Parent Grief 1-13 Months After Death in Neonatal and Pediatric Intensive Care Units

Hurricane-Force Grief: A Mirror of Fathers' Love

A child's death is a traumatic experience that profoundly impacts parents' psychological, physical, and social wellbeing. The literature describes gender differences in grief response associated with child loss, yet less is known about fathers' grief in comparison that of mothers due to fathers' underrepresentation in bereavement research. There is a need for scholarly exploration to advance understanding of fathers' grief. This article presents selected findings on fathers' grief responses that emerged from a larger qualitative study, which aimed to describe fathers' lived experience of bereavement after a child's death. Profound grief emerged as one essential theme of fathers' bereavement experience. Participants described the meaning of their grief, their multidimensional grief responses, their grief triggers, and their grief intensity. Findings deepen understanding of fathers' grief associated with child loss and advance the body of parental bereavement literature.

The impact of approaching grief on the neonatal team: professional experience report

This case report describes the holistic performance of the multidisciplinary team in a context of approaching the moment of death of a newborn, in a cross-cultural approach, and its impact on the working group. We report the clinical case of a neonate diagnosed as severe congenital heart disease, who evolved with early surgical intervention and died on the second day of life. Considering the neonatal intensive care unit an area requiring performance of a specialized team that addresses, with a high level of complexity, in a broad way, the patient, and his family, the death of a child breaks the logic of the life cycle. The multiprofessional and family management of the newborn in question illustrates the opportunities that are still being improved in the care of mourning in the neonatal period. Demonstrating that the care process does not end at the time of death, and the period of mourning is still a challenge for the neonatal team. Even so, parents can be welcomed, with care provided in a private and secure manner, with their needs, and preserved individuality. We observe the need for professional qualification and support for mourning and the need for specific institutional policies, since the health organizations must be attentive and take care of those who care, be cared for with a different look at their emotions.

Overwhelming and unjust: A qualitative study of fathers' experiences of grief following neonatal death

Limited research has examined the grief experiences of fathers following neonatal death. Using a qualitative research design, ten fathers were interviewed, and thematic analysis resulted in three overarching themes: 'A complicated grief experience: Neonatal death is highly emotional', 'Grief is multidimensional' and 'Sense of injustice'. Overall, results showed that grief was a multidimensional experience for fathers, with expressions of grief including strong feelings of anger and guilt and the manifestation of grief in physical symptoms. In addition, the findings also indicated a sense of injustice that contributed to the disenfranchisement of grief for fathers. The results of this study contribute to developing a better understanding of the grief that fathers experience following neonatal death, and can inform improvements in healthcare practices after the death of a baby in the neonatal period, including father-specific programs and adequate provision of information.

Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units

It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician's concept of personhood, or "what makes you, 'you'", we adopt Radha Krishna's Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support.

Worldviews about the self mediate the impact of immature and mature defense styles on posttraumatic symptoms in bereaved parents

The present study analyzed the mediating role of assumptive worldviews on the effect of defense mechanisms on post-traumatic stress symptoms (PTS) in bereaved parents. Sample included a convenience sample of 153 bereaved parents and a control group of 157 nonbereaved parents. Structural equation modeling was conducted to examine our hypotheses. Bereaved parents presented higher levels of PTS and more negative assumptions compared to nonbereaved participants. Worthiness of the self mediated the effect of both immature and mature defense styles on PTS levels, and neurotic defense style directly predicted PTS levels.

Parental bereavement - impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review

BACKGROUND

Losing a child tragically impacts the well-being and functioning of parents. With these effects extending beyond emotional, physical morbidity and compromising self-perceptions, appropriate, longitudinal, timely and personalised support is key to effective care of bereaved parents. However, in the absence of a comprehensive understanding of parental bereavement, effective support of bereaved parents remains suboptimal. To address this gap, we scrutinise prevailing data on the effects of a child's death, aged 0-12 years, through the lens of the Ring Theory of Personhood (RToP).

METHODS

To study prevailing accounts of bereaved parents following the death of a child, we adopt Krishna's Systematic Evidence Based Approach (SEBA) to structure our Systematic Scoping Review (SSR in SEBA).

RESULTS

Three thousand seventy-four abstracts were reviewed, 160 full text articles were evaluated, and 111 articles were included and analysed using thematic and content analysis. Four themes/categories were identified relating to the four rings of the RToP. Findings reveal that static concepts of protective and risk factors for grief are misplaced and that the support of healthcare professionals is key to assisting bereaved parents.

CONCLUSION

In the absence of consistent support of bereaved parents, this study highlights the need for effective training of healthcare professionals, beginning with an appreciation that every aspect of an individual parent's personhood is impacted by the loss of their child. Acknowledging grief as a complex, evolving and personalised process subjected to parental characteristics, settings, context and available support, this SSR in SEBA calls attention to effective nurturing of the relationship between parents and healthcare professionals, and suggests use of the RToP to assess and direct personalised, timely, specific support of parents in evolving conditions. We believe the findings of this review also call for further studies to support healthcare professionals as they journey with bereaved parents.

Specialized Pediatric Palliative Care in Neonates with Life-Limiting Illness: A Systematic Review

OBJECTIVE

The aim of this study is to assess the impact of specialized pediatric palliative care (PPC) on neonates with life-limiting conditions compared to standard care.

STUDY DESIGN

MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Scopus, and Embase databases were searched from January 2000 to September 2018. Randomized clinical trials, experimental or observational studies, and secondary administrative database analyses published in English, Spanish, French, and German were included. Two independent reviewers extracted data, and used the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool for quality analysis. Discrepancies were resolved as a team.

RESULTS

From the 37,788 records obtained, only eight articles met the inclusion criteria. A meta-analysis was not possible due to the heterogeneity in how the outcomes were defined; however, a qualitative synthesis of the results was possible; organizing outcomes into eight different categories: psychological, social and spiritual support; communication; location of care; symptom management; bereavement care; predicted versus actual neonatal outcomes; and parental coping, stress, and satisfaction.

CONCLUSION

Specialized versus may have an impact on neonates with life-limiting conditions and their families. More studies that evaluate the impact of specialized versus in neonates with sound statistical analysis is warranted.

Lived Experiences of Mothers Following a Perinatal Loss

BACKGROUND

Perinatal mortality affects the health of mothers negatively. Sub-Saharan Africa accounts for 95% of the global statistics of perinatal mortalities. Despite this, studies that investigate the experiences of mothers following a perinatal loss are limited.

AIMS

The aim of this study was to explore the lived experiences of a perinatal loss among mothers in a rural setting in Kenya.

METHODS

An interpretative phenomenological study was conducted using eight purposively sampled mothers who had experienced a perinatal loss. Data was collected using semi structured audiotaped interviews, which were transcribed, and analyzed using thematic analysis.

RESULTS

Data analysis led to four main themes and five sub-themes from the theme of emotionally distressing. The main themes included (1) Searching for Answers, (2) Shattered Maternal Roles and Expectations, (3) Altered Relationships, and (4) Emotionally Distressing. Five sub-themes were also identified from the theme of emotionally distress: (1) shock, (2) sadness and pain, (3) confusion, (4) denial and disbelief, (5) anger.

DISCUSSION

Perinatal loss was a traumatizing experience for mothers in this study. Their social experiences influenced their recovery from the losses. Findings suggest the need for adequate midwife support and continuity in care for mothers affected by perinatal losses.

CONCLUSION

The results highlight critical issues in mothers' experience of perinatal losses. Specific, adequate and professional interventions are needed to help mothers cope with perinatal losses.

Grief and Bereavement in Fathers After the Death of a Child: A Systematic Review

CONTEXT

The death of a child is devastating, and complicated grief adversely impacts parental physical and psychosocial well-being. Most research currently is centered on bereaved mothers, and the experiences of fathers remains underexplored.

OBJECTIVE

We systematically reviewed the literature to characterize the grief and bereavement experiences of fathers after the death of a child.

DATA SOURCES

We searched Medline, PsycInfo, Embase, and Cumulative Index to Nursing and Allied Health Literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

STUDY SELECTION

Inclusion criteria encompassed English language articles published between 2007 and 2019 that evaluated the grief and bereavement experiences of fathers after the death of their child. We excluded studies describing paternal bereavement after the death of a child aged older than 21 years, stillbirth, miscarriage, or studies that did not specify age of death.

DATA EXTRACTION

Extracted domains included study design, demographics, findings, and quality assessment.

RESULTS

We screened 1848 deduplicated titles and abstracts and 139 full articles, yielding 21 articles for inclusion in this analysis. Fathers often avoided discussing their grief with others, returned to work earlier, and used goal-oriented tasks as coping strategies. Intense grief reactions and posttraumatic psychological sequelae diminished over time in mothers yet persisted in fathers.

LIMITATIONS

Included studies were primarily descriptive in nature, without ability to ascertain causality. Limited paternal data exists in the literature compared with maternal data.

CONCLUSIONS

Despite evolving gender roles, many fathers navigate loss through stoicism, self-isolation, and hard work. For some fathers, these coping mechanisms may be inadequate for navigating grief.

Grief reaction and psychosocial impacts of child death and stillbirth on bereaved North Indian parents: A qualitative study

BACKGROUND

Grief following stillbirth and child death are one of the most traumatic experience for parents with psychosomatic, social and economic impacts. The grief profile, severity and its impacts in Indian context are not well documented. This study documented the grief and coping experiences of the Indian parents following stillbirth and child death.

METHODS

This exploratory qualitative study in Delhi (India) included in-depth interviews with parents (50 mothers and 49 fathers), who had stillbirth or child death, their family members (n = 41) and community representatives (n = 12). Eight focus group discussions were done with community members (n = 72). Inductive data analysis included thematic content analysis. Perinatal Grief Scale was used to document the mother's grief severity after 6-9 months of loss.

RESULTS

The four themes emerged were grief anticipation and expression, impact of the bereavement, coping mechanism, and sociocultural norms and practices. The parents suffered from disbelief, severe pain and helplessness. Mothers expressed severe grief openly and some fainted. Fathers also had severe grief, but didn't express openly. Some parents shared self-guilt and blamed the hospital/healthcare providers, themselves or family. Majority had no/positive change in couple relationship, but few faced marital disharmony. Majority experienced sleep, eating and psychological disturbances for several weeks. Mothers coped through engaging in household work, caring other child(ren) and spiritual activities. Fathers coped through avoiding discussion and work and professional engagement. Fathers resumed work after 5-20 days and mothers took 2-6 weeks to resume household chores. Unanticipated loss, limited family support and financial strain affected the severity and duration of grief. 57.5% of all mothers and 80% mothers with stillbirth had severe grief after 6-9 months.

CONCLUSIONS

Stillbirth and child death have lasting psychosomatic, social and economic impacts on parents, which are usually ignored. Sociocultural and religion appropriate bereavement support for the parents are needed to reduce the impacts.

The Grief of Parents After the Death of a Young Child

Research demonstrates that severe forms of grief and grief-related pathology exist in the general population. Less attention, however, has been paid to the grief of parents following the death of a young, dependent child. In this review, we summarize a search of Pubmed, PsycINFO and Web of Science from 1995 to 2017, using the terms 'parental complicated grief', 'parental traumatic grief', and 'parent Prolonged Grief Disorder', specifically addressing parental grief and identified risk factors for complicated or prolonged grief. Forty-two studies met criteria and indicate a significant burden of complicated or prolonged grief in parents of children dying from virtually any cause. It appears that the empiric literature is undermined by great variability, including the composition of samples, the causes of death studied, the psychometric measures used, and post-loss intervals. We conclude that the uniform severity of grief experiences following the death of a young child is potentially a distinct subtype of grief, deserving of attention in its own right in future research and diagnostic formulations.

Drowning in the desert: family denial of brain death

Drowning continues to be a cause of childhood mortality that is associated with significant psychological distress to the affected families. The unexpected death due to such preventable injury causes excessive grieving responses in these situations. In the present report, we describe a case of a 3-year-old child who was a victim of drowning in a recreational pool, whose family went through severe denial phase following the establishment of brain death. Single-photon emission computed tomography brain scan showed the absence of tracer uptake within brain parenchyma, while the calvarium showed increased tracer distribution, also known as the "halo sign." She also had electrocerebral inactivity revealed by electroencephalography. We also discuss the magnitude of this family distress that led to total family avoidance of meeting with the treating team, from the time the parents were informed about the established brain death in the drowning child till the patient had cardiopulmonary arrest 2 weeks later.

Having Therapeutic Conversations With Fathers Grieving the Death of a Child

A child's death is a traumatic life experience for parents. Health-care professionals (HCPs) have sought guidance on how to intervene with grieving parents, particularly with fathers. Having therapeutic conversations is an effective way for HCPs to support grieving fathers. In our previous study, fathers identified core beliefs that influenced their experience of grief and coping. In this article, the Illness Beliefs Model was integrated with the findings to provide a framework for interventions to create open conversations, ease fathers' suffering, and thereby help their spouse and family suffering as well. This article will guide HCPs to engage in therapeutic conversations to support bereaved fathers.

Comparison of mothers and grandmothers physical and mental health and functioning within 6 months after child NICU/PICU death

Background

Losing a child is devastating for parents and grandparents. Family and friends generally focus on comforting and supporting the bereaved parents, unintentionally ignoring the bereaved grandparents. Grandmothers and grandfathers often struggle with wanting to help their adult children (deceased child’s parents) without usurping the parents’ responsibilities and decisions regarding the deceased child. Research on mothers’ and grandmothers’ health at about the same time after the same child’s death in the neonatal or pediatric intensive care unit is lacking. The aim of this study was to compare mothers and grandmothers on physical health, mental health, and functioning in the first 1–6 months after the same child’s death in a neonatal or pediatric intensive care unit.

Methods

This cross-sectional secondary analysis compared 32 mothers with 32 grandmothers of the same 32 deceased children (newborn-6 years). Grandmothers were recruited through these 32 mothers. Most grandmothers and mothers were Hispanic (25%, 34%) or Black (44%, 41%), respectively. Mothers and grandmothers separately completed questions about their Physical Health, Mental Health [depression (Beck Depression Inventory), Post-Traumatic Stress Disorder (PTSD, Impact of Events-R), grief (Hogan Grief Reaction Checklist)], and Functioning (social support [MSPSS] and Employment) since the child’s/grandchild’s death. Paired t-tests and Chi Square tests were used to compare grandmothers with mothers of the same deceased infant/child on their private and separate responses to study measures.

Results

Mothers had significantly more acute illnesses than grandmothers. More mothers (63%) than grandmothers (37%) were categorized as clinically depressed. More mothers (69%) than grandmothers (44%) had clinical PTSD. Mothers reported significantly higher levels of despair and detachment than grandmothers. Only 4 mothers and 2 grandmothers were in therapy at the time of interview. Grandmothers and mothers rated their ability to concentrate on their work and their level of social support similarly.

Conclusions

Mothers had more acute illnesses, more severe depression, and a higher level of grief than grandmothers. However, few received therapy despite their high levels of depressive and PTSD symptoms.

Representation of Social History Factors Across Age Groups: A Topic Analysis of Free-Text Social Documentation

As individuals age, there is potential for dramatic changes in the social and behavioral determinants that affect health status and outcomes. The importance of these determinants has been increasingly recognized in clinical decision-making. We sought to characterize how social and behavioral health determinants vary in different demographic groups using a previously established schema of 28 social history types through both manual analysis and automated topic analysis of social documentation in the electronic health record across the population of an entire integrated healthcare system. Our manual analysis generated 8,335 annotations over 1,400 documents, representing 24 (86%) social history types. In contrast, automated topic analysis generated 22 (79%) social history types. A comparative evaluation demonstrated both similarities and differences in coverage between the manual and topic analyses. Our findings validate the widespread nature of social and behavioral determinants that affect health status over populations of individuals over their lifespan.

Suporte aos pais que vivenciam a perda do filho neonato: revisão de literatura

Objetivos: investigar y discutir publicaciones acerca del soporte relacionado al duelo de padres que vivencian la pérdida del hijo neonato. Material y método: revisión crítica de literatura con búsqueda en las bases de datos CINAHL, Embase, PubMed, PsycINFO y Scopus, de artículos publicados entre enero del 2010 y julio del 2017, utilizando análisis temática para el tratamiento de los datos recolectados. Resultados: se diseñaron tres categorías temáticas: 1) apoyo y soporte a los padres que vivencian la experiencia de la pérdida del hijo neonato; 2) sentimientos de los padres ante situaciones de muerte y duelo, y 3) participación de los padres en el proceso de tratamiento y pronóstico del hijo. Se destacaron algunas necesidades: mejor preparo de los profesionales, comunicación adecuada; formación de memoria del neonato, vínculo de los padres en el proceso de muerte. Conclusiones: se evidencia la diversidad cultural en la experiencia de duelo, la que se debe considerar en el cuidado al enlutado; la continuidad del vínculo con familiares luego del proceso de muerte/morir del neonato puede ser fuente de prevención de trastornos durante el duelo. Reflexionar sobre directrices, políticas y formación curricular ampliada puede traer diferencial al equipo de salud en la asistencia al duelo y, por ende, a la salud mental.