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Xie J, Hunter A, Biesty L, Grealish A. The impact of midwife/nurse-led psychosocial interventions on parents experiencing perinatal bereavement: An integrative review. Int J Nurs Stud 2024; 157:104814. [PMID: 38833996 DOI: 10.1016/j.ijnurstu.2024.104814] [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] [Received: 12/07/2023] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Perinatal loss is a traumatic event associated with a high risk of parents experiencing negative psychological outcomes. Despite most parents being in regular contact with midwives and nurses during the perinatal period, there is a lack of evidence which hampers these professionals from using effective psychosocial interventions with parents. AIM This study aims to synthesise the existing evidence on the types of psychosocial interventions delivered by midwives/nurses for parents with perinatal bereavement, their impacts on bereaved parents' mental health and the experiences of midwives and nurses in delivering psychosocial interventions for parents experiencing perinatal loss. DESIGN An integrative review of the literature. METHODS Whittemore and Knafl's five-stage integrative review framework guided this review. A systematic literature search of the Medline, PsycINFO, Embase, CINAHL and ASSIA, Cochrane Library and ProQuest databases was conducted from inception to January 2023, with no language or geographical limiters set due to the paucity of research published in this subject area. Two researchers independently screened and reviewed each study's data extraction and methodological quality using the Joanna Briggs Institute and Mixed Method Appraisal Tool. Results were analysed and synthesised using narrative synthesis. RESULTS A total of 21 studies met the inclusion criteria. From these, we identified nine types of psychosocial interventions for perinatal bereavement that can be delivered by midwives and nurses. The positive impacts of midwife/nurse-led psychosocial interventions on grief, anxiety, depression posttraumatic stress disorder and other psychosocial outcomes amongst parents experiencing perinatal loss have been demonstrated. In addition, we identified the useful components of these interventions and the experiences of midwives and nurses in delivering psychosocial interventions, thereby highlighting barriers such as lack of knowledge and skills, stressful working environments and inadequate emotional support. CONCLUSION Our findings demonstrate that midwife/nurse-led psychosocial interventions have the potential to improve grief, anxiety, depression, posttraumatic stress disorder symptoms and other psychosocial outcomes for parents experiencing perinatal loss. Thus, future research should consider training, workload, time cost and emotional support for midwives/nurses when developing midwife/nurse-led psychosocial interventions for parents with perinatal loss. REGISTRATION NUMBER CRD42022369032. TWEETABLE ABSTRACT Midwife/nurse-led psychosocial interventions have the potential to improve mental health amongst parents experiencing perinatal loss.
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Affiliation(s)
- Jiaying Xie
- School of Nursing and Midwifery, University of Galway, Galway, Ireland.
| | - Andrew Hunter
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Linda Biesty
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Annmarie Grealish
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland; Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
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Kendrick JIS, Sterrett-Hong E. Navigating Loss Together: A Scoping Review of Couples Therapy Interventions for Perinatal Death. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231212653. [PMID: 37963230 DOI: 10.1177/00302228231212653] [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: 11/16/2023]
Abstract
The loss of a pregnancy at any stage can serve as an enormous stressor to a couple's relationship. However, empirically based interventions to reduce distress after perinatal loss have historically been aimed at the pregnant person, not the couple dyad. This excludes non-birthing individuals from receiving professional support and leads to a deficit in evidence-based therapeutic support for the couple dyad at a time in which a lack of connection has been shown to contribute to poor mental health and relationship outcomes for the individual and couple. This scoping review examines existing couple-based interventions for perinatal loss and the measurement of impact on the individual and couple dyad.
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Affiliation(s)
- Jennifer I S Kendrick
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | - Emma Sterrett-Hong
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
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Bakhbakhi D, Siassakos D, Davies A, Merriel A, Barnard K, Stead E, Shakespeare C, Duffy JMN, Hinton L, McDowell K, Lyons A, Fraser A, Burden C. Interventions, outcomes and outcome measurement instruments in stillbirth care research: A systematic review to inform the development of a core outcome set. BJOG 2023; 130:560-576. [PMID: 36655361 DOI: 10.1111/1471-0528.17390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which have been identified as an important research priority. OBJECTIVES To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. SEARCH STRATEGY Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. SELECTION CRITERIA Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention. DATA COLLECTION AND ANALYSIS Interventions, outcomes reported, definitions and outcome measurement tools were extracted. MAIN RESULTS Forty randomised and 200 non-randomised studies were included. Fifty-eight different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). A total of 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. A total of 242 outcome measurement instruments were used, with 0-22 tools per outcome. CONCLUSIONS Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research.
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Affiliation(s)
| | | | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | | | | | - Emma Stead
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | - Lisa Hinton
- THIS Institute, University of Cambridge, Cambridge, UK
| | | | - Anna Lyons
- Northern General Hospital, Sheffield, UK
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Arach AAO, Nakasujja N, Rujumba J, Mukunya D, Odongkara B, Musaba MW, Napyo A, Tumwine JK, Nankabirwa V, Ndeezi G, Kiguli J. Cultural beliefs and practices on perinatal death: a qualitative study among the Lango community in Northern Uganda. BMC Pregnancy Childbirth 2023; 23:222. [PMID: 37013468 PMCID: PMC10069138 DOI: 10.1186/s12884-023-05550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Perinatal death has profound psychosocial effects on women and their families. Sociocultural contexts influence the burden, rituals and bereaved's support. Little is known about cultural beliefs and practices related to perinatal death. This study explored the cultural perspectives of the Lango community on perinatal death. METHODS This study utilised a focused ethnographic design anchored on a symbolic interactionist framework to understand the meanings attached to beliefs and practices on stillbirth or neonatal death among the Lango community in Lira District, Northern Uganda. Participants were sampled purposively for FGD while key informants were identified through snowballing technique. Data were audio recorded in Lango, transcribed, and later translated, a codebook was developed and data entered into Atlas. ti version 8.4.26 and then coded. It was analysed both deductively and inductively into themes. RESULTS Stillbirth and early neonatal death both attract similar rituals as would an older child. Burial is not rushed and is attended by family members and close friends. Stillbirths and children that die before naming are buried without names. Bereaved families are comforted and encouraged about future pregnancies. Currently, Lango associates the deaths to biomedical explanations such as teenage pregnancies, inadequate pregnancy care, health system challenges and poor health-seeking behaviour, unlike previously when they were attributed to consequences of unacceptable social behaviours, superstitious beliefs and witchcraft. Antenatal care and health facility childbirths are currently preferred over traditional practices for good pregnancy outcomes. CONCLUSION Stillbirth or early neonatal death is viewed as the death of a child, different from other settings. Thus, rituals are performed to honour, create memory, and maintain the connection with deceased babies. Bereaved parents are supported. Health care workers need to provide culturally sensitive support to parents after perinatal loss. The prevailing beliefs of perinatal death cause in terms of biomedical explanations consistent with known determinants and preference for health facility care for prevention creates an opportunity for improving perinatal health.
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Affiliation(s)
- Anna Agnes Ojok Arach
- Department of Nursing and Midwifery, Faculty of Health Sciences, Lira University, P.O Box 1035, Lira, Uganda.
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Mukunya
- Department of Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University Faculty of Medicine, Gulu, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Agnes Napyo
- Department of Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Intervention Science and Maternal Child Health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Arach AAO, Kiguli J, Nankabirwa V, Nakasujja N, Mukunya D, Musaba MW, Napyo A, Tumwine JK, Ndeezi G, Rujumba J. "Your heart keeps bleeding": lived experiences of parents with a perinatal death in Northern Uganda. BMC Pregnancy Childbirth 2022; 22:491. [PMID: 35705910 PMCID: PMC9202140 DOI: 10.1186/s12884-022-04788-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Worldwide, two million babies are stillborn and 1.8 million babies die before completing seven days of life. Approximately 4% of pregnant women in Uganda experience perinatal death. The response following a perinatal death tends to be socio-culturally constructed. Investigating the unique personal experiences of parents from a low-income setting with unique cultural beliefs and practices is crucial for the design and implementation of appropriate interventions. Objective To describe the lived experiences of parents following perinatal death in Lira district, Northern Uganda. Methods A qualitative study was carried out drawing on the tenets of descriptive phenomenology. We conducted 32 in-depth interviews in Lira district, Northern Uganda between August 2019 and September 2020 with 18 women and 14 men who had experienced a stillbirth or an early neonatal death within the preceding 2 years. Participants were selected from different families and interviewed. A local IRB approved the study. All in-depth interviews were audio-recorded, transcribed, translated, and data were analysed using a content thematic approach. Key findings were discussed based on Worden’s Four Tasks of Mourning theory. Results The themes that emerged from the analyses included reaction to the perinatal loss and suggestions for support. The participants’ immediate reactions were pain, confusion, and feelings of guilt which were aggravated by the unsupportive behaviour of health care providers. Men cumulatively lost financial resources in addition to facing multiple stressful roles. Delayed reactions such as pain and worries were triggered by the sight of similar-age-babies, subsequent pregnancy losses, and marital challenges. Participants recommended emotional support and management of postnatal complications for parents faced with perinatal loss. Conclusion Losing a baby during the perinatal period in a resource-constrained setting negatively affected both gender. In addition, men suffered the loss of financial resources and the burden of multiple stressful roles. Acknowledging the pain and offering support to the grieving parents reinforce their coping with a perinatal loss. In addition to family and community members, health care providers need to provide emotional support and postnatal care to parents who experience perinatal death.
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Affiliation(s)
- Anna Agnes Ojok Arach
- Department of Nursing and Midwifery, Faculty of Health Sciences, Lira University, Lira, Uganda. .,Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.,Centre for Intervention Science and Maternal Child Health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Quinn S, Dierckx E, Long T, Rowland AG. Sudden Unexpected Death in Childhood in Greater Manchester (United Kingdom): A Five-Year Review (2015–2020). Compr Child Adolesc Nurs 2022; 45:349-367. [DOI: 10.1080/24694193.2022.2047828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Siobhan Quinn
- Lead Employer, St Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, UK
- Department of Community Paediatrics, Manchester Local Care Organisation (MLCO), Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Elizabeth Dierckx
- Department of Community Paediatrics, Manchester Local Care Organisation (MLCO), Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Tony Long
- School of Health and Society, The University of Salford, Frederick Road Campus, Salford, UK
| | - Andrew Graeme Rowland
- Lead Employer, St Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, UK
- Department of Community Paediatrics, Manchester Local Care Organisation (MLCO), Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
- School of Health and Society, The University of Salford, Frederick Road Campus, Salford, UK
- Emergency Department, North Manchester General Hospital, Manchester, UK
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7
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Sudden Unexpected Death in Infancy [SUDI]: What the clinician, pathologist, coroner and researchers want to know. Paediatr Respir Rev 2022; 41:14-20. [PMID: 34998675 DOI: 10.1016/j.prrv.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Abstract
The loss of an apparently healthy infant is confronting for any family, puzzling for a clinician and challenging for the pathologist charged with the task of demonstrating a cause for death. The term "cot death" evolved to "sudden infant death syndrome" [SIDS] and now "sudden unexpected death in infancy [SUDI]" as the epidemiology and pathology of infant death changed. Community interventions were successful in changing sleep practices for young babies. The current research focus is on understanding genetic predispositions to unexpected death in early childhood. Whilst much has been achieved in reducing the infant mortality rate from SUDI by between 50%, and 80% in some countries, over the last 30 years, there remain challenges for improving rates of accurate diagnosis and reaching out to more vulnerable families with clearly modifiable risk factors for SUDI. These challenges directly involve the clinician through taking a systematic and detailed history and better standardised death scene evaluations with specifically accredited assessors. Better knowledge regarding circumstances of SUDI cases will help Coroners and researchers provide answers for grieving families now, and in the future contribute to further reductions in the rate of SUDI in communities across the world.
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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
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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
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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.
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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
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10
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Breen LJ, O'Connor M. The Fundamental Paradox in the Grief Literature: A Critical Reflection. OMEGA-JOURNAL OF DEATH AND DYING 2016; 55:199-218. [DOI: 10.2190/om.55.3.c] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A key theme in the bereavement literature is the recognition that every grief experience is unique and dependent on many variables, such as the circumstances of the death, characteristics of the bereaved individual, their relationship with the deceased, the provision and availability of support, and a myriad of sociocultural factors. Concurrently, there are corresponding efforts to define “normal” grief and delineate it from “complicated” grief experiences. The discord between these two potentially opposing statements remains a paradox evident within the three major tensions within the thanatological literature—the dominance of grief theories, the medicalization of grief, and the efficacy of grief interventions. Three recommendations for moving beyond the paradox are discussed—the provision of improved grief education for service providers, the bereaved, and the wider community; the conduct of research that emphasizes the context of grief and is relevant to service provision; and the examination of current grief interventions.
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Ellis A, Chebsey C, Storey C, Bradley S, Jackson S, Flenady V, Heazell A, Siassakos D. Systematic review to understand and improve care after stillbirth: a review of parents' and healthcare professionals' experiences. BMC Pregnancy Childbirth 2016; 16:16. [PMID: 26810220 PMCID: PMC4727309 DOI: 10.1186/s12884-016-0806-2] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/18/2016] [Indexed: 11/16/2022] Open
Abstract
Background 2.7 million babies were stillborn in 2015 worldwide; behind these statistics lie the experiences of bereaved parents. The first Lancet series on stillbirth in 2011 described stillbirth as one of the “most shamefully neglected” areas of public health, recommended improving interaction between families and frontline caregivers and made a plea for increased investment in relevant research. Methods A systematic review of qualitative, quantitative and mixed-method studies researching parents and healthcare professionals experiences of care after stillbirth in high-income westernised countries (Europe, North America, Australia and South Africa) was conducted. The review was designed to inform research, training and improve care for parents who experience stillbirth. Results Four thousand four hundred eighty eight abstracts were identified; 52 studies were eligible for inclusion. Synthesis and quantitative aggregation (meta-summary) was used to extract findings and calculate frequency effect sizes (FES%) for each theme (shown in italics), a measure of the prevalence of that finding in the included studies. Researchers’ areas of interest may influence reporting of findings in the literature and result in higher FES sizes, such as; support memory making (53 %) and fathers have different needs (18 %). Other parental findings were more unexpected; Parents want increased public awareness (20 %) and for stillbirth care to be prioritised (5 %). Parental findings highlighted lessons for staff; prepare parents for vaginal birth (23 %), discuss concerns (13 %), give options & time (20 %), privacy not abandonment (30 %), tailored post-mortem discussions (20 %) and post-natal information (30 %). Parental and staff findings were often related; behaviours and actions of staff have a memorable impact on parents (53 %) whilst staff described emotional, knowledge and system-based barriers to providing effective care (100 %). Parents reported distress being caused by midwives hiding behind ‘doing’ and ritualising guidelines whilst staff described distancing themselves from parents and focusing on tasks as coping strategies. Parents and staff both identified the need for improved training (parents 25 % & staff 57 %); continuity of care (parents 15 % & staff 36 %); supportive systems & structures (parents 50 %); and clear care pathways (parents 5 %). Conclusions Parents’ and healthcare workers’ experiences of stillbirth can inform training, improve the provision of care and highlight areas for future research. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0806-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alison Ellis
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.
| | - Caroline Chebsey
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK
| | | | | | | | - Vicki Flenady
- Mater Research Institute -The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Alexander Heazell
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Dimitrios Siassakos
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.,University of Bristol, School of Social & Community Medicine, Bristol, UK
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12
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Endo K, Yonemoto N, Yamada M. Interventions for bereaved parents following a child's death: A systematic review. Palliat Med 2015; 29:590-604. [PMID: 25805741 DOI: 10.1177/0269216315576674] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND A child's death is one of the most stressful events that parents and siblings may experience. Interventions for bereaved families following a child's death have been examined over the last several decades. However, there is little high-quality evidence to support any rationale for determining optimal interventions for bereaved parents and siblings. AIM This study objectives were to evaluate the efficacy of interventions for bereaved parents and siblings following a child's death, to collect empirical evidence of the quality of these intervention studies, and to identify methodological challenges. DESIGN A systematic review of data from randomized controlled trials of interventions for parents or siblings bereaved after a child loss. DATA SOURCES We searched MEDLINE (from 1949), PsycINFO (from 1806), and CINAHL (from 1806) databases for key terms and checked the reference lists of potentially relevant articles. RESULTS We identified nine articles describing eight eligible trials from which we extracted data. The four types of intervention included support groups, counseling, psychotherapy, and crisis intervention. Most intervention trials showed some effect on participants in at least one outcome measure. However, we identified many severe methodological issues and outcome sets in these trials. CONCLUSION Very little evidence of sufficient quality is available to confirm the effects of intervention measures on bereaved parents and siblings following a child's death. Well-designed randomized controlled trials are needed to improve our understanding of the efficacy and implementation of interventions targeting bereaved parents and siblings.
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Affiliation(s)
- Kaori Endo
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Ratislavová K, Kalvas F, Beran J. Validation of the Czech version of the Perinatal grief scale. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2015. [DOI: 10.15452/cejnm.2015.06.0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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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.
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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
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Raitio K, Kaunonen M, Aho AL. Evaluating a bereavement follow-up intervention for grieving mothers after the death of a child. Scand J Caring Sci 2015; 29:510-20. [PMID: 25623822 DOI: 10.1111/scs.12183] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/17/2014] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to produce information about parental grief intervention and its impacts on maternal grief. BACKGROUND The grief after death of a child is a lifelong process. Social support is often stated as the most important factor in coping after the death of a child. DESIGN A single measure post-test control group design was used to evaluate whether there are differences in the grief reactions between the mothers in the intervention program (n = 83) and the mothers in the control group (n = 53). METHOD The data were collected by using a questionnaire which included background variables and Hogan Grief Reactions Checklist 6 months after the child's death. The data were analysed by statistical methods. RESULTS There were no significant differences in the grief reactions between the intervention group and the control group. However, greater support from the healthcare professionals was associated with stronger personal growth. The mothers' age, self-perceived health status and the age of deceased child were associated with the grief reactions. This study emphasises the importance of social support to grieving mothers. CONCLUSION Health care professionals are in an important role when considering support for grieving mothers; the given support may relieve the mothers' grief reactions.
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Affiliation(s)
- Katja Raitio
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Marja Kaunonen
- School of Health Science, University of Tampere, Tampere, Finland.,Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Anna Liisa Aho
- School of Health Science, University of Tampere, Tampere, Finland.,Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
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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.
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Affiliation(s)
- Cybele Blood
- School of Social Work, Arizona State University, Phoenix, USA
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17
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Aho AL, Åstedt-Kurki P, Kaunonen M. Peer Supporters' Experiences of a Bereavement Follow-up Intervention for Grieving Parents. OMEGA-JOURNAL OF DEATH AND DYING 2014; 68:347-66. [DOI: 10.2190/om.68.4.d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to describe the experiences of peer supporters of a bereavement intervention for grieving parents and how the program should be developed further. The intervention included: a support package for grieving parents, peer supporters' contact, and healthcare personnel's contact with parents. The sample included 16 peer supporters. Data were collected via open-format questionnaires and telephone interviews and analyzed by content analysis. Peer supporters perceived the intervention and its viability as mostly good. Parents' willingness to receive support and peer supporters' good resources were important for the follow-up contact. However, the peer sup-porters' resources were insufficient to meet parents' unexpected needs. Continuous training and systematic supervision of peer supporters is needed. Study results suggest that support interventions aimed at grieving families need a greater number of male supporters, as fathers hope to receive more support from their male counterparts. Inter-organizational cooperation in supporting parents is important and must be further developed.
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18
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Gear R. Bereaved Parents' Perspectives on Informal Social Support: “What Worked for You?”. JOURNAL OF LOSS & TRAUMA 2014. [DOI: 10.1080/15325024.2013.763548] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stroebe M, Schut H, Finkenauer C. Parents coping with the death of their child: From individual to interpersonal to interactive perspectives. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/19424620.2013.819229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Koopmans L, Wilson T, Cacciatore J, Flenady V. Support for mothers, fathers and families after perinatal death. Cochrane Database Syst Rev 2013; 2013:CD000452. [PMID: 23784865 PMCID: PMC7086381 DOI: 10.1002/14651858.cd000452.pub3] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Provision of an empathetic, sensitive, caring environment and strategies to support mothers, fathers and their families experiencing perinatal death are now an accepted part of maternity services in many countries. Interventions such as psychological support or counselling, or both, have been suggested to improve outcomes for parents and families after perinatal death. OBJECTIVES To assess the effect of any form of intervention (i.e. medical, nursing, midwifery, social work, psychology, counselling or community-based) on parents and families who experience perinatal death. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and article bibliographies. SELECTION CRITERIA Randomised trials of any form of support aimed at encouraging acceptance of loss, bereavement counselling, or specialised psychotherapy or counselling for mothers, fathers and families experiencing perinatal death. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility of trials. MAIN RESULTS No trials were included. AUTHORS' CONCLUSIONS Primary healthcare interventions and a strong family and social support network are invaluable to parents and families around the time a baby dies. However, due to the lack of high-quality randomised trials conducted in this area, the true benefits of currently existing interventions aimed at providing support for mothers, fathers and families experiencing perinatal death is unclear. Further, the currently available evidence around the potential detrimental effects of some interventions (e.g. seeing and holding a deceased baby) remains inconclusive at this point in time. However, some well-designed descriptive studies have shown that, under the right circumstances and guided by compassionate, sensitive, experienced staff, parents' experiences of seeing and holding their deceased baby is often very positive. The sensitive nature of this topic and small sample sizes, make it difficult to develop rigorous clinical trials. Hence, other research designs may further inform practice in this area. Where justified, methodologically rigorous trials are needed. However, methodologically rigorous trials should be considered comparing different approaches to support.
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Affiliation(s)
- Laura Koopmans
- MaterMedical Research Institute,MaterHealth Services,Woolloongabba, Australia.
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21
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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]
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22
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Scheidt CE, Hasenburg A, Kunze M, Waller E, Pfeifer R, Zimmermann P, Hartmann A, Waller N. Are individual differences of attachment predicting bereavement outcome after perinatal loss? A prospective cohort study. J Psychosom Res 2012; 73:375-82. [PMID: 23062812 DOI: 10.1016/j.jpsychores.2012.08.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/25/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the influence of attachment, social support and the quality of the current partnership on the outcome of bereavement after perinatal loss. METHODS In a prospective cohort design 33 women after perinatal loss were approached on admission to hospital and reassessed four weeks, four months and nine months later. The initial assessment included the Adult Attachment Interview and self-report questionnaires for social support and quality of the current partnership. Bereavement outcome was assessed using measures of grief (MTS), depression and anxiety (HADS), psychological distress (BSI), somatisation (BSI-SOM) and symptoms of PTSD (PDS). RESULTS All measures of outcome showed a significant improvement over time. Standardized effect sizes between the initial assessment and nine month follow-up ranged between .36 for anxiety (HADS) and 1.02 for grief (MTS). Social support, quality of the partnership and secure attachment correlated inversely, and insecure preoccupied attachment correlated positively with the outcome measures. Preoccupied attachment was included as a predictor in two multivariate statistical models of non-linear regression analysis, one with somatisation (adjusted R2=.698, P=.016), the other with posttraumatic stress symptoms at nine month follow-up (adjusted R2=.416, P=.002) as target variable. Initial assessment scores of psychological distress predicted the course of the respective measure during follow-up (adjusted R2=.432, P=.014). CONCLUSION Attachment, social support and the quality of the current partnership have an impact on the course of bereavement after perinatal loss. Secondary prevention after the event may focus on these factors in order to offer specific counselling and support.
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Affiliation(s)
- C E Scheidt
- Freiburg Institute of Advanced Studies, Interdisciplinary Research Groups, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Germany.
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Begovac B, Begovac I. Dreams of deceased children and countertransference in the group psychotherapy of bereaved mothers: clinical illustration. DEATH STUDIES 2012; 36:723-741. [PMID: 24563938 DOI: 10.1080/07481187.2011.584014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article presents, in the form of a clinical illustration, a therapeutic group of bereaved mothers with special reference to their dreams about their deceased children. The article presents descriptions of the emotions of these mothers and countertransference feelings, a topic that, to our knowledge, has not been frequently studied. The group was small, analytically oriented, slow-open, comprised of women bereaved by the death of a child, and conducted by a female therapist. Over more than three years, the group included 20 members in total. This article describes a number of dreams recorded during a period when the group included seven members. Dreams helped the group members access their emotional pain, helplessness, yearning for a relationship with the deceased, guilt, and feelings of survival guilt. The transference-countertransference relationships were characterized by holding. Countertransference feelings of helplessness predominated. The therapist and the group as a whole contained various emotions, allowing the group members to return to the normal mourning processes from the parallel encouragement of group development and interpersonal relationships.
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Affiliation(s)
- Branka Begovac
- Department of Psychiatry, Clinical Hospital Center, Zagreb, Croatia.
| | - Ivan Begovac
- Department of Psychological Medicine, School of Medicine, University Zagreb, Clinical Hospital Center, Zagreb, Croatia
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24
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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]
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25
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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.
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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
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26
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Macnab AJ, Northway T, Ryall K, Scott D, Straw G. Death and bereavement in a paediatric intensive care unit: Parental perceptions of staff support. Paediatr Child Health 2011; 8:357-62. [PMID: 20052329 DOI: 10.1093/pch/8.6.357] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine which staff behaviours and interventions were helpful to a family who had a child die in the intensive care unit (ICU) and which behaviours could be improved. METHODS Families whose child died six to 18 months earlier were invited to participate. Families whose child's death involved a coroner's inquiry were excluded. Family members were interviewed by a grief counselor, and completed the Grief Experience Inventory Profile and an empirically designed questionnaire. RESULTS No family refused to participate. All family members (13 families, 24 individuals) reported that they wanted, were offered and had: time to be alone with their child, time to hold the child, chances to discuss their feelings, and an opportunity to cry and express their emotions openly. Tangible mementos of the child were appreciated. Support provided by nursing staff was rated as excellent. Some physicians appeared to be abrupt, cold and unfeeling. Hospital social workers and chaplains, when available, were appreciated. Parents valued access to private space and holding their child, but these options needed to be suggested, as they did not know to ask for them. Some families wanted more information about funeral arrangements; most wanted more timely information about autopsy results and feedback on organ donations. Follow-up contact from the hospital about four weeks after the death was valued. Families saw the study as an opportunity to provide feedback that may help others. CONCLUSIONS Many acute bereavement interventions need to be initiated by staff because families do not know to request them. Physicians do not always meet individual family's needs for support. Contact initiated by staff following a death is appreciated.
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Affiliation(s)
- Andrew J Macnab
- Intensive Care Unit, Children's and Women's Health Centre of British Columbia, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
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Michon B, Balkou S, Hivon R, Cyr C. Death of a child: Parental perception of grief intensity - End-of-life and bereavement care. Paediatr Child Health 2011; 8:363-6. [PMID: 20052330 DOI: 10.1093/pch/8.6.363] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The death of a child is a tragedy resulting in family trauma and disorganization. The present study sought to evaluate the intensity of grief experienced by parents who have lost a child in the perinatal period (stillbirth, premature baby, term baby less than one month) and parents who have lost a child after the perinatal period (one month to 18 years). METHOD To compare the intensities of the bereavement reactions among grieving parents and to follow the course of such phenomena, a detailed bereavement questionnaire (the French version of the Texas Revised Inventory of Grief [TRIG-F]) was used. The TRIG-F is a three-part questionnaire that quantifies the intensity of grief near the time of death and in the present, and the perceived capacity of coping. RESULTS Seventy-one bereaved parents, representing 43 families, completed the questionnaire. Parents who lost a child after the perinatal period showed grief at a higher intensity, measured by the TRIG-F, than parents who had lost a child in the perinatal period (83+/-22 versus 69+/-20 [mean+/-SD]; P=0.004). Mothers expressed a greater intensity of grief than fathers. No significant difference between mothers of the perinatal group and mothers of the postperinatal group was shown. Sudden death and death ocurring at home were associated with a higher grief intensity. CONCLUSION Bereavement after the loss of a newborn or an older child is intense and prolonged. These findings support the importance of bereavement care for grieving parents and suggest that these parents appreciate help from health care professionals.
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28
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Murray JA. LOSS AS A UNIVERSAL CONCEPT: A REVIEW OF THE LITERATURE TO IDENTIFY COMMON ASPECTS OF LOSS IN DIVERSE SITUATIONS. JOURNAL OF LOSS & TRAUMA 2011. [DOI: 10.1080/108114401753201679] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Reilly D, Huws J, Hastings R, Vaughan F. Life and death of a child with down syndrome and a congenital heart condition: experiences of six couples. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2010; 48:403-416. [PMID: 21166547 DOI: 10.1352/1934-9556-48.6.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Individuals with Down syndrome are at increased risk of congenital heart conditions (CHCs), and mortality is higher in people with Down syndrome and a CHC than those without (J. C. Vis et al., 2009). As a consequence, parents of children with Down syndrome and a CHC are more likely to outlive their child. In this research, semistructured interviews were used to explore the experiences of 6 couples whose child with Down syndrome and a CHC had died. The interviews were analyzed qualitatively using interpretative phenomenological analysis (IPA), and 4 themes emerged: dilemmas associated with the dual diagnosis; treatment decisions during the life and the death of their child ("We had to make a decision"); ways couples coped when bereaved ("We weren't really going through it together"); and ripples from the child's life. There was a high degree of similarity of experience within couples. Differences between couples existed in their experiences of coping and supporting each other. Practical implications include the importance of considering the specific needs of couples, individuals, and fathers within partnerships.
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Affiliation(s)
- Deirdre Reilly
- School of Psychology, University of East London, London, UK.
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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]
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Liisa AA, Marja-Terttu T, Päivi ÅK, Marja K. Health care personnel's experiences of a bereavement follow-up intervention for grieving parents. Scand J Caring Sci 2010; 25:373-82. [PMID: 21039718 DOI: 10.1111/j.1471-6712.2010.00837.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study is to investigate the experiences of health care personnel of a bereavement follow-up intervention for grieving parents and of the ways to develop it. The intervention included three components: a support package for grieving parents, peer supporters' and health care personnel's contact with parents. The sample included 29 health professionals. Data were collected via open-format questionnaires and telephone interviews from health care personnel. Content analysis was used as a means of data analysis. The support package for grieving parents was considered important and versatile. Health care personnel perceived the intervention and its viability as mostly good. Parents' willingness to receive support, health care personnel's good resources and organizational preconditions were important for the follow-up contact. The intervention clarified the policy related to supporting grieving parents. It was enabled by a good attitude, shift arrangements and co-worker support. However, the implementation was considered difficult because of scarce resources. Parental support engendered negative feelings in health care personnel and they desired systematic supervision to deal with these. Follow-up care of grieving parents is a demanding task. Continuous education about bereavement follow-up care and systematic supervision to health care personnel is needed. Family-focused care in supporting grieving families after leaving from hospital should be increased. Inter-organizational cooperation in supporting parents is important and feasible.
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Affiliation(s)
- Aho Anna Liisa
- Department of Nursing Science, University of Tampere, Pirkanmaa Hospital District, Tampere University Hospital (TAYS), Tampere, Finland.
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Dyregrov K. How do the young suicide survivors wish to be met by psychologists? A user study. OMEGA-JOURNAL OF DEATH AND DYING 2009; 59:221-38. [PMID: 19791518 DOI: 10.2190/om.59.3.c] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Little user-knowledge has been documented on the experiences of young suicide bereaved with psychosocial assistance and therapy. Thirty-two adolescents who had lost a close family member or friend by suicide participated in a research project by filling in questionnaires and participating in focus group interviews. The article explores the young people's experiences with and wishes for help from psychologists, and shows that the young bereaved do not receive the psychological assistance they wish for and need. The shortcomings are discussed in relation to the organization, form, and contents of the help. In order to reach youth with adequate assistance in an extreme life situation, it is worth listening to their opinions about how they want to be approached in the wake of a suicide.
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Abstract
BACKGROUND Provision of an empathetic caring environment, and strategies to enable the mother, father and family to accept the reality of perinatal death, are now an accepted part of standard nursing and social support in most of the developed world. Provision of interventions such as psychological support or counselling, or both, has been suggested to improve outcomes for families after a perinatal death. OBJECTIVES The objective of this review was to assess the effects of the provision of any form of medical, nursing, social or psychological support or counselling, or both, to mother, father and families after perinatal death. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 October 2007) and reference lists of articles. SELECTION CRITERIA Randomised trials of any form of general support aimed at encouraging acceptance of loss, specific bereavement counselling, or specialised psychological support/counselling including psychotherapy for mother, father and families experiencing perinatal death. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility of trials; a third person subsequently assessed the quality of the identified trials as a part of this review update. MAIN RESULTS No trials were included. AUTHORS' CONCLUSIONS There is currently insufficient information available from randomised trials to indicate whether there is or is not a benefit from interventions which aim to provide psychological support or counselling for mothers, fathers or families after perinatal death. Methodologically rigorous trials are needed.
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Affiliation(s)
- V Flenady
- Women's and Children's Health Service, Centre for Clinical Studies-Women's and Children's Health, Mater Health Services, Raymond Tce, South Brisbane, Queensland, Australia 4101.
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Abstract
In this Review, we look at the relation between bereavement and physical and mental health. Although grief is not a disease and most people adjust without professional psychological intervention, bereavement is associated with excess risk of mortality, particularly in the early weeks and months after loss. It is related to decrements in physical health, indicated by presence of symptoms and illnesses, and use of medical services. Furthermore, bereaved individuals report diverse psychological reactions. For a few people, mental disorders or complications in the grieving process ensue. We summarise research on risk factors that increase vulnerability of some bereaved individuals. Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of coping) are likely to co-determine excesses in ill-health. We also assess the effectiveness of psychological intervention programmes. Intervention should be targeted at high-risk people and those with complicated grief or bereavement-related depression and stress disorders.
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Affiliation(s)
- Margaret Stroebe
- Research Institute for Psychology and Health, Utrecht University, Utrecht, Netherlands.
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Cimete G, Kuguoglu S. Grief Responses of Turkish Families after the Death of their Children from Cancer. JOURNAL OF LOSS & TRAUMA 2006. [DOI: 10.1080/15325020500194455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
There is scarce research on "the forgotten bereaved"--the children and adolescents who lose a sibling by suicide. In this paper we explore their psychosocial situation and needs for assistance through a Norwegian nationwide study. The results show that particularly younger bereaved siblings are suffering from posttraumatic and grief reactions, depression, and anxiety. Most of the difficulties are not individual, but rather relational and social in nature, and largely contextually dependent. Necessary help is impeded due to the extraordinary experience leaving the siblings outside the circle of friends and parental grief community. A systematic outreach help program is presented.
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Abstract
This paper reviews quantitative evaluations of the efficacy of intervention programs designed to reduce the pain and suffering associated with bereavement. After identifying the psychological and physical health impacts of bereavement and outlining the prevalence of detrimental outcomes, we conclude that a minority of bereaved persons experience severe and sometimes lasting consequences, whereas the majority manage to overcome their grief across the course of time. We detail criteria for establishing the efficacy of bereavement intervention and examine the impact of intervention according to these stringent criteria. We critically examine previous reviews and summarize their conclusions. Using a narrative review approach, we apply a public health framework to organize intervention programs into primary, secondary, and tertiary prevention strategies. A comprehensive, updated review of empirical studies in these categories leads to the following conclusions: Routine intervention for bereavement has not received support from quantitative evaluations of its effectiveness and is therefore not empirically based. Outreach strategies are not advised, and even provision of intervention for those who believe that they need it and who request it should be carefully evaluated. Intervention soon after bereavement may interfere with "natural" grieving processes. Intervention is more effective for those with more complicated forms of grief. Finally, a research agenda is outlined that includes the use of rigorous design and methodological principles in both intervention programs themselves and in studies evaluating their efficacy; systematic investigation of "risk factors"; and comparison of relative effectiveness of different intervention programs (i.e., what works for whom).
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Affiliation(s)
- Henk Schut
- Department of Clinical Psychology, Utrecht University, the Netherlands.
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Wagner B, Knaevelsrud C, Maercker A. Internet-Based Treatment for Complicated Grief: Concepts and Case Study. JOURNAL OF LOSS & TRAUMA 2005. [DOI: 10.1080/15325020590956828] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gwyther LP, Altilio T, Blacker S, Christ G, Csikai EL, Hooyman N, Kramer B, Linton J, Raymer M, Howe J. Social work competencies in palliative and end-of-life care. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2005; 1:87-120. [PMID: 17387058 DOI: 10.1300/j457v01n01_06] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Social workers from clinical, academic, and research settings met in 2002 for a national Social Work Leadership Summit on Palliative and End-of-Life Care. Participants placed the highest priority on the development and broad dissemination of a summary document of the state-of-the-art practice of social work in palliative and end-of-life care. Nine Summit participants reviewed the literature and constructed this detailed description of the knowledge, skills, and values that are requisite for the unique, essential, and appropriate role of social work. This comprehensive statement delineates individual, family, group, team, community, and organizational interventions that extend across settings, cultures, and populations and encompasses advocacy, education, training, clinical practice, community organization, administration, supervision, policy, and research. This document is intended to guide preparation and credentialing of professional social workers, to assist interdisciplinary colleagues in their collaboration with social workers, and to provide the background for the testing of quality indicators and "best practice" social work interventions.
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Affiliation(s)
- Lisa P Gwyther
- Duke University Institute on Care at the End of Life, Duke University Medical Center, Durham, NC 27710, USA
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Dyregrov K. Strategies of professional assistance after traumatic deaths: Empowerment or disempowerment? Scand J Psychol 2004; 45:181-9. [PMID: 15016272 DOI: 10.1111/j.1467-9450.2004.00393.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Referring to research and theory in the field, this discussion paper addresses the more overarching question of current strategies for professional assistance to populations bereaved by traumatic death. The issues and controversies that have long surrounded the "medicalization" of mental health arise anew with respect to the medicalization and professionalization of psychosocial help for people who have been traumatically bereaved. Who should provide what help and how? To what extent should the bereaved be expected to help themselves, receive help and support from friends and family, or even the wider community; and to what extent should the bereaved be able to access appropriate professional help when they are in crisis? Recent studies have indicated that bereaved parents want to receive help from mainstream crisis psychology, and this is not always available. Families experiencing traumatic bereavement are not able to access appropriate services along the same lines as those suffering similar levels of somatic complaints. It is argued that the main factors contributing to this situation are the lack of knowledge and inadequate organization of services; the fact that somatic issues take priority over psychosocial difficulties and dysfunction, and curative services over prophylactic intervention; and particularly the de-medicalization ideology. By not listening to the needs of user groups, the de-medicalization movement disempowers rather than empowers users - the very opposite of the desired effect.
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Abstract
Most bereavement caregivers accept as a truism that their interventions are helpful. However, an examination of the bereavement intervention literature suggests that the scientific basis for accepting the efficacy of grief counseling may be quite weak. This article summarizes the findings of four recent qualitative and quantitative reviews of the bereavement intervention literature. It then discusses three possible explanations for these surprising findings and concludes with recommendations for both researchers and clinicians in thanatology that could help to focus efforts to answer the questions of when and for whom grief counseling is helpful.
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Dyregrov K. Assistance from local authorities versus survivors' needs for support after suicide. DEATH STUDIES 2002; 26:647-668. [PMID: 12243197 DOI: 10.1080/07481180290088356] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
As part of a larger study, this article describes the local authorities in Norway as providers of help and survivors as recipients of help after the suicide of a young person (<30 years) in 83 families. A questionnaire developed for this study maps the extent of professional community support as reported by parent survivors (N = 128). Additionally, 41 survivors described the quality of the assistance through in-depth interviews. Another questionnaire assesses the provisions and the organization of intervention strategies in local communities. Personnel in 321 of Norway's 481 municipalities responded. Although survivors' wishes for ideal support coincide with recommendations by experts in the field, local authorities lack the organization to fulfill such expectations. The discussion highlights issues relating to content, organization, and ideology of the assistance.
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Rowa-Dewar N. Do interventions make a difference to bereaved parents? A systematic review of controlled studies. Int J Palliat Nurs 2002; 8:452-7. [PMID: 12362126 DOI: 10.12968/ijpn.2002.8.9.10690] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The provision of bereavement support for parents who have lost a child is based on the assumption that it will lead to better subsequent adjustment. To determine the validity of this assumption, a systematic review of studies was undertaken, looking at bereavement support programmes for parental grief between 1990 and 2001. This review focused on controlled studies. The exclusion of non-controlled studies, case studies and those using only participant evaluation as an outcome measure, left only three studies. No overall benefit for the interventions was shown. However, for highly distressed mothers, psychological symptoms and marital dysfunction were significantly reduced. Disparities in the findings, such as the effects of interventions on fathers, may be explained by flawed methodology. Applied to practice, these findings suggest that only some bereaved parents benefit from bereavement support programmes. A targeted approach may therefore be the best use of resources.
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Abstract
BACKGROUND Provision of an empathetic caring environment, and strategies to enable the mother and family to accept the reality of perinatal death, are now part of standard nursing and social support in most of the developed world. OBJECTIVES The objective of this review was to assess the effects of the provision of any form of medical, nursing, social or psychological support and/or counselling to mothers and families after perinatal death. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register, Medline (1966 to 1998) and reference lists of articles. SELECTION CRITERIA Randomised trials of any form of general support aimed at encouraging acceptance of loss, specific bereavement counselling, or specialised psychological support/counselling including psychotherapy for women and families experiencing perinatal death. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed eligibility of trials. MAIN RESULTS No trials were included. REVIEWER'S CONCLUSIONS No information is available from randomised trials to indicate whether there is or is not a benefit from providing specific psychological support or counselling after perinatal death.
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Affiliation(s)
- H M Chambers
- Pathology Services, King Edward Memorial and Princess Margaret Hospitals, 374 Bagot Road, Subiaco, Western Australia, Australia, 6008.
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