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Kruse RF, Stiel S, Schwabe S. Supporting Bereaved Family Members: A Qualitative Interview Study on the Experience of Bereavement Counselling by the Bereavement Network Lower Saxony (BNLS) in Germany for Parents Who Have Lost Children or Teenagers. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241263367. [PMID: 38907636 DOI: 10.1177/00302228241263367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
The "Trauer Netzwerk Niedersachsen" ("Bereavement Network Lower Saxony" (BNLS)) aims at supporting families after the loss of a child or teenager due to various causes. This study aims to describe the experiences of bereaved family members with the BNLS counsellors. 12 semi-structured interviews were conducted with parents who had received or were currently receiving BNLS counselling. The interviews revealed the vital role counselling played aiding individuals cope with their grief. Participants valued the bereavement support, which was often lacking in their personal support networks. Counselling assisted parents in returning to daily life and caring for loved ones. Discussing "death" and "dying" helped participants find peace with their loss. Our findings suggest that bereavement counselling should be considered an essential component of healthcare for family members dealing with the loss of a child. Additionally, there is need for awareness and publicity for both the BNLS and its bereavement counselling services.
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Affiliation(s)
- Rebecca F Kruse
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Sven Schwabe
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
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2
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Gold KJ, Boggs ME. Communication, Training, and Debriefing After Stillbirth in U.S. Hospitals: A National Survey. J Womens Health (Larchmt) 2024. [PMID: 38842446 DOI: 10.1089/jwh.2024.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background: Stillbirth is a devastating event for families as well as hospital staff. Hospital practices around internal and external staff communication, debriefing, and training are unknown. Methods: We systematically sampled U.S. hospitals that provide obstetrical care. Staff knowledgeable of bereavement care on labor and delivery were invited to participate in an anonymous survey linked to hospital descriptors. We evaluated stillbirth communication, debriefing, and training for staff. Results: We received 289 usable surveys from 429 eligible staff (67% response). Most (94%) noted hospitals' marked rooms housing bereaved families, but only a third (37%) reported a marker on the paper or electronic medical record. Half of the hospitals had no standard debriefings post-loss, and 38% reported no perinatal loss training for labor and delivery nurses. Conclusions: Hospitals have significant variations and gaps in staff communication, support, and training, which are key aspects of respectful stillbirth care.
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Affiliation(s)
- Katherine J Gold
- Department of Family Medicine and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Martha E Boggs
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Gandino G, Diecidue A, Sensi A, Venera EM, Finzi S, Civilotti C, Veglia F, Di Fini G. The psychological consequences of Sudden Infant Death Syndrome (SIDS) for the family system: A systematic review. Front Psychol 2023; 14:1085944. [PMID: 36910838 PMCID: PMC9995968 DOI: 10.3389/fpsyg.2023.1085944] [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: 10/31/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
The Sudden Infant Death Syndrome (SIDS) is a tragic and difficult experience for families. It involves not only the death of the baby but also the loss of a future as a parent, sibling or grandparent. The subsequent grief is multifaceted and each family member has different needs and resources. Through a systematic review of literature, we identified 24 studies between 1982 and 2021: they dealt with individual, family and couple experience when a SIDS occurs; in addition, some studies compared perinatal loss and neonatal loss with SIDS loss. Our results point out the need for an intervention that focuses on the needs of each family member and tailored around the specifics of SIDS loss rather than general grief.
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Affiliation(s)
- Gabriella Gandino
- Department of Psychology, University of Turin, Turin, Italy
- SUID and SIDS Italia Onlus, Turin, Italy
| | | | - Annalisa Sensi
- Department of Psychology, University of Turin, Turin, Italy
- SUID and SIDS Italia Onlus, Turin, Italy
| | | | - Sarah Finzi
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Fabio Veglia
- Department of Psychology, University of Turin, Turin, Italy
| | - Giulia Di Fini
- Department of Psychology, University of Turin, Turin, Italy
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Minton EA, Wang CX, Anthony C, Fox A. Advice from Bereaved Parents on Strategies to Heal After Baby Loss. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221133589. [PMID: 36219066 DOI: 10.1177/00302228221133589] [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: 11/16/2022]
Abstract
With close to one in three babies dying between conception and infancy, research examining how to assist bereaved parents after loss is critical. Prior research focuses primarily on a general understanding of the journey post-loss or on a specific strategy that can be pursued to assist in healing but does not adequately provide a holistic examination of post-loss strategies nor is it from firsthand recommendations of bereaved parents. Our research addresses this gap in the literature by identifying the post-loss healing strategies recommended by bereaved parents themselves, thereby informing coping post-loss. To do this, 30 semi-structured interviews were conducted with bereaved mothers. Four themes emerged from our findings: (1) honor the deceased baby, (2) engage in helpful practices, (3) pursue healing now, and (4) embrace the post-loss journey as unique.
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Affiliation(s)
| | - Cindy Xin Wang
- College of Business, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Carissa Anthony
- Lebow College of Business, Drexel University, Philadelphia, PA, USA
| | - Alexa Fox
- College of BusinessUniversity of Akron, Akron, OH, USA
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Green L, Stewart-Lord A, Baillie L. End-of-life and immediate postdeath acute hospital interventions: scoping review. BMJ Support Palliat Care 2022:bmjspcare-2021-003511. [PMID: 35896320 DOI: 10.1136/spcare-2021-003511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hospital remains the most common place of death in the UK, but there are ongoing concerns about the quality of end-of-life care provision in this setting. Evaluation of interventions in the last days of life or after a bereavement is methodologically and ethically challenging. AIM The aim was to describe interventions at the very end of life and in the immediate bereavement period in acute hospitals, with a particular focus on how these are evaluated. METHOD A scoping review was conducted. Studies were restricted to peer-reviewed original research or literature reviews, published between 2011 and 2021, and written in the English language. Databases searched were CINAHL, Medline and Psychinfo. RESULTS From the search findings, 42 studies were reviewed, including quantitative (n=7), qualitative (n=14), mixed method (n=4) and literature reviews (n=17). Much of the current research about hospital-based bereavement care is derived from the intensive and critical care settings. Three themes were identified: (1) person-centred/family-centred care (memorialisation), (2) institutional approaches (quality of the environment, leadership, system-wide approaches and culture), (3) infrastructure and support systems (transdisciplinary working and staff support). There were limited studies on interventions to support staff. CONCLUSION Currently, there are few comprehensive tools for evaluating complex service interventions in a way that provides meaningful transferable data. Quantitative studies do not capture the complexity inherent in this form of care. Further qualitative studies would offer important insights into the interventions.
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Affiliation(s)
- Laura Green
- Faculty of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Adele Stewart-Lord
- Department of Allied Health Sciences, London South Bank University, London, UK
| | - Lesley Baillie
- Florence Nightingale Foundation Chair, London South Bank University, London, UK
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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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Bottomley JS, Smigelsky MA. Bereavement in the Aftermath of Suicide, Overdose, and Sudden-Natural Death: Evaluating a New Measure of Needs. Assessment 2022; 30:1052-1064. [PMID: 35272500 PMCID: PMC9463411 DOI: 10.1177/10731911221081139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Bereavement has been associated with a number of adverse outcomes, including mortality, particularly among those who experience the sudden loss of a close other. With rising rates of sudden death in the United States, fueled by an alarming increase in fatal overdose deaths, identifying bereavement-related needs among the sudden-death bereaved is essential. The present study investigated the factor structure, internal reliability, and validity of the Sudden Bereavement Needs Inventory (SBNI) in a sample of sudden loss survivors (i.e., fatal overdose, suicide, and sudden-natural loss; N = 403). Confirmatory factor analysis supported a six-factor structure, with items reflecting pragmatic, informational, spiritual, relational, meaning, and emotional needs. SBNI factors showed adequate internal consistency, with significant associations between SBNI scores, loss characteristics, and mental health outcomes (e.g., prolonged grief symptoms, meaning-making, posttraumatic stress disorder [PTSD] symptoms, and anxiety), supporting the scale's validity and highlighting the potential applicability of the instrument in both research and clinical contexts. Future research should examine test-retest reliability of the SBNI, particularly through the lens of understanding whether and how bereavement needs change over time.
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Affiliation(s)
| | - Melissa A Smigelsky
- U.S. Department of Veterans Affairs, Integrative Mental Health, Durham, NC, USA
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Kanits F, L'Hoir MP, Boere-Boonekamp MM, Engelberts AC, Feskens EJM. Renewed Attention Needed for Prevention of Sudden Unexpected Death in Infancy in the Netherlands. Front Pediatr 2021; 9:757530. [PMID: 34938696 PMCID: PMC8685403 DOI: 10.3389/fped.2021.757530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/09/2021] [Indexed: 01/14/2023] Open
Abstract
Background: The incidence of sudden unexpected death in infancy (SUDI), which includes sudden infant death syndrome (SIDS), has declined in developed countries since the 1980s, including the Netherlands. To identify improvement opportunities in SUDI prevention, we monitored the adherence of parents to the prevention advice on infant care habits over the past 20 years, especially in relation to the SUDI incidence over time. Potential changes in parental adherence between the latest surveys are of specific interest, as these indicate where current focus is needed. Methods: Description of the prevalence of infant care factors related to the risk of SUDI, assessed from five Dutch national surveys from 1999 to 2017 among parents of infants under 12 months, and analysis of the potential differences in these prevalences between the two latest surveys in 2010/11 and 2017 with a z-test. Results: Supine sleeping position decreased from the highest prevalence of 92% in 2010/11, to 83% in 2017. Sleep sack use has increased to 55%, the highest prevalence up to now. Avoiding a duvet has remained reasonably stable since 2002/03 and now 95% of parents do not use a duvet. The prevalence of room-sharing, without sharing the bed, increased from 14% in 1999 to the highest prevalence in 2017 (31%). However, also bed-sharing almost doubled from 5.6% in 2010/11 to 10% in 2017. Breastfeeding decreased between 1999 and 2010/11, but increased from 34% in 2010/11 to 42% in 2017. An increased prevalence of mothers who abstained from smoking during pregnancy, as well as both parents not smoking, was observed, although mostly higher educated parents showed this beneficial behavior. Discussion and Conclusion: Much has already been achieved first by decreasing prone sleeping since the 80's, and subsequently promoting supine as the safest sleep position. The decrease in duvet use and smoking, and an increase in breastfeeding have also had impact. Indications of a recent decreased prevalence of the supine sleeping position and higher prevalence of bed-sharing might relate to the slightly increasing SUDI incidence in the Netherlands. Renewed attention for prevention of SUDI and specific advice targeting high-risk groups is needed. Modern, picture driven information via internet is recommended.
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Affiliation(s)
- Floortje Kanits
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Monique P. L'Hoir
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
- Community Health Centre, GGD Noord-Oost-Gelderland, Warnsveld, Netherlands
| | - Magda M. Boere-Boonekamp
- Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
| | - Adèle C. Engelberts
- Department of Pediatrics, Zuyderland Medical Centre, Sittard-Geleen, Netherlands
| | - Edith J. M. Feskens
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
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Bereaved parents’ experiences of being informed about autopsy findings after the sudden and unexpected loss of an infant or small child. SCANDINAVIAN JOURNAL OF FORENSIC SCIENCE 2021. [DOI: 10.2478/sjfs-2019-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Following the sudden and unexpected loss of an infant or small child, the police usually request a forensic autopsy. National guidelines exist for how the autopsy report should be made available for the bereaved parents, but there is limited knowledge whether the guidelines are followed. This study aims to explore bereaved parents’ experiences of being informed about autopsy findings.
Methodology: As part of in-depth follow-up interviews at 13 months post-loss, 24 couples were asked how they experienced being informed about autopsy findings. Participants’ responses underwent thematic analysis.
Results: The results show that the waiting period before the autopsy report was made available was a burden for many parents, particularly those who experienced a delay in the process. Two main themes related to parents’ experiences of being informed when the report was available: ‘informed in a supportive and caring way’ and ‘difficult or negative experiences’.
Conclusion: Several factors are described that help parents cope with being informed about autopsy findings, such as: being informed according to the given timeframe by competent health personnel, face-to-face meetings at the hospital, being able to ask questions and routine follow-up contact. These factors are mostly described in the national guidelines. This study shows that when guidelines were followed, the majority of parents were satisfied with how they were informed. Unfortunately, some parents had negative experiences. Regular training and continuing education for health personnel are recommended.
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Burden C, Bakhbakhi D, Heazell AE, Lynch M, Timlin L, Bevan C, Storey C, Kurinczuk JJ, Siassakos D. Parents' Active Role and ENgagement in The review of their Stillbirth/perinatal death 2 (PARENTS 2) study: a mixed-methods study of implementation. BMJ Open 2021; 11:e044563. [PMID: 33727271 PMCID: PMC7970278 DOI: 10.1136/bmjopen-2020-044563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE When a formal review of care takes places after the death of a baby, parents are largely unaware it takes place and are often not meaningfully involved in the review process. Parent engagement in the process is likely to be essential for a successful review and to improve patient safety. This study aimed to evaluate an intervention process of parental engagement in perinatal mortality review (PNMR) and to identify barriers and facilitators to its implementation. DESIGN Mixed-methods study of parents' engagement in PNMR. SETTING Single tertiary maternity unit in the UK. PARTICIPANTS Bereaved parents and healthcare professionals (HCPs). INTERVENTIONS Parent engagement in the PNMR (intervention) was based on principles derived through national consensus and qualitative research with parents, HCPs and stakeholders in the UK. OUTCOMES Recruitment rates, bereaved parents and HCPs' perceptions. RESULTS Eighty-one per cent of bereaved parents approached (13/16) agreed to participate in the study. Two focus groups with bereaved parents (n=11) and HCP (n=7) were carried out postimplementation to investigate their perceptions of the process.Overarching findings were improved dialogue and continuity of care with parents, and improvements in the PNMR process and patient safety. Bereaved parents agreed that engagement in the PNMR process was invaluable and helped them in their grieving. HCP perceived that parent involvement improved the review process and lessons learnt from the deaths; information to understand the impact of aspects of care on the baby's death were often only found in the parents' recollections. CONCLUSIONS Parental engagement in the PNMR process is achievable and useful for parents and HCP alike, and critically can improve patient safety and future care for mothers and babies. To learn and prevent perinatal deaths effectively, all hospitals should give parents the option to engage with the review of their baby's death.
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Affiliation(s)
- Christy Burden
- Bristol Medical School, Department of Translational Health Sciences, University of Bristol, Faculty of Health Sciences, Bristol, UK
| | - Danya Bakhbakhi
- Bristol Medical School, Department of Translational Health Sciences, University of Bristol, Faculty of Health Sciences, Bristol, UK
| | | | - Mary Lynch
- Bristol Medical School, Department of Translational Health Sciences, University of Bristol, Faculty of Health Sciences, Bristol, UK
| | - Laura Timlin
- Bristol Medical School, Department of Translational Health Sciences, University of Bristol, Faculty of Health Sciences, Bristol, UK
| | | | | | | | - Dimitrios Siassakos
- University College London Institute for Women's Health, London, UK
- University College London Hospital, London, UK
- Wellcome EPSRC centre for Interventional + Surgical Sciences (WEISS), London, UK
- NIHR UCLH Biomedical Research Centre, London, UK
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Steffen EM, Timotijevic L, Coyle A. A qualitative analysis of psychosocial needs and support impacts in families affected by young sudden cardiac death: The role of community and peer support. Eur J Cardiovasc Nurs 2020; 19:681-690. [PMID: 32370539 PMCID: PMC7817993 DOI: 10.1177/1474515120922347] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Young sudden cardiac death (YSCD), often occurring in previously healthy individuals, is a tragic event with devastating impact on affected families, who are at heightened risk of posttraumatic stress and prolonged grief and may themselves be at risk of YSCD. Previous research suggests that surviving family members' psychosocial support needs are often unmet. PURPOSE This study sought to identify how YSCD-affected families experience dedicated community and peer support in light of their psychosocial support needs. METHODS The study used a qualitative design, employing a thematic analysis of focus group and interview data. Three focus groups and five individual interviews were conducted with affected family members (N = 19). The sample was drawn from a UK-based charity, Cardiac Risk in the Young. Audio-recordings of the focus groups and interviews were transcribed and subjected to thematic analysis. RESULTS Three super-ordinate themes were identified: 1. YSCD community support as offering a place of safety, 2. YSCD community support as fostering sense-making, 3. YSCD community support as facilitating finding new meaning. CONCLUSIONS YSCD-affected families can benefit from access to dedicated community and peer support that offers a safe environment, provides affiliation, understanding and normalisation and enables sense-making and the rebuilding of a sense of self. Dedicated community support can facilitate meaningful re-engagement with life through helping prevent YSCD and through memorialisation and legacy-building to maintain a continuing bond with the deceased. Clinicians need to be aware of the need to incorporate available community and peer support into patient pathways.
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Affiliation(s)
| | - Lada Timotijevic
- School of Psychology, Faculty of Health and Medical Sciences,
University of Surrey, Guildford, UK
| | - Adrian Coyle
- Department of Psychology, Kingston University London, UK
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Palumbo K, Koncicki ML. Pediatric Palliative Care and the PICU: Where We Have Been and Where We Are Going. CURRENT PEDIATRICS REPORTS 2020. [DOI: 10.1007/s40124-020-00230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Medical certificate of cause of death: Looking for an European single standard. J Forensic Leg Med 2020; 75:102052. [PMID: 32891932 DOI: 10.1016/j.jflm.2020.102052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022]
Abstract
The European Union share many laws, and medical certification of cause of death standards should be probably one of them. In an analysis of medical certificates of cause of death (MCCD) from 27 countries that form or formed part of the European Union, there was considerable variability of their content. Ways to improve and harmonize the current datasets are suggested, based on what is done in different European nations, and that could be adopted elsewhere, sharing good practice. It is also suggested the need to allow the cause of death to be, at least partially, available to relatives, to help with the bereavement process and any required proceedings (which could be different to the country of issue of the certification). This common approach could reduce the risk of errors among clinicians working across different nations; it could improve information flow when decedents are transferred among distinct countries and their forms are processed; and eventually, it could help when mortality data is used to compare states.
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Parents' Wishes for What They Had or Had Not Done and Their Coping After Their Infant's or Child's Neonatal Intensive Care Unit/Pediatric Intensive Care Unit/Emergency Department Death. J Hosp Palliat Nurs 2020; 21:333-343. [PMID: 30933014 DOI: 10.1097/njh.0000000000000559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This qualitative study asked 70 mothers and 26 fathers 3 open-ended questions on what they wish they had and had not done and on coping 2, 4, 6, and 13 months after their infant's/child's neonatal intensive care unit/pediatric intensive care unit/emergency department death. Mothers wished they spent more time with the child, chosen different treatments, advocated for care changes, and allowed the child his or her wishes. Fathers wished they had spent more time with the child and gotten care earlier. Mothers wished they had not agreed to child's surgery/treatment, taken her own actions (self-blame), and left the hospital before the death. Fathers wished they had not been so hard on the child, agreed with doctors/treatment, and taken own actions (self-blame). Religious activities, caring for herself, and talking about/with the deceased child were the most frequent mothers' coping strategies; those of the fathers were caring for self and religious activities. Both mothers and fathers wished they had spent more time with their child and had not agreed to surgery/treatments. The most frequent coping was caring for themselves, likely to care for the family and retain employment. Nurses must be sensitive to parents' need for time with their infant/child before and after death and to receive information on child's treatments at levels and in languages they understand.
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15
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Piumelli R, Nassi N, Buccoliero A, Occhini R, Nardini V, Toti P, Salvatori C, Peruzzi M, Arzilli C. The multiagency approach to Sudden Unexpected Infant Deaths (SUID): eleven years' experience in the Tuscany Region. Ital J Pediatr 2020; 46:99. [PMID: 32690066 PMCID: PMC7372863 DOI: 10.1186/s13052-020-00867-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background The Sudden Unexpected Infant Death Syndrome (SUID) is one of the leading causes of mortality in the first year of life. The aim of this work was the retrospective evaluation of the incidence of SUID and the effectiveness of the multiagency approach to this phenomenon in the Tuscany Region. Methods Data were obtained from the regional registry of SUID cases in the period 2009–2019. The registry contains both sudden unexpected deaths in the first week of life (Sudden Unexpected Early Neonatal Deaths - SUEND), and those occurring after the first week up to 1 year of age (SUID). Results In this timeframe a total of 73 sudden unexpected deaths occurred in our region; 32 were Unexplained (i.e. Sudden Infant Death Syndrome - SIDS), 24 Explained, 10 Undetermined, and 7 SUEND. Autopsies were performed in 91% of cases, and in 95% of these by three groups of selected pathologists according to our protocol. We found a low incidence of SUID (0.21 ‰), and SIDS deaths accounted for 0.1‰ of live births (48% of cases) with a high prevalence of infants of non-Italian ethnicity (38% of cases). Bereaved families were able to receive psychological support from mental health professionals and have contact with the family association, Seeds for SIDS. Audits were organized when post-mortem examinations were not carried out or carried out incorrectly in procedural terms, and when the diagnosis was particularly uncertain. Conclusions This paper first provides data on SUID mortality based on complete post-mortems in an Italian region. According to these findings we can state that our approach is effective both in terms of correctly performed autopsies and support for bereaved families. Future efforts are necessary to further reduce the incidence of SUID especially among non- Italian infants. An improvement action is also recommended for ensuring a more accurate and consistent picture of the circumstances of death. The final approval of the National Protocol for the management of SUID cases is therefore strongly advocated in order to improve surveillance in this specific field and abolish disparities among the Italian regions.
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Affiliation(s)
- Raffaele Piumelli
- Sleep Breathing Disorders and SIDS Centre, Meyer Children's Hospital, Florence, Italy.
| | - Niccolò Nassi
- Sleep Breathing Disorders and SIDS Centre, Meyer Children's Hospital, Florence, Italy
| | | | | | | | - Paolo Toti
- Pathology Unit, University of Siena, Siena, Italy
| | - Cristina Salvatori
- Sleep Breathing Disorders and SIDS Centre, Meyer Children's Hospital, Florence, Italy
| | - Marta Peruzzi
- Sleep Breathing Disorders and SIDS Centre, Meyer Children's Hospital, Florence, Italy
| | - Cinzia Arzilli
- Sleep Breathing Disorders and SIDS Centre, Meyer Children's Hospital, Florence, Italy
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16
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Matschke J, Sperhake JP, Wilke N, Püschel K, Glatzel M. Cerebellar heterotopia of infancy in sudden infant death syndrome: an observational neuropathological study of four cases. Int J Legal Med 2020; 134:2143-2147. [PMID: 32435901 PMCID: PMC7577907 DOI: 10.1007/s00414-020-02316-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/08/2020] [Indexed: 12/31/2022]
Abstract
Sudden infant death syndrome (SIDS) is the sudden unexpected death of an infant < 1 year of age that remains unexplained after comprehensive workup including complete autopsy and investigation of the circumstances of death. The triple risk hypothesis posits that SIDS results as a combination of both intrinsic and extrinsic factors on the background of a predisposing vulnerability. Neuropathological examination in the past has focussed mainly on the brainstem as the major player in respiratory control, where subtle findings have been linked to the chain of events leading to death in SIDS. The cerebellum has received less attention, probably due to an assumed negligible role in central cardiorespiratory control. We report four cases of SIDS in which neuropathological investigation revealed cerebellar heterotopia of infancy, a distinct malformation of the cerebellum, and discuss the potential impact of this condition on the aetiology and pathogenesis of SIDS.
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Affiliation(s)
- Jakob Matschke
- Forensic Neuropathology Unit, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Jan-Peter Sperhake
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Nadine Wilke
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Institute of Legal Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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A retrospective study of death scene investigation practices for sudden unexpected death of infants (SUDI) in Cape Town, South Africa. Forensic Sci Med Pathol 2019; 16:49-56. [PMID: 31808133 DOI: 10.1007/s12024-019-00206-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 12/30/2022]
Abstract
A death scene investigation (DSI) forms an integral part of the inquiry into death, particularly for sudden unexpected death of infants (SUDI). Global guidelines exist for DSI, however, previous studies have shown that South Africa does not routinely perform DSI for SUDI cases, nor is there a standard protocol in this regard. This was largely attributed to the large burden of SUDI cases as well as the lack of resources, due to South Africa being a developing country. This study assessed DSI practices at one of the largest mortuaries in Cape Town (Salt River Mortuary) to assess the scope of these practices within a resource-constrained context. Data were collected by retrospectively reviewing medico-legal case files (n = 454) from SUDI cases investigated at Salt River Mortuary over a two-year period. The results showed that SUDI death scenes were visited in 59.2% of cases at Salt River Mortuary, with poor and inconsistent levels of documentation. Death scenes were never investigated in cases where the infant was pronounced dead on arrival at a medical facility. The findings support the need for a locally relevant approach to DSI, coupled with specialized training for staff. Based on the limited resources, this should focus on the training of staff using the available resources and accurate use of documentation.
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Denhup C. Bereavement care to minimize bereaved parents' suffering in their lifelong journey towards healing. Appl Nurs Res 2019; 50:151205. [DOI: 10.1016/j.apnr.2019.151205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 06/17/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022]
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Bekkering HJ, Woodgate RL. The Parental Experience of Unexpectedly Losing a Child in the Pediatric Emergency Department. OMEGA-JOURNAL OF DEATH AND DYING 2019; 84:28-50. [PMID: 31547765 DOI: 10.1177/0030222819876477] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Child loss is the most traumatic loss a parent can experience, increasing their risk of negative outcomes such as complicated grief. Unexpected loss in the unfamiliar environment of the Emergency Department (ED) significantly increases this risk. Despite this knowledge, research on child loss in the context of the ED is scarce. An interpretive description qualitative research study was performed with eight parents (five mothers and three fathers) to examine their experience of unexpectedly losing a child in the pediatric ED. Data collection included interviews, demographic questionnaires, and field notes. Data were analyzed using a constant comparative method and revealed four main themes: "grief as waves," "being the good parent," "coping through the waves of grief," and "the new normal." Improving understanding around child loss and implementing stronger support for parents, through communication, advocacy, and physical presence while in the ED, could greatly reduce parents' risk of negative outcomes.
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Affiliation(s)
- Holly J Bekkering
- Health Sciences Center - Variety Children's Heart Center, Winnipeg, Manitoba, Canada
| | - Roberta L Woodgate
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Shipstone RA, Young J, Thompson JMD, Byard RW. An evaluation of pathologists’ application of the diagnostic criteria from the San Diego definition of SIDS and unclassified sudden infant death. Int J Legal Med 2019; 134:1015-1021. [DOI: 10.1007/s00414-019-02126-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022]
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Dias N, Hendricks-Ferguson VL, Wei H, Boring E, Sewell K, Haase JE. A Systematic Literature Review of the Current State of Knowledge Related to Interventions for Bereaved Parents. Am J Hosp Palliat Care 2019; 36:1124-1133. [DOI: 10.1177/1049909119858931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aims: The purpose of this systematic literature review is to describe the interventions for bereaved parents, evaluate intervention effectiveness through study methodology rigor, replicability, and theoretical foundations. Methods: We searched MEDLINE via PubMed (1966-2018), CINAHL (1937-present), PsycINFO (1887-present), and Embase (1947-present) using various search words and MeSH terms related to the study purpose. A blinded screening of title/abstract was performed, with conflicting inclusion decisions resolved through group discussions. Matrices for remaining articles were created and discussed among the team. The levels of evidence of the 9 records were rated from very low to high based on the Grading of Recommendations Assessment, Development, and Evaluation guidelines. Results: Our initial pool included 1025 articles. After the screening of titles/abstracts, 63 articles were retained for full-text reviews. Evaluated based on the inclusion/exclusion criteria, 9 records met the review criteria. Of the 9 records, 1 was graded as very low, 3 low, and 5 low to moderate. The interventions for bereaved parents varied from using single-model interventions such as expressive arts therapy and telephone support to multimodal interventions that combined resources (ie, peer support, resource packets, and health-care support). Only 1 study explicitly illustrated how its bereavement intervention was designed based on the proposed theoretical model. Conclusions: This review highlights the need for individualized, well-tested, and effective bereavement care interventions to support bereaved parents. In summary, the state of the science on interventions for bereaved parents is poor and much work needs to be done to effectively address the needs of bereaved parents, including both their physical and emotional health needs.
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Affiliation(s)
- Nancy Dias
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | | | - Holly Wei
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | - Elizabeth Boring
- Hope in Healing Pediatric Bereavement Program, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Kerry Sewell
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | - Joan E. Haase
- The IUPUI Research in Palliative and End-of-Life Communication and Training (RESPECT), Indiana University School of Nursing, Indianapolis, IN, USA
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Berbís‐Morelló C, Mora‐López G, Berenguer‐Poblet M, Raigal‐Aran L, Montesó‐Curto P, Ferré‐Grau C. Exploring family members’ experiences during a death process in the emergency department: A grounded theory study. J Clin Nurs 2019; 28:2790-2800. [DOI: 10.1111/jocn.14514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/17/2018] [Accepted: 05/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Carme Berbís‐Morelló
- Joan XXIII University Hospital of Tarragona Tarragona Catalunya Spain
- Department of Nursing Rovira i Virgili University Tarragona Catalunya Spain
| | | | | | - Laia Raigal‐Aran
- Department of Nursing Rovira i Virgili University Tarragona Catalunya Spain
| | | | - Carme Ferré‐Grau
- Department of Nursing Rovira i Virgili University Tarragona Catalunya Spain
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Watson J, Simmonds A, La Fontaine M, Fockler ME. Pregnancy and infant loss: a survey of families' experiences in Ontario Canada. BMC Pregnancy Childbirth 2019; 19:129. [PMID: 30991981 PMCID: PMC6469137 DOI: 10.1186/s12884-019-2270-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/27/2019] [Indexed: 11/29/2022] Open
Abstract
Background Pregnancy and infant loss has a pervasive impact on families, health systems, and communities. During and after loss, compassionate, individualized, and skilled support from professionals and organizations is important, but often lacking. Historically, little has been known about how families in Ontario access existing care and supports around the time of their loss and their experiences of receiving such care. Methods An online cross-sectional survey, including both closed-ended multiple choice questions and one open-ended question, was completed by 596 people in Ontario, Canada relating to their experiences of care and support following pregnancy loss and infant death. Quantitative data were analyzed descriptively using frequency distributions. Responses to the one open-ended question were thematically analyzed using a qualitative inductive approach. Results The majority of families told us that around the time of their loss, they felt they were not adequately informed, supported and cared for by healthcare professionals, and that their healthcare provider lacked the skills needed to care for them. Almost half of respondents reported experiencing stigma from providers, exacerbating their experience of loss. Positive encounters with care providers were marked by timely, individualized, and compassionate care. Families indicated that improvements in care could be made by providing information and explanations, discharge and follow-up instructions, and through discussions about available supports. Conclusions Healthcare professionals can make a positive difference in how loss is experienced and in overall well-being by recognizing the impact of the loss, minimizing uncertainty and isolation, and by thoughtfully working within physical environments often not designed for the experience of loss. Ongoing supports are needed and should be tailored to parents’ changing needs. Prioritizing access to specialized education for professionals providing services and care to this population may help to reduce the stigma experienced by bereaved families.
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Affiliation(s)
- Jo Watson
- Pregnancy and Infant Loss (PAIL) Network, Women and Babies Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Anne Simmonds
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Michelle La Fontaine
- Pregnancy and Infant Loss (PAIL) Network, Women and Babies Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Megan E Fockler
- Pregnancy and Infant Loss (PAIL) Network, Women and Babies Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Ngo M, Matthews LR, Quinlan M, Bohle P. Information needs of bereaved families following fatal work incidents. DEATH STUDIES 2019; 44:478-489. [PMID: 30938585 DOI: 10.1080/07481187.2019.1586792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The sudden and unexpected nature of fatal work incidents can leave family members with a strong need to know how and why the worker died. Forty Australian family members were interviewed to identify the information sought following fatal work incidents and explore the factors enhancing or impairing satisfaction with the account of the death. Findings demonstrated that employers tended to divert responsibility to the worker, to mask underlying systemic failures. Satisfaction was enhanced if family members believed a sense of justice was attained and formal investigations were able to expose the truth and those responsible for the death were identified.
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Affiliation(s)
- Mark Ngo
- Work and Health Research Team, Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Lynda R Matthews
- Work and Health Research Team, Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Michael Quinlan
- School of Management, The University of New South Wales, Kensington, Australia
| | - Philip Bohle
- Work and Health Research Team, Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
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The Best Interests of Infants and Families During Palliative Care at the End of Life: A Review of the Literature. Adv Neonatal Care 2019; 19:E9-E14. [PMID: 30394915 DOI: 10.1097/anc.0000000000000567] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Palliative care is an integral element of care provision in neonatal intensive care units (NICUs). Healthcare providers working in NICUs are likely to provide palliative care at some point in their career. PURPOSE This article examines what neonatal palliative care entails, how parents perceive healthcare providers' actions, what they potentially need at the end of their infant's life, and what bereavement interventions are most supportive for parents. SEARCH STRATEGY We conducted a search of full-text articles published in English in PubMed and CINAHL using the following key words: "NICU bereavement care," "end-of-life care," "infant loss," and "palliative care." FINDINGS Healthcare providers should consider alleviation of the infant's pain and suffering when discussing whether to provide or continue aggressive medical interventions. The timing of these discussions is important. Parents appear to be most comforted by compassionate, caring healthcare providers who show competence and knowledge in the provision of medical/nursing and palliative care. IMPLICATIONS FOR PRACTICE Healthcare providers working in NICUs require specific training in bereavement/palliative care for infants. Families facing the death of their infant must receive support from qualified providers both during and after that death. Furthermore, the infant's quality of life must be considered when discussing withholding or withdrawing care. IMPLICATIONS FOR RESEARCH There is a need for further research investigating the specific types of training required by healthcare providers in NICU settings who are providing bereavement/palliative care to neonates, in order to best support the families' needs in these situations.
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Parents: Wish I had done, wish I had not done, and coping after child NICU/PICU death. J Am Assoc Nurse Pract 2019; 31:175-183. [DOI: 10.1097/jxx.0000000000000110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dyregrov A, Dyregrov K, Pereira M, Kristensen P, Johnsen I. Early intervention for bereaved children: What mental health professionals think. DEATH STUDIES 2018; 44:201-209. [PMID: 30556790 DOI: 10.1080/07481187.2018.1531086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
People rarely specify what "early intervention" following bereavement means, so we explored the views of experienced professionals working primarily with bereaved children. In an anonymous online survey, 84 mental health professionals answered questions about the content and timeframe of early intervention. The types of interventions varied, but conversation and support were most frequent. Most considered early intervention to mean before or during the first month following the loss. Although meta-analyses show little benefit of early intervention, professionals disagree and see the need to tailor interventions to the type of death, the situation of the family, and the intensity of reactions.
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Affiliation(s)
- Atle Dyregrov
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Kari Dyregrov
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Mariana Pereira
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Pål Kristensen
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Iren Johnsen
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Sheach-Leith V, Stephen AI. The experiences and support needs of adult family members who face a sudden adult death: a qualitative systematic review protocol. ACTA ACUST UNITED AC 2018; 14:93-105. [PMID: 27536796 DOI: 10.11124/jbisrir-2016-2000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Valerie Sheach-Leith
- 1. School of Nursing and Midwifery, Faculty of Health and Social Care, Robert Gordon University, United Kingdom2. The Scottish Centre for Evidence-based Multi-professional Practice: a Collaborating centre of The Joanna Briggs Institute
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Vos A, van der Wal AC, Teeuw AH, Bras J, Vink A, Nikkels PGJ. Cardiovascular causes of sudden unexpected death in children and adolescents (0-17 years) : A nationwide autopsy study in the Netherlands. Neth Heart J 2018; 26:500-505. [PMID: 30178211 PMCID: PMC6150875 DOI: 10.1007/s12471-018-1152-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Little is known about the causes of unexpected death in minors (0–17 years). In young adults an important cause is cardiovascular disease, with primary arrhythmogenic disorders, atherosclerotic events, cardiomyopathies and myocarditis as main contributors. The aim of this autopsy study was to determine the contribution of cardiovascular disease to unexpected death in minors. Methods and results In the Netherlands, systematic investigation of all cases of unexplained death in minors was compulsory in a nationwide governmental project during a 15-month period. Autopsies were performed according to a standardised protocol (autopsy rate 85%). A cardiovascular cause of death was found in 13/56 cases (23%). In the group <1 year, the main cardiovascular causes were various congenital defects (n = 3) and myocarditis (n = 2). In the 1–9 year group, no cardiovascular causes were found. In the 10–14 year group, hypertrophic cardiomyopathy (n = 1) and ruptured ascending aortic aneurysm (n = 1) were among the observed cardiovascular causes. In 14/56 (25%) cases autopsy revealed no structural abnormalities that could explain the sudden death, mostly in the group <1 year. Conclusion This national cohort with a high autopsy rate reveals a high incidence (23%) of cardiovascular diseases as the pathological substrate of sudden unexpected death in children. Another high percentage of minors (25%) showed no structural abnormalities, with the possibility of a genetic arrhythmia. These findings underline the importance of systematic autopsy in sudden death in minors, with implications for cardiogenetic screening of relatives. Electronic supplementary material The online version of this article (10.1007/s12471-018-1152-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Vos
- Department of Pathology, University Medical Center, Utrecht, The Netherlands.
| | - A C van der Wal
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - A H Teeuw
- Department of Paediatrics, Academic Medical Center, Amsterdam, The Netherlands
| | - J Bras
- Department of Pathology, University Medical Center, Utrecht, The Netherlands.,Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - A Vink
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - P G J Nikkels
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
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Abstract
OBJECTIVES To describe practical considerations and approaches to best practices for end-of-life care for critically ill children and families in the PICU. DATA SOURCES Literature review, personal experience, and expert opinion. STUDY SELECTION A sampling of the foundational and current evidence related to the withdrawal of life-sustaining therapies in the context of childhood critical illness and injury was accessed. DATA EXTRACTION Moderated by the authors and supported by lived experience. DATA SYNTHESIS Narrative review and experiential reflection. CONCLUSIONS Consequences of childhood death in the PICU extend beyond the events of dying and death. In the context of withdrawal of life-sustaining therapies, achieving a quality death is impactful both in the immediate and in the longer term for family and for the team. An individualized approach to withdrawal of life-sustaining therapies that is informed by empiric and practical knowledge will ensure best care of the child and support the emotional well-being of child, family, and the team. Adherence to the principles of holistic and compassionate end-of-life care and an ongoing commitment to provide the best possible experience for withdrawal of life-sustaining therapies can achieve optimal end-of-life care in the most challenging of circumstances.
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Butler AE, Hall H, Copnell B. Bereaved parents' experiences of the police in the paediatric intensive care unit. Aust Crit Care 2018; 32:40-45. [PMID: 29571596 DOI: 10.1016/j.aucc.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND A child's death in the intensive care unit is often sudden and unexpected, requiring the involvement of the state coroner to investigate both the cause and the circumstances surrounding the death. This process often involves the police, who arrive in intensive care to identify the body and collect statements from the parents. At present, very little is known about parents' experiences of this process. OBJECTIVES To explore bereaved parents' experiences of police presence in intensive care, as part of routine coronial investigations. The findings arose from a larger study on bereaved parents' experiences of the death of a child in the intensive care unit. METHODS Secondary analysis of incidental data from a larger grounded theory study. Nine bereaved parents from two paediatric intensive care units (PICUs) mentioned police presence in the PICU during their original audio-recorded, semistructured interviews. These data were extracted, and thematic analysis techniques were used to identify key themes. RESULTS Three main concepts were identified with the parents' experiences: (i) timing of police interviews; (ii) the impacts of police presence; and (iii) the demeanour of the officers. Overall, the parents' experiences of police presence were negative. They felt that police arrived too soon after their child's death and took too long taking their statements, hindering their ability to say goodbye. The presence of police officers also made parents feel as though they were being accused of involvement in their child's death. Finally, several participants also experienced inappropriate or unsympathetic attitudes from the police officers attending their child's death. CONCLUSIONS Findings from our study indicate that parents' experiences of police presence in the PICU as part of a coronial investigation may be negative, leaving lasting impressions on their experiences of their child's death. These findings provide areas for improvements in care delivery and the treatment of newly bereaved parents during the early phases of a coronial investigation.
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Affiliation(s)
- Ashleigh E Butler
- School of Nursing and Midwifery, Monash University, Victoria, Australia; Adult and Paediatric Intensive Care Unit, Monash Health, Victoria, Australia.
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, Victoria, Australia.
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Victoria, Australia.
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Kitzmiller L, Kline-Tilford AM. Supporting the family left behind – Loss of a child to congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Background Here we present additional information from the Safe Passage Study, where the effect of alcohol exposure during pregnancy on sudden infant death syndrome and stillbirth was investigated. Objective To explore bereaved mothers' attitudes toward obtaining an autopsy on their stillborn baby, and the future implications of consenting or non-consenting to autopsy in retrospect. Methods Demographic data was obtained by a questionnaire. A largely qualitative mixed-methods approach was used to meet the aims of the study, using an exploratory and descriptive research design to provide a detailed description of maternal attitudes. A semi-structured questionnaire based on information from literature and reflections on practice was administered during individual interviews. Results We interviewed 25 women who had had a recent stillbirth. The time interval between the time of consenting to autopsy and completing this study ranged from 6 to 18 months. Most participants reported that autopsy results provided peace of mind and helped alleviate their feelings of blame. Participants who were unable to comprehend the results reported negative reactions to receiving autopsy results. The majority of participants were of the opinion that they benefited from consenting to autopsy. Conclusion Autopsy and the disclosure of its results generally contribute positively to coping following stillbirth.
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Lima L, Gonçalves S, Pinto C. Sudden death in paediatrics as a traumatic experience for critical care nurses. Nurs Crit Care 2017; 23:42-47. [PMID: 29210143 DOI: 10.1111/nicc.12326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research shows that nurses working in critical care units and in particular, paediatric units, are at risk of developing symptoms of secondary traumatic stress (STS). However, little attention has been given to this phenomenon when associated with situations of sudden death in paediatrics. AIM This study aimed to examine the impact of sudden death in paediatrics on nurses working in paediatrics critical care units and to explore nurses' experiences of this event. METHODS This study used a mixed-methods design. The Impact of Event Scale - Revised was used for investigating the presence of STS symptoms. In addition, an interview was conducted with six nurses. RESULTS Fifty-seven percent of nurses responded to the surveys and six nurses were interviewed. The results showed that the sudden death of children and adolescents is an event that elicits symptoms of STS in nurses. The quantitative assessment, revealed that 19·4% presented total scores indicating high impact. The participants interviewed described experiences of subjective distress, such as intrusive thoughts, avoidance and hyperarousal. Other factors were also reported as influencing the experience of the sudden death of a child/adolescent, namely, the child's age, the cause of death and the family's reaction to the loss. According to the participants, the emotional impact was also determined by parenthood, previous training and professional experience. CONCLUSIONS Sudden death in paediatric critical care units is one of the most difficult situations in nursing practice and elicits STS symptoms, which may severely impact the physical and psychological health of nurses and ultimately affect the quality of the provided care. RELEVANCE FOR CLINICAL PRACTICE This study emphasizes the need for promoting better conditions for professional practice, namely, with regard to emotional support, as well as training programmes for skills development in the area of management of traumatic situations and of communication with clients.
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Affiliation(s)
- Lígia Lima
- Escola Superior de Enfermagem do Porto (Nursing School of Porto), Porto, Portugal
| | - Sandra Gonçalves
- Hospital Dr. Nélio Mendonça, Avenida Luís de Camões, n° 57-9004-514 Funchal, Portugal
| | - Cândida Pinto
- Escola Superior de Enfermagem do Porto (Nursing School of Porto), Porto, Portugal
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Heltne U, Dyregrov A, Dyregrov K. Death scene investigation: parents’ experiences. SCANDINAVIAN JOURNAL OF FORENSIC SCIENCE 2017. [DOI: 10.1515/sjfs-2016-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
This article presents the results of a study undertaken to evaluate how parents experience voluntary Death Scene Investigation (DSI) in their homes. In total, 35 parents were interviewed using semi-structured qualitative interview guidelines developed for this project. These focused on the parents’: 1) appraisal of information provided prior to the DSI and motivation for participating in the study, 2) experience of, and reactions to the DSI, and 3) thoughts and reactions following the DSI. The evaluation shows that performing a DSI is an important part of providing good care for bereaved parents following Sudden Infant Death Syndrome. If such an investigation is undertaken by professionals with extensive professional knowledge and experience in meeting bereaved parents in an empathic and caring manner, it can be a positive experience for parents, and help support them in coping with the painful death of their infant.
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Affiliation(s)
- Unni Heltne
- Center for Crisis Psychology, Bergen, Norway
| | - Atle Dyregrov
- Center for Crisis Psychology, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen
| | - Kari Dyregrov
- Center for Crisis Psychology, Bergen, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway
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Garstang J, Griffiths F, Sidebotham P. Rigour and Rapport: a qualitative study of parents' and professionals' experiences of joint agency infant death investigation. BMC Pediatr 2017; 17:48. [PMID: 28173849 PMCID: PMC5297208 DOI: 10.1186/s12887-017-0803-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In many countries there are now detailed Child Death Review (CDR) processes following unexpected child deaths. CDR can lead to a fuller understanding of the causes for each child's death but this potentially intrusive process may increase the distress of bereaved families. In England, a joint agency approach (JAA) is used where police, healthcare and social services investigate sudden child deaths together and a key part of this is the joint home visit (JHV) where specialist police and paediatricians visit the home with the parents to view the scene of death. This study aimed to learn of bereaved parents' experiences of JAA investigation following Sudden Unexpected Death in Infancy (SUDI). METHODS This was a qualitative study of joint agency investigation of SUDI by specialist police, healthcare and social services including case note analysis, parental questionnaires, and in-depth interviews with parents and professionals. Families were recruited at the conclusion of the JAA. Data were analysed using a Framework Approach. RESULTS 21/113 eligible families and 26 professionals participated giving theoretical saturation of data. There was an inherent conflict for professionals trying to both investigate deaths thoroughly as well as support families. Bereaved parents appreciated the JAA especially for the information it provided about the cause of death but were frustrated with long delays waiting to obtain this. Many parents wanted more emotional support to be routinely provided. Most parents found the JHV helpful but a small minority of mothers found this intensely distressing. In comparison to JHVs, when police visited death scenes without paediatricians, information was missed and parents found these visits more upsetting. There were issues with uniformed non-specialist police traumatising parents by starting criminal investigations and preventing parents from accessing their home or collecting vital possessions. CONCLUSIONS Overall most parents feel supported by professionals during the JAA; however there is scope for improvement. Paediatricians should ensure that parents are kept updated with the progress of the investigations. Some parents require more emotional support and professionals should assist them in accessing this.
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Affiliation(s)
- Joanna Garstang
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, CV7 4AL, UK.
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV7 4AL, UK
| | - Peter Sidebotham
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, CV7 4AL, UK
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Abstract
PURPOSE OF REVIEW It is recognized that death is inevitable but rarely are we prepared for the death of significant persons in our lives. Sudden death is by its nature unexpected and thus shocking for family members and friends of the decedent. Sudden deaths have customarily been divided into four categories based on the cause of death, including natural, accidental, suicidal, or homicidal (NASH) deaths. Supporting the suddenly bereaved can be stressful, for both novice and experienced professionals; this review provides information important to healthcare professionals (HCP) who are often in a position to support family members after a sudden death. RECENT FINDINGS Evidence suggests that supportive actions for those suddenly bereaved include HCPs conveying empathy, answering questions about the cause of death, allowing family members an opportunity to say goodbye, and providing follow-up over time. Bereaved individuals appreciate ongoing connections with healthcare professionals after the death, and HCPs need to recognize that the bereaved are at increased risk of illness in the months after a sudden death. SUMMARY Supporting those bereaved after a sudden unexpected death is not easy, even for experienced professionals. This review identifies supportive strategies to use with individuals and family members who are suddenly bereaved. The suggestions in this review can be used in emergency departments and other settings involved with death notifications. Also provided is information that HCPs can use to support bereaved family members.
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Gijzen S, L’Hoir MP, Boere-Boonekamp MM, Need A. How do parents experience support after the death of their child? BMC Pediatr 2016; 16:204. [PMID: 27927172 PMCID: PMC5142355 DOI: 10.1186/s12887-016-0749-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 12/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A child's death is an enormous tragedy for both the parents and other family members. Support for the parents can be important in helping them to cope with the loss of their child. In the Netherlands little is known about parents' experiences of the support they receive after the death of their child. The purpose of this study is to determine what support parents in the Netherlands receive after the death of their child and whether the type of care they receive meets their needs. METHOD Parents who lost a child during pregnancy, labour or after birth (up to the age of two) were eligible for participation. They were recruited from three parents' associations. Sixty-four parents participated in four online focus group discussions. Data on background characteristics were gathered through an online questionnaire. SPSS was used to analyse the questionnaires and Atlas ti. was used for the focus group discussions. RESULTS Of the 64 participating parents, 97% mentioned the emotional support they received after the death of their child. This kind of support was generally provided by family, primary care professionals and their social network. Instrumental and informational support, which respectively 80% and 61% of the parents reported receiving, was mainly provided by secondary care professionals. Fifty-two per cent of the parents in this study reported having received insufficient emotional support. Shortcomings in instrumental and informational support were experienced by 25% and 19% of the parents respectively. Parental recommendations were directed at ongoing support and the provision of more information. CONCLUSION To optimise the way Dutch professionals respond to a child's death, support initiated by the professional should be provided repeatedly after the death of a child. Parents appreciated follow-up contacts with professionals at key moments in which they were asked whether they needed support and what kind of support they would like to receive.
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Grants
- INTERREG Deutschland-Nederland, as the leading financer, The Ministry for Youth and Families, Land NRW, Land Niedersachsen, University of Twente, University of Münster, TNO Child Health, Menzis Health Insurance, MKB Netherlands, Foundation ‘Kinderpostzegel
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Affiliation(s)
- Sandra Gijzen
- Department HTSR, IGS Institute for Innovation and Governance Studies, University of Twente, PO Box 217, 7500 AE Enschede, Netherlands
| | | | - Magda M. Boere-Boonekamp
- Department HTSR, IGS Institute for Innovation and Governance Studies, University of Twente, PO Box 217, 7500 AE Enschede, Netherlands
| | - Ariana Need
- Department Public Administration, IGS Institute for Innovation and Governance Studies, University of Twente, PO Box 217, 7500 AE Enschede, Netherlands
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Parental experiences with a hospital-based bereavement program following the loss of a child to cancer. Palliat Support Care 2016; 15:348-358. [DOI: 10.1017/s1478951516000821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AbstractObjective:The death of a child from cancer is an intense and life-changing loss for a parent. Guided by the principles of patient- and family-centered care, hospital-based caregivers developed a program to provide bereavement support for parents through phone calls and mailings. The aim of the present qualitative phenomenological study was to understand how parents experienced participating in this bereavement program.Method:A total of eight parents from six families participated in a focus-group evaluation of the two-year hospital-based bereavement program. Two social work clinicians/researchers independently analyzed the transcript of the focus group to define themes.Results:Four themes were identified: (1) lived experience of grief, (2) importance of relationships with the hospital-based team, (3) bereavement support from hospital-based providers, and (4) extending bereavement care.Significance of Results:Participants indicated the value of ongoing communication and connection with members of the healthcare team, who were often central to a family's life for years during their child's cancer treatment. Parents also provided suggestions for extending bereavement support through continued contact with providers and informal annual gatherings, as well as through a peer (parent-to-parent) support program.
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Neonatal Death in the Emergency Department: When End-of-Life Care Is Needed at the Beginning of Life. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Garstang J, Griffiths F, Sidebotham P. Parental understanding and self-blame following sudden infant death: a mixed-methods study of bereaved parents' and professionals' experiences. BMJ Open 2016; 6:e011323. [PMID: 27198994 PMCID: PMC4885458 DOI: 10.1136/bmjopen-2016-011323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Improvements in our understanding of the role of modifiable risk factors for sudden infant death syndrome (SIDS) mean that previous reassurance to parents that these deaths were unpreventable may no longer be appropriate. This study aimed to learn of bereaved parents' and healthcare professionals' experiences of understanding causes of death following detailed sudden unexpected death in infancy (SUDI) investigations. The research questions were: How do bereaved parents understand the cause of death and risk factors identified during detailed investigation following a sudden unexpected infant death? What is the association between bereaved parents' mental health and this understanding? What are healthcare professionals' experiences of sharing such information with families? DESIGN This was a mixed-methods study using a Framework Approach. SETTING Specialist paediatric services. PARTICIPANTS Bereaved parents were recruited following detailed multiagency SUDI investigations; 21/113 eligible families and 27 professionals participated giving theoretical saturation of data. DATA COLLECTION We analysed case records from all agencies, interviewed professionals and invited parents to complete the Hospital Anxiety and Depression Scale (HADS) and questionnaires or in-depth interviews. RESULTS Nearly all bereaved parents were able to understand the cause of death and several SIDS parents had a good understanding of the relevant modifiable risk factors even when these related directly to their actions. Paediatricians worried that discussing risk factors with parents would result in parental self-blame and some deliberately avoided these discussions. Over half the families did not mention blame or blamed no one. The cause of death of the infants of these families varied. 3/21 mothers expressed overwhelming feelings of self-blame and had clinically significant scores on HADS. CONCLUSIONS Bereaved parents want detailed information about their child's death. Our study suggests parents want health professionals to explain the role of risk factors in SIDS. We found no evidence that sharing this information is a direct cause of parental self-blame.
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Affiliation(s)
- Joanna Garstang
- Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | - Peter Sidebotham
- Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK
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"Have no regrets:" Parents' experiences and developmental tasks in pregnancy with a lethal fetal diagnosis. Soc Sci Med 2016; 154:100-9. [PMID: 26954999 DOI: 10.1016/j.socscimed.2016.02.033] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 02/11/2016] [Accepted: 02/17/2016] [Indexed: 11/20/2022]
Abstract
SIGNIFICANCE Lethal fetal diagnoses are made in 2% of all pregnancies. The pregnancy experience is certainly changed for the parents who choose to continue the pregnancy with a known fetal diagnosis but little is known about how the psychological and developmental processes are altered. METHODS This longitudinal phenomenological study of 16 mothers and 14 fathers/partners sought to learn the experiences and developmental needs of parents who continue their pregnancy despite the lethal diagnosis. The study was guided by Merleau-Ponty's philosophic view of embodiment. Interviews (N = 90) were conducted with mothers and fathers over time, from mid-pregnancy until 2-3 months post birth. Data analysis was iterative, through a minimum of two cycles of coding, theme identification, within- and cross-case analysis, and the writing of results. RESULTS Despite individual differences, parents were quite consistent in sharing that their overall goal was to "Have no regrets" when all was said and done. Five stages of pregnancy were identified: Pre-diagnosis, Learning Diagnosis, Living with Diagnosis, Birth & Death, and Post Death. Developmental tasks of pregnancy that emerged were 1) Navigating Relationships, 2) Comprehending Implication of the Condition, 3) Revising Goals of Pregnancy, 4) Making the Most of Time with Baby, 5) Preparing for Birth and Inevitable Death, 6) Advocating for Baby with Integrity, and 7) Adjusting to Life in Absence of Baby. Prognostic certainty was found to be highly influential in parents' progression through developmental tasks. CONCLUSION The framework of parents' pregnancy experiences with lethal fetal diagnosis that emerged can serve as a useful guide for providers who care for families, especially in perinatal palliative care. Providing patient-centered care that is matched to the stage and developmental tasks of these families may lead to improved care and greater parent satisfaction.
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Sereshti M, Nahidi F, Simbar M, Ahmadi F, Bakhtiari M, Zayeri F. Mothers' Perception of Quality of Services from Health Centers after Perinatal Loss. Electron Physician 2016; 8:2006-17. [PMID: 27054012 PMCID: PMC4821318 DOI: 10.19082/2006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/04/2016] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Perinatal loss is one of the most stressful life events that parents and caregivers experience. Providing an empathetic, caring environment to support mothers who experience perinatal loss is necessary. The aim of this study was to assess mothers' perception of the quality of services received from health centers after perinatal loss. METHODS This study was conducted in 2014-2015 using qualitative content analysis. Participants in the study were 40 women with a history of miscarriage, stillbirth, or neonatal death who live in Tehran and Shahrekord, Iran. Data were collected from the participants through semi-structured, in-depth interviews, and they were analyzed using qualitative content analysis. RESULTS One theme and six main categories were developed, and they indicated the mothers' experiences and understandings of the quality of service received after perinatal loss. The major theme was 'dissatisfaction with the quality of care received.' The main categories included: 1) effective communication, 2) expecting responsiveness, 3) expecting to respect the patient's dignity, 4) expecting better care, 5) tension of medical expenses, and 6) insufficient facilities. CONCLUSION The findings of this study highlighted the weaknesses, inadequacies, strengths, and opportunities in providing health services. They can help reproductive health policy-makers reduce the pain and suffering of the affected families with appropriate measures.
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Affiliation(s)
- Manije Sereshti
- Department of Midwifery & Reproductive Health, School of Nursing and Midwifery, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fateme Nahidi
- Department of Midwifery & Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masomeh Simbar
- Department of Midwifery & Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fazlollah Ahmadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Maryam Bakhtiari
- Departments of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Matthews LR, Fitzpatrick SJ, Quinlan MG, Ngo M, Bohle P. Bereaved families and the coronial response to traumatic workplace fatalities: Organizational perspectives. DEATH STUDIES 2015; 40:191-200. [PMID: 26681297 DOI: 10.1080/07481187.2015.1115787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Work remains a significant source of illness, injury, and death in developed countries. In Australia, for example, over 2,000 people die from work-related causes each year, with heavy social, economic, and personal costs (Safe Work Australia, 2013a ). Most die as a result of work-related disease. However, many die from trauma. In 2012, 223 workers were fatally injured in Australia and in the United States the figure was 4,383 (Bureau of Labor Statistics, 2014 ; Safe Work Australia, 2013b ). Apart from the immediate tragedy of each worker's death, these deaths affect the victim's immediate family, wider family, friends, and co-workers. It has been estimated that, on average, every death has an impact on at least 20 other people (Dyregrov, Nordanger, & Dyregrov, 2003 ), especially when the deceased had several families, which is an increasingly common phenomenon (OECD, 2014 ). Little is known, however, about how regulatory responses following a traumatic workplace fatality meet the needs of surviving families. With a focus on the coronial investigation, this article provides information about the regulatory responses to a traumatic workplace fatality and examines how various organizations involved in the coronial process following the death viewed its ability to accommodate the needs and wishes of surviving families.
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Affiliation(s)
- Lynda R Matthews
- a Ageing Work and Health Research Unit, Faculty of Health Sciences , The University of Sydney , Sydney , Australia
| | - Scott J Fitzpatrick
- a Ageing Work and Health Research Unit, Faculty of Health Sciences , The University of Sydney , Sydney , Australia
- b Centre for Rural and Remote Mental Health , The University of Newcastle , Newcastle , Australia
| | - Michael G Quinlan
- a Ageing Work and Health Research Unit, Faculty of Health Sciences , The University of Sydney , Sydney , Australia
- c School of Management , The University of New South Wales , Sydney , Australia
| | - Mark Ngo
- a Ageing Work and Health Research Unit, Faculty of Health Sciences , The University of Sydney , Sydney , Australia
| | - Philip Bohle
- a Ageing Work and Health Research Unit, Faculty of Health Sciences , The University of Sydney , Sydney , Australia
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Garstang J, Ellis C, Sidebotham P. An evidence-based guide to the investigation of sudden unexpected death in infancy. Forensic Sci Med Pathol 2015; 11:345-57. [PMID: 25999133 DOI: 10.1007/s12024-015-9680-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Many countries now have detailed investigations following sudden unexpected death in infancy (SUDI) but there is no clear evidence as to the most effective way to investigate SUDI. This systematic literature review addresses the following questions: What are the current models of practice for investigating SUDI? What is the evidence to support these investigative models? What are the key factors for effective SUDI investigation? METHODS This was a systematic review of papers from Europe, North America, and Australasia, detailing models of SUDI investigation or the outcomes of SUDI investigations. RESULTS The review includes data detailing four different models of investigation: police-led, coroner or medical examiner-led, healthcare-led or joint agency approach models. There were 18 different publications providing evidence of effectiveness of these models. All models, with the exception of police-led models, have the potential to reach best practice standards for SUDI investigation. Key factors identified for effective SUDI investigation include the need for mandatory investigation, strong leadership, integration with coronial services, and for investigations to be provided by specialist professionals. CONCLUSION Detailed SUDI investigation should lead to greater understanding of why infants die and should help prevent future deaths. The challenge is now to ensure that local SUDI investigative practices are as effective as possible.
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Affiliation(s)
- Joanna Garstang
- Division of Mental Health and Wellbeing, Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL, UK,
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