, putamen, hypothalamus, middle frontal gyrus, and anterior cingulate cortex. Amygdala and putamen activations were significantly correlated with Texas Revised Inventory of Grief scores in the CG group, suggesting that the higher level of grief in this group was associated with a greater activation in both brain areas while watching death-related pictures. A significant interaction between image type and group was observed in the amygdala, midbrain, periaqueductal gray, cerebellum, and hippocampus, largely driven by the greater activation of these areas in the CG group when watching death-related pictures and the lower activation when watching positive-valence pictures. In this study, individuals with CG showed significantly distinct brain activations in response to different emotional images.
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Myers-Coffman K, Baker FA, Daly BP, Palisano R, Bradt J. The Resilience Songwriting Program for Adolescent Bereavement: A Mixed Methods Exploratory Study. J Music Ther 2019; 56:348-380. [PMID: 31605612 DOI: 10.1093/jmt/thz011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Music therapy research with youth who are grieving often reports on a combination of interventions, such as lyric analysis, improvisation, and/or songwriting. Unfortunately, the lack of theoretical transparency in how and why these interventions affect targeted outcomes limits interpretation and application of this important research. In this exploratory study, the authors evaluated the impact of an 8-session, theory-driven group songwriting program on protective factors in adolescent bereavement, and also sought to better understand adolescents' experiences of the program. Using a single-group, pretest-posttest convergent mixed methods design, participants were enrolled from three study sites and included 10 adolescents (five girls and five boys), ages 11-17 years, who self-identified as grieving a loss. Outcomes measured included grief, coping, emotional expression, self-esteem, and meaning making. Qualitative data were captured through in-session journaling and semi-structured interviews. There were no statistically significant improvements for grief, self-esteem, coping, and meaning making. Individual score trends suggested improvements in grief. The majority of the participants reported greater inhibition of emotional expression, and this was statistically significant. Thematic findings revealed that the program offered adolescents a sense of togetherness, a way to safely express grief-related emotions and experiences verbally and nonverbally, and opportunities for strengthening music and coping skills. These findings suggest that engaging in collaborative therapeutic songwriting with grieving peers may decrease levels of grief, enhance creative expression, and provide social support. More research is needed on measuring self-esteem, emotional expression, coping, and meaning making outcomes in ways that are meaningful to adolescents.
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Affiliation(s)
| | | | | | | | - Joke Bradt
- Drexel University, Philadelphia, Pennsylvania
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15
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Robinson C, Pond DR. Do online support groups for grief benefit the bereaved? Systematic review of the quantitative and qualitative literature. COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2019.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Joanne McCallum K, Jackson D, Walthall H, Aveyard H. A focused mapping review and synthesis of current practice in qualitative end of life research with the bereaved. Nurse Res 2019; 27:14-19. [PMID: 31468923 DOI: 10.7748/nr.2019.e1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Nursing research is dedicated to improving care, but research into end of life care can be challenging because of a possible reluctance by researchers to invite bereaved people to take part in studies. AIM To use a focused mapping approach to explore the recruitment to studies of grieving and bereaved people. DISCUSSION There is no 'gold standard' method of recruitment and no best way to approach participants. The outcome of each method, measured by the percentage of potential participants recruited, appears to be unrelated to the approach used. CONCLUSION There is no evidence that participation in research harms those who have recently been bereaved, but there is evidence of benefits from participating. IMPLICATIONS FOR PRACTICE Researchers should not feel they need to protect the bereaved from participating in research and can invite bereaved individuals to join a study without worrying about causing them harm.
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Affiliation(s)
- Kay Joanne McCallum
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, England
| | - Debra Jackson
- University of Technology Sydney, Ultimo, Sydney, Australia
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17
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Myers-Coffman K, Baker FA, Bradt J. The Resilience Songwriting Program: A working theoretical model and intervention protocol for adolescent bereavement. NORDIC JOURNAL OF MUSIC THERAPY 2019. [DOI: 10.1080/08098131.2019.1642373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Felicity A. Baker
- Melbourne Conservatorium of Music, The University of Melbourne, Melbourne, Australia
| | - Joke Bradt
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
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Holm M, Årestedt K, Öhlen J, Alvariza A. Variations in grief, anxiety, depression, and health among family caregivers before and after the death of a close person in the context of palliative home care. DEATH STUDIES 2019; 44:531-539. [PMID: 30907298 DOI: 10.1080/07481187.2019.1586797] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article investigates longitudinal variations in grief, self-rated health, and symptoms of anxiety and depression among family caregivers in palliative care. Data were taken from a randomized psycho-educational intervention trial and were collected at four time-points; at baseline, upon completion, 2 months later, and 6 months after the patient's death. In total, 117 family caregivers completed all questionnaires. The participants' grief was stable across the measurements, while anxiety, depression, and health varied significantly (p < 0.05). No significant differences were found between the intervention or control group. In conclusion, grief emerged as a constant phenomenon, distinct from symptoms of anxiety and depression.
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Affiliation(s)
- Maja Holm
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Kalmar County Hospital, Kalmar, Sweden
| | - Joakim Öhlen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care Unit, Dalen Hospital, Stockholm, Sweden
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19
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Vegsund HK, Reinfjell T, Moksnes UK, Wallin AE, Hjemdal O, Eilertsen MEB. Resilience as a predictive factor towards a healthy adjustment to grief after the loss of a child to cancer. PLoS One 2019; 14:e0214138. [PMID: 30897157 PMCID: PMC6428287 DOI: 10.1371/journal.pone.0214138] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/07/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Grief among bereaved parents is known to cause psychological distress and physical illness, but knowledge concerning factors that can contribute to health promotion after bereavement is scarce. Childhood cancer remains the most common non-accidental cause of death among children in Norway. The aim of the present study was to explore if resilience factors among cancer-bereaved parents could predict whether they will be able to come to terms with their grief 2-8 years following the loss. METHODS A Norwegian cross-sectional national survey was conducted among 161 cancer-bereaved parents using a study-specific questionnaire. Logistic regression was used to explore whether resilience factors predicted parents' grief outcome 2-8 years after their loss. RESULTS On the Resilience Scale for Adults (RSA), three of the resilience factors contributed significantly in predicting whether the parents in the present study would come to terms with their grief 2-8 years after the loss their child: "Perception of self "(OR 2.08, p = .048), "Social resources" (OR 2.83, p = .008) and "Family cohesion" (OR .41, p = .025). The results showed a negative relationship between time since loss (2-6 years) and whether the parents answered that they had come to terms with their grief (p = < .05). The loss of a parent (OR .30, p = .030) combined with the loss of their child had a negative and significant effect on whether they indicated that they had processed their grief. CONCLUSION The total score of RSA and three of the six resilient factors contributed significantly in predicting whether cancer-bereaved parents in the present study indicated that they had come to terms with their grief to a great extent. The present study supports hypotheses that regard resilience as an important contribution in predicting healthy outcomes in people exposed to adverse life events.
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Affiliation(s)
- Hilde Kristin Vegsund
- Department of Public Health and Nursing, Centre for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Trude Reinfjell
- Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Unni Karin Moksnes
- Department of Public Health and Nursing, Centre for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Odin Hjemdal
- Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Mary-Elizabeth Bradley Eilertsen
- Department of Public Health and Nursing, Centre for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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Climent-Rodríguez JA, Navarro-Abal Y, López-López MJ, Gómez-Salgado J, García MEA. Grieving for Job Loss and Its Relation to the Employability of Older Jobseekers. Front Psychol 2019; 10:366. [PMID: 30863343 PMCID: PMC6399146 DOI: 10.3389/fpsyg.2019.00366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/06/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Loss of employment is an experience that is lived and interpreted differently depending on a series of individual variables, including the psychological resources available to the affected person as well as their perception of their degree of employability. Losing one's job can be one of the most painful and traumatic events a person has to withstand. Following a dismissal, the worker needs to overcome a period of emotional adaptation to the loss. But that period of grieving can also condition the job searching process of the individual and can be influenced by different variables, highlighting the age and work experience. The objective of this study is to analyse the relationship between intensity and type of affliction due to the loss of employment in older workers and their level of employability. Methods: We carried out a descriptive and analytical cross-sectional study. The sample consisted of 140 unemployed participants, from 19 to 65 years of age-users of Job Orientation in the Public Employment Service of Andalusia (Spain). Of the total participants, 66 were unemployed and over 45 years of age. They all took the Labour Insertion Potential Assessment Test and the Texas Revised Inventory of Grief, adapted for job loss. Results: Significant differences are shown in the grieving process due to loss of employment between both groups, with the older unemployed living the process more intensely. In relation to the employability potential, differences are found between both groups in terms of availability, perceived difficulties and fears. Interrelationships between total grieving intensity and the importance that older jobseekers give to work are also indicated. Conclusion: Loss of employment and the psychological and health consequences of this situation are identified with those that arise in the grieving process. Older workers present a series of features that determine that their job loss grieving process is more intense and lasts longer than that of other younger workers, regardless of whether the job loss was recent or not. On the other hand, it is shown that the intensity of grieving for job loss is related to the decrease of certain variables that are part of the concept of employability.
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Affiliation(s)
| | - Yolanda Navarro-Abal
- Department of Social, Developmental and Education Psychology, Faculty of Education Science, University of Huelva, Huelva, Spain
| | - María José López-López
- Department of Clinical and Experimental Psychology, Faculty of Education Science, University of Huelva, Huelva, Spain
| | - Juan Gómez-Salgado
- Department of Nursing, University of Huelva, Huelva, Spain
- Espíritu Santo University, Guayaquil, Ecuador
| | - Marta Evelia Aparicio García
- Department of Social, Work and Differential Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
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Riley SG, Pettus KI, Abel J. The buddy group - peer support for the bereaved. LONDON JOURNAL OF PRIMARY CARE 2018; 10:68-70. [PMID: 30042806 PMCID: PMC6055940 DOI: 10.1080/17571472.2018.1455021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe in this paper the story of the ‘Buddy Groups’ for bereaved people that were set up at Weston Hospicecare in 2008 and have endured ever since. The group have helped bereaved people to find meaning and value despite their grief. We observed that, through the strength of the relationships formed, people were able to recover well. Group members reported back to us the significant value they placed on being in a Buddy Group.
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Affiliation(s)
| | - Katherine Irene Pettus
- International Association for Hospice and Palliative Care, Iahpc, USA.,Vienna NGO Committee on Drugs, Iahpc, USA
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22
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Hendrickson ZM, Kim J, Tol WA, Shrestha A, Kafle HM, Luitel NP, Thapa L, Surkan PJ. Resilience Among Nepali Widows After the Death of a Spouse: "That Was My Past and Now I Have to See My Present". QUALITATIVE HEALTH RESEARCH 2018; 28:466-478. [PMID: 29110564 DOI: 10.1177/1049732317739265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Responses to the death of a spouse vary; although some are at increased risk of poorer physical and mental health outcomes, others have more resilient responses. In light of the limited scope of research on widows' experiences in Nepal, a setting where widows are often marginalized, we explore themes of resilience in Nepali widows' lives. Drawing from a larger qualitative study of grief and widowhood, a thematic narrative analysis was performed on narratives from four widows that reflected resilient outcomes. Individual assets and social resources contributed to these widows' resilient outcomes. Forgetting, acceptance, and moving forward were complemented by confidence and strength. Social support and social participation were key to widows' resilient outcomes. These four narratives reflect the sociocultural context that shape widows' resilient outcomes in Nepal. Future studies on the emergent themes from this exploratory study will help identify how best to encourage resilient outcomes among widows.
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Affiliation(s)
- Zoé M Hendrickson
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jane Kim
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wietse A Tol
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abina Shrestha
- 2 Women for Human Rights, Single Women Group, Kathmandu, Nepal
| | - Hari Maya Kafle
- 2 Women for Human Rights, Single Women Group, Kathmandu, Nepal
| | | | - Lily Thapa
- 2 Women for Human Rights, Single Women Group, Kathmandu, Nepal
| | - Pamela J Surkan
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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23
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Nogueras DJ, Postma J, Van Son C. Why didn't I know? Perspectives from adult children of elderly parents with dementia. J Am Assoc Nurse Pract 2016; 28:668-674. [DOI: 10.1002/2327-6924.12382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/05/2016] [Indexed: 11/06/2022]
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Rossi Ferrario S, Omarini P, Cerutti P, Balestroni G, Omarini G, Pistono M. When LVAD Patients Die: The Caregiver's Mourning. Artif Organs 2015; 40:454-8. [PMID: 26527229 DOI: 10.1111/aor.12594] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Left ventricular assist devices (LVADs) have progressively evolved, particularly in the last 10 years, to serve patients affected by severe heart failure as a bridge to transplant or destination therapy. The survival rate and quality of life of pre- and postimplant patients, as well as caregivers' perceptions and distress, are under investigation by the scientific community. But what caregivers think and feel after the loss of their loved one has not so far been examined. We contacted 16 principal caregivers of deceased LVAD patients by telephone. They were asked to evaluate their experience with LVADs and were administered a specific questionnaire about their mourning, the Caregiver Mourning Questionnaire (CMQ), to evaluate their perceptions of the physical, emotional, and social support-related problems that they had experienced during the previous 3 months. Positive aspects reported by the caregivers were the patient's overall subjective well-being and increased survival. Negative aspects were the difficulty to manage infections and the driveline, and the incomplete autonomy of the patient. Half of the caregivers reported not being preadvised about many of the problems they would face. The CMQ revealed that numerous caregivers had health problems, difficulty in sleeping, eating disorders, lack of energy, and loneliness. Use of psychotropic drugs and regrets about how they assisted their loved one also emerged. In conclusion, caregivers of LVAD patients may experience complicated mourning. Our data support in particular the need for an early intervention of palliative care which could prevent or reduce complicated mourning.
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Affiliation(s)
| | | | - Paola Cerutti
- Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Veruno, NO, Italy
| | | | - Giovanna Omarini
- Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Veruno, NO, Italy
| | - Massimo Pistono
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno, NO, Italy
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