1
|
Groden CM, Raed M, Helft P, Allen JD. End of life care in a level IV outborn neonatal intensive care unit. J Perinatol 2024; 44:1022-1028. [PMID: 38480788 DOI: 10.1038/s41372-024-01930-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Describe care surrounding the end of life (EOL) in the neonatal intensive care unit (NICU). STUDY DESIGN Retrospective chart review of 208 infants who died in a level IV referral-only NICU over 5 years. RESULTS A goals of care (GOC) conversation was documented before the day of death for 63% of infants. 73% died following withdrawal of life-sustaining treatment (WD); 13% died in a code. The median age at death was 17.5 days. 72% were held by a parent at EOL. 94% of families desired formal memory-making. We identified associations with mode of death and parental holding at death, including: WD was associated with palliative care consultation, early GOC conversations, and increased unit-specific length of stay. Holding was associated with chaplain visits, memory-making, and increased home-to-hospital distance. CONCLUSION We present a detailed description of EOL care in an outborn NICU, including novel data on parental holding and memory-making.
Collapse
Affiliation(s)
| | - Mona Raed
- Division of Palliative Care, Community Health Network, Indianapolis, IN, USA
| | - Paul Helft
- Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jayme D Allen
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
2
|
Roberts LR, Nick JM, Sarpy NL, Peters J, Tamares S. Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review. JBI Evid Synth 2024:02174543-990000000-00324. [PMID: 38932508 DOI: 10.11124/jbies-23-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE The objective of the scoping review was to explore the evidence and describe what is known about perinatal bereavement care guidelines provided within health care facilities prior to discharge. Additionally, the review sought to identify what is known about parents' mental health outcomes, and map these outcomes to the characteristics of the bereavement care guidelines. INTRODUCTION Perinatal loss poses a serious risk of emotional trauma and mental health sequelae. Conflicting evidence for international bereavement care guidelines and inconsistent implementation, a lack of experimental studies, and older syntheses with a limited focus or population made synthesis complex. Therefore, a scoping review was undertaken to determine the breadth and depth of the existing literature on this topic. INCLUSION CRITERIA Sources pertaining to bereavement care guidelines used in health care facilities immediately after perinatal loss (miscarriage, stillbirth, or neonatal death) and parents' mental health outcomes were included. Sources pertaining to family members other than parents, perinatal loss occurring outside of a health care facility, and physical care guidelines were excluded. METHODS The review was conducted using JBI methodology for scoping reviews. The team considered quantitative and qualitative studies, practice guidelines, case reports, expert opinions, systematic reviews, professional organization websites, and gray literature. CINAHL (EBSCOhost), PsycINFO (EBSCOhost), SocINDEX (EBSCOhost), Cochrane Library, JBI Evidence-based Practice Database (Ovid), Embase, PubMed (NLM), ProQuest Dissertations and Theses A&I (ProQuest), Web of Science Core Collection, and Epistemonikos were the major databases searched. OpenGrey, Google Scholar, and organizational websites were also searched. The earliest empirical study publication found (1976) served as the starting date limit. After pilot-testing the screening process, data were extracted, collated, and presented in narrative form as well as in tables and figures. The search was first conducted in September and October 2021, and an updated search was performed on February 9, 2023. RESULTS The results provide a broad view of bereavement care guidelines to support grieving parents' mental health. The included sources (n = 195) were comprised of 28 syntheses, 96 primary studies, and 71 literature review/text and opinion. From the studies that specified the number of participants, 33,834 participants were included. Key characteristics of bereavement care guidelines were categorized as i) making meaning/memories, ii) good communication, iii) shared decision-making, iv) effective emotional and social support, and v) organizational response. Parents' reported mental health outcomes included both negative outcomes, such as depression, anxiety, anger, and helplessness, and positive outcomes, including coping, healing, recovery, and well-being. CONCLUSIONS Conceptually the characteristics of published guidelines are fairly consistent across settings, with cultural variations in specific components of the guidelines. Despite the exponential increase in research pertaining to bereavement care after perinatal loss, there is a gap in research pertaining to certain characteristics of bereavement care guidelines accepted as best practice to support parents' mental health outcomes. This review provides support for future research given the trauma and mental health risks following perinatal loss. Policies ensuring consistent and appropriate implementation of bereavement care guidelines are essential to improve parents' mental health outcomes.
Collapse
Affiliation(s)
- Lisa R Roberts
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
| | - Jan M Nick
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
| | - Nancy L Sarpy
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Judith Peters
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Shanalee Tamares
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
- Del Webb Library, Loma Linda University, Loma Linda, CA, USA
| |
Collapse
|
3
|
Vivekananda K, McDowell C, Knipe K, McMaster C, Rahimi F, Richards M, Salvini S. Professional bereavement photography for perinatal loss: A mixed-methods study. DEATH STUDIES 2024; 48:489-499. [PMID: 37489063 DOI: 10.1080/07481187.2023.2237440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
This study addresses research gaps regarding the impact of professional bereavement photography for perinatal loss. Utilizing a mixed-methods research design, 504 parents completed an online survey measuring their attitudes toward bereavement photography and its impact. Thirty-one parents participated in semi-structured interviews. The results indicate a high level of acceptability and satisfaction for professional bereavement photography by parents (including those from more diverse backgrounds). Data triangulation confirmed that photos are valuable in enfranchising grief, validating parental and babies' identities and facilitating connections with others. Significant correlations were found for sharing of photos with both positive attitudes toward photography and for continuing bonds. The expression of continuing bonds in public social media spaces suggests increased social acceptance and validation for grieving perinatal losses. The findings from this study further inform practice guidelines for supporting perinatal loss.
Collapse
Affiliation(s)
- Kitty Vivekananda
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Chiara McDowell
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Kayleigh Knipe
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Charlotte McMaster
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Fatima Rahimi
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Mia Richards
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Sarah Salvini
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| |
Collapse
|
4
|
Pedraza EC, Vokinger AK, Cleves D, Michel G, Wrigley J, Baker JN, Garcia-Quintero X, McNeil MJ. Grief and Bereavement Support for Parents in Low- or Middle-Income Countries: A Systematic Review. J Pain Symptom Manage 2024; 67:e453-e471. [PMID: 38244706 DOI: 10.1016/j.jpainsymman.2024.01.023] [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: 11/15/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION The death of a child may be the most traumatic event a family can experience. Bereavement care for parents is essential for their physical and mental well-being and is a psychosocial standard of care. Childhood mortality is higher in low- or middle-income countries (LMICs); however, little is known regarding bereavement support or interventions for parents in LMICs. AIM To identify programs, services, initiatives, or interventions offered to bereaved parents in LMICs in hospital settings. METHODS A systematic search was executed following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles from LMICs describing interventions, programs, or resources provided to parents after the death of a child (0-18 years old) from any cause were included. Extracted data was categorized by demographics, study design, outcomes, and quality assessment using the McGill Mixed Methods Appraisal Tool (MMAT). RESULTS We retrieved 4428 papers and screened their titles and abstracts, 36 articles were selected for full-text assessment, resulting in nine articles included in the final analysis. Most interventions described support for parents whose child died during the prenatal or neonatal period. The primary interventions included psychological counseling, creating mementos (such as photographs or footprints), and bereavement workshops. Only one paper described a fully established bereavement program for parents. Eight of the papers met high-quality criteria. DISCUSSION Although bereavement care is crucial for parents whose child has died, only a few studies have documented bereavement interventions in LMICs. More research may help with bereavement program implementation and improved care for bereaved parents in LMICs.
Collapse
Affiliation(s)
- Eddy Carolina Pedraza
- Faculty of Health Sciences and Medicine (P.E.C., V.A.K., M.G.), University of Lucerne, Lucerne, Switzerland.
| | - Anna Katharina Vokinger
- Faculty of Health Sciences and Medicine (P.E.C., V.A.K., M.G.), University of Lucerne, Lucerne, Switzerland
| | - Daniela Cleves
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Gisela Michel
- Faculty of Health Sciences and Medicine (P.E.C., V.A.K., M.G.), University of Lucerne, Lucerne, Switzerland
| | - Jordan Wrigley
- Biomedical Library (W.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Division of Quality of Life and Pediatric Palliative Care (B.J.N.), Stanford Medicine Children's Health, Palo Alto, California, USA
| | - Ximena Garcia-Quintero
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Michael J McNeil
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| |
Collapse
|
5
|
Giang C, Alvis L, Oosterhoff B, Kaplow JB. Protective Factors in the Context of Childhood Bereavement: Youth Gratitude, Future Orientation, and Purpose in Life. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241246919. [PMID: 38621174 DOI: 10.1177/00302228241246919] [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: 04/17/2024]
Abstract
The objective of the study was to examine potential associations between positive youth development constructs (gratitude, future orientation, purpose in life) and psychological functioning (posttraumatic stress symptoms, depressive symptoms, maladaptive grief reactions) among bereaved youth and test whether these associations vary by age. A diverse sample of 197 clinic-referred bereaved youth (56.2% female; M = 12.36, SD = 3.18; 36.1% Hispanic, 23.7% White, 20.1% Black, 11.9% Multiracial, and 8.2% another race/ethnicity) completed self-report measures of psychological functioning and positive youth development constructs. Linear regression models indicated that gratitude and purpose were associated with lower posttraumatic stress and depressive symptoms among bereaved youth. Future orientation was associated with higher posttraumatic stress symptoms. Results were consistent across age. If replicated longitudinally, gratitude and purpose may be important protective factors against negative mental health outcomes in the aftermath of losing a loved one.
Collapse
Affiliation(s)
- Christopher Giang
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lauren Alvis
- The Trauma and Grief Center, Meadows Mental Health Policy Institute, Houston, TX, USA
| | - Benjamin Oosterhoff
- The Trauma and Grief Center, Meadows Mental Health Policy Institute, Houston, TX, USA
| | - Julie B Kaplow
- The Trauma and Grief Center, Meadows Mental Health Policy Institute, Houston, TX, USA
- Department of Psychiatry, Tulane University School of Medicine, New Orleans, LA, USA
| |
Collapse
|
6
|
DeForge CE, George M, Baldwin MR, South K, Beauchemin M, McHugh ME, Smaldone A. Do Interventions Improve Symptoms Among ICU Surrogates Facing End-of-Life Decisions? A Prognostically-Enriched Systematic Review and Meta-Analysis. Crit Care Med 2022; 50:e779-e790. [PMID: 35997501 PMCID: PMC10193371 DOI: 10.1097/ccm.0000000000005642] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Evaluate the efficacy of interventions to improve symptoms for ICU surrogates at highest risk of developing psychologic distress: those facing end-of-life care decisions. DATA SOURCES MEDLINE, CINAHL, PsycInfo, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched through April 16, 2022. STUDY SELECTION Following an a priori protocol, randomized trials of interventions delivered to surrogates of adult ICU patients who died or had high likelihood of mortality evaluating surrogate symptoms were identified. DATA EXTRACTION Two reviewers performed screening and data extraction and assessed risk of bias (Cochrane Risk of Bias [RoB] 2 tool). Trials were eligible for meta-analysis if group mean symptom scores were provided at 3 or 6 months. Pooled effects were estimated using a random effects model. Heterogeneity was assessed (Cochrane Q, I2 ). Certainty of evidence was assessed (Grading of Recommendations Assessment, Development and Evaluation). DATA SYNTHESIS Of 1,660 records, 10 trials met inclusion criteria representing 3,824 surrogates; eight were included in the meta-analysis. Overall RoB was rated Some Concerns. Most ( n = 8) interventions focused on improving communication and enhancing psychologic support in the ICU. All trials measured anxiety, depression, and posttraumatic stress. Significant improvement was seen at 3 months (depression, mean difference [MD], -0.68; 95% CI, -1.14 to -0.22, moderate certainty; posttraumatic stress, standardized MD, -0.25; 95% CI, -0.49 to -0.01, very low certainty) and 6 months (anxiety, MD, -0.70; 95% CI, -1.18 to -0.22, moderate certainty). Sensitivity analyses suggest significant findings may be unstable. Subgroup analyses demonstrated differences in effect by trial location, interventionist, and intervention dose. CONCLUSIONS Communication and psychological support interventions in the ICU yielded small but significant improvement in psychological symptoms with moderate to very low certainty evidence in a prognostically-enriched sample of ICU surrogates facing end-of-life care decisions. A new approach to interventions that extend beyond the ICU may be needed.
Collapse
Affiliation(s)
| | | | - Matthew R Baldwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | | | | | - Marlene E McHugh
- Columbia University School of Nursing, New York, NY
- Palliative Care Service, Department of Family Medicine, Montefiore Medical Center, New York, NY
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, NY
- College of Dental Medicine, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
7
|
Bonnot Fazio S, Dany L, Dahan S, Tosello B. Communication, information, and the parent–caregiver relationship in neonatal intensive care units: A review of the literature. Arch Pediatr 2022; 29:331-339. [DOI: 10.1016/j.arcped.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/15/2021] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
|
8
|
Being a Parent: Findings from a Grounded Theory of Memory-Making in Neonatal End-of-Life Care. J Pediatr Nurs 2021; 61:51-58. [PMID: 33752063 DOI: 10.1016/j.pedn.2021.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Neonatal palliative care guidelines increasingly recommend that parents be encouraged to provide care for their dying baby and to spend time with the before and after death. However, little is currently known about how parents perceive such memory-making interventions. This study explored the significance of memory-making for bereaved parents and the impact of memory-making on parents' experience of neonatal end-of-life care. DESIGN AND METHODS We conducted extended interviews with 18 parents who had experienced neonatal loss. Corbin and Strauss' grounded theory method was used throughout sampling, data collection and data analysis. A constant comparative approach was utilised throughout each stage of the data collection/data analysis process, resulting in the development of a grounded theory titled "Affirmed Parenthood". RESULTS The core category of "Affirmed parenthood" was underpinned by three primary categories: 'Creating Evidence', 'Needing Guidance' and 'Being a parent'. Opportunities to parent the baby by having contact with them, engaging with them, and providing care were central to parent's experiences of memory-making in the context of neonatal bereavement. CONCLUSIONS 'Being a Parent' provided important affirmation of the baby's identity and importance, and affirmed the role of the parents. 'Being a Parent' was a critical element of memory-making and had a significant impact on parents' experience of loss. PRACTICE IMPLICATIONS Parents should be supported to have unrestricted contact with their baby, to engage with them, and to provide care throughout the baby's brief life and after their baby's death.
Collapse
|
9
|
Goldberg JM, Duplechain AC, Fraser CE, Boles JC. An Interdisciplinary Hospital-Based Committee to Improve Pediatric Bereavement Care. Hosp Pediatr 2021; 11:1287-1294. [PMID: 34599017 DOI: 10.1542/hpeds.2021-005964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although frequently overshadowed by adult mortality rates and bereavement care needs, the death of a child can significantly jeopardize the physical, psychosocial, and emotional health of surviving parents, caregivers, and family members. Unfortunately, researchers have only recently begun to explore the trajectory of pediatric bereavement care needs. As an ongoing public health concern, health care institutions and related organizations must partner with interdisciplinary care providers and bereaved families to design effective and sustainable bereavement supports in their communities. Therefore, the purpose of this article is to describe the development and accomplishments of an interdisciplinary bereavement committee at a children's hospital within an academic medical center. By relying on available empirical evidence and close collaboration with bereaved parent members, this effort has generated sizeable practice improvements and new service offerings within the organization, local community, and the individual patients and families the institution serves.
Collapse
Affiliation(s)
- Jessica M Goldberg
- Patient- and Family-Centered Care, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Anne C Duplechain
- Patient- and Family-Centered Care, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Camille E Fraser
- Patient- and Family-Centered Care, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Jessika C Boles
- Patient- and Family-Centered Care, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee .,Department of Psychology and Human Development, Peabody College Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
10
|
Paraíso Pueyo E, González Alonso AV, Botigué T, Masot O, Escobar-Bravo MÁ, Lavedán Santamaría A. Nursing interventions for perinatal bereavement care in neonatal intensive care units: A scoping review. Int Nurs Rev 2021; 68:122-137. [PMID: 33686660 DOI: 10.1111/inr.12659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite technological advances and specialist training of neonatal teams, perinatal deaths still occur. Such events are traumatic experiences for the parents and increase the risk of pathological grieving. Nursing is one of the main sources of support. However, the important work of nurses in these situations is made more difficult by the lack of recognized strategies that can be implemented to assist parents and family members in the bereavement process. AIM Identify nursing interventions to help parents of neonates admitted to neonatal intensive care units cope with perinatal loss. METHODS A scoping review based on the methodological framework established by Arksey and O'Malley was used. A total of 327 relevant studies were identified through a bibliographic search in Pubmed, CINAHL Plus, APA PsycNET and Scopus between 2000 and 2019. The screening process included an initial analysis of the relevance of the abstract and, when required, an extensive review of the full paper. RESULTS A total of 9 papers were finally selected which responded to the research question. All nine papers are from the USA and have different methodological characteristics. A number of effective interventions were identified, including legacy creation, support groups, family-centred accompaniment and follow-up, parental involvement in pre-mortem care, intergenerational bereavement programmes, and the use of technological and spiritual resources. CONCLUSION In general, the scant evidence that is available about nursing interventions around perinatal bereavement care underlines the requirement to thoroughly assess the effectiveness of those that have already been designed and implemented. IMPLICATIONS FOR NURSING PRACTICE AND POLICY This scoping review contributes to the potential implementation of effective interventions to deal with and help parents and family members cope with perinatal bereavement, with nursing staff as the main source of support and leading interventions which have family members in the care team. This review also makes a substantial contribution to the development of a practical and evidence-based clinical guide for nursing, with recommendations that can be adapted to effective quality care criteria. It is additionally intended to encourage visibility in health policies of care and attention to perinatal grief in neonatal intensive care units.
Collapse
Affiliation(s)
- Elena Paraíso Pueyo
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| | | | - Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| | - Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| | - Miguel Ángel Escobar-Bravo
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| | - Ana Lavedán Santamaría
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| |
Collapse
|
11
|
Wang E, Hu H, He Y, Xu Y. Can social support matter? The relationship between social support and mental health among bereaved parents in an only-child society: Evidence from China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:476-486. [PMID: 32701221 DOI: 10.1111/hsc.13108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
Shidu parents (parents who lost their only child) experience poor mental health, and social support is expected to alleviate mental stress and facilitate mental adaptation of bereaved parents. However, the literatures on the effects of social support on mental health of bereaved parents have yield mixed outcomes, and the relationship between social support and mental health among Shidu parents has been unexplored in China. The purpose of this study was to examine the relationship between social support and mental health among Shidu parents in China. Multistage stratified random sampling was conducted to collect data in 2017, and a total of 1,750 Shidu parents were employed as the analytical sample. The Ordinary Least Squares Model and Instrumental Variables (IV) Method were both employed. The variable of community services for the aged provided by the market was employed as the IV of the study considering death taboo inveterately rooted in philosophies and religions in Chinese culture. The results indicated that there was a positive relationship between social support and mental health among Shidu parents, specifically, objective social support and social support utilisation were significantly related to mental health of Shidu parents, while subjective social support was not. Implications of the study include the following: First, it is crucial to help spouse and friends gain appropriate social support skills. Mutual associations can be an important source of social support. Second, objective social support should be given a top priority, and suitable amount, timing, source and structure of social support should be paid more attention to strengthen the 'goodness of fit' between the needs of Shidu parents and support provided. Third, some other social services such as community care, social work services and professional consulting services can be appropriate alternatives to alleviate mental stress of Shidu parents.
Collapse
Affiliation(s)
- Enjian Wang
- School of Humanities and Social Sciences, North China Electric Power University, Baoding, P.R. China
| | - Hongwei Hu
- School of Public Administration and Policy, Renmin University of China, Beijing, P.R. China
| | - Yongjia He
- School of Social and Behavioral Sciences, Nanjing University, Nanjing, P.R. China
| | - Yang Xu
- College of Humanity and Law, Huazhong Agricultural University, Wuhan, P.R. China
| |
Collapse
|
12
|
Azeez S, Obst KL, Oxlad M, Due C, Middleton P. Australian fathers' experiences of support following neonatal death: a need for better access to diverse support options. J Perinatol 2021; 41:2722-2729. [PMID: 34556801 PMCID: PMC8460396 DOI: 10.1038/s41372-021-01210-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To explore fathers' experiences of support following neonatal death, including the availability and perceived adequacy of support, barriers and facilitators to support and desired support. STUDY DESIGN Semi-structured interviews were conducted with ten Australian fathers who had experienced the death of a baby in the neonatal period at least 6 months previously. Data were analysed using thematic analysis. RESULTS Two overarching themes were identified: From hospital to home: Continuity of care and Self and community barriers to support. Fathers who could access the support they required found this to be beneficial. Overall, however, supports were perceived as inadequate in variety and availability, with more follow-up support from the hospital desired. Fathers highlighted limited opportunities to form emotional connections with others and a strong desire to talk about their baby. CONCLUSION Healthcare professionals and support organisations can more effectively assist fathers by increasing the variety of supports available and facilitating follow-up or referrals after hospital discharge.
Collapse
Affiliation(s)
- Shazleen Azeez
- School of Psychology, University of Adelaide, Adelaide, SA, Australia.
| | - Kate Louise Obst
- grid.1010.00000 0004 1936 7304School of Psychology, University of Adelaide, Adelaide, SA Australia
| | - Melissa Oxlad
- grid.1010.00000 0004 1936 7304School of Psychology, University of Adelaide, Adelaide, SA Australia
| | - Clemence Due
- grid.1010.00000 0004 1936 7304School of Psychology, University of Adelaide, Adelaide, SA Australia
| | - Philippa Middleton
- grid.430453.50000 0004 0565 2606South Australian Health and Medical Research Institute, Adelaide, SA Australia
| |
Collapse
|
13
|
Norton EA, Mastroyannopoulou K, Rushworth I. Parents experience of using "cold" facilities at a children's hospice after the death of their baby: A qualitative study. DEATH STUDIES 2020; 46:1501-1507. [PMID: 33085586 DOI: 10.1080/07481187.2020.1836070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There is a growing movement in children's hospice care to offer families time with their baby after death through use of a "cold cot"; however, there is very limited research in this area. We interviewed seven parents (four mothers and three fathers). Our thematic analysis identified six themes: being able to care for my baby in a way that I never had, space and time to adjust to the loss, time as a family, having my baby close, creating memories, and awareness of societal perceptions. The authors conclude that these facilities provided memories, strengthened legacy, and were a valuable experience.
Collapse
Affiliation(s)
- Elisabeth A Norton
- Department of Clinical Psychology, University of East Anglia, Norwich, United Kingdom
| | | | - Imogen Rushworth
- Department of Clinical Psychology, University of East Anglia, Norwich, United Kingdom
| |
Collapse
|
14
|
Ho AHY, Dutta O, Tan-Ho G, Tan THB, Low XC, Ganapathy S, Car J, Ho RMH, Miao CY. A Novel Narrative E-Writing Intervention for Parents of Children With Chronic Life-Threatening Illnesses: Protocol for a Pilot, Open-Label Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17561. [PMID: 32623367 PMCID: PMC7380996 DOI: 10.2196/17561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 12/28/2022] Open
Abstract
Background A novel evidence-based Narrative e-Writing Intervention (NeW-I) has been developed and tested in Singapore to advance psychosociospiritual support for parents of children with chronic life-threatening illnesses. NeW-I is informed by an international systematic review and a Singapore-based qualitative inquiry on the lived experience of parental bereavement and supported by literature on anticipatory grief interventions for improving the holistic well-being of parent caregivers of seriously ill children. Objective This study's aim was to provide an accessible platform, NeW-I—which is a strengths- and meaning-focused and therapist-facilitated mobile app and web-based counseling platform—that aims to enhance quality of life, spiritual well-being, hope, and perceived social support and reduce depressive symptoms, caregiver burden, and risk of complicated grief among parents of children with chronic life-threatening illnesses. Methods The NeW-I therapist-facilitated web-based platform comprises a mobile app and a website (both of which have the same content
and functionality). NeW-I has been implemented in Singapore as a pilot open-label randomized controlled trial comprising intervention and control groups. Both primary and secondary outcomes will be self-reported by participants through questionnaires. In collaboration with leading pediatric palliative care providers in Singapore, the trial aims to enroll 36 participants in each group (N=72), so that when allowing for 30% attrition at follow-up, the sample size will be adequate to detect a small effect size of 0.2 in the primary outcome measure, with 90% power and two-sided significance level of at least .05. The potential effectiveness of NeW-I and the accessibility and feasibility of implementing and delivering the intervention will be assessed. Results Funding support and institutional review board approval for this study have been secured. Data collection started in January 2019 and is ongoing. Conclusions NeW-I aspires to enhance holistic pediatric palliative care services through a structured web-based counseling platform that is sensitive to the unique cultural needs of Asian family caregivers who are uncomfortable with expressing emotion even during times of loss and separation. The findings of this pilot study will inform the development of a full-scale NeW-I protocol and further research to evaluate the efficacy of NeW-I in Singapore and in other Asian communities around the world. Trial Registration ClinicalTrials.gov NCT03684382; https://clinicaltrials.gov/ct2/show/NCT03684382 International Registered Report Identifier (IRRID) DERR1-10.2196/17561
Collapse
Affiliation(s)
- Andy Hau Yan Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Oindrila Dutta
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Toh Hsiang Benny Tan
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Xinyi Casuarine Low
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ringo Moon-Ho Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Chun Yan Miao
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
15
|
Thornton R, Nicholson P, Harms L. Creating Evidence: Findings from a Grounded Theory of Memory-Making in Neonatal Bereavement Care in Australia. J Pediatr Nurs 2020; 53:29-35. [PMID: 32344367 DOI: 10.1016/j.pedn.2020.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Perinatal and neonatal palliative care guidelines recommend the provision of photographs and other mementos as an element of care for parents bereaved by neonatal loss. However, little is known about parents' perceptions of such bereavement interventions. This study explored the significance of memory-making for bereaved parents and the impact of memory-making on parents' experience of loss following neonatal loss. DESIGN AND METHODS We conducted semi-structured interviews with 18 bereaved parents. A grounded theory approach informed by Corbin and Strauss was used to underpin data sampling, data collection and data analysis. A constant comparative approach was used to engage in open, axial and selective coding to distil parents' stories into categories supporting a core concept. RESULTS "Creating evidence" emerged as a key theme in the grounded theory of memory-making in bereavement care for parents following neonatal loss. Creating evidence involved taking photographs, creating mementos, as well as involving friends and family during the baby's time in the Neonatal Unit. CONCLUSIONS Creating evidence affirmed the life of the baby and the role of the parents. Creating evidence was a significant element of memory-making that had a positive impact on parents' experience of bereavement. PRACTICE IMPLICATIONS Parents should be supported to create evidence of their baby's life, through taking photos, creating mementos, and involving others in their baby's care. Such interventions provide affirmation of the baby's life and of the individual's role as a parent.
Collapse
Affiliation(s)
- Rebecca Thornton
- Department of Social Work, Alan Gilbert Building, The University of Melbourne, Victoria, Australia; Deakin University, Building W, 221 Burwood Hwy, Burwood, Victoria, Australia.
| | - Patricia Nicholson
- School of Nursing and Midwifery, Centre of Quality and Safe Patient Research, Deakin University, Geelong, Victoria, Australia
| | - Louise Harms
- Department of Social Work, Alan Gilbert Building, The University of Melbourne, Victoria, Australia
| |
Collapse
|
16
|
Raharjo CV, Hetherington K, Donovan L, Fardell JE, Russell V, Cohn RJ, Morgan NL, Siddiqui J, Wakefield CE. An Evaluation of By My Side: Peer Support in Written Form is Acceptable and Useful for Parents Bereaved by Childhood Cancer. J Pain Symptom Manage 2020; 59:1278-1286. [PMID: 32006611 DOI: 10.1016/j.jpainsymman.2020.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 11/20/2022]
Abstract
CONTEXT Cancer is the leading cause of nonaccidental death in childhood, with the death of a child representing a devastating loss for families. Peer support offers a valuable way to support parents' adjustment in bereavement. The By My Side book provides written peer support by sharing bereaved parents' stories to normalize grief experiences and reduce parents' isolation. It is available free of charge. OBJECTIVES This project evaluated the acceptability, relevance, emotional impact, and usefulness of By My Side. DESIGN Bereaved parents and health care professionals (HCPs) provided feedback via a questionnaire. We used descriptive statistics and qualitative analysis of open-ended responses to analyze the data. SETTING/PARTICIPANTS We mailed a study invitation and evaluation questionnaire to parents and HCPs who ordered a copy of By My Side. RESULTS About 24 bereaved parents and seven HCPs provided feedback. Parents thought the book's length (91.7%) and amount of information (83.3%) was just right. About 75% of parents reported that the book made them feel that their reactions to their child's death were normal and/or appropriate. Parents reported positive and negative emotional reactions to the book (e.g., 87.5% felt comforted, 87.5% felt sadness). All parents and HCPs reported that the book provided useful information about grief. About 83.4% of parents and 85.7% of HCPs would recommend it to others. CONCLUSION By My Side was acceptable and useful to bereaved parents and HCPs. Results suggest that peer support in written form may help normalize aspects of grief and comfort parents bereaved by childhood cancer.
Collapse
Affiliation(s)
- Callista V Raharjo
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kate Hetherington
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
| | - Leigh Donovan
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; Paediatric Palliative Care Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Joanna E Fardell
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Vera Russell
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | | | | | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| |
Collapse
|
17
|
Seo W, Lee H, Oh S, Sa H, Kim H. [Bereavement Care for Parents in the Neonatal Intensive Care Unit: A Literature Review]. CHILD HEALTH NURSING RESEARCH 2020; 26:286-295. [PMID: 35004472 PMCID: PMC8650932 DOI: 10.4094/chnr.2020.26.2.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 11/06/2022] Open
Abstract
Purpose The purpose of this study was to review studies investigating the effect of bereavement care provided for parents in the neonatal intensive care unit. Methods We conducted a literature review of databases (MEDLINE, Embase, Cochrane Library, and CINAHL) for studies published in English and four databases (RISS, KISS, NANET, and KoreaMed) for Korean studies. The selection criteria included original articles that evaluated the parents' perceptions or responses to bereavement care provided in the neonatal intensive care unit. Of 889 articles from the initial screening, 66 articles underwent full-text review and five articles were finally selected for analysis. Results None of the studies was conducted in Korea. Only one study used a randomized control trial design. The forms of bereavement care reviewed included a provision of a memory package, grief information, and emotional and/or social support from peers or health care providers. The effectiveness of bereavement care was measured by including grief, social support, and depression. Conclusion Bereavement care can be considered to be beneficial for relieving grief reactions and enhancing the personal growth of bereaved parents. Future research should assess the needs of bereaved parents in Korea. Nurses may play a role in developing the bereavement care for parents.
Collapse
|
18
|
Tovey R, Turner S. Stillbirth memento photography. J Vis Commun Med 2019; 43:2-16. [PMID: 31822151 DOI: 10.1080/17453054.2019.1691439] [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: 10/25/2022]
Abstract
Research into stillbirth memento photography shows the practice to be welcomed by the bereaved. The visual attributes and content of stillbirth memento photographs are yet to be rigorously analysed however, representing a significant gap in current understanding. This study seeks to address this. 51 professionally produced stillbirth memento photographs have been sampled, anonymised and analysed. Using a content analysis methodology, imagery was characterised by aesthetic and semantic properties. The results were then cross-referenced against existing stillbirth scholarship, data from an interview study with people who had experienced pregnancy loss, and against image theories. The content analysis identified four distinctive image tropes in the sample: images of mother, father and baby, with the baby being held and the parents touching; macro photography of the baby; portrait photographs of babies lying alone with little or no physical trauma evident; and images of a parent, usually the mother, cradling the baby. The analysis also identified specific attributes, present across the sample, that appeared significant and distinctive of stillbirth memento photography. These were: (1) stylistic attributes, (2) acknowledgement and validation, (3) identity construction, (4) ambiguity and (5) embodiment.
Collapse
Affiliation(s)
- Rob Tovey
- School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - Sarah Turner
- Faculty of Arts and Humanities, Coventry University, Coventry, UK
| |
Collapse
|
19
|
Dias N, Hendricks-Ferguson VL, Wei H, Boring E, Sewell K, Haase JE. A Systematic Literature Review of the Current State of Knowledge Related to Interventions for Bereaved Parents. Am J Hosp Palliat Care 2019; 36:1124-1133. [DOI: 10.1177/1049909119858931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aims: The purpose of this systematic literature review is to describe the interventions for bereaved parents, evaluate intervention effectiveness through study methodology rigor, replicability, and theoretical foundations. Methods: We searched MEDLINE via PubMed (1966-2018), CINAHL (1937-present), PsycINFO (1887-present), and Embase (1947-present) using various search words and MeSH terms related to the study purpose. A blinded screening of title/abstract was performed, with conflicting inclusion decisions resolved through group discussions. Matrices for remaining articles were created and discussed among the team. The levels of evidence of the 9 records were rated from very low to high based on the Grading of Recommendations Assessment, Development, and Evaluation guidelines. Results: Our initial pool included 1025 articles. After the screening of titles/abstracts, 63 articles were retained for full-text reviews. Evaluated based on the inclusion/exclusion criteria, 9 records met the review criteria. Of the 9 records, 1 was graded as very low, 3 low, and 5 low to moderate. The interventions for bereaved parents varied from using single-model interventions such as expressive arts therapy and telephone support to multimodal interventions that combined resources (ie, peer support, resource packets, and health-care support). Only 1 study explicitly illustrated how its bereavement intervention was designed based on the proposed theoretical model. Conclusions: This review highlights the need for individualized, well-tested, and effective bereavement care interventions to support bereaved parents. In summary, the state of the science on interventions for bereaved parents is poor and much work needs to be done to effectively address the needs of bereaved parents, including both their physical and emotional health needs.
Collapse
Affiliation(s)
- Nancy Dias
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | | | - Holly Wei
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | - Elizabeth Boring
- Hope in Healing Pediatric Bereavement Program, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Kerry Sewell
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | - Joan E. Haase
- The IUPUI Research in Palliative and End-of-Life Communication and Training (RESPECT), Indiana University School of Nursing, Indianapolis, IN, USA
| |
Collapse
|
20
|
Ramirez FD, Bogetz JF, Kufeld M, Yee LM. Professional Bereavement Photography in the Setting of Perinatal Loss: A Qualitative Analysis. Glob Pediatr Health 2019; 6:2333794X19854941. [PMID: 31236429 PMCID: PMC6572886 DOI: 10.1177/2333794x19854941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 11/22/2022] Open
Abstract
Perinatal loss, including fetal and infant death, is a devastating experience for parents, resulting in long-term adverse physical and psychosocial outcomes. However, little is known about what services might best support grieving parents. We aimed to understand the role of professional bereavement photography in assisting the grieving process of parents who have lost a fetus or infant, by examining the perspectives of bereaved parents, professional photographers, and health care professionals. Twenty semistructured interviews were conducted, and interview transcripts were analyzed using modified grounded theory. Twenty-three individuals participated, including 6 bereaved parents, 8 photographers, and 9 health care professionals. Analyses generated 5 major themes describing ways in which the photographs were valuable to parents: validation of the experience, permission to share, creation of a permanent and tangible legacy, creation of positive memories, and moving forward after the loss. Hospitals should consider incorporation of professional bereavement photography services into palliative care and bereavement programs.
Collapse
Affiliation(s)
| | - Jori F Bogetz
- Seattle Children's Hospital, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | | | - Lynn M Yee
- Northwestern University, Chicago, IL, USA
| |
Collapse
|
21
|
The Best Interests of Infants and Families During Palliative Care at the End of Life: A Review of the Literature. Adv Neonatal Care 2019; 19:E9-E14. [PMID: 30394915 DOI: 10.1097/anc.0000000000000567] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Palliative care is an integral element of care provision in neonatal intensive care units (NICUs). Healthcare providers working in NICUs are likely to provide palliative care at some point in their career. PURPOSE This article examines what neonatal palliative care entails, how parents perceive healthcare providers' actions, what they potentially need at the end of their infant's life, and what bereavement interventions are most supportive for parents. SEARCH STRATEGY We conducted a search of full-text articles published in English in PubMed and CINAHL using the following key words: "NICU bereavement care," "end-of-life care," "infant loss," and "palliative care." FINDINGS Healthcare providers should consider alleviation of the infant's pain and suffering when discussing whether to provide or continue aggressive medical interventions. The timing of these discussions is important. Parents appear to be most comforted by compassionate, caring healthcare providers who show competence and knowledge in the provision of medical/nursing and palliative care. IMPLICATIONS FOR PRACTICE Healthcare providers working in NICUs require specific training in bereavement/palliative care for infants. Families facing the death of their infant must receive support from qualified providers both during and after that death. Furthermore, the infant's quality of life must be considered when discussing withholding or withdrawing care. IMPLICATIONS FOR RESEARCH There is a need for further research investigating the specific types of training required by healthcare providers in NICU settings who are providing bereavement/palliative care to neonates, in order to best support the families' needs in these situations.
Collapse
|
22
|
Akard TF, Duffy M, Hord A, Randall A, Sanders A, Adelstein K, Anani UE, Gilmer MJ. Bereaved mothers' and fathers' perceptions of a legacy intervention for parents of infants in the NICU. J Neonatal Perinatal Med 2018; 11:21-28. [PMID: 29689746 DOI: 10.3233/npm-181732] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Legacy-making, actions or behaviors aimed at being remembered, may be one strategy to enhance coping and improve grief outcomes for bereaved parents and siblings. While legacy interventions have been developed and tested in pediatric and adult populations, legacy activities specific to bereaved parents in the neonatal intensive care unit remain unexplored. This study explored bereaved parents' perceptions of a digital storytelling legacy-making intervention for parents after the death of an infant. METHODS Six bereaved mothers and fathers participated in a focus group interview three to 12 months after the death of an infant in the NICU. A semi-structured interview guide with open-ended questions was used to obtain parent self-reports. Qualitative content analysis identified emerging themes. RESULTS Four major themes emerged regarding participants' perceptions of a legacy intervention: (a) parents' willingness to participate in a legacy intervention, (b) parents' suggestions for a feasible intervention, (c) parents' suggestions for an acceptable intervention, and (d) parents' perceived benefits of legacy-making. CONCLUSIONS Participants reported that a legacy-making intervention via digital storytelling would be feasible, acceptable, and beneficial for NICU parents. Study results support the need and desire for legacy-making services to be developed and offered in the NICU.
Collapse
Affiliation(s)
- T F Akard
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | - M Duffy
- Vanderbilt University, Nashville, TN, USA
| | - A Hord
- Vanderbilt University, Nashville, TN, USA
| | - A Randall
- Vanderbilt University, Nashville, TN, USA
| | - A Sanders
- Vanderbilt University, Nashville, TN, USA
| | - K Adelstein
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | - U E Anani
- Monroe Carell Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - M J Gilmer
- Vanderbilt University School of Nursing, Nashville, TN, USA.,Monroe Carell Children's Hospital at Vanderbilt, Nashville, TN, USA
| |
Collapse
|
23
|
Martel S, Ives-Baine L. Nurses' Experiences of End-of-life Photography in NICU Bereavement Support. J Pediatr Nurs 2018; 42:e38-e44. [PMID: 29887165 DOI: 10.1016/j.pedn.2018.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To qualitatively explore neonatal intensive care nurses' experiences with end-of-life photography as part of their bereavement support work with families. DESIGN AND METHODS An Interpretive Phenomenological Analysis with data collected through a focus group (n = 6) and one semi-structured interview (n = 1) with neonatal nurses from a Level 3/4 NICU in a Canadian pediatric hospital. RESULTS Participants' comfort with EOL photography developed over time through exposure to bereavement scenarios and positive experiences with families. Participants' experienced a feeling of pressure to balance the photography with clinical responsibilities and find the right time to introduce photography while being sensitive to family experiences. Participants experienced EOL photography as something tangible to give families and were satisfied knowing the images might play an important role in the family's healing after the NICU. CONCLUSIONS All participants had come to value EOL photography as a positive and meaningful part of their work with bereaved families. Identified challenges related to balancing the practice with the unpredictable flow and demands of critical care and to developing an appreciation for and comfort with the photography as part of their healing and the families' healing. PRACTICAL IMPLICATIONS Findings contribute insight into care-provider experience that can inform best practices, training, and staff support for palliative and bereavement work in neonatal and pediatric settings. The findings suggest a need to support nurses emotionally and clinically in carrying out this photography as part of their care for families.
Collapse
Affiliation(s)
- Sara Martel
- Joint Graduate Program in Communication & Culture, York University/Ryerson University, Toronto, Ontario, Canada.
| | | |
Collapse
|
24
|
Yildiz H, Cimete G. The effect of a grief support program on Turkish parents whose babies have died. DEATH STUDIES 2017; 41:602-610. [PMID: 28486074 DOI: 10.1080/07481187.2017.1326541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to determine the effect of the Grief Support Program on the bereavement of parents whose babies had died. The sample consisted of 77 couples. The data was collected by the Texas Revised Inventory of Grief and the Coping Strategies Inventory. The intervention group was offered before, immediately after, and a month after death of their baby in accordance with the Grief Support Program guideline. The Grief Support Program did not affect grief intensity in the short term but had a positive effect 1 year later.
Collapse
Affiliation(s)
- Hatice Yildiz
- a Nursing Faculty, Söke School Health Science , Institution Adnan Menderes University , Aydin , Turkey
| | - Güler Cimete
- b Faculty of Health Sciences, Üsküdar University , Istanbul , Turkey
| |
Collapse
|
25
|
Abstract
Bereaved parents have higher morbidity and mortality rates when compared to nonbereaved parents. Although parental grief is well studied, the complexities of challenges bereaved parents face are not understood. This study describes parental bereavement challenges during the first 6 months following the death of their child. The complex parental bereavement challenges are characterized by the absence of the child, their emotional response, and the changed relationships with family and friends. The adaptive leadership framework is a useful framework to identify and classify challenges. Future research can use this framework to provide a structure that test interventions to address the challenges.
Collapse
Affiliation(s)
- Nancy Dias
- a Indiana University School of Nursing , Indianapolis , Indiana , USA
| | - Sharron Docherty
- b Department of Pediatrics, School of Medicine , Duke University School of Nursing , Durham , North Carolina , USA
| | - Debra Brandon
- b Department of Pediatrics, School of Medicine , Duke University School of Nursing , Durham , North Carolina , USA
| |
Collapse
|
26
|
Coombs M, Mitchell M, James S, Wetzig K. Intensive care bereavement practices across New Zealand and Australian intensive care units: a qualitative content analysis. J Clin Nurs 2017; 26:2944-2952. [DOI: 10.1111/jocn.13624] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Maureen Coombs
- Graduate School of Nursing, Midwifery and Health; Victoria University Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - Marion Mitchell
- NHMRC Centre of Research Excellence in Nursing; Menzies Health Institute Queensland; Southport Qld Australia
- Princess Alexandra Hospital; Woolloongabba Qld Australia
| | - Stephen James
- Capital and Coast District Health Board; Wellington New Zealand
- Wellington Intensive Care Unit; Capital and Coast District Health Board; Wellington New Zealand
| | - Krista Wetzig
- Princess Alexandra Hospital; Woolloongabba Qld Australia
| |
Collapse
|
27
|
Foster J, Kain V, Patterson T. Parents’ and families’ experiences of palliative and end-of-life neonatal care in neonatal settings. ACTA ACUST UNITED AC 2016; 14:99-105. [DOI: 10.11124/jbisrir-2016-003175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
28
|
Banerjee J, Kaur C, Ramaiah S, Roy R, Aladangady N. Factors influencing the uptake of neonatal bereavement support services - Findings from two tertiary neonatal centres in the UK. BMC Palliat Care 2016; 15:54. [PMID: 27357123 PMCID: PMC4928251 DOI: 10.1186/s12904-016-0126-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on perinatal bereavement services is limited. The aim of the study was to compare the uptake of bereavement support services between two tertiary neonatal units (NNU), and to investigate influencing factors. METHOD The medical and bereavement records of all neonatal deaths were studied from January 2006 to December 2011. Data collected included parent and baby characteristics, mode of death, consent for autopsy and bereavement follow-up. The categorical data were compared by chi-square or Fisher's exact test and continuous data by Wilcoxon signed-rank test; a multivariable regression analysis was performed using STATA 12.0. RESULTS The neonatal deaths of 297 babies (182 in NNU1 and 115 in NNU2) with full datasets were analysed. Baby characteristics were similar between units except for lower median gestational age in NNU1 (p = 0.03). Significantly more NNU1 parents were non-Caucasian (p < 0.01), from lower socio-economic status (p = 0.01) and had previous stillbirth/miscarriage (p = 0.03). More babies had care withdrawn in NNU2 (p < 0.01). A significantly higher proportion of parents from NNU1 (61 %) attended bereavement follow-up compared to NNU2 (34 %; p < 0.01). On multivariable analysis, significantly more parents who were married or co-habiting (p = 0.02) and consented for an autopsy (p = 0.01) attended bereavement services. CONCLUSION Uptake of bereavement services varied between the two NNUs, which could be due to differences in the ethnic and socio-economic mix of the population. Significantly more parents who were married or co-habiting, or consented for autopsy, attended bereavement follow up services.
Collapse
Affiliation(s)
- Jayanta Banerjee
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom.,Centre for Paediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Neonatal Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Charanjit Kaur
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom
| | - Sridhar Ramaiah
- Neonatal Unit, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Rahul Roy
- Neonatal Unit, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Narendra Aladangady
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom. .,Centre for Paediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. .,Department of Paediatrics, SDM Medical College and Hospitals, Dharwad, India.
| |
Collapse
|
29
|
Joronen K, Kaunonen M, Aho AL. Parental relationship satisfaction after the death of a child. Scand J Caring Sci 2015; 30:499-506. [PMID: 26346414 DOI: 10.1111/scs.12270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
Abstract
This study describes Finnish parents' (n = 461) parental relationship satisfaction and examines factors associated with relationship satisfaction after the death of a child in the family. This reported study is part of a broader investigation concerning parents' experiences after the death of a child. Most respondents were very (36%) or quite satisfied (49%) with their current relationship. Lower relationship satisfaction scores were reported by older respondents, people with poorer subjective health and people who had other living children. Causes of death other than stillbirth, need for marriage counselling and moderate or poor marital relationship of the respondents' own parents in childhood were also related to lower relationship satisfaction.
Collapse
Affiliation(s)
- Katja Joronen
- Nursing Science, School of Health Sciences, University of Tampere, Tampere, Finland
| | - Marja Kaunonen
- General Administration, School of Health Sciences, University of Tampere and Pirkanmaa Hospital District, Tampere, Finland
| | - Anna Liisa Aho
- Nursing Science, School of Health Sciences, University of Tampere, Tampere, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland
| |
Collapse
|
30
|
Price JE, Jones AM. Living Through the Life-Altering Loss of a Child: A Narrative Review. ACTA ACUST UNITED AC 2015; 38:222-40. [DOI: 10.3109/01460862.2015.1045102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
31
|
Donovan LA, Wakefield CE, Russell V, Cohn RJ. Hospital-based bereavement services following the death of a child: a mixed study review. Palliat Med 2015; 29:193-210. [PMID: 25395578 DOI: 10.1177/0269216314556851] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There has been a breadth of research on the grief experience of parents following the death of a child. However, the role and impact of hospital-based bereaved services remain unclear. AIM To identify services offered to bereaved families in perinatal, neonatal, and pediatric hospital settings and summarize the psychosocial impact of these services and published recommendations for best practice hospital-based bereavement care. DESIGN Systematic review of qualitative, quantitative, and mixed method studies guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and methodological quality appraised in accordance with the Mixed Method Appraisal Tool. DATA SOURCES MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, and PsychINFO were searched to find studies describing hospital-based bereavement services/interventions for parents, siblings, and grandparents. RESULTS In all, 14 qualitative, 6 quantitative, and 10 mixed method studies were identified. Nine descriptive articles were also included. Qualitatively, family members described feeling cared for and supported by staff, a reduction in sense of isolation, and improved coping and personal growth. Quantitatively, bereavement services have most effect for parents experiencing more complex mourning. It is recommended that bereavement services be theoretically driven and evidence based, offer continuity of care prior to and following the death of a child, and provide a range of interventions for the "whole family" and flexibility in service delivery. CONCLUSIONS There is a role for transitional hospital-based services/interventions for families in the lead up to and following the death of a child. Further mixed method research is required to inform best practice bereavement care guidelines in the perinatal, neonatal, and pediatric hospital settings.
Collapse
Affiliation(s)
- Leigh A Donovan
- Kids Cancer Centre, Sydney Children's Hospital (SCH), Randwick, NSW, Australia School of Women's and Children's Health, Faculty of Medicine, UNSW Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia Paediatric Palliative Care Service, Royal Children's Hospital (RCH), Herston, QLD, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital (SCH), Randwick, NSW, Australia School of Women's and Children's Health, Faculty of Medicine, UNSW Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Vera Russell
- Kids Cancer Centre, Sydney Children's Hospital (SCH), Randwick, NSW, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital (SCH), Randwick, NSW, Australia School of Women's and Children's Health, Faculty of Medicine, UNSW Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| |
Collapse
|
32
|
Rosenbaum JL, Smith JR, Yan Y, Abram N, Jeffe DB. Impact of a Neonatal-Bereavement-Support DVD on Parental Grief: A Randomized Controlled Trial. DEATH STUDIES 2015; 39:191-200. [PMID: 25530502 PMCID: PMC4382412 DOI: 10.1080/07481187.2014.946628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study tested the effect of a neonatal-bereavement-support DVD on parental grief after their baby's death in a Neonatal Intensive Care Unit compared with standard bereavement care (controls). Following a neonatal death, the authors measured grief change from a 3- to 12-month follow-up using a mixed-effects model. Intent-to-treat analysis was not significant, but only 18 parents selectively watched the DVD. Thus, we subsequently compared DVD viewers with DVD nonviewers and controls. DVD viewers reported higher grief at 3-month interviews compared with DVD nonviewers and controls. Higher grief at 3 months was negatively correlated with social support and spiritual/religious beliefs. These findings have implications for neonatal-bereavement care.
Collapse
Affiliation(s)
- Joan L Rosenbaum
- a Edward Mallinckrodt Department of Pediatrics , Washington University School of Medicine , St. Louis , Missouri , USA
| | | | | | | | | |
Collapse
|
33
|
Duffey H. Water immersion in neonatal bereavement photography. Nurs Womens Health 2014; 18:429-33. [PMID: 25316544 DOI: 10.1111/1751-486x.12152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Water immersion in neonatal bereavement photography is a new technique intended to enhance the quality of the photographs provided to families following their loss. Water immersion appears to be most helpful following a second trimester fetal demise. This technique can be used by nurses, professional photographers and others in addition to more traditional neonatal bereavement photography. It does not require special skills or equipment and can be implemented in virtually any perinatal setting. The enhanced quality of photographs produced with this method can potentially provide a source of comfort to grieving families.
Collapse
|
34
|
Blood C, Cacciatore J. Best practice in bereavement photography after perinatal death: qualitative analysis with 104 parents. BMC Psychol 2014; 2:15. [PMID: 25815187 PMCID: PMC4362629 DOI: 10.1186/2050-7283-2-15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/29/2014] [Indexed: 11/18/2022] Open
Abstract
Background Postmortem memento photography has emerged in Western hospitals as part of compassionate bereavement care for parents facing perinatal death. Many parents endorse this psychosocial intervention, yet implementation varies greatly and little research on parents’ specific needs guides health care professionals. Parents are in crisis and vulnerable after the death of their child, thus best practice is crucial. This study contributes 104 parents’ experiences and opinions toward the understanding of best practice in perinatal bereavement photography. Methods Parents who experienced the perinatal death of their child were recruited from U.S.-based bereavement organizations and social media sites. Volunteers completed an anonymous internet survey with open- and closed-ended questions. Direct recommendations and pertinent statements regarding the process of postmortem photography were analyzed for thematic content in keeping with conventional content analysis. Recurrent themes and sub-themes were counted to identify response patterns. Results Of 93 parents with pictures, 92 endorsed them. Of 11 without pictures, nine wanted them. Parents made a variety of recommendations regarding appropriate psychosocial support, the consent process, obstacles to photography, logistics of photography, and material aspects of photographs themselves. Overall, parents wanted many pictures and much variety. Some wanted professional photography while others wanted support for taking their own pictures. Parents wanted guidance from staff who respected their particular needs. Many said decisions were difficult during their crisis. Parents who were initially resistant expressed current appreciation for pictures or expressed regret that they had not participated. Parents recommended that professionals strongly encourage parents to create memento photos despite parents’ initial reservations. Persistent cultural reasons against photography emerged in one case. Quotes by parents illuminate themes and enable respondents to speak directly to health care professionals. Conclusions Parents overwhelmingly support postmortem bereavement photography when conducted sensitively, even if imperfectly executed. Providers significantly influence parents during their crises; mindful, patient-centered care with appropriate respect for difference is necessary. Providers must understand the importance of postmortem photographs to parents who have limited opportunity to capture memories of their child. Hospitals should provide education and support for this important psychosocial intervention. Electronic supplementary material The online version of this article (doi:10.1186/2050-7283-2-15) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Cybele Blood
- School of Social Work, Arizona State University, Phoenix, USA
| | | |
Collapse
|
35
|
Blood C, Cacciatore J. Parental grief and memento mori photography: narrative, meaning, culture, and context. DEATH STUDIES 2014; 38:224-233. [PMID: 24524585 DOI: 10.1080/07481187.2013.788584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Postmortem photography is a widespread practice in perinatal bereavement care, yet few studies have explored how it affects bereaved parents, or how it might be received by parents of older children. This study is an examination of the meaning, utility, and social context of postmortem photography in a sample of 181 bereaved parents. Data were subjected to both quantitative and qualitative analysis. Photographs were positively regarded by most parents after perinatal death and several parents of older children. Other parents rejected postmortem photography for aesthetic, personal, or cultural reasons. Brief recommendations are offered for healthcare providers.
Collapse
Affiliation(s)
- Cybele Blood
- a School of Social Work , Arizona State University , Phoenix , Arizona , USA
| | | |
Collapse
|
36
|
Michelson KN, Blehart K, Hochberg T, James K. Bereavement photography for children: program development and health care professionals' response. DEATH STUDIES 2013; 37:513-528. [PMID: 24520925 PMCID: PMC3929211 DOI: 10.1080/07481187.2011.649942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Reports of in-hospital bereavement photography focus largely on stillborns and neonates. Empiric data regarding the implementation of bereavement photography in pediatrics beyond the neonatal period and the impact of such programs on healthcare professionals (HCPs) is lacking. The authors describe the implementation of a pediatric intensive care unit (PICU) bereavement photography program and use questionnaire data from HCPs to describe HCPs' reflections on the program and to identify program barriers. From July 2007 through April 2070, families of 59 (36%) of the 164 patients who died in the PICU participated in our bereavement photography program. Forty questionnaires from 29 HCPs caring for 39 participating patients/families indicated that families seemed grateful for the service (n = 34; 85%) and that the program helped HCPs feel better about their role (n = 30; 70%). Many HCPs disagreed that the program consumed too much of his/her time (n = 34; 85%) and that the photographer made his/her job difficult (n = 37; 92.5%). Qualitative analysis of responses to open-ended questions revealed 4 categories: the program's general value; positive aspects of the program; negative aspects of the program; and suggestions for improvements. Implementing bereavement photography in the PICU is feasible though some barriers exist. HCPs may benefit from such programs.
Collapse
Affiliation(s)
- Kelly Nicole Michelson
- Division of Critical Care Medicine, Children's Memorial Hospital, Chicago, Illinois, USA.
| | - Kathleen Blehart
- Division of Critical Care Medicine, Children's Memorial Hospital, Chicago, Illinois, USA
| | - Todd Hochberg
- Touching Souls Bereavement Photography, and Heartlight, Family Support, Children's Memorial Hospital, Chicago, Illinois, USA
| | - Kristin James
- Heartlight, Family Support, Children's Memorial Hospital, Chicago, Illinois, USA
| |
Collapse
|
37
|
Nikkola I, Kaunonen M, Aho AL. Mother’s experience of the support from a bereavement follow-up intervention after the death of a child. J Clin Nurs 2013; 22:1151-62. [DOI: 10.1111/j.1365-2702.2012.04247.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
38
|
Tejedor Torres J, López de Heredia Goya J, Herranz Rubia N, Nicolás Jimenez P, García Munóz F, Pérez Rodríguez J. Recomendaciones sobre toma de decisiones y cuidados al final de la vida en neonatología. An Pediatr (Barc) 2013; 78:190.e1-190.e14. [DOI: 10.1016/j.anpedi.2012.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 07/16/2012] [Accepted: 07/17/2012] [Indexed: 10/27/2022] Open
|
39
|
Lee KE. Critical review of the literature: Parental grief after the loss of a multiple. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.jnn.2011.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
McGrath JM, Butt ML, Samra H(A. Supporting Parents Who Lose a Child of a Multiple Birth: A Critical Review of Research in the Neonatal Intensive Care Unit. ACTA ACUST UNITED AC 2011. [DOI: 10.1053/j.nainr.2011.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
41
|
Aho AL, Tarkka MT, Astedt-Kurki P, Sorvari L, Kaunonen M. Evaluating a bereavement follow-up intervention for grieving fathers and their experiences of support after the death of a child--a pilot study. DEATH STUDIES 2011; 35:879-904. [PMID: 24501857 DOI: 10.1080/07481187.2011.553318] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article describes a study designed to evaluate the effectiveness of an intervention program for bereaved fathers and their experiences of it in a sample of intervention (n = 62) and control (n = 41) fathers. Data were collected by 3 scales: the Hogan Grief Reactions Checklist, a scale for measuring received social support, and a scale for measuring fathers' experiences of the intervention program. Assessment at 6 months after leaving the hospital showed that intervention fathers reported lower grief reaction scores and stronger personal growth. Intervention fathers reported the most emotional support from both health care personnel and peer supporters. The support received was perceived as helpful in coping, and fathers rated the intervention favorably. The findings support the continuation of the intervention.
Collapse
Affiliation(s)
- Anna Liisa Aho
- School of Health Sciences, University of Tampere, Tampere, Finland.
| | | | | | - Leena Sorvari
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Marja Kaunonen
- School of Health Sciences, University of Tampere, Tampere, Finland
| |
Collapse
|
42
|
Informing parents about the actual or impending death of their infant in a newborn intensive care unit. J Perinat Neonatal Nurs 2011; 25:261-7. [PMID: 21825916 DOI: 10.1097/jpn.0b013e3182259943] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Modern perinatal and neonatal care practices have increased survival of infants that in previous care eras would have perished. The majority of infants admitted to a newborn intensive care unit following delivery currently do well and are discharged home. Unfortunately for others, the ultimate outcome may be death. The death of a newborn infant is clearly a devastating loss to parents. How parents are informed of their infant's actual or impending death can either add to a grief reaction, or help support parents through their loss. The literature supports that most healthcare professionals frequently feel inept while discussing the death of a newborn with the baby's family. This article will present parents' descriptions of what helped or did not help when they were informed of their infant's inevitable death. It will also demonstrate how simulation may be effective in improving communication of bad or sad news to families in a manner that sustains them in the immediate present, as well as adds to their future well-being.
Collapse
|
43
|
Abstract
OBJECTIVE To establish what bereavement care services are available in neonatal units in the United Kingdom and to establish the availability to staff (doctors, nurses, and chaplains) of bereavement education, training, communication, and multicultural support. For families who lose a baby in the neonatal period, the support they receive from hospital staff can be pivotal in their ability to cope with their grief. Hospital staff are not always trained to provide this support. Limited evidence is available regarding hospital-based bereavement care in neonatology or its impact on outcome. INTERVENTIONS Questionnaire survey of selected doctors, nurses, and chaplains in 200 neonatal units in the United Kingdom. MEASUREMENTS AND MAIN RESULTS We had responses from 100% of neonatal units surveyed. Of 600 individuals, 320 responded; 11% of doctors had never received any formal training in bereavement care, compared with 0.8% of nurses and 1.2% and chaplains. In addition, 31% of respondents thought the training they received was inadequate. Knowledge of grief theorists was poor. Up to 99% of units were helping parents create memories through photographs or handprints. Parents were uniformly given the chance to be with their baby at the time of death (99% overall). Siblings were encouraged to be present 71% of the time; 75% of respondents felt that information about the needs of different faith groups was available. Formal psychological support was offered to 45% of families after bereavement. CONCLUSIONS Studies have shown that parents value clear communication, education about grieving, and demonstrated emotional support by staff. Our study has shown that there are deficiencies in staff training and education in this area. Educators must promote the inclusion of content on bereavement/end-of-life care. Additional education on cultural issues would be helpful. Managing the bereavement process well to minimize morbidity for families and healthcare providers is an important challenge for the future.
Collapse
|
44
|
Affiliation(s)
- Scott M Klein
- VNS-NY Hospice, 1250 Broaway, 7th Floor, New York, NY 10001, USA.
| |
Collapse
|
45
|
|
46
|
Warrick C, Perera L, Murdoch E, Nicholl RM. Guidance for withdrawal and withholding of intensive care as part of neonatal end-of-life care. Br Med Bull 2011; 98:99-113. [PMID: 21596714 DOI: 10.1093/bmb/ldr016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Advances in foetal medicine and neonatology have enabled increased antenatal diagnosis of life-limiting conditions and improved preterm survival, escalating the debate surrounding the ethics of neonatal end-of-life care and withholding or withdrawing intensive care. SOURCES OF DATA Literature search of MEDLINE and the Cochrane library databases using the search terms [neonatal palliative care] AND [neonatal AND withdrawal of intensive care and treatment]. Review of consensus statements and guidelines. AREAS OF AGREEMENT UK practice is aided by Grade 3-4 evidence, consensus statements and practice frameworks. There is limited systematic evidence. AREAS OF CONTROVERSY We illustrate UK practice with clinical cases and describe worldwide variations. GROWING POINTS Neonatal end-of-life care incorporating withholding and withdrawing intensive care is not uncommon. The child's 'best interests' take precedent and clinical guidance has been published to support the joint decision-making partnership of clinicians and families. Withholding and withdrawing intensive care should be part of an overall end-of-life care plan incorporating the principles and standards of palliative care. AREAS TIMELY FOR DEVELOPING RESEARCH Further guidance on standards and staff training with regard to communicating and delivering neonatal end-of-life care is required to ensure consistent practice of staff and choices for families. The recommended establishment of neonatal outcome databases should aid UK preterm decision-making (NHS and Department of Health Neonatal Taskforce, Toolkit for high-quality neonatal services, London, Department of Health 2009).
Collapse
Affiliation(s)
- Catherine Warrick
- Neonatal Unit, Northwick Park Hospital, North West London Hospitals NHS Trust, Harrow, UK
| | | | | | | |
Collapse
|
47
|
Aho AL, Åstedt-Kurki P, Tarkka MT, Kaunonen M. Development and implementation of a bereavement follow-up intervention for grieving fathers: an action research. J Clin Nurs 2010; 20:408-19. [DOI: 10.1111/j.1365-2702.2010.03523.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
The BRACELET Study: surveys of mortality in UK neonatal and paediatric intensive care trials. Trials 2010; 11:65. [PMID: 20504341 PMCID: PMC2896344 DOI: 10.1186/1745-6215-11-65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 05/26/2010] [Indexed: 11/23/2022] Open
Abstract
Background The subject of death and bereavement in the context of randomised controlled trials in neonatal or paediatric intensive care is under-researched. The objectives of this phase of the Bereavement and RAndomised ControlLEd Trials (BRACELET) Study were to determine trial activity in UK neonatal and paediatric intensive care (2002-06); numbers of deaths before hospital discharge; and variation in mortality across intensive care units and trials and to determine whether bereavement support policies were available within trials. These are essential prerequisites to considering the implications of future policies and practice subsequent to bereavement following a child's enrolment in a trial. Methods The units survey involved neonatal units providing level 2 or 3 care, and paediatric units providing level II care or above; the trials survey involved trials where allocation was randomized and interventions were delivered to intensive care patients, or to parents but designed to affect patient outcomes. Results Information was available from 191/220 (87%) neonatal units (149 level 2 or 3 care); and 28/32 (88%) paediatric units. 90/177 (51%) eligible responding units participated in one or more trial (76 neonatal, 14 paediatric) and 54 neonatal units and 6 paediatric units witnessed at least one death. 50 trials were identified (36 neonatal, 14 paediatric). 3,137 babies were enrolled in neonatal trials, 210 children in paediatric trials. Deaths ranged 0-278 (median [IQR interquartile range] 2 [1, 14.5]) per neonatal trial, 0-4 (median [IQR] 1 [0, 2.5]) per paediatric trial. 534 (16%) participants died post-enrolment: 522 (17%) in neonatal trials, 12 (6%) in paediatric trials. Trial participants ranged 1-236 (median [IQR] 21.5 [8, 39.8]) per neonatal unit, 1-53 (median [IQR] 11.5 [2.3, 33.8]) per paediatric unit. Deaths ranged 0-37 (median [IQR] 3.5 [0.3, 8.8]) per neonatal unit, 0-7 (median [IQR] 0.5 [0, 1.8]) per paediatric unit. Three trials had a formal policy for responding to bereavement. Conclusions A substantial number of deaths after trial enrolment were identified, distributed over many trials and units. Few trial teams had responses to bereavement in place. Those with the largest numbers of deaths might be best placed to collaborate in developing and assessing responses to bereavement.
Collapse
|
49
|
Einaudi MA, Le Coz P, Malzac P, Michel F, D'Ercole C, Gire C. Parental experience following perinatal death: exploring the issues to make progress. Eur J Obstet Gynecol Reprod Biol 2010; 151:143-8. [PMID: 20430509 DOI: 10.1016/j.ejogrb.2010.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 03/21/2010] [Accepted: 04/01/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study was performed to understand the parental attitudes, needs and ethical issues associated with perinatal death, to assist in the development of interventions for bereaved families. STUDY DESIGN We conducted a qualitative descriptive survey of parental experiences with perinatal death. We developed a questionnaire based on the Delphi method, conducted semi-directed interviews or asked subjects to return the questionnaire by post. As a secondary analysis, we examined whether certain ethical principles (i.e., the concepts of beneficence, nonmaleficence, autonomy, and justice) were encountered by the study participants. The study population consisted of families who had experienced perinatal death in the maternity department of a French university hospital, as well as members of bereaved parent support groups. RESULTS Six of the 12 parents who participated in the survey were members of a support group. Responses were analyzed according to precise objectives and grouped according to key themes. In particular, we studied deaths that occurred during neonatal palliative care and deaths relating to multiple pregnancies. Parents expressed opinions about the caregivers' practices (e.g., which practices were beneficial and detrimental). Half of the parents did not feel that their feelings and decisions were respected according to ethical principles. Understanding the experience of parents allows staff to reconsider and change their practices. CONCLUSIONS By understanding parents' feelings toward neonatal death, caregivers can better assist with the grieving process. Our study reveals parents' attitudes toward the ethical decision-making process and shows that it is difficult for perinatal medicine caregivers to respect parents' autonomy.
Collapse
Affiliation(s)
- M A Einaudi
- Department of Pediatrics-Neonatology, Hôpital Nord, Université de la Méditerranée, Marseille, France.
| | | | | | | | | | | |
Collapse
|