Grief as a transformative experience: weaving through different lifeworlds after a loved one has completed suicide

The functions of the dreams of the deceased: A qualitative study of women bereaved by partner's suicide

Suicide bereavement is a challenging experience that affects relationships, feelings, and physical and mental health. The research on dreams during suicide bereavement might deepen the understanding of how the loved one's suicide affects the person and what functions the dreams can have during the bereavement process. Therefore, the goal of the current study was to explore the functions of the dreams of the deceased during suicide bereavement in a sample of 9 women bereaved by their partner's suicide. The data was gathered by conducting semi-structured interviews and analyzed using reflexive thematic analysis. Three themes were generated: dreams function as helping during the process of suicide bereavement; dreams reflect the traumatic aspects of suicide bereavement; dreams function as a space to maintain or sever an ongoing relationship with the deceased. The findings reveal that dreams can function in different ways and can be a valid part of suicide bereavement.

Existential loneliness and life suffering in being a suicide survivor: a reflective lifeworld research study

Purpose

The aim of the study was to describe the loss of a family member by suicide, based on the lived experience of suicide survivors.

Methods

A phenomenology study with a Reflective Lifeworld Research approach was conducted, consisting of sixteen interviews with eight suicide survivors.

Results

The essence of losing a family member by suicide encompasses experiences of involuntary and existential loneliness, life suffering, and additional burdens in a life that is radically transformed, comprising prolonged and energy-intensive attempts to understand. Life for the family member encompasses a constant fear of being judged and an ambiguous silence, where this silence can both lead to involuntary loneliness and be a source of support and fellowship. Support mechanisms inside the family fall apart, and it becomes obvious that the survivors’ experiences affect others. The loss also implies an active endeavour to maintain the memory of the deceased.

Conclusions

Based on these results, it is important for professionals to accept the survivors as suffering human beings early—from the point of the notification of death—and consider them as patients in need of compassionate care. Such support might reduce life suffering, counteract stigma and involuntary loneliness, and work simultaneously as suicide prevention.

Factors contributing and promoting Open Innovation in Indian female-owned Food Processing SMEs- Prioritizing through the AHP technique

The prime motivation behind this investigation is to recognize and organize the different factors connected to Open Innovation in the already up and running from last five years Indian female owned SMEs in Food Processing Industry. Fifteen Indian female owners were chosen. An AHP system was utilized to examine the weight of basic elements leading towards Open Innovation. All things considered, the respondents organized advancement technique, opportunity acknowledgment, money and inspiration as the principle criteria that leads to Open Innovation in Indian females owned SMEs in Food Processing. COVID-19, gender gap, raising inner and outer funds were likewise observed as a hindrance ladies face that usually would keep them away from innovative tasks performed for business. The result of this examination is giving policymakers in India food for thought regarding the significance of the factors connected to development of Indian female owned SMEs in Food Processing Industry and will be able to move towards sustainable development goals- Goal 9 (Industry, Innovation and Infrastructure) and Goal 5 (gender equality) which is required for the economic development of the country. This will assist them with systemizing and organizing the basic, advancement of open innovation factors in Indian female owned Food Processing SMEs, which will give a boost to the contribution of Indian females in the financial development of India, which a developing country currently.

"When my worse fear happened": Mental health nurses' responses to the death of a client through suicide

WHAT IS KNOWN ON THE SUBJECT?: The death of a client to suicide evokes a range of grief responses for mental health nurses (MHNs), which vary in intensity according to the nature of the therapeutic relationship with the deceased client. There are limited qualitative studies on the experiences of nurses working in the community and the personal or professional strategies used by nurses to cope with the death of a client by suicide. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Following a client suicide, MHNs were often left to carry the burden of grief alone and to care for themselves with the support of their family and colleagues. While all participants perceived the need for support following the death of a client by suicide, they were offered minimal support beyond the debriefing meetings, with their grief experience being largely unacknowledged and disenfranchised. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MHNs and services need to establish and promote a culture of openness in which suicide is anticipated as a possible outcome, even with excellent standards of care and wherein all staff are supported and encouraged to discuss and reflect on their concerns and fears during the aftermath of a client suicide. As MHNs are often left to carry the burden of grief alone, services need to recognize the emotional cost of embodied engagement with clients and families and provide the necessary supports. ABSTRACT: Introduction Experiencing a client's death through suicide is complex and challenging, yet limited research exists on how MHNs might deal with its aftermath. Aim This study aimed to explore the impact and responses of MHNs to a client suicide. Method The study design is a secondary analysis of an existing data set involving semi-structured interview with 33 MHNs that were analysed using the principles of grounded theory. To answer the secondary question on the impact and responses of MHNs to the death of a client by suicide a subset of the data from 10 participants who experienced the death of a client by suicide were re-analysed using thematic analysis. Ethical approval was granted by the university ethics committee. Findings The findings identified five themes: "Hearing the news," "Experiencing the impact of grief," "Grieving privately" "Searching for meaning" and "Questioning practice." Discussion Findings highlighted that although participants perceived the need for support, they were offered minimal support beyond the debriefing meetings, with their grief experience being largely unacknowledged and disenfranchised. Implications for practice MHN services need to promote a culture of openness wherein all MHNs are supported and encouraged to discuss their concerns and fears during the aftermath of a client suicide.

Culture-related grief beliefs of Chinese Shidu parents: Development and psychometric properties of a new scale

Background: In China, parents whose only-child dies and who have no living or adopted child are called Shidu parents. Negative thinking is assumed to contribute to the development of emotional problems in bereavement. Because grief cognitions are likely influenced by the concepts of Chinese traditional culture (e.g., family continuation), Shidu parents may hold specific culture-related grief beliefs about themselves or the world, which, in turn, could impede their recovery. Objective: This study developed a questionnaire assessing the culture-related grief beliefs of Shidu parents and examined its psychometric properties. Methods: This newly developed questionnaire was administered to the combined sample of 313 Shidu parents. Exploratory (n = 164) and confirmatory factor analysis (n = 149) were conducted. Psychometric properties of the questionnaire were evaluated. Results: Exploratory factor analysis revealed three distinct factors (filial piety belief, destiny belief and perceived stigma), generating a nine-item culture-related grief beliefs of Shidu parents questionnaire (CBSQ). Confirmatory factor analysis verified the three-factor structure (χ²(24) = 39.103, p = 0.027, χ²/df = 1.630, CFI = .980, TLI = .970, RMSEA = .065, SRMR = .052). Internal consistency and temporal stability were adequate. Convergent, discriminant and concurrent validity were supported. Conclusions: This study highlights the importance of extending the concept of grief cognitions to include culture-specific beliefs, and provides a first measurement tool to assess culture-related grief beliefs after only-child loss, which can be used in future research with Shidu parents.

Junior doctor psychiatry placements in hospital and community settings: a phenomenological study

OBJECTIVES

The proportion of junior doctors required to complete psychiatry placements in the UK has increased, due in part to vacant training posts and psychiatry career workforce shortages, as can be seen across the world. The aim of this study was to understand the lived experience of a Foundation Year 1 junior doctor psychiatry placement and to understand how job components influence attitudes.

DESIGN

The study was conducted using a cross-sectional qualitative phenomenological approach.

SETTING

Hospital and community psychiatry department settings in the North East of England, UK.

PARTICIPANTS

In total, 14 Foundation Year 1 junior doctors were interviewed including seven men and seven women aged between 23 and 34 years. The majority had completed their medical degree in the UK and were White British.

RESULTS

The lived experience of a junior doctor psychiatry placement was understood by three core themes: exposure to patient recovery, connectedness with others in the healthcare team and subjective interpretations of psychiatry. The experiences were moderated by instances of role definition, reaction to the specialty and the organisational fit of the junior doctor capacity in the specialty.

CONCLUSIONS

The study reinforces and adds to the literature by identifying connectedness as being important for both job satisfaction and morale, which is currently damaged within the junior doctor population. The study provides in-depth insights into the lived experience of psychiatry placements and can be taken forward by educationalists to ensure the placements are meaningful experiences for junior doctors by developing role definition, belonging, structure and psychiatric care responsibility.

Angels of Courage: The Experiences of Mothers Who Have Been Bereaved by Suicide

Despite the increasing number of people being bereaved by suicide, little is understood concerning the experiences of those bereaved by suicide as they struggle to make sense of a loved one's death. The current study explored the experiences of four mothers who had been bereaved by suicide and the role of support groups in the meaning-making process following bereavement by suicide. Participants were interviewed and transcribed interviews were then analysed from an interpretative phenomenological perspective. Four main themes were identified: Continuing role of the mother; A never-ending quest; Finding sanctuary; and Rising up from the ashes. These themes relate to a range of emotions following bereavement by suicide, the meaning-making process, the social context and the role of the support group. Clinical implications are discussed in relation to these findings.

Liberating burdensomeness of suicide survivorship loss: A Critical Interpretive Synthesis

AIMS AND OBJECTIVES

What is an interpreted and synthesised understanding of responses of survivors to a suicide death of a close person?

BACKGROUND

It is well known that survivors of suicide loss who are in a close relationship with the deceased are at high risk for suicidality and health conditions. Nurses in various settings need evidenced-informed approaches to encounter these vulnerable persons and support their healing journey from postvention to prevention.

DESIGN

The design is reflexive and iterative.

METHOD

A Critical Interpretive Synthesis comprised of six phases: formulating the review question; searching literature; sampling; determining quality; extracting data; interpretive synthesis. Qualitative content analysis was also.

RESULTS

Based on a sample of 15 published full-text qualitative and quantitative nursing research studies published between 1990 and 2016, an aggregated, interpreted and synthesised understanding of responses of survivors of suicide loss to the suicide death of a close person emerged. Four synthesised concepts were: dreading burden of suicide risk and stigma; facing burdensomeness in the aftermath of suicide death; enduring being burdened-unburdened, striving to invest in living; and liberating burdensomeness, journeying toward healing.

CONCLUSIONS

Contextually, geo-cultural gaps exist in published nursing studies. Most studies were from North American and a few from Asia. The reported suicide deaths occurred over a wide range of time. Conceptually, four synthesised concepts can be viewed as a process of moving from burdensomeness to liberating burdensomeness. Methodologically, a small body of knowledge that met quality appraisal was interpreted and synthesised into an understanding of an evidenced-informed approach to guide nurses' encounters with survivors of suicide loss.

RELEVANCE TO CLINICAL PRACTICE

The results contribute to an evidenced-informed approach for nurses in practice to support survivors of suicide loss journeying from burdensomeness to liberating burdensomeness. Results also serve as a foundation for further research.

The experience of Greek-Cypriot individuals living with mental illness: preliminary results of a phenomenological study

BACKGROUND

Research evidence shows that healthcare professionals do not fully comprehend the difficulty involved in problems faced by people living with severe mental illness (SMI). As a result, mental health service consumers do not show confidence in the healthcare system and healthcare professionals, a problem related to the phenomenon of adherence to therapy. Moreover, the issue of unmet needs in treating individuals living with SMI is relared to their quality of life in a negative way.

METHODS

A qualitative methodological approach based on the methodology of van Manen phenomenology was employed through a purposive sampling of ten people living with SMI. The aim was to explore their perceptions and interpretations regarding: a) their illness, b) their self-image throughout the illness, c) the social implications following their illness, and d) the quality of the therapeutic relationship with mental health nurses. Participants were recruited from a community mental health service in a Greek-Cypriot urban city. Data were collected through personal, semi-structured interviews.

RESULTS

Several main themes were identified through the narratives of all ten participants. Main themes included: a) The meaning of mental illness, b) The different phases of the illness in time, c) The perception of the self during the illness, d) Perceptions about the effectiveness of pharmacotherapy, e) Social and personal consequences for participants following the diagnosis of mental illness, f) Participants' perceptions regarding mental health professionals and services and g) The therapeutic effect of the research interview on the participants.

CONCLUSIONS

The present study provides data for the enhancement of the empathic understanding of healthcare professionals regarding the concerns and particular needs of individuals living with SMI, as well as the formation of targeted psychosocial interventions based on these needs. Overall, the present data illuminate the necessity for the reconstruction of the provided mental healthcare in Cyprus into a more recovery- oriented approach in order to address personal identity and self-determination issues and the way these are related to management of pharmacotherapy. Qualitative studies aiming to further explore issues of self-identity during ill health and its association with adherence to therapy, resilience and self-determination, are also proposed.

The Stigma of Suicide Survivorship and Related Consequences-A Systematic Review

Background

considerable proportion of the population experiences major life disruptions after losing a loved one to suicide. Social stigma attached to suicide survivors adds to complications occurring in the course of suicide bereavement. Despite its known risks, stigma related to suicide survivors has been sparsely investigated.

Methods

We conducted a systematic literature search in PubMed, Web of Science, PsycInfo and PsyArticles, of studies indexed up through August 2015. Articles were eligible for inclusion if they addressed experiences of stigma in suicide survivors, compared them to other bereavement populations, or investigated stigmatizing attitudes within the public. The search was restricted to English-language studies.

Results

25 records matched inclusion criteria. Study designs were heterogeneous, making comparisons difficult. Results demonstrated that suicide survivors experience stigma in the form of shame, blame, and avoidance. Suicide survivors showed higher levels of stigma than natural death survivors. Stigma was linked to concealment of the death, social withdrawal, reduced psychological and somatic functioning, and grief difficulties. Only one study investigated stigmatizing attitudes towards suicide survivors among the general population.

Limitations

Internal and external validity of the studies was restricted by a lack of valid measures and selection bias.

Conclusions

More methodologically sound research is needed to understand the impact of stigma on suicide survivors’ grief trajectories and to separate it from other grief aspects. Clinicians and grief-counselors as well as the public should be educated about the persistent stigma experienced by suicide survivors.

A Qualitative Systematic Review of the Bereavement Process Following Suicide

Despite the fact that a large number of people are bereaved by suicide each year, the experiences of those bereaved by suicide are poorly understood. It has been suggested that a contributing factor in relation to this lack of understanding has been the use of quantitative methods, which may not be sensitive to the bereavement process and its thematic content. Therefore, the current article outlines a systematic review of 11 qualitative studies that address issues related to the bereavement process following suicide. The results indicate that those bereaved by suicide encounter a range of difficult feelings following suicide including blame, guilt, and emptiness and that these feelings are affected by participants’ ability to make meaning of the event. The meaning-making process is a complex one that occurs within a difficult social context in which both those bereaved by suicide and members of the wider community struggle to interact with each other in a beneficial way. Clinical implications of these findings are discussed.

Developing Optimal Search Strategies for Retrieving Qualitative Studies in PsycINFO

Researchers and practitioners have problems retrieving qualitative studies. Search strategies that can easily and effectively retrieve these studies from large databases such as PsycINFO are therefore important. To determine if search strategies can identify qualitative studies, 64 journals published in 2000 were hand searched using explicit methodological criteria to identify qualitative studies. The authors tested multiple search strategies using 4,985 potential search terms in PsycINFO (Ovid Technologies) and compared the results with the hand search data to calculate retrieval effectiveness. A total of 125 qualitative studies were identified. Single-term and multiple-term strategies had sensitivities (maximizing retrieval of qualitative studies) up to 94.4% and specificities (minimizing retrieval of nonqualitative studies and reports) up to 98.6% with ranges of precision and accuracy. Search strategies included terms that were variations of interview, qualitative, themes, and experience. Formal indexing terms performed poorly. Empirically derived search strategies combining textwords can effectively, but not perfectly, retrieve qualitative studies from PsycINFO.

Two perspectives on the needs of individuals bereaved by suicide

To qualitatively explore the needs of suicidally bereaved individuals, researchers interviewed 11 suicide bereaved individuals and 4 mental health workers. Common themes of bereaved persons included the suicide grief experience, coping, interpersonal domain, struggle with meaning, self-reflection, and moving forward. Mental health workers emphasized the nature of the helping relationship, the need to emotionally process the grief, the centrality of meaning making, importance of support groups, and the role of individual counseling. These 2 perspectives informed "best practices" for postvention (e.g., understanding the need for meaning-making while recognizing when to move on).

Talking through the dead: the impact and interplay of lived grief after suicide

In the aftermath of suicide, grief becomes a multi-faceted experience. Traditionally, this grief was silenced where the shame attached to suicide invalidated a person's need for expression. Even now, it can be difficult for people to fully articulate their grief, let alone find an empathetic audience. How do we examine this grief to more clearly hear the voices of the bereaved, and to better understand how to support those who are grieving a suicide death? Indeed, the ripple of suicide grief touches more than those traditionally considered to be impacted by the death. Whole communities can be affected and it cannot be presumed that researchers do not have their own lived experiences of suicide bereavement. In this way, the newly-opened discourse around the experience of suicide grief needs to be dissected within more practical and appropriate research. A balance needs to be created in research where the voices of grief can be included but the experiential context understood and respected.

Unanticipated death of a partner: the loss experience of bereaved girlfriends of fallen Israeli soldiers

This qualitative study examined the loss experience of 15 Israeli bereaved girlfriends of fallen soldiers. The girlfriends of fallen Israeli soldiers are socially unacknowledged as being bereaved. This disenfranchised experience of grief is conveyed through social exclusion components and personal experiences of grief that were conceptualized into four themes: (a) learning about the loss; (b) loneliness and lack of social support; (c) intensifying initial experiences while creating alternative social networks; and (d) missed opportunities. The results provide new insight into the concept of disenfranchised grief suggesting it is a multidimensional experience that includes personal, interpersonal, and social dimensions, each of which falls along a continuum ranging from a sense of acceptance to a sense of exclusion. Results also suggest that there are various depths to the experience of disenfranchised grief, which changes over time. Thus, disenfranchised grief is an ongoing and temporal personal, interpersonal, and social experience. Practical implications are discussed.

Events prior to completed suicide: perspectives of family survivors

Relatively little is known about the experiences of those bereaved by suicide, particularly in the weeks leading to the death of a loved one. This study used a qualitative methodology to explore the perspectives of close survivors of a completed suicide. Ten people who were bereaved by suicide participated in face-to-face interviews that were digitally recorded, transcribed verbatim, and thematically analysed. Analysis revealed the following three themes: He Tried to Hang Himself: Purposeful indications of the intent to end life; They Still Ignored It: Disappointment with health services; and Nobody Talked to Me: Exclusion of family members from treatment information. Prior to the suicide of their loved one, participants had identified that the loved one was at risk and perceived they were unable to acquire appropriate assistance from services. Rather, services were perceived by participants as unsupportive and inadequate. Health and social service professionals could benefit from further specialised education concerning suicide and its sequelae to ensure more effective and sensitive care delivery to suicide survivors.

A moral life after a suicide death in Taiwan

In this article we present the findings of a qualitative study exploring what suicide survivors in Taiwan experienced after a family member's suicide and how they adjusted to the perceived stigma. Fifteen suicide survivors participated in this study. We found that when a family member's suicide death occurred, survivors first kept a low profile when holding the funeral, and then tried to expel the dead person from their family. They also wished that their grief and painful, shameful feelings could be buried with the dead person. These findings suggest that health care professionals need to work more closely with suicide survivors through understanding the survivors' fear and pain from a sociocultural perspective, and to help them construct a new moral life.

The experiences of parents readjusting to the workplace following the death of a child by suicide

Suicide among young people has become a growing concern in life in the 21st century and is a tragedy faced by an increasing number of families and in particular parents. This study set out to focus on the experiences of parents reentering the workplace following the death of a child by suicide. Although the immediate aftermath of experiencing traumatic death has been studied, we know less about the longer-term effects on life tasks such as returning to work. A sample of bereaved parents was interviewed and their responses thematically analyzed. The three major areas of experience related by parents were social and emotional aspects of readjusting to the workplace, followed by changes in cognitive, emotional and physical functioning and their changed attitudes toward work and life. Limitations of the study include the transferability of findings to other populations and to less close-knit cultures. The implications for employee adjustment and employers and co-workers' responses are considered. A fuller picture of adjustment might emerge from future studies that seek to document all parties' experiences during this period of transition.

The Invisible Family: A Qualitative Study of Suicide Survivors in Taiwan

The purpose of this interpretive phenomenological study is to describe the commonality of the lived experience of suicide survivors and how it influences their family relationships in Taiwan from a sociocultural perspective. Thirteen suicide survivors have participated in this study. Study results reveal that some survivors blame themselves, some blame others, and some are blamed by their family as part of their need to find a reason for the death. Consequently, family members ignore each other and treat each other as if they are invisible. These Chinese suicide survivors, unlike Western survivors, maintain their strained family connections because of strong cultural influences. Therefore, health professionals should acknowledge the experiences of living with an invisible family when supporting Chinese suicide survivors.

Surviving After Suicide Loss: The Healing Potential of Suicide Survivor Support Groups

With participant observations from peer-facilitated suicide survivor support group meetings, collected over a four-year period, this article applies Shulman's dynamics of mutual aid theory to explain how survivors' healing is facilitated by support group participation. Shulman's principles provide guidance on how survivors help and empower each other to deal with their grief in survivor support groups. Group facilitators can provide more clarity and direction to survivors with Shulman's principles, better helping survivors to navigate the bewildering course of healing after suicide loss. We also suggest ways group facilitation knowledge—an essential resource for enhancing healing—can be more widely distributed.

Assessment and management of hospitalized suicidal patients

Suicide in inpatient psychiatric settings is a critical problem. A comprehensive literature review was performed to determine risk factors for inpatient suicide, instruments for assessing suicide, and treatment of hospitalized suicidal patients. Findings suggested that root causes of inpatient suicide were factors related to the treatment environment, failure to assess patient behavioral characteristics, and staff reliance on no-suicide contracts. Recommendations include assessing suicide risk regularly throughout hospitalization, including on admission, during changes in a patient's mental or physical status, after a change in observation level, and before discharge. Orientation and inservice education for all staff and additional research on the psychometric properties of available suicide assessment instruments are also essential.

"The wholeness of things": infusing diversity and social justice into death education

This article presents resources and strategies for the infusion of diversity and social justice themes into an undergraduate death and dying course. The intent is not to replace or dismiss existing thanatological insights and debates, but rather to widen the cultural perspective to bring these insights and debates into conversation with multiple ways of perceiving and understanding. The article covers definitions, goals and rationales, challenges in identifying and developing appropriate resources, and overall course design. It also explores readings, audiovisual materials, class activities, and pedagogical approaches to foster: student engagement with diverse world-views and experiences; understanding of "cultural competence" in various fields; awareness of the impact of race, class, gender, etc., on access to resources and care; commitment to activism for social justice; and exposure to many forms of resilience, meaning-making, and creative healing.

From Husserl to van Manen. A review of different phenomenological approaches

This paper traces the development of phenomenology as a philosophy originating from the writings of Husserl to its use in phenomenological research and theory development in nursing. The key issues of phenomenological reduction and bracketing are also discussed as they play a pivotal role in the how phenomenological research studies are approached. What has become to be known as "new" phenomenology is also explored and the key differences between it and "traditional" phenomenology are discussed. van Manen's phenomenology is also considered in light of its contemporary popularity among nurse researchers.