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Widyaratne A, Bally JMG. Utilization of the Keeping Hope Possible Toolkit with parents of children with life limiting and life threatening illnesses during the COVID-19 pandemic: Exploring pediatric nurses and allied healthcare provider opinions. J Pediatr Nurs 2024; 77:e177-e186. [PMID: 38627171 DOI: 10.1016/j.pedn.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND For families with children diagnosed with complex illnesses, the COVID-19 pandemic added many challenges. In order to mitigate inevitable disruptions in pediatric care settings, caregivers may need added supports and resources. The Keeping Hope Possible (KHP) Toolkit is a self-administered intervention intended to enhance caregiving experiences of parents with a child with multiple needs. However, little is known about effectively disseminating the Toolkit. PURPOSE AND METHODS A qualitative, thematic analysis was conducted to explore the opinions and perceptions of pediatric nurses and allied healthcare providers (HCPs) in relation to the dissemination and use of the KHP Toolkit for use by families with complex medical needs. Structured interview data were analyzed from a sample of seven pediatric HCPs working in various care settings in one Canadian province. FINDINGS Five themes were developed including: Recognising Importance of the KHP Toolkit; Needing Support and Direction; Implementation and Use of the KHP Toolkit; Realizing Important Considerations for Success; and, Emphasizing Connection through Isolated Times. DISCUSSION Participants recognized the importance of the KHP Toolkit for parents and extended family in a variety of settings to encourage self-care, daily structure, and connectedness. Thus, pediatric nurses' awareness and openness to the initial dissemination of the Toolkit is essential, and a subsequent interprofessional team approach will ensure consistent reminders and support for families. APPLICATION TO PRACTICE Careful assessment of family readiness for learning about and using the KHP Toolkit is essential, along with an interprofessional approach to consistent inquiry and support at each family encounter.
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Affiliation(s)
- Amaya Widyaratne
- College of Arts & Science, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada.
| | - Jill M G Bally
- College of Nursing, University of Saskatchewan, 104 Clinic Drive, Saskatoon, SK S7N 2Z4, Canada
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Middlemiss AL, Kilshaw S. Further Hierarchies of Loss: Tracking Relationality in Pregnancy Loss Experiences. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231182273. [PMID: 37282837 DOI: 10.1177/00302228231182273] [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: 06/08/2023]
Abstract
The article extends Robson and Walter's concept of hierarchies of loss by describing further factors which afford differential social legitimacy to death-related losses. Drawing on our separate research with women in England who have experienced pre-viability pregnancy loss through different types of miscarriage and termination for foetal anomaly, we note that closeness of relationship to the object of loss does hierarchise pregnancy loss. However, other relational elements are also implicated, including ontological positions on what it was which was lost, in relation to other individually and socially experienced losses. Hierarchies are both imposed and agentially used by those who are implicated. This wider analysis extends the concept of hierarchies of loss so it can include experiences which do and do not involve grief and bereavement, and experiences of social recognition alongside those where loss is disenfranchised, marginalised, or ungrievable.
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Affiliation(s)
- Aimee L Middlemiss
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Susie Kilshaw
- Department of Anthropology, University College London, London, UK
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Tatterton MJ, Lyon JA. 'I no longer feel alone': meeting the needs of bereaved grandparents through a children's hospice support group. Int J Palliat Nurs 2022; 28:193-201. [PMID: 35648684 DOI: 10.12968/ijpn.2022.28.5.193] [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: 11/11/2022]
Abstract
BACKGROUND Children's hospices provide a range of family-centred care services, including bereavement support. Not all hospices provide specific services for grandparents. AIM To explore how a hospice-based bereavement support group supported grandparents in their grief following the death of a grandchild. METHODS Grandparents attending a group were invited to complete an anonymous questionnaire. Questionnaires from eight groups, run between 2015 and 2019 were collated and interpreted to identify themes. FINDINGS A total of 121 grandparents attended the groups; 113 returned the questionnaires (93% response). A total of three superordinate themes were identified: environment and space, being with people who understand, and the opportunity to hear the stories of others. Grandparents valued hearing the stories of others, providing an opportunity to reflect on the experience of others. CONCLUSION Grandparents felt supported and validated by the group. Facilitated sessions increased coping and resilience of participants, enabling grandparents to support their partner, adult children and surviving grandchildren more effectively.
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Affiliation(s)
- Michael J Tatterton
- Associate Professor and Professional Lead for Children and Young People's Nursing, School of Nursing and Healthcare Leadership, University of Bradford; Visiting Consultant Nurse Children's Palliative Care, Martin House Children's Hospice, UK
| | - Judith A Lyon
- Staff Nurse and Grandparent Lead, Martin House Children's Hospice, UK
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Arnone M, Dumond LG, Yazdani N, El-Baroudi R, Pouliot A, Modanloo S. Evaluation of a grandparent bereavement support group in a Pediatric Palliative Care Hospice. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1988311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Madelena Arnone
- Roger Neilson House, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Lynn Grandmaison Dumond
- Roger Neilson House, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Nahal Yazdani
- Roger Neilson House, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Rayan El-Baroudi
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Annie Pouliot
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Shokoufeh Modanloo
- Roger Neilson House, Ottawa, Ontario, Canada
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Lockton J, Oxlad M, Due C. Grandfathers' Experiences of Grief and Support Following Pregnancy Loss or Neonatal Death of a Grandchild. QUALITATIVE HEALTH RESEARCH 2021; 31:2715-2729. [PMID: 34772285 DOI: 10.1177/10497323211041331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pregnancy loss and neonatal death are recognized as distressing experiences for parents and other family members. However, no research has specifically addressed the experiences of grandfathers. This study aimed to understand grandfathers' grief experiences, and to identify supports they provide, receive, and desire following the loss of a grandchild in pregnancy or the neonatal period. Semi-structured interviews with 10 Australian grandfathers were analyzed, applying principles of thematic analysis. Three themes related to grief and three themes related to support were identified. Findings indicated that grandfathers expressed grief in a range of ways, and emotional expressiveness did not reflect the extent of their grief. Grandfathers typically provided extensive support to their child and family; however, few supports were available to help grandfathers. Recognition and validation of grandfathers' grief, early access to information, and guidance to a variety of supports including written materials, peer and professional support, is required.
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Affiliation(s)
- Jane Lockton
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Melissa Oxlad
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Clemence Due
- The University of Adelaide, Adelaide, South Australia, Australia
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Obst KL, Oxlad M, Due C, Middleton P. Factors contributing to men's grief following pregnancy loss and neonatal death: further development of an emerging model in an Australian sample. BMC Pregnancy Childbirth 2021; 21:29. [PMID: 33413199 PMCID: PMC7792062 DOI: 10.1186/s12884-020-03514-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background Historically, men’s experiences of grief following pregnancy loss and neonatal death have been under-explored in comparison to women. However, investigating men’s perspectives is important, given potential gendered differences concerning grief styles, help-seeking and service access. Few studies have comprehensively examined the various individual, interpersonal, community and system/policy-level factors which may contribute to the intensity of grief in bereaved parents, particularly for men. Methods Men (N = 228) aged at least 18 years whose partner had experienced an ectopic pregnancy, miscarriage, stillbirth, termination of pregnancy for foetal anomaly, or neonatal death within the last 20 years responded to an online survey exploring their experiences of grief. Multiple linear regression analyses were used to examine the factors associated with men’s grief intensity and style. Results Men experienced significant grief across all loss types, with the average score sitting above the minimum cut-off considered to be a high degree of grief. Men’s total grief scores were associated with loss history, marital satisfaction, availability of social support, acknowledgement of their grief from family/friends, time spent bonding with the baby during pregnancy, and feeling as though their role of ‘supporter’ conflicted with their ability to process grief. Factors contributing to grief also differed depending on grief style. Intuitive (emotion-focused) grief was associated with support received from healthcare professionals. Instrumental (activity-focused) grief was associated with time and quality of attachment to the baby during pregnancy, availability of social support, acknowledgement of men’s grief from their female partner, supporter role interfering with their grief, and tendencies toward self-reliance. Conclusions Following pregnancy loss and neonatal death, men can experience high levels of grief, requiring acknowledgement and validation from all healthcare professionals, family/friends, community networks and workplaces. Addressing male-specific needs, such as balancing a desire to both support and be supported, requires tailored information and support. Strategies to support men should consider grief styles and draw upon father-inclusive practice recommendations. Further research is required to explore the underlying causal mechanisms of associations found. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03514-6.
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Affiliation(s)
- Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, South Australia.
| | - Melissa Oxlad
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Philippa Middleton
- South Australian Health and Medical Research Institute, Adelaide, South Australia
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Lockton J, Oxlad M, Due C. Knowing how to help: Grandmothers' experiences of providing and receiving support following their child's pregnancy loss. Women Birth 2020; 34:585-592. [PMID: 33153951 DOI: 10.1016/j.wombi.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/16/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Abstract
PROBLEM Pregnancy loss is a distressing experience for parents, however no research has addressed grandmothers' experiences of grief and support following a child's pregnancy loss. BACKGROUND No research has specifically addressed grandmothers' experiences of support and bereavement care following pregnancy loss. AIM This study seeks to understand three key areas: (1) the support grandmothers provide to their child; (2) the support they received themselves following pregnancy loss, and; (3) supports desired by grandmothers. The study aims to contribute insights into actions midwives could take to support grandmothers following pregnancy loss. METHODS Semi-structured interviews were conducted with 14 grandmothers to understand their support experiences. Interviews were analysed using Braun and Clarke's approach to thematic analysis. FINDINGS Themes related directly to the three research questions: one: providing support, comprising two themes - being strong, protecting their family and the challenges of knowing how to help. Two, receiving support, also comprised two themes - lack of professional support offered to grandmothers and informal support and self-support strategies. Three, desired support, comprised three themes - I had no idea: increasing knowledge of pregnancy loss, peer support helps: they know how it feels, and honouring our grandchildren, making meaning. DISCUSSION Grandmothers may give extensive support to their child following pregnancy loss but lack confidence and face challenges in doing so. Few formal supports are available to grandmothers themselves, with grandmothers relying on their social networks for their own support. CONCLUSIONS Grandmothers need early access to information and guidance from midwives and hospital bereavement services, as well as ongoing peer support with flexible delivery options.
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Affiliation(s)
- Jane Lockton
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Clemence Due
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
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Fernández-Sola C, Camacho-Ávila M, Hernández-Padilla JM, Fernández-Medina IM, Jiménez-López FR, Hernández-Sánchez E, Conesa-Ferrer MB, Granero-Molina J. Impact of Perinatal Death on the Social and Family Context of the Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3421. [PMID: 32422977 PMCID: PMC7277582 DOI: 10.3390/ijerph17103421] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Perinatal death (PD) is a painful experience, with physical, psychological and social consequences in families. Each year, there are 2.7 million perinatal deaths in the world and about 2000 in Spain. The aim of this study was to explore, describe and understand the impact of perinatal death on parents' social and family life. METHODS A qualitative study based on Gadamer's hermeneutic phenomenology was used. In-depth interviews were conducted with 13 mothers and eight fathers who had suffered a perinatal death. Inductive analysis was used to find themes based on the data. RESULTS Seven sub-themes emerged, and they were grouped into two main themes: 1) perinatal death affects family dynamics, and 2) the social environment of the parents is severely affected after perinatal death. CONCLUSIONS PD impacts the family dynamics of the parents and their family, social and work environments. Parents perceive that society trivializes their loss and disallows or delegitimizes their grief. IMPLICATIONS Social care, health and education providers should pay attention to all family members who have suffered a PD. The recognition of the loss within the social and family environment would help the families to cope with their grief.
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Affiliation(s)
- Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 La Cañada de San Urbano, Spain; (I.M.F.-M.); (F.R.J.-L.); (J.G.-M.)
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco 01090, Chile
| | - Marcos Camacho-Ávila
- Hospital La Inmaculada, 04600 Huércal-Overa, Spain;
- Hospital de Torrevieja, 03186 Torrevieja, Spain;
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 La Cañada de San Urbano, Spain; (I.M.F.-M.); (F.R.J.-L.); (J.G.-M.)
- School of Health and Education, Middlesex University, London NW4 4BH, UK
| | - Isabel María Fernández-Medina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 La Cañada de San Urbano, Spain; (I.M.F.-M.); (F.R.J.-L.); (J.G.-M.)
| | - Francisca Rosa Jiménez-López
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 La Cañada de San Urbano, Spain; (I.M.F.-M.); (F.R.J.-L.); (J.G.-M.)
| | - Encarnación Hernández-Sánchez
- Hospital de Torrevieja, 03186 Torrevieja, Spain;
- Faculty of Health Sciences, Universidad Católica de San Antonio de Murcia, 30107 Guadalupe de Maciascoque, Spain
| | | | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 La Cañada de San Urbano, Spain; (I.M.F.-M.); (F.R.J.-L.); (J.G.-M.)
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco 01090, Chile
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Lockton J, Due C, Oxlad M. Love, Listen and Learn: Grandmothers' Experiences of Grief Following Their Child's Pregnancy Loss. Women Birth 2019; 33:401-407. [PMID: 31387781 DOI: 10.1016/j.wombi.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In Australia, 15-20% of pregnancies result in miscarriage, and 0.69% in stillbirth. Pregnancy loss is a distressing experience for parents, with many turning to their own parents for support. Pregnancy loss has been identified as an ambiguous loss, leading to disenfranchised grief. However little research has been conducted regarding grandparents' experiences following pregnancy loss. Much of what is known comes indirectly from family studies of grief and loss. This study aimed to explore grandparents' experiences of loss and grief, following a child's pregnancy loss. DESIGN A grounded theory approach using a qualitative inductive thematic analysis research design was employed. Individual participant interviews provided the data for analysis which was conducted using a six-step approach. METHODS Interviews were conducted with 14 grandmothers. Interviews were semi-structured, with open-ended questions. Thematic Analysis was applied using Braun and Clarkes' (2013) approach to analysis. RESULTS Five themes were identified: Pregnancy loss is a grief like no other, Excited anticipation - then nothing, Ambiguity following pregnancy loss exacerbates grief, Grief is isolating, Multiple losses, changed family relationships, and Ceremonies and mementoes: Tangible, with lasting benefits for grandparents. CONCLUSIONS Early access to information and guidance, ongoing peer support with flexible delivery options, and involvement in memory making activities could reduce ambiguity and disenfranchisement. Increasing community education and participation in raising awareness was identified as a way for grandparents to honour their loss and support others. Further research could explore grandfathers' experiences, the longer-term outcomes for grandparents and families, and the impact of support strategies.
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Affiliation(s)
- Jane Lockton
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Clemence Due
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
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Tatterton MJ, Walshe C. Understanding the bereavement experience of grandparents following the death of a grandchild from a life‐limiting condition: A meta‐ethnography. J Adv Nurs 2019; 75:1406-1417. [DOI: 10.1111/jan.13927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/12/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Michael J. Tatterton
- Martin House Children's Hospice Wetherby West Yorkshire UK
- International Observatory on End of Life Care Lancaster University Lancaster UK
| | - Catherine Walshe
- International Observatory on End of Life Care Lancaster University Lancaster UK
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