The space in between: narratives of silence and genetic terminations

The witnessing of disenfranchised grief: reliability and validity

BACKGROUND AND PURPOSE

To examine the psychometric properties of a newly designed instrument: Witnessing of Disenfranchised Grief (WDG).

METHODS

The 22-item questionnaire was administered to a community-based sample of convenience (N = 201). Each subject reported having experienced a loss by death or miscarriage. There was no stipulation regarding the timing of the loss.

RESULTS

The tool was found to be one dimensional with factor loadings of 0.40-0.78, inter-item correlation ranging from p < .01 to p < .05, and a Cronbach's alpha of 0.91. A loss that was viewed as witnessed resulted in decreased manifestation of some grief symptoms.

CONCLUSIONS

The WDG is a measure of the degree to which one who grieves perceives their loss to be witnessed.

What parents say about disclosing the end of their pregnancy due to fetal abnormality

OBJECTIVE

to describe men's and women's experiences of deciding whether to tell people in their social network, including their children, about their pregnancy loss following a termination for fetal abnormality.

DESIGN

secondary analysis of qualitative narrative interview data informed by a critical realist approach.

SETTING

respondents were recruited throughout the United Kingdom and interviewed at home between 2004 and 2005.

PARTICIPANTS

twenty-eight women and nine men who had ended a pregnancy diagnosed with a fetal abnormality and who talked about disclosing or not disclosing the termination to others.

FINDINGS

few respondents reported having any advice or information about whether or how to disclose their termination. None said they completely concealed their decision from adults in their social network; most said they disclosed selectively, telling close friends and family they had terminated and acquaintances they had miscarried. Most respondents reported telling their young children that the baby had died but did not reveal that they had chosen to end the pregnancy. A minority had not told their existing offspring about the pregnancy loss. Common reasons given for (partially) concealing a termination were: guilt over the decision; to avoid being judged; and to protect other people's feelings. Common reasons for disclosure were: others knew of the pregnancy; needing time off work; needing practical help and/or emotional support during diagnosis and termination; and wanting recognition of their loss. Positive consequences of disclosure were said to be getting more support and less criticism than expected; negative consequences included not getting the anticipated support and empathy; and encountering disapproval. Some respondents felt that concealing their pregnancy loss from their children had resulted in their confusion over the cause of their parents' distress. Some men said they found it hard to access emotional support from their social networks because of expectations about how men 'should' deal with emotions.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

midwives have to make difficult judgements about what, how and when to provide information when trying to support and advise parents who have ended a pregnancy due to fetal abnormality. Further education and training in this area could be of benefit. Midwives could signpost parents to existing sources of advice around disclosure, taking into account parents' individual preferences, help parents to consider the potential implications of disclosure and concealment and different ways of disclosing. They could also recommend alternative sources of emotional support, bearing in mind that men in particular may find it harder to access support from their social networks.

Grief in healthcare chaplains: an investigation of the presence of disenfranchised grief

We examined how chaplains respond to grief and determined the prevalence of disenfranchised grief (i.e., grief that is not or cannot be acknowledged or supported by society) in healthcare chaplains. We conducted an online survey of members of the Association of Professional Chaplains. Of 3131 potential participants, 577 (18%) responded to the survey. In response to grief in the workplace, chaplains stated they would have low energy (78%), feel sad or moody (63%), feel like they had no time for themselves (44%), go through the motions (41%), and distance themselves from others (31%). As an indicator of disenfranchised grief, 21% of chaplains felt that their grief was not supported and affirmed in the workplace and 63% listed circumstances of death about which they felt very uncomfortable hearing or talking about. The results suggest that grief, and disenfranchised grief in particular, may be an important concern to address in healthcare chaplaincy.