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Jabali O, Shubietah ARM, Ktaifan M, Zakaria Z, Abumohsen H. Perspectives of Palestinian Healthcare Workers on Factors Affecting the Families' Acceptance of News of Death: A Cross-Sectional Study. Cureus 2023; 15:e39001. [PMID: 37323303 PMCID: PMC10263072 DOI: 10.7759/cureus.39001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction In a healthcare setting, communication is essential for every aspect of care. The ability to break bad news to patients and families is one of the most crucial talents in a medical professional's communication toolkit. This study aims to investigate the factors affecting the family's acceptance of death news in Palestinian medical facilities. Methods A survey was constructed and distributed to participants through Palestinian medical social media groups. Palestinian medical health professionals who had reported at least one death (N=136) were included. Associations and correlations were calculated. P-values of < 0.05 were considered significant. Results We found that death is more likely to be accepted by the family if it's reported by an experienced staff member (p-value= 0.031) or a member who was involved in the cardiopulmonary resuscitation (CPR) of the deceased person (Adjusted odds ratio (AOR) = 19.335, p-value = 0.046). The medical ward staff is also more likely to achieve family acceptance (AOR = 6.857, p-value= 0.020). However, no evidence was found to support the claim that adhering to the SPIKES model increases the likelihood of family acceptance of death news (p-value= 0.102). Death of young people and unexpected death are less likely to be accepted (p-value < 0.05). Conclusion Families are less likely to accept unexpected death or the death of young members. Thus, reporting such deaths (mostly in the emergency department) should be done with greater care. We suggest letting experienced staff members or those who were involved in CPR report the death news in such situations.
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Affiliation(s)
- Oqab Jabali
- Research, An-Najah National University, Language Center, Faculty of Humanities, Nablus, PSE
| | - Abdalhakim R M Shubietah
- Medicine and Surgery, Darwish Nazzal Government Hospital, Palestinian Ministry of Health, Qalqilya, PSE
| | - Mahfouz Ktaifan
- Research, An-Najah National University, College of Medicine and Health Siences, Department of Medicine, Nablus, PSE
| | - Zaid Zakaria
- Medicine and Surgery, Palestinian Ministry of Health, Rafidia Government Surgical Hospital, Nablus, PSE
| | - Haytham Abumohsen
- Medicine and Surgery, Tubas Government Hospital,Palestinian Ministry of Health, Tubas, PSE
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Attwood C, Benkwitz A, Holland M. "We are the forgotten grievers": Bereaved family members' experiences of support and mental ill-health following a road traffic collision. DEATH STUDIES 2022:1-8. [PMID: 36583725 DOI: 10.1080/07481187.2022.2160032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Road traffic collisions (RTCs) are a global public health concern; however, research on the impact of bereavement on families remains limited. A critical realist approach was adopted to explore experiences of families suffering bereavement following RTCs, using interviews with 14 participants in the United Kingdom (UK) who have lost a family member. Three key themes were identified: (1) worsening mental health following bereavement, (2) negative impact of an RTC-related bereavement upon family members, (3) limited support following an RTC. Findings highlighted the requirement for appropriate support for bereaved families, and outlined significant flaws within the UK legal system, sentencing, and treatment of families.
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Affiliation(s)
- C Attwood
- Faculty of Arts, Society and Professional Studies, Newman University, Birmingham, UK
| | - A Benkwitz
- Faculty of Arts, Society and Professional Studies, Newman University, Birmingham, UK
| | - M Holland
- Faculty of Arts, Society and Professional Studies, Newman University, Birmingham, UK
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3
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Loxton I, Oxlad M, Perry A. Consulting parents bereaved by childhood cancer: A qualitative study to improve bereavement services. DEATH STUDIES 2022; 47:891-901. [PMID: 36344115 DOI: 10.1080/07481187.2022.2142325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Twelve Australian parents bereaved by childhood cancer were interviewed about their experiences of, and preferences for, bereavement support, to inform recommendations to improve bereavement care. Reflexive thematic analysis resulted in five themes: Care, empathy, and connection assist with bereavement; Communication makes a difference; Early and ongoing support is desired; Gender matters when grieving the loss of a child; and The pull of peer support. Parents can be assisted through empathy, early and ongoing support, enhanced communication, peer support, and care that is inclusive of all genders. Parents in non-metropolitan areas require increased and flexible support options.
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Affiliation(s)
- Isabella Loxton
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Anna Perry
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Childhood Cancer Association, Adelaide, Australia
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4
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The experience of pre-hospital emergency personnel in breaking death news: a phenomenological study. BMC Nurs 2022; 21:127. [PMID: 35614483 PMCID: PMC9130693 DOI: 10.1186/s12912-022-00899-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today, breaking the death of patients to their families has become one of the challenges for medical staff. Considering the lack of study in the pre-hospital emergency, the present study aimed to explore the experience of pre-hospital emergency personnel regarding the breaking death news to families. METHOD In this qualitative study with a descriptive phenomenological method, data were collected by purposeful sampling method through in-depth interviews with thirteen pre-hospital emergency personnel in Kermanshah and Kurdistan provinces. After recording and writing the interviews, the data were managed by MAQUDA-10 software and analyzed using the Collaizi approach. RESULTS Of 13 participants, five from Kermanshah, eight from Kurdistan, and 12 (92%) were married. The mean age and work experience were 34.38 and 10.38 years, respectively. Five main extracted themes were 1) perceived stress, 2) challenge factors of breaking death news, 3) unnecessary actions, 4) death breaking precautions, and 5) BDN requirements. They were covered fifteen sub-themes. CONCLUSION In this study, emergency medical employees were always faced with stress and challenges to announce the patient's death to families, including the stress of violence against employees. Hereof, personnel had to take unnecessary care actions such as slow resuscitation to transfer the patient to the hospital.
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van Kempen MM, Kochen EM, Kars MC. Insight into the content of and experiences with follow-up conversations with bereaved parents in paediatrics: A systematic review. Acta Paediatr 2022; 111:716-732. [PMID: 34995378 PMCID: PMC9304260 DOI: 10.1111/apa.16248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Abstract
Aim A follow‐up conversation with bereaved parents is a relatively well‐established intervention in paediatric clinical practice. Yet, the content and value of these conversations remain unclear. This review aims to provide insight into the content of follow‐up conversations between bereaved parents and regular healthcare professionals (HCPs) in paediatrics and how parents and HCPs experience these conversations. Methods Systematic literature review using the methods PALETTE and PRISMA. The search was conducted in PubMed and CINAHL on 3 February 2021. The results were extracted and integrated using thematic analysis. Results Ten articles were included. This review revealed that follow‐up conversations are built around three key elements: (1) gaining information, (2) receiving emotional support and (3) facilitating parents to provide feedback. In addition, this review showed that the vast majority of parents and HCPs experienced follow‐up conversations as meaningful and beneficial for several reasons. Conclusion An understanding of what parents and HCPs value in follow‐up conversations aids HCPs in conducting follow‐up conversations and improves care for bereaved parents by enhancing the HCPs' understanding of parental needs.
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Affiliation(s)
- Merel M. van Kempen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Eline M. Kochen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Marijke C. Kars
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
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6
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Erickson CC, Salerno JC, Berger S, Campbell R, Cannon B, Christiansen J, Moffatt K, Pflaumer A, Snyder CS, Srinivasan C, Valdes SO, Vetter VL, Zimmerman F. Sudden Death in the Young: Information for the Primary Care Provider. Pediatrics 2021; 148:peds.2021-052044. [PMID: 34155130 DOI: 10.1542/peds.2021-052044] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
There are multiple conditions that can make children prone to having a sudden cardiac arrest (SCA) or sudden cardiac death (SCD). Efforts have been made by multiple organizations to screen children for cardiac conditions, but the emphasis has been on screening before athletic competition. This article is an update of the previous American Academy of Pediatrics policy statement of 2012 that addresses prevention of SCA and SCD. This update includes a comprehensive review of conditions that should prompt more attention and cardiology evaluation. The role of the primary care provider is of paramount importance in the evaluation of children, particularly as they enter middle school or junior high. There is discussion about whether screening should find any cardiac condition or just those that are associated with SCA and SCD. This update reviews the 4 main screening questions that are recommended, not just for athletes, but for all children. There is also discussion about how to handle post-SCA and SCD situations as well as discussion about genetic testing. It is the goal of this policy statement update to provide the primary care provider more assistance in how to screen for life-threatening conditions, regardless of athletic status.
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Affiliation(s)
- Christopher C Erickson
- Children's Specialty Physicians, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska .,Creighton University Medical Center, Creighton University, Omaha, Nebraska
| | - Jack C Salerno
- Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, Washington
| | - Stuart Berger
- Lurie Children's Hospital and Northwestern University, Chicago, Illinois
| | - Robert Campbell
- Children's Healthcare of Atlanta Sibley Heart Center and School of Medicine, Emory University, Atlanta, Georgia
| | | | - James Christiansen
- Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, Washington
| | - Kody Moffatt
- Children's Specialty Physicians, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska
| | - Andreas Pflaumer
- The Royal Children's Hospital and University of Melbourne, Melbourne, Australia
| | - Christopher S Snyder
- Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio
| | - Chandra Srinivasan
- McGovern Medical School, The University of Texas and The University of Texas Health Science Center, Houston, Texas
| | - Santiago O Valdes
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Victoria L Vetter
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Kochen EM, Jenken F, Boelen PA, Deben LMA, Fahner JC, van den Hoogen A, Teunissen SCCM, Geleijns K, Kars MC. When a child dies: a systematic review of well-defined parent-focused bereavement interventions and their alignment with grief- and loss theories. BMC Palliat Care 2020; 19:28. [PMID: 32164668 PMCID: PMC7068872 DOI: 10.1186/s12904-020-0529-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/19/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The availability of interventions for bereaved parents have increased. However, most are practice based. To enhance the implementation of bereavement care for parents, an overview of interventions which are replicable and evidence-based are needed. The aim of this review is to provide an overview of well-defined bereavement interventions, focused on the parents, and delivered by regular health care professionals. Also, we explore the alignment between the interventions identified and the concepts contained in theories on grief in order to determine their theoretical evidence base. METHOD A systematic review was conducted using the methods PALETTE and PRISMA. The search was conducted in MEDLINE, Embase, and CINAHL. We included articles containing well-defined, replicable, paediatric bereavement interventions, focused on the parent, and performed by regular health care professionals. We excluded interventions on pathological grief, or interventions performed by healthcare professionals specialised in bereavement care. Quality appraisal was evaluated using the risk of bias, adapted risk of bias, or COREQ. In order to facilitate the evaluation of any theoretical foundation, a synthesis of ten theories about grief and loss was developed showing five key concepts: anticipatory grief, working models or plans, appraisal processes, coping, and continuing bonds. RESULTS Twenty-one articles were included, describing fifteen interventions. Five overarching components of intervention were identified covering the content of all interventions. These were: the acknowledgement of parenthood and the child's life; establishing keepsakes; follow-up contact; education and information, and; remembrance activities. The studies reported mainly on how to conduct, and experiences with, the interventions, but not on their effectiveness. Since most interventions lacked empirical evidence, they were evaluated against the key theoretical concepts which showed that all the components of intervention had a theoretical base. CONCLUSIONS In the absence of empirical evidence supporting the effectiveness of most interventions, their alignment with theoretical components shows support for most interventions on a conceptual level. Parents should be presented with a range of interventions, covered by a variety of theoretical components, and aimed at supporting different needs. Bereavement interventions should focus more on the continuous process of the transition parents experience in readjusting to a new reality. TRIAL REGISTRATION This systematic review was registered in Prospero (registration number: CRD42019119241).
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Affiliation(s)
- Eline M Kochen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Floor Jenken
- Department Woman and Baby, Wilhelmina Childrens Hospital, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of clinical psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands
| | - Laura M A Deben
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Jurrianne C Fahner
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department Woman and Baby, Wilhelmina Childrens Hospital, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Karin Geleijns
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
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8
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Cooper JJ, Stock RC, Wilson SJ. Emergency Department Grief Support: A Multidisciplinary Intervention to Provide Bereavement Support After Death in the Emergency Department. J Emerg Med 2020; 58:141-147. [PMID: 31744710 DOI: 10.1016/j.jemermed.2019.09.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The nature of death in the emergency department (ED) may put survivors at higher risk for complicated bereavement. Access to bereavement care could mitigate this, but many EDs do not include bereavement follow-up as part of their routine practice. OBJECTIVE We describe the implementation at our institution of ED Grief Support, a program developed to extend care to the bereaved through in-person, telephone, and e-mail follow-up for 1 year after the death of a loved one. METHODS Bereavement follow-up was preferentially extended to survivors of patients <45 years of age who were chosen because of the higher likelihood of unexpected death in this age group. Detailed records of each case were collected prospectively using online data management software and outcomes were recorded. Successful strategies to navigate communication and resource referrals are discussed. RESULTS We enrolled 192 patients during our 2-year period of observation. The majority died from trauma and parents were the most common next-of-kin to be contacted. Commonly requested services included: clarification of the circumstances of death, the interpretation of autopsy reports, referral to community bereavement resources, and family meetings. Challenges included supporting the emotional well-being of staff and the resource-intensive nature of the follow-up. Staff members who worked with ED Grief Support find it meaningful and note a positive influence on their well-being as providers. CONCLUSIONS Longitudinal bereavement follow-up from the ED is feasible and had a perceived positive impact on the bereaved as well as ED staff.
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Affiliation(s)
- Julie J Cooper
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware
| | - Rachel C Stock
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware
| | - Sister Julian Wilson
- Department of Pastoral Services, Christiana Care Health System, Newark, Delaware
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9
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Eggly S, Meert KL, Berger J, Zimmerman J, Anand K, Newth CJ, Harrison R, Carcillo J, Dean JM, Willson DF, Nicholson C. Physicians’ conceptualization of “Closure” as A benefit of Physician-Parent Follow-Up Meetings after A Child's Death in the Pediatric Intensive Care Unit. J Palliat Care 2018. [DOI: 10.1177/082585971302900202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined physicians’ conceptualization of closure as a benefit of follow-up meetings with bereaved parents. The frequency of use and the meaning of the word “closure” were analyzed in transcripts of interviews with 67 critical care physicians affiliated with the Collaborative Pediatric Critical Care Research Network. In all, 38 physicians (57 percent) used the word “closure” at least once (median: 2; range: 1 to 7), for a total of 86 times. Physicians indicated that closure is a process or trajectory rather than an achievable goal. They also indicated that parents and physicians can move toward closure by gaining a better understanding of the causes and circumstances of the death and by reconnecting with, or resolving relationships between, parents and health professionals. Physicians suggested that a primary reason to conduct follow-up meetings is that such meetings offer parents and physicians an opportunity to move toward closure. Future research should attempt to determine whether follow-up meetings reduce the negative effects of bereavement for parents and physicians.
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Affiliation(s)
- Susan Eggly
- S Eggly (corresponding author) Department of Oncology, Wayne State University, 4100 John R Street, MM03CB, Detroit, Michigan, USA 48201
| | - Kathleen L. Meert
- Children's Hospital of Michigan, Detroit, Michigan, USA; J Berger: Critical Care Unit, Children's National Medical Center, Washington, DC, USA
| | - John Berger
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Jerry Zimmerman
- Children's Hospital of Michigan, Detroit, Michigan, USA; J Berger: Critical Care Unit, Children's National Medical Center, Washington, DC, USA
| | - K.J.S. Anand
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Christopher J.L. Newth
- University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee, USA; CJL Newth: Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Rick Harrison
- Mattel Children's Hospital at University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Carcillo
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - J. Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA; DF Willson: University of Virginia Children's Hospital, Charlottesville, Virginia, USA
| | - Douglas F. Willson
- Pediatric Critical Care and Rehabilitation Program, National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Carol Nicholson
- Pediatric Critical Care and Rehabilitation Program, National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Brink HL, Thomsen AK, Laerkner E. Parents' experience of a follow-up meeting after a child's death in the Paediatric Intensive Care Unit. Intensive Crit Care Nurs 2016; 38:31-39. [PMID: 27526626 DOI: 10.1016/j.iccn.2016.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 06/20/2016] [Accepted: 06/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE 'To identify parents' experience of a follow up meeting and to explore whether the conversation was adequate to meet the needs of parents for a follow-up after their child's death in the Paediatric Intensive Care Unit (PICU). DESIGN AND SETTING Qualitative method utilising semi-structured interviews with six pairs of parents 2-12 weeks after the follow-up conversation. The interviews were held in the parents' homes at their request. Data were analysed using a qualitative, descriptive approach and thematic analysis. FINDINGS Four main themes emerged: (i) the way back to the PICU; (ii) framework; (iii) relations and (iv) closure. CONCLUSION The parents expressed nervousness before the meeting, but were all pleased to have participated in these follow-up meetings. The parents found it meaningful that the follow-up meeting was interdisciplinary, since the parents could have answers to their questions both about treatment and care. It was important that the staff involved in the follow-up meeting were those who had been present through the hospitalisation and at the time of the child's death. Parents experienced the follow-up meeting as being a closure of the course in the PICU, regardless the length of the hospitalisation.
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Affiliation(s)
- Helle L Brink
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark.
| | - Anja K Thomsen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
| | - Eva Laerkner
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
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Breen LJ, O'Connor M. The Fundamental Paradox in the Grief Literature: A Critical Reflection. OMEGA-JOURNAL OF DEATH AND DYING 2016; 55:199-218. [DOI: 10.2190/om.55.3.c] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A key theme in the bereavement literature is the recognition that every grief experience is unique and dependent on many variables, such as the circumstances of the death, characteristics of the bereaved individual, their relationship with the deceased, the provision and availability of support, and a myriad of sociocultural factors. Concurrently, there are corresponding efforts to define “normal” grief and delineate it from “complicated” grief experiences. The discord between these two potentially opposing statements remains a paradox evident within the three major tensions within the thanatological literature—the dominance of grief theories, the medicalization of grief, and the efficacy of grief interventions. Three recommendations for moving beyond the paradox are discussed—the provision of improved grief education for service providers, the bereaved, and the wider community; the conduct of research that emphasizes the context of grief and is relevant to service provision; and the examination of current grief interventions.
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12
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Martinčeková L, Klatt J. Mothers’ Grief, Forgiveness, and Posttraumatic Growth After the Loss of a Child. OMEGA-JOURNAL OF DEATH AND DYING 2016; 75:248-265. [DOI: 10.1177/0030222816652803] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate maternal grief after losing a child in relation to forgiveness and posttraumatic growth. A sample of 60 grieving mothers from Slovakia completed the following battery: The Texas Revised Inventory of Grief, a modified version of the Enright Forgiveness Inventory, and the Posttraumatic Growth Inventory. The results showed a negative association between forgiveness and grief and a strong positive association between forgiveness and posttraumatic growth, which was not moderated by the time elapsed since the loss. Semistructured interviews were conducted with 12 mothers. The data were analyzed through Consensual Qualitative Research to gain deeper understanding of forgiveness and posttraumatic growth experiences after the loss of a child. Categories and subcategories are discussed.
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Affiliation(s)
| | - John Klatt
- University of Wisconsin-Madison, Madison, WI, USA
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13
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Donovan LA, Wakefield CE, Russell V, Cohn RJ. Hospital-based bereavement services following the death of a child: a mixed study review. Palliat Med 2015; 29:193-210. [PMID: 25395578 DOI: 10.1177/0269216314556851] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There has been a breadth of research on the grief experience of parents following the death of a child. However, the role and impact of hospital-based bereaved services remain unclear. AIM To identify services offered to bereaved families in perinatal, neonatal, and pediatric hospital settings and summarize the psychosocial impact of these services and published recommendations for best practice hospital-based bereavement care. DESIGN Systematic review of qualitative, quantitative, and mixed method studies guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and methodological quality appraised in accordance with the Mixed Method Appraisal Tool. DATA SOURCES MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, and PsychINFO were searched to find studies describing hospital-based bereavement services/interventions for parents, siblings, and grandparents. RESULTS In all, 14 qualitative, 6 quantitative, and 10 mixed method studies were identified. Nine descriptive articles were also included. Qualitatively, family members described feeling cared for and supported by staff, a reduction in sense of isolation, and improved coping and personal growth. Quantitatively, bereavement services have most effect for parents experiencing more complex mourning. It is recommended that bereavement services be theoretically driven and evidence based, offer continuity of care prior to and following the death of a child, and provide a range of interventions for the "whole family" and flexibility in service delivery. CONCLUSIONS There is a role for transitional hospital-based services/interventions for families in the lead up to and following the death of a child. Further mixed method research is required to inform best practice bereavement care guidelines in the perinatal, neonatal, and pediatric hospital settings.
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Affiliation(s)
- Leigh A Donovan
- Kids Cancer Centre, Sydney Children's Hospital (SCH), Randwick, NSW, Australia School of Women's and Children's Health, Faculty of Medicine, UNSW Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia Paediatric Palliative Care Service, Royal Children's Hospital (RCH), Herston, QLD, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital (SCH), Randwick, NSW, Australia School of Women's and Children's Health, Faculty of Medicine, UNSW Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Vera Russell
- Kids Cancer Centre, Sydney Children's Hospital (SCH), Randwick, NSW, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital (SCH), Randwick, NSW, Australia School of Women's and Children's Health, Faculty of Medicine, UNSW Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
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14
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Feasibility and perceived benefits of a framework for physician-parent follow-up meetings after a child's death in the PICU. Crit Care Med 2014; 42:148-57. [PMID: 24105453 DOI: 10.1097/ccm.0b013e3182a26ff3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the feasibility and perceived benefits of conducting physician-parent follow-up meetings after a child's death in the PICU according to a framework developed by the Collaborative Pediatric Critical Care Research Network. DESIGN Prospective observational study. SETTING Seven Collaborative Pediatric Critical Care Research Network-affiliated children's hospitals. SUBJECTS Critical care attending physicians, bereaved parents, and meeting guests (i.e., parent support persons, other health professionals). INTERVENTIONS Physician-parent follow-up meetings using the Collaborative Pediatric Critical Care Research Network framework. MEASUREMENTS AND MAIN RESULTS Forty-six critical care physicians were trained to conduct follow-up meetings using the framework. All meetings were video recorded. Videos were evaluated for the presence or absence of physician behaviors consistent with the framework. Present behaviors were evaluated for performance quality using a 5-point scale (1 = low, 5 = high). Participants completed meeting evaluation surveys. Parents of 194 deceased children were mailed an invitation to a follow-up meeting. Of these, one or both parents from 39 families (20%) agreed to participate, 80 (41%) refused, and 75 (39%) could not be contacted. Of 39 who initially agreed, three meetings were canceled due to conflicting schedules. Thirty-six meetings were conducted including 54 bereaved parents, 17 parent support persons, 23 critical care physicians, and 47 other health professionals. Physician adherence to the framework was high; 79% of behaviors consistent with the framework were rated as present with a quality score of 4.3 ± 0.2. Of 50 evaluation surveys completed by parents, 46 (92%) agreed or strongly agreed the meeting was helpful to them and 40 (89%) to others they brought with them. Of 36 evaluation surveys completed by critical care physicians (i.e., one per meeting), 33 (92%) agreed or strongly agreed the meeting was beneficial to parents and 31 (89%) to them. CONCLUSIONS Follow-up meetings using the Collaborative Pediatric Critical Care Research Network framework are feasible and viewed as beneficial by meeting participants. Future research should evaluate the effects of follow-up meetings on bereaved parents' health outcomes.
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Abstract
Informing the family members about the sudden death of their loved one is a highly stressful experience for the treating doctors. Breaking the bad news to the bereaved family needs special skill on the part of the clinicians. An elaborate, step-wise modified action plan for breaking the sad news and grief reduction based on the literature has been presented here. The guidelines mentioned in the article are simply the tips to the clinicians and not to be considered as any form of protocols. Inclusion of this subject into the undergraduate medical curriculum has to be considered. By doing so, we can look forward to produce junior doctors who are better at coping with this awkward but extremely important aspect of clinical medicine.
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Affiliation(s)
- Sadananda B Naik
- Department of Internal Medicine, Alva's Health Centre, Moodabidri, Karnataka, India
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Nikkola I, Kaunonen M, Aho AL. Mother’s experience of the support from a bereavement follow-up intervention after the death of a child. J Clin Nurs 2013; 22:1151-62. [DOI: 10.1111/j.1365-2702.2012.04247.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Eggly S, Meert KL, Berger J, Zimmerman J, Anand KJS, Newth CJL, Harrison R, Carcillo J, Dean JM, Willson DF. Physicians' conceptualization of "closure" as a benefit of physician-parent follow-up meetings after a child's death in the pediatric intensive care unit. J Palliat Care 2013; 29:69-75. [PMID: 23923469 PMCID: PMC3817557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We examined physicians' conceptualization of closure as a benefit of follow-up meetings with bereaved parents. The frequency of use and the meaning of the word "closure" were analyzed in transcripts of interviews with 67 critical care physicians affiliated with the Collaborative Pediatric Critical Care Research Network. In all, 38 physicians (57 percent) used the word "closure" at least once (median: 2; range: 1 to 7), for a total of 86 times. Physicians indicated that closure is a process or trajectory rather than an achievable goal. They also indicated that parents and physicians can move toward closure by gaining a better understanding of the causes and circumstances of the death and by reconnecting with, or resolving relationships between, parents and health professionals. Physicians suggested that a primary reason to conduct follow-up meetings is that such meetings offer parents and physicians an opportunity to move toward closure. Future research should attempt to determine whether followup meetings reduce the negative effects of bereavement for parents and physicians.
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Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University, 4100 John R Street, MM03CB, Detroit, Michigan 48201, USA.
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Briller SH, Schim SM, Thurston CS, Meert KL. Conceptual and design issues in instrument development for research with bereaved parents. OMEGA-JOURNAL OF DEATH AND DYING 2012; 65:151-68. [PMID: 22953511 PMCID: PMC3814013 DOI: 10.2190/om.65.2.e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many childhood deaths in the United States occur in pediatric intensive care units (PICUs) and parents have special needs in this death context. As an interdisciplinary research team, we discuss conceptual and design issues encountered in creating a new instrument, the Bereaved Parent Needs Assessment-PICU, for assessing parents' needs in this setting. Using a qualitative approach, our team previously explored how the culture and related ways of providing care in one urban Midwestern children's hospital PICU affected parents' bereavement needs and experiences. We describe using this qualitative foundation in the development of a new quantitative instrument to more widely validate and measure bereaved parents' needs around the time of a child's death across multiple PICUs. We highlight a series of issues that warrant consideration in designing a research instrument for this vulnerable population including setting and context, format and content, temporality, recruitment, and content expertise.
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Affiliation(s)
- Sherylyn H Briller
- Department of Anthropology, Wayne State University, Detroit, Michigan 48202, USA.
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Aho AL, Tarkka MT, Astedt-Kurki P, Sorvari L, Kaunonen M. Evaluating a bereavement follow-up intervention for grieving fathers and their experiences of support after the death of a child--a pilot study. DEATH STUDIES 2011; 35:879-904. [PMID: 24501857 DOI: 10.1080/07481187.2011.553318] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article describes a study designed to evaluate the effectiveness of an intervention program for bereaved fathers and their experiences of it in a sample of intervention (n = 62) and control (n = 41) fathers. Data were collected by 3 scales: the Hogan Grief Reactions Checklist, a scale for measuring received social support, and a scale for measuring fathers' experiences of the intervention program. Assessment at 6 months after leaving the hospital showed that intervention fathers reported lower grief reaction scores and stronger personal growth. Intervention fathers reported the most emotional support from both health care personnel and peer supporters. The support received was perceived as helpful in coping, and fathers rated the intervention favorably. The findings support the continuation of the intervention.
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Affiliation(s)
- Anna Liisa Aho
- School of Health Sciences, University of Tampere, Tampere, Finland.
| | | | | | - Leena Sorvari
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Marja Kaunonen
- School of Health Sciences, University of Tampere, Tampere, Finland
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20
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Longden JV. Parental perceptions of end-of-life care on paediatric intensive care units: a literature review. Nurs Crit Care 2011; 16:131-9. [PMID: 21481115 DOI: 10.1111/j.1478-5153.2011.00457.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM AND OBJECTIVE The aim of this study was to review the literature relating to parental perceptions on what constitutes quality end-of-life care (ELC) at the time of their child's death in paediatric intensive care units (PICUs). BACKGROUND There are few issues in medicine as complex as those involving ELC provision and within paediatric intensive care, these decisions are particularly emotive. Improving the quality of ELC has become a national priority and an understanding of the reality of parents during and after the loss of a child is a mandatory step in achieving this. Efforts to improve ELC in PICU must be based on an understanding of the issues and problems that are unique to parents within this environment and cannot simply be extrapolated from other settings. It is imperative that this has a high priority in training, clinical practice and research for all members of the intensive care team. SEARCH STRATEGY Databases were systematically searched to identify primary research that related specifically to parental needs during the death of their child on PICU and published between 2000 to the present. CONCLUSIONS Although the retrospective nature of the studies reviewed presents some limitations, it does provide a broad overview of the characteristics of parental needs, indicating the scope for further empirical research. The identification and acknowledgement of the fundamental needs of parents at this time can enable health professionals to provide competent and compassionate ELC which is as focussed and evidence based as other aspects of paediatric critical care medicine.
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Affiliation(s)
- Jennifer V Longden
- Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Oxford Road, Manchester, UK.
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21
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Waiting in no-man’s-land – Mothers’ experiences before the induction of labour after their baby has died in utero. SEXUAL & REPRODUCTIVE HEALTHCARE 2011; 2:51-5. [DOI: 10.1016/j.srhc.2011.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 02/11/2011] [Accepted: 02/13/2011] [Indexed: 11/18/2022]
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22
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Eggly S, Meert KL, Berger J, Zimmerman J, Anand KJS, Newth CJL, Harrison R, Carcillo J, Dean JM, Willson DF, Nicholson C. A framework for conducting follow-up meetings with parents after a child's death in the pediatric intensive care unit. Pediatr Crit Care Med 2011; 12:147-52. [PMID: 20625339 PMCID: PMC3285236 DOI: 10.1097/pcc.0b013e3181e8b40c] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a framework to assist pediatric intensive care unit physicians in conducting follow-up meetings with parents after their child's death. Many childhood deaths occur in pediatric intensive care units. Parents of children who die in pediatric intensive care units often desire a follow-up meeting with the physician(s) who cared for their child. DATA SOURCES Prior research conducted by the Collaborative Pediatric Critical Care Research Network on the experiences and perspectives of bereaved parents and pediatric intensive care unit physicians regarding the desirability, content, and conditions of follow-up meetings. RESULTS The framework includes suggestions for inviting families to follow-up meetings (i.e., developing an institutional system, invitation timing, and format); preparing for the meeting (i.e., assessing family preferences; determining location, attendees, and discussion topics; reviewing medical and psychosocial history); structure of the meeting (i.e., opening, closing, and developing a meeting agenda); communicating effectively during the meeting; and follow-up for both parents and physicians. CONCLUSION This framework is based on the experience and perspectives of bereaved parents and pediatric intensive care unit physicians. Future research should be conducted to determine the extent to which physician-parent follow-up meetings provide a benefit to parents, families, physicians, and other healthcare providers participating in these encounters.
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Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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23
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Physicians' experiences and perspectives regarding follow-up meetings with parents after a child's death in the pediatric intensive care unit. Pediatr Crit Care Med 2011; 12:e64-8. [PMID: 20581729 PMCID: PMC3327296 DOI: 10.1097/pcc.0b013e3181e89c3a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate critical care physicians' experiences and perspectives regarding follow-up meetings with parents after a child's death in the pediatric intensive care unit. Parents of children who die in the pediatric intensive care unit often desire a follow-up meeting with the physicians who cared for their child. DESIGN Semistructured, audio-recorded telephone interviews. SETTING Six clinical centers affiliated with the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. PARTICIPANTS Seventy critical care physicians (i.e., attendings and fellows) practicing or training at a Child Health and Human Development Collaborative Pediatric Critical Care Research Network clinical center between February 1, 2008 and June 30, 2008. MEASUREMENTS AND MAIN RESULTS Twenty-three (33%) physicians reported never participating in a follow-up meeting with bereaved parents; 22 (31%) participated in one to five meetings; and 25 (36%) participated in more than five meetings. Of those with prior experience, 44 (94%) met with parents at the hospital and 40 (85%) met within 3 months of the death. Meeting content included discussing autopsy, parent questions, hospital course, cause of death, genetic risk, bereavement services, and legal or administrative issues; providing emotional support; and receiving parent feedback. Forty (85%) physicians perceived the meetings to be beneficial to families, and 35 (74%) to physicians. Barriers included time and scheduling, family and physician unwillingness, distance and transportation, language and cultural issues, parent anger, and lack of a system for meeting initiation and planning. CONCLUSIONS Critical care physicians have a wide range of experience conducting follow-up meetings with bereaved parents. Although physicians perceive benefits to follow-up meetings, barriers exist that interfere with their implementation in clinical practice.
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Meert KL, Briller SH, Schim SM, Thurston C, Kabel A. Examining the needs of bereaved parents in the pediatric intensive care unit: a qualitative study. DEATH STUDIES 2009; 33:712-740. [PMID: 19697483 DOI: 10.1080/07481180903070434] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The pediatric intensive care unit (PICU) is a high-tech setting aimed at restoring health to critically ill children. When childhood death occurs in the PICU, it constitutes a special context for parent bereavement. The purpose of this interdisciplinary qualitative research was to gain a deeper understanding of parents' needs around the time of their child's death in the PICU. Through interviews and focus groups with bereaved parents and hospital chaplains, categories of parents' needs emerged. Deeper understanding of parents' needs will allow health professionals to better support parents during bereavement as well as to provide more customized care.
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Affiliation(s)
- Kathleen L Meert
- Department of Pediatrics, Wayne State University School of Medicine and Critical Care Medicine, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, USA.
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25
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Abstract
O estudo teve por objetivo descrever os antecedentes, atributos e conseqüências do conceito de morte digna da criança. Utilizou-se a estratégia de análise de conceito para avaliar os 40 artigos, tendo como foco publicações nas áreas médica e de enfermagem, que estudaram ou focalizaram a morte digna da criança. Os atributos do conceito de morte digna da criança incluem: qualidade de vida, cuidado centrado na criança e na família, conhecimento específico sobre cuidados paliativos, decisão compartilhada, alívio do sofrimento da criança, comunicação clara, relacionamento de ajuda e ambiente acolhedor. Poucos artigos trazem a definição de morte digna da criança e, quando isso ocorre, essa definição é vaga e, muitas vezes, ambígua entre os vários autores. Esse aspecto indica que o conceito ainda não é consistentemente definido, demandando estudos de sua manifestação na prática clínica, contribuindo com os cuidados no final da vida em pediatria.
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26
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Abstract
There is a need in the NICU for an end-of-life care guideline that nurses can follow when working with dying infants and their families. Maintaining intravenous access to relieve the infant's pain, communicating sensitively to the family, and creating precious, everlasting memories are goals that should be part of every dying infant's care. The nurse's ability to partner with the family in caring for the infant is integral to helping the family take the first steps in their grief journey. Evidence-based literature provides NICU nurses with the knowledge that they are the facilitators of end-of-life care for dying infants. New mothers and fathers are not aware of the caring parental tasks they can perform for their dying baby. They look to and depend on their infant's nurses to encourage them. The guideline included here provides nurses with a tool for ensuring that families have the opportunity to create memories that will not only help them with their immediate pain, but also comfort them for a lifetime.
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MESH Headings
- Adaptation, Psychological
- Communication
- Congenital Abnormalities/nursing
- Evidence-Based Medicine
- Grief
- Humans
- Infant, Extremely Low Birth Weight
- Infant, Newborn
- Infant, Newborn, Diseases/nursing
- Infant, Newborn, Diseases/psychology
- Infant, Premature, Diseases/nursing
- Infant, Premature, Diseases/psychology
- Intensive Care Units, Neonatal
- Nurse's Role/psychology
- Palliative Care/psychology
- Parenting/psychology
- Professional-Family Relations
- Terminal Care/psychology
- United States
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Apatira L, Boyd EA, Malvar G, Evans LR, Luce JM, Lo B, White DB. Hope, truth, and preparing for death: perspectives of surrogate decision makers. Ann Intern Med 2008; 149:861-8. [PMID: 19075205 PMCID: PMC2622736 DOI: 10.7326/0003-4819-149-12-200812160-00005] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although many physicians worry that openly discussing a poor prognosis will cause patients and families to lose hope, surrogate decision makers' perspectives on this topic are largely unknown. OBJECTIVE To determine surrogate decision makers' attitudes toward balancing hope and telling the truth when discussing prognosis. DESIGN Prospective, mixed-methods cohort study. SETTING 4 intensive care units at the University of California, San Francisco, Medical Center, San Francisco, California. PARTICIPANTS 179 surrogate decision makers for incapacitated patients at high risk for death. MEASUREMENTS One-on-one, semistructured interviews with surrogates were conducted on the patients' 5th day of receiving mechanical ventilation. Constant comparative methods were used to inductively develop a framework to describe participants' responses. Validation methods included multidisciplinary analysis and member checking. RESULTS Overall, 93% (166 of 179) of surrogates felt that avoiding discussions about prognosis is an unacceptable way to maintain hope. The main explanatory theme was that timely discussion of prognosis is essential to allow family members to prepare emotionally and logistically for the possibility of a patient's death. Other themes that emerged included surrogates' belief that an accurate understanding of a patient's prognosis allows them to better support the patient and each other, a moral aversion to the idea of false hope, the perception that physicians have an obligation to discuss prognosis, and the notion that some surrogates look to physicians primarily for truth and seek hope elsewhere. A few surrogates (6 of 179) felt that physicians should withhold prognostic information because of a belief that discussing death could be emotionally damaging to the family or could negatively affect the patient's health. LIMITATION The authors did not longitudinally assess whether early disclosure about prognosis predicts fewer adverse bereavement outcomes. CONCLUSION Most surrogates of critically ill patients do not view withholding prognostic information as an acceptable way to maintain hope, largely because timely discussions about prognosis help families begin to prepare emotionally, existentially, and practically for the possibility that a patient will die.
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Affiliation(s)
- Latifat Apatira
- University of California, San Francisco, and San Francisco General Hospital, San Francisco, California 94143, USA
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28
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Levetown M. Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics 2008; 121:e1441-60. [PMID: 18450887 DOI: 10.1542/peds.2008-0565] [Citation(s) in RCA: 271] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Health care communication is a skill that is critical to safe and effective medical practice; it can and must be taught. Communication skill influences patient disclosure, treatment adherence and outcome, adaptation to illness, and bereavement. This article provides a review of the evidence regarding clinical communication in the pediatric setting, covering the spectrum from outpatient primary care consultation to death notification, and provides practical suggestions to improve communication with patients and families, enabling more effective, efficient, and empathic pediatric health care.
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29
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Dealing with death: an audit of family bereavement programs in Australian intensive care units. Aust Crit Care 2008; 18:146, 148-51. [PMID: 18038535 DOI: 10.1016/s1036-7314(05)80027-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patient death in Intensive Care Units (ICU) can be sudden and unexpected, leading to emotionally charged situations and life changing circumstances for family members. Supporting families during and after this critical period is particularly challenging for ICU nurses who often feel dissatisfied with the way they deal with the situation. Bereavement programs in various areas of nursing have been reported to be beneficial in promoting normal grief patterns. There is, however, a lack of research in the area of evaluation of bereavement programs in adult ICUs. This paper presents the results of an Australia-wide audit on current practices in the area of bereavement programs within adult ICUs. Surveys were sent to 117 adult Australian ICUs; 99 surveys were returned completed (84.6% response rate). It was identified that most surveyed units offer minimal components of bereavement programs, such as viewing of the deceased and communicating with family members. Less than one third (n=26) provide additional follow-up services in the form of telephone calls and sympathy cards or referral to additional services. Ten units employ some form of program evaluation. Verbal feedback from staff and families is the primary assessment method. Over half of responding ICUs indicated they are considering or interested in providing a bereavement program in their unit. This study highlights the need for research-based data to support the introduction or deletion of strategies for bereavement programs using family-centred outcome measures. ICU nurses are interested in this area of clinical practice and require considerable support. It is recommended that this support can come via postgraduate and on-going education, hospital policies and procedures.
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Wijngaards-de Meij L, Stroebe M, Stroebe W, Schut H, Van den Bout J, Van Der Heijden PGM, Dijkstra I. The impact of circumstances surrounding the death of a child on parents' grief. DEATH STUDIES 2008; 32:237-252. [PMID: 18705169 DOI: 10.1080/07481180701881263] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A longitudinal study was conducted among bereaved parents to examine the relationship between the circumstances surrounding the death of their child and psychological adjustment. Two hundred nineteen couples participated at 6, 13, and 20 months post-loss. Examination was made of two categories of factors: those that were determined by the particular death circumstances (e.g., whether the parent was present at the death) versus those over which parents themselves could have influence (e.g., choice of cremation or burial). Results indicated that some but not all factors were related to adjustment over time. Importantly, the feeling of having said goodbye to the child and presenting the body for viewing at home were associated with lower levels of the parents' grief. Implications for supporting bereaved parents are discussed.
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Affiliation(s)
- Leoniek Wijngaards-de Meij
- Department of Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands.
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Chan MF, Lou FL, Zang YL, Chung YF, Wu LH, Cao FL, Li P. RETRACTED: Attitudes of midwives towards perinatal bereavement in Hong Kong. Midwifery 2007; 23:309-21. [PMID: 17095131 DOI: 10.1016/j.midw.2006.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 05/01/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to explore attitudes towards perinatal bereavement care among midwives working in Hong Kong through examination of relationships between attitudes towards bereavement support, need for bereavement education and appropriate hospital policy. DESIGN a descriptive correlational survey. SETTING the obstetric and gynaecology units at two hospitals. INSTRUMENT a structured self-report questionnaire on attitudes towards perinatal bereavement support; required support and education needs for midwives on bereavement care. PARTICIPANTS 154 out of 202 midwives (76.2% response rate) working at the two units. FINDINGS two-step cluster analysis yielded two clusters. Cluster 1 consisted of 91 (59.1%) midwives and cluster 2 consisted of 63 (40.9%) midwives. Cluster 2 midwives were younger, had less obstetric and gynaecology experience, junior ranking and less post-qualification education than cluster 1 midwives. Cluster 1 midwives had additional personal grieving experiences and experience of caring for grieving parents. Attitudes towards bereavement care were positively correlated with educational needs (r(s)=0.55, p< 0.001) and hospital policy support (r(s)=0.50, p< 0.001). CONCLUSIONS Hong Kong midwives require increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team member support. Findings may be used to improve support of midwives, to ensure sensitive bereavement care in perinatal settings and to reflect training needs in the midwifery education curricula. Study findings highlight the universality of grief for a lost baby, irrespective of cultural differences in approaching emotional topics. This study may help midwives internationally to gain a broader perspective in this area.
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Affiliation(s)
- Moon Fai Chan
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
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32
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Meert KL, Eggly S, Pollack M, Anand KJS, Zimmerman J, Carcillo J, Newth CJL, Dean JM, Willson DF, Nicholson C. Parents' perspectives regarding a physician-parent conference after their child's death in the pediatric intensive care unit. J Pediatr 2007; 151:50-5, 55.e1-2. [PMID: 17586190 PMCID: PMC1993355 DOI: 10.1016/j.jpeds.2007.01.050] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 12/01/2006] [Accepted: 01/31/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate parents' perspectives on the desirability, content, and conditions of a physician-parent conference after their child's death in the pediatric intensive care unit (PICU). STUDY DESIGN Audio-recorded telephone interviews were conducted with 56 parents of 48 children. All children died in the PICU of one of six children's hospitals in the National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) 3 to 12 months before the study. RESULTS Only seven (13%) parents had a scheduled meeting with any physician to discuss their child's death; 33 (59%) wanted to meet with their child's intensive care physician. Of these, 27 (82%) were willing to return to the hospital to meet. Topics that parents wanted to discuss included the chronology of events leading to PICU admission and death, cause of death, treatment, autopsy, genetic risk, medical documents, withdrawal of life support, ways to help others, bereavement support, and what to tell family. Parents sought reassurance and the opportunity to voice complaints and express gratitude. CONCLUSIONS Many bereaved parents want to meet with the intensive care physician after their child's death. Parents seek to gain information and emotional support, and to give feedback about their PICU experience.
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Aho AL, Tarkka MT, Astedt-Kurki P, Kaunonen M. Fathers' experience of social support after the death of a child. Am J Mens Health 2007; 3:93-103. [PMID: 19477722 DOI: 10.1177/1557988307302094] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aims of this study were to describe fathers' social networks and their experience of social support after the death of a child. The sample consisted of 8 fathers who had lost a child under the age of 3. The data were collected with open-ended questions and interviews. Data analysis used qualitative content analysis. The fathers' social support networks varied over time and between fathers. The support networks included either just the spouse or the spouse and other people. Social relationships broke down and new relationships formed in their place. The fathers experienced social isolation but also deliberately isolated themselves from human relationships. The support the fathers received was felt to be both positive and negative. Peer support was only positive. Support from professionals was reported to be important but was also criticized. In particular better family care, informal support, and systematic support after leaving the hospital were expected.
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Affiliation(s)
- Anna Liisa Aho
- Department of Nursing Science, University of Tampere, Finland.
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Parris RJ, Schlosenberg J, Stanley C, Maurice S, Clarke SFJ. Emergency department follow-up of bereaved relatives: an audit of one particular service. Emerg Med J 2007; 24:339-42. [PMID: 17452701 PMCID: PMC2658479 DOI: 10.1136/emj.2006.042671] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2007] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although much has been written about the treatment of bereaved relatives in emergency departments, very little has been published about their follow-up after they have left the department. METHODS One model of follow-up is described, in which relatives are invited to a meeting in the department 4-6 weeks after their loss. In this model, it is emphasised that the follow-up is not a counselling session but an opportunity to ask questions, and an audit of the service is presented. RESULTS AND CONCLUSION It is suggested that the provision of information is theoretically beneficial to the bereavement process.
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Affiliation(s)
- R J Parris
- Emergency Department, Royal Bolton Hospital, Bolton NHS Trust, Bolton, UK
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Abstract
Patients and families in NICU and PICU settings can be well served by fundamental palliative care approaches during curative and end-of-life care.A wide variety of patients are suitable for these services. Although barriers exist to implementing these teams within the ICU, the concepts remain sound,and models for successful integration of practices in these settings exist.
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Affiliation(s)
- Brian S Carter
- Pediatric Advance Comfort Team, Department of Pediatrics, Vanderbilt Children's Hospital (Neonatology), 11111 Doctor's Office Tower, Nashville, TN 37232-9544, USA
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deJong-Berg MA, deVlaming D. Bereavement care for families part 1: a review of a paediatric follow-up programme. Int J Palliat Nurs 2006; 11:533-9. [PMID: 16301956 DOI: 10.12968/ijpn.2005.11.10.19981] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The World Health Organization suggests that palliative care needs to offer a support system to the family during the patient's illness as well as during his/her bereavement. Bereavement follow-up services in paediatrics offer families an additional source of support in their grieving process. This article reviews the development of a bereavement follow-up programme delivered by the paediatric palliative care team and explores the lessons learnt and challenges faced in developing the programme.
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Affiliation(s)
- Margaret A deJong-Berg
- Stollery Children's Hospital, WMC University Hospital, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7.
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Chan MF, Wu LH, Day MC, Chan SH. Attitudes of nurses toward perinatal bereavement: findings from a study in Hong Kong. J Perinat Neonatal Nurs 2005; 19:240-52. [PMID: 16106232 DOI: 10.1097/00005237-200507000-00010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Nurses' attitudes toward perinatal bereavement care are explored by identifying profiles of nurses working in 2 obstetrics and gynecology units in Hong Kong. Relationships between nurses' attitudes toward bereavement supports, need for bereavement education, and hospital policy are explored. RESEARCH METHOD A descriptive, correlational survey design was used, and 169 nurses recruited from an obstetric and gynecology (ob-gyn) unit at 2 local public hospitals in Hong Kong completed a structured questionnaire. OUTCOME MEASURES Attitudes toward perinatal bereavement support; required support and education needs for nurses on bereavement care. FINDINGS Two-step cluster analysis yielded 2 clusters. Cluster 1 consisted of 55.6% (n = 94) and cluster 2 consisted of 44.3% (n = 75) of nurses. Cluster 2 nurses were younger and had less ob-gyn experience, more junior ranking, and less education than cluster 1 nurses. Cluster 1 nurses had additional midwifery and bereavement care education, personal grieving experiences, and experience handling grieving clients. The majority held positive bereavement care attitudes, but only 29.6% (n = 50) had bereavement-related education. Attitudes toward bereavement care were positively correlated with educational needs (r(s) = 0.52) and hospital policy support (r(s) = 0.56). CONCLUSIONS Hong Kong nurses emphasized the need for increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team members' support. Findings may be used to improve support of nurses, to ensure sensitive bereavement care in perinatal settings, and to enhance nursing curricula. The desire of Hong Kong nurses for bereavement education highlights the universality of grief for a lost infant, regardless of cultural differences in approaching emotional topics. This study may help nurses in the United States and elsewhere gain a broader perspective in this area.
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Affiliation(s)
- Moon Fai Chan
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
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Salas Arrambide M, Gabaldón Poc O, Mayoral Miravete JL, Pérez-Yarza EG, Amayra Caro I. El pediatra ante la muerte del niño: integración de los cuidados paliativos en la unidad de cuidados intensivos pediátricos. An Pediatr (Barc) 2005; 62:450-7. [PMID: 15871827 DOI: 10.1157/13074619] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Palliative care is essential in the pediatric intensive care unit (PICU). Because of the mortality rates and the presence of life-threatening conditions in children admitted to the PICU, pediatricians must be prepared to provide palliative care independently of cure-directed therapies. The present article reviews certain issues, including the decision-making process in the PICU, psychosocial needs and susceptibility to burnout among PICU staff, and the emotions and attitudes of the staff when a child dies. We provide some guidelines on how to act when a child dies, how to meet with parents after the child's death and how to follow-up parental bereavement. Strategies that can help PICU pediatricians to cope with the numerous loses they experience are suggested.
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Affiliation(s)
- M Salas Arrambide
- Departamento de Psicología, Facultad de Filosofía y Ciencias de la Educación, Universidad de Deusto, Bilbao, España.
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