The lived experience of grieving the loss of an important other

The Humanbecoming Concept Inventing Model: Feeling Sad

In this paper, the scholar explored the universal humanuniverse living experience of feeling sad with the humanbecoming concept inventing model. The now-truth of feeling sad is penetrating discomfort arising with contemplating joy-sorrow of affiliations amid envisioning new possibilities. The theoretical statement as the ingenuous proclamation of feeling sad is imaging the connecting-separating of transforming with the scholar's chosen artform, Melancholy by Albert Gyorgy. The scholar aimed to advance nursing knowledge of the universal humanuniverse living experience of feeling sad.

Review of Research Related to Parse's Theory of Human Becoming

Ninety-three retrievable studies guided by the human becoming theory between 1985 and 2006, are reviewed. A summary of the studies is tabulated according to the two basic human becoming research methods, the human becoming applied research method, and other qualitative research methods using human becoming as the frame of reference. The authors provide an overview of the studies and the human becoming research methods and further illuminate the findings of studies reviewed under four major themes that describe the phenomena studied.

Abstractions and Particulars: Learning Theory for Practice

Debates continue about the role of nursing theory in nursing and yet it is generally accepted that all knowledge is theoretical and all learning requires abstract theory. This column looks at the interplay between abstract theoretical concepts and particulars from nursing practice and research that are informed by theory and that at the same time expand understanding of the abstract notion. Examples from practice and research highlight the critical role of nursing theory.

A New State of Being

In spite of growing bereavement literature, the meaning of the lived experience of parental bereavement is not well understood. This article presents selected findings from a Heideggerian hermeneutic phenomenological study which aimed to describe the lived experience of bereaved parents who experienced the death of a child due to cancer. Conversational interviews were conducted with six parents who experienced the death of a young child due to cancer at least one year prior to participation. The nature of parental bereavement was revealed to be a new state of being into which parents enter immediately after the death of a child and which has no end point. Findings will equip health professionals and others who work with bereaved parents with a deeper understanding of the meaning of parental bereavement.

The Psychological Impact of Stillbirth on Women: A Systematic Review

This systematic review explored the psychological impact of stillbirth (from 20 weeks gestation) on mothers. A search was conducted in the National Library for Health and Web of Science, Cochrane Review, and Google Scholar. A secondary search based on results from the preliminary search was undertaken. A systematic search identified 26 articles (8 qualitative, 18 quantitative studies), which met criteria and were reviewed according to guidelines. The findings revealed that stillbirth is a distressing experience that can result in high levels of psychological symptoms including anxiety, depression, distress, and negative well-being. Symptoms appear to be highest in the first few months post loss although there is evidence to suggest that for some, symptoms may persist up to 3 years. The long-lasting impact of stillbirth on women was echoed in the qualitative research. Risk factors for higher levels of anxious and depressive symptoms included higher parity at the time of loss and not being married. Social support in particular was identified to be beneficial for women post loss. Longitudinal studies utilizing designs which permit causality to be determined are required to explore the specific experience of stillbirth. Further exploration of risk and protective factors, cultural beliefs, and the impact on partner relationships is needed. Clinical implications of the findings are discussed in light of current guidance.

Coping With Stillbirth Among Ultraorthodox Jewish Women

Stillbirth is a traumatic prenatal loss with personal, familial, and social implications. We explored the meaning of stillbirth for ultraorthodox Israeli women for whom grieving for prenatal loss derived from the power of faith. We conducted semistructured interviews with ten ultraorthodox women, ages 26 to 55, in a qualitative study that was focused on thematic content analysis and influenced by the phenomenological-hermeneutic tradition. The loss of the fetus was experienced as a test to the women's belief in God, and was perceived as a way to experience God's love. The women's faith became stronger and provided relief, calm, and confidence in God as benefactor. The meanings they attributed to their losses enabled them to move on. Findings are discussed in the context of research and theoretical literature on coping, bereavement, and mourning processes, and meaning for pregnancy-related losses. Awareness of ethnic meanings of stillbirth promotes implementation of culture-sensitive psychosocial interventions.

Meditations on the Unitary Rhythm of Dying-Grieving

When someone faces loss of a loved one, that person simultaneously grieves and dies a little, just as the one dying also grieves. The author’s personal conceptualization of dying and grieving as a unitary rhythm is explored based primarily on her interpretation of Rogers’ science of unitary human beings, along with selected examples from related nursing literature and from the emerging focus on continuing bonds in other disciplines. Examples from contemporary songwriters that depict such a unitary conceptualization are given along with personal examples. The author concludes with her description of the unitary rhythm of dying-grieving.

The Lived Experience of Feeling Sad

The purpose of this study was to enhance understanding of the lived experience of feeling sad. Parse’s phenomenological-hermeneutic research method was used to answer the research question: What is the structure of the lived experience of feeling sad? Participants were 7 elders who had lost a pet. Data were collected with dialogical engagement. The major finding of the study is the structure: Feeling sad is penetrating anguish surfacing with contemplating absent-yet present intimacies, while prevailing amid misfortune. Feeling sad is discussed in relation to the principles of humanbecoming and in relation to how it can inform future nursing research and nursing practice.

Feeling Lonely: A Parse Method Study With Children

Feeling lonely is a phenomenon experienced by all humans. The purposes of this research study were to discover the structure of the experience of feeling lonely, to contribute to nursing knowledge, and to expand the knowledge of feeling lonely. The Parse research method was used to guide this study and answer the research question: What is the structure of the lived experience of feeling lonely? Participants were 10 children ages 7 to 10 years. The central finding of this study was the following structure: The lived experience of feeling lonely is distressing isolation amid contentedness arising with cherished engagements. New knowledge extended the theory of humanbecoming and enhanced understanding of the experience of feeling lonely.

Struggling in change at the end of life: A nursing inquiry

Objective: The purpose of this human science nursing inquiry is to explore the meaning of struggling in change for persons at the end of life.

Methods: Guided by Parse's theory of human becoming, a descriptive exploratory method was used to answer the research question: What is the meaning of the experience of struggling in change for persons at the end of life? Eight persons who were living with dying described experiences of struggling in change during face-to-face audiotaped interviews.

Results: A process of analysis–synthesis revealed three themes that are discussed in relation to extant related literature and interpreted in light of the human becoming perspective.

Significance of results: Findings from the study contribute new knowledge about human experience at the end of life from a human science perspective and offer new insights on struggling in change as a rhythmical pattern of living and dying. Implications for palliative practice, research, and education are discussed.

Exploring parental grief: combining quantitative and qualitative measures

PURPOSE

This study explores parental grief on the death of a child of any age.

STUDY DESIGN

The sampling frame for the study consisted of 74 respondents reporting that they experienced the death of a living child. With the exception of standard demographic measures, the quantitative and qualitative items in the instrument were designed specifically for this project. The content validity of the instrument was assessed by a panel of experts on grief. Key quantitative items related to child loss and grief were formatted with between three- and five-point ordinal answer categories. Two types of qualitative items were developed by the authors. The reliability of the instrument designed for this study was not determined.

RESULTS

This survey of parents who experienced the death of a child during their lifetime explores and extends current understanding of the complex emotional response of grief. The study offers empirical support for the notion of grief as ongoing in the life of a parent whose child had died. The findings have significant implications for further clinical research supporting studies to explore commonalities in the experience of grieving families regardless of the cause of and time since the death of their child. In addition, the findings may serve to inform the development and provision of services for bereaved parents.

Grieving a Loss: The Lived Experience for Elders Residing in an Institution

Grieving a loss is a profound and universal human experience. This phenomenological-hermeneutic study was an inquiry into the lived experience of grieving a loss. The nursing perspective was Parse’s human becoming theory. Participants were 10 elderly persons residing in a long-term care facility. The study finding specifies the structure of the lived experience of grieving a loss as aching solitude amid enduring cherished affiliations, as serene acquiescence arises with sorrowful curtailments. Findings are discussed in relation to the guiding theoretical perspective and related literature. Recommendations for additional research and insights for practice are presented.

The language of loss when a baby dies prior to birth: cocreating human experience

When a baby dies prior to birth, a woman and her family begin a life long journey of living and transforming with loss. The language used with families during times of devastating loss is important to reflect upon since, language has the potential to either intensify suffering or enhance the family's experience of grieving. Words that affirm the meaning the baby holds for the family can provide comfort as families engage with the reality of lost hopes and dreams. Recognizing that healthcare professionals do not intend to harm families whose babies die prior to birth, the current authors offer this column as a vehicle for reflecting on the meanings of words used during this particular time of loss and grief. The authors further explore the role that the arts have to play in expressing loss and in helping others to understand.

Mis-takes across paradigms

In this column, the authors reflect on mis-takes across paradigms, misconceived or misunderstood meanings given and taken among scholars with differing worldviews. Mis-takes of paradigmatic perspectives, human science, distinctiveness, ways of knowing, and rationality are explored. It is proposed that mis-taken views of opposing perspectives are often deliberately advanced by scholars as ways to discredit the opposition, not to further dialogue. The authors call for an appreciation of difference in the context of the intellectual sparring and debating with regard to fundamental issues that characterize evolving disciplines.

Parallels in practice: palliative nursing practice and Parse's theory of human becoming

Nurses experienced in the art and science of palliative nursing will find many elements of congruence between the principles and philosophy of palliative practice and the theory of human becoming. In this brief exploration of parallels in practice between Parse's theory of human becoming and traditional palliative and hospice nursing practice, the author suggests that the theory of human becoming is consistent and consonant with the values that shape palliative nursing practice. The theory is briefly described, and four parallels of practice are identifed: whole person care; the presence of paradox in human experience; primacy of the person; and presence and dialogue, or "being with, " dying persons. The theory of human becoming holds relevance and promise in its capacity to provide palliative and hospice nurses with a theoretical framework with which to inform and guide nursing practice with dying persons.

Transforming loss: Taiwanese women's adaptation to stillbirth

AIM

To explore the experiences of Taiwanese mothers of stillborn babies, their coping strategies, and the ways in which their subsequent human interactions are shaped by Taiwanese culture.

BACKGROUND

Giving birth to a male family heir is still considered an important responsibility for Taiwanese women. The ideology of continuity is still at the centre of Chinese family life in which women are expected to deliver babies that will continue their husbands' family lines. Research on the connection between this responsibility and women's reaction to stillbirth in a cultural context is limited. Understanding Taiwanese women's experiences with stillbirth will add to the body of nursing knowledge, especially in terms of giving culturally competent nursing care.

METHODS

Interpretive ethnographic procedures were used to locate coping strategies. Twenty mothers who had stillbirth experiences were interviewed periodically during the 2 years following their losses. Following Agar's example, data were analysed to identify themes representing coping strategies.

FINDINGS

The four major themes identified were (a) transforming the meaning of death, (b) doing something for the deceased, (c) anticipating another pregnancy, and (d) rebuilding a social fabric.

CONCLUSION

The processes that the mothers of stillborn babies experience represent transformations that involve engagement with cultural expectations for woman. The authors suggest that these cultural impacts should be incorporated into nursing assessment and treatment practices.

Learning to practice the discipline of nursing

This column addresses the issues of teaching and growing the discipline of nursing. Experiences of two undergraduate nursing students highlight the benefits and opportunities that accompany the teaching of nursing theories in undergraduate programs. The 3rd-year baccalaureate students, Kendra Fitzsimmons and Elspeth Ferguson, submitted papers from their York University nursing program to help demonstrate key points in this column. Their papers show thoughtful critique and passionate belief in nursing as a discipline and a basic science. Kudos to them and the faculty who inspired them.

The lived experience of grieving for persons living with HIV who have used injection drugs

Parse's research method was used to investigate the lived experience of grieving for 10 persons self-identified as HIV-positive injection drug users. These individuals compose an understudied and poorly understood population, and their grief experiences have rarely been documented. The losses grieved by persons living with HIV infection include the loss of life, friends, family members, employment, energy, and sex. The lived experience of grieving was found to be "overwhelming anguish that shapes hopes and intentions as a wretched aloneness is punctuated with cherished uplifting engagements, while gratitude inspires courage in the midst of ambiguity." This new conceptualization of the grieving process is discussed in light of Parse's human becoming theory of nursing.

Weathering the storm: persevering through a difficult time

Parse's human becoming theory of nursing and research methodology were used to uncover the structure of the lived experience of persevering through a difficult time for eight women with ovarian cancer. Three core concepts surfaced: deliberately persisting, significant engagements, and shifting life patterns. Through conceptual integration these emerged as powering valuing in the connecting-separating of originating. Deliberately persisting, an active forging onward, was supported in the perseverance literature. The concept significant engagements, a variety of encounters uniquely important to an individual, was further clarified. Shifting life patterns, the changing ways of living as the difficult time emerged, was not addressed in the perseverance literature and represents new knowledge to the discipline of nursing.

The lived experience of serenity: using Parse's research method

Parse's research method was used to investigate the meaning of serenity for survivors of a life-threatening illness or traumatic event. Ten survivors of cancer told their stories of the meaning of serenity as they had lived it in their lives. Descriptions were aided by photographs chosen by each participant to represent the meaning of serenity for them. The structure of serenity was generated through the extraction-synthesis process. Four main concepts--steering-yielding with the flow, savoring remembered visions of engaging surroundings, abiding with aloneness-togetherness, and attesting to a loving presence--emerged and led to a theoretical structure of serenity from the human becoming perspective. Findings confirm serenity as a multidimensional process.

Defensive mothering in HIV-positive mothers

The grounded theory study discussed in this article provides an explanatory schema that illuminates the mothering experiences of women living with HIV infection. Eighteen HIV-positive mothers provided 24 in-depth interviews. The grounded theory method was used for data analysis. Defensive mothering was the basic social psychological process that these HIV-positive mothers used in response to their diagnosis and the inherent stigma. Their defensive posture afforded these mothers and their children some degree of psychological protection. Defensive mothering involved much mental work and included three subprocesses: preventing the spread of HIV, preparing the children for a motherless future, and protecting themselves through thought control.

Considering tomorrow: Parse's theory-guided research

The purpose of this nursing study, guided by Parse's human becoming theory and research methodology, was to investigate the meaning of considering tomorrow for women who are homeless. This is the first study to explore the newly conceptualized health phenomenon of considering tomorrow; thus, this research provides new knowledge for nursing and expands Parse's theory in relation to considering tomorrow, health, and quality of life. Through dialogical engagements with 10 women who were homeless and the process of extraction-synthesis, the researcher generated the structure of considering tomorrow as contemplating desired endeavors in longing for the cherished, while intimate alliances with isolating distance emerge, as resilient endurance surfaces amid disturbing unsureness. Conceptual integration led to a theoretical structure in which considering tomorrow is imaging the valuing in the connecting-separating of originating.

A father's grief: dealing with stillbirth

In the end each person's experience of stillbirth is unique. There is no right or wrong way to grieve and each person defines it uniquely (Pilkington, 1993). My own experiences have shown me that it is important for the father to be strong and to take responsibility for what needs to be done, yet acknowledge his grief. My wife and child were the most important people at that time, and while I needed to grieve, I felt I could do it only my way, and at a time when I felt I had completed my initial responsibilities. I do not feel guilty about being strong, nor do I feel guilty about being weak. I do feel bad about being too proud and not seeking more support from groups set up specifically to help parents. Three years down the track, I still miss my daughter and still think of her. I have another child, who can never replace Angel, and when she grows up, she, too, will learn about her older sister.

Transforming research and practice with the human becoming theory

This article focuses on the human becoming theory as a guide to the transformation of research and practice. New knowledge gained from human becoming research guides the nurse in practice. Different ways of being in true presence in living the human becoming theory are discussed.

Health as an individual's way of existence

This paper examines health from the viewpoint of Finnish individuals. The goal of the study was to understand and describe the human being's health as an individual way of existence on the basis of life descriptions. The methodology of the study were based on the existentialist phenomenological conception of a human being's existence and the essence of knowledge. The study answers the research question: How do Finnish adults who have been cared for in hospital experience health? The data were collected from 60 persons via free form thematic interviews. The data were analysed by applying the grounded theory method. The analysis led to the identification of five different ways to experience health. To the interviewees, health meant independent coping, drifting with the current of life, developing one's personal existence, avoiding threats in one's life situation and taking care of the components of one's life situation. The results provide a deeper understanding of health within daily life and of a human being as a nursing client.

Quality of life for persons living with Alzheimer's disease: the human becoming perspective

The purpose of this research was to ascertain the meaning of quality of life for persons living with Alzheimer's disease. The human becoming theory was the nursing perspective for this descriptive-exploratory study in which 25 people, designated as having mild to moderate Alzheimer's disease, were asked to describe their quality of life. Findings showed that quality for these participants is a contentment with the remembered and now affiliations that arises amidst the tedium of the commonplace, as an easy-uneasy flow of transfiguring surfaces with liberating possibilities and confining constraints, while desiring cherished intimacies yields with inevitable distancing in the vicissitudes of life, as contemplating the ambiguity of the possibles emerges with yearning for successes in the moment. Implications for further research and practice are also discussed.

Quality of life and the human becoming theory: exploring discipline-specific contributions

This article explores the concept of quality of life. Current understandings of quality of life are considered in relation to the notion of discipline-specificity. The authors contend that different disciplines require distinct definitions of quality of life and that research which informs practitioners about quality of life needs to be discipline-specific and theory-based. The contribution of the human becoming theory to knowledge and understanding of quality of life in nursing science is explored, drawing on insights from theory-guided practice and research.

The Pinwheel Model of Bereavement

The Pinwheel Model of Bereavement is a process-orientated model of grief which recognizes loss as a unique lived experience. The model and relevant nursing response are described using Margaret Newman's nursing theory of health as expanding consciousness. The model is based on research by Carter (1989) and clinical experience. The contextual theme for the model is "personal history." Six core themes are: being stopped, hurting, missing, holding, seeking, and valuing. Three meta themes are change, expectations, and inexpressibility. Capacities for "being with" the bereaved are identified for the practice of nursing.

The meaning of grieving for families living with AIDS

Parse's research method was used to study the meaning of grieving for families living with AIDS. In videotaped dialogues, diverse families living with AIDS described their experiences of grieving in relation to death and other losses. Narratives of the grieving experiences of each family were constructed. Through the process of extraction-synthesis, the structure of grieving was generated. The four concepts within the structure are explicated in this article as essential in family grieving. Further interpretation led to a theoretical structure of grieving within the human becoming belief system. This view of grieving, as a multidimensional rhythmical process of intersubjective becoming, expands and specifies nursing's theory base. The study also confirms that Parse's methodology is valuable for family-centered nursing research.

The role of theory in qualitative research

Increasingly philosophers and scientists have affirmed that all knowledge is theory-laden and that methods are theory-driven. These assertions raise important questions related to the role of theory in qualitative research. There are scholars who propose that qualitative research can enhance understanding and expand theoretical knowledge from a disciplinary perspective. And there are others who contend that qualitative inquiry is purely inductive and that its validity can therefore be judged by the extent to which preconceived theory is absent from it. The purpose of this article is to examine three qualitative methods, grounded theory, ethnography, and phenomenology, and their use in nursing in order to explicate the role of theory in knowledge development. The authors propose that, by nature, inquiry, discovery, and theoretical interpretation coexist simultaneously and must be recognized as such if the theory-research linkage is to advance nursing science through qualitative research.