New directions in bereavement research: exploration of gender differences

Grief Trajectories of Bereaved Parents of Adolescents and Young Adults With Advanced Cancer: A Qualitative Analysis Using Phenomenology

Different parents grieve differently. However, research directed at understanding the important contextual or individual factors that influence the path each bereaved parent takes is lacking. In this qualitative analysis we seek to understand the array of bereaved parent experiences more completely. By deeply diving into one parent dyad using interpretive phenomenology analysis and situating that story within the conventional content analysis of 13 other bereaved parents of adolescents and young adults (AYAs) who died from advanced cancer, we illustrate the roles of religion/spirituality, maintaining a connection, and fulfilling parental roles as elements of grief processing. Clinicians and investigators should consider similar individualized approaches to understanding and supporting the grief experiences of bereaved parents before and after the death of a child.

Experiences of Parental Suicide-Bereavement: A Longitudinal Qualitative Analysis Over Two Years

Limited research exists on the experiences of parents bereaved by suicide. Our earlier qualitative analysis examined the experiences of parents’ suicide bereavement at 6 and 12 months after their loss. The current study aimed to extend the analysis over 24 months, outlining the key themes of parents’ suicide bereavement experience. In the frames of a longitudinal study of suicide bereavement in Queensland, Australia, parents were interviewed at 6, 12, and 24 months after their loss. Thematic analysis was used to further explore new themes and three key themes identified in earlier analyses: searching for answers and sense-making, coping strategies and support, and finding meaning and purpose. Results at 24 months revealed a clearer differentiation between strategies adopted by mothers and fathers. Anger and blame had changed towards feelings of depression. A polarization was observed between parents still oscillating in brooding rumination and those who have shifted towards sense-making. The former more frequently reported depression symptoms, and the latter reported a more positive attitude towards life and acceptance of their loss. Consistent with the dual-process model, parents managed to reach acceptance after oscillating between sense-making and meaning making. Findings provide insights how suicide loss affects parents, with implications for postvention.

Effectiveness of bereavement counselling through a community-based organization: A naturalistic, controlled trial

This controlled, longitudinal investigation tested the effectiveness of a bereavement counselling model for adults on reducing complicated grief (CG) symptoms. Participants (N = 344; 79% female; mean age: 49.3 years) were adult residents of Scotland who were bereaved of a close relation or partner, experiencing elevated levels of CG, and/or risks of developing CG. It was hypothesized that participants who received intervention would experience a greater decline in CG levels immediately following the intervention compared to the control participants, but the difference would diminish at follow‐up (due to relapse). Data were collected via postal questionnaire at 3 time points: baseline (T), post‐intervention (T + 12 months), and follow‐up (T + 18 months). CG, post‐traumatic stress, and general psychological distress were assessed at all time points. Multilevel analyses controlling for relevant covariates were conducted to examine group differences in symptom levels over time. A stepwise, serial gatekeeping procedure was used to correct for multiple hypothesis testing. A main finding was that, contrary to expectations, counselling intervention and control group participants experienced a similar reduction in CG symptoms at postmeasure. However, intervention participants demonstrated a greater reduction in symptom levels at follow‐up (M = 53.64; d = .33) compared to the control group (M = 62.00). Results suggest community‐based bereavement counselling may have long‐term beneficial effects. Further longitudinal treatment effect investigations with extensive study intervals are needed.

Coping Strategies Following a Child's Violent Death: How Parents Differ in their Responses

This study examined coping strategies used by bereaved parents whose adolescent and young adult children died by accident, suicide, or homicide. Death event data were verified from Medical Examiner's records. A community-based sample of 261 parents was recruited 6 to 28 weeks following the deaths and followed prospectively up to five years postdeath. Coping data were obtained five times during the study, using COPE, a 53-item standardized questionnaire with 13 conceptually distinct subscales (Carver, Scheier,&Weintraub, 1989). The data provide partial support for the gender socialization hypothesis. Bereaved mothers reported using emotion-focused strategies in conjunction with other coping methods. Similarly, bereaved fathers did not report problem-focused coping at the exclusion of other strategies. Nonetheless, logistic regression analyses showed that 4 of the 53 COPE items correctly predicted gender 75 percent of the time. Current conceptualizations of coping are called into question.

What is Complicated Grief? A Social Constructionist Perspective

Research into complicated grief assumes that it is a psychological disorder of the grieving individual. This article suggests seven other things that complicated grief may also be: a normalizing construct of psychiatric medicine, an operational requirement of bereavement agencies, a concept by which society as a whole and families can discipline mourning members, a label applied to those who actively resist cultural norms about grief, a product of a society obsessed with risk, and the result of negotiation between various parties in the bereavement field. If complicated grief exists, it is much more multi-faceted than is usually acknowledged.

Grief, like death itself, is undisciplined, risky, wild. That society seeks to discipline grief, as part of its policing of the border between life and death, is predictable, and it is equally predictable that modern society would medicalize grief as the means of policing (Foote & Frank, 1999, p. 170).

Bereavement Responses among Palestinian Widows, Daughters and Sons Following the Hebron Massacre

In February 1994, an Israeli settler shot Muslim worshippers at the Ibrahime Mosque at Hebron, West Bank. Fifty-three people were killed, and 200 injured. The Derogatis Symptom Checklist-Revised (SCL-90-R), a 90-item 5-point self-administered discomfort scale was administered to all surviving widows ( n=23), daughters ( n=12), and sons ( n=26). Statistically significant different results occurred in 3 of 9 subscales. Widows scored higher somatization than the daughters, who scored higher than the sons. Daughters scored higher phobia than the widows, who scored higher than the sons. Widows scored higher anxiety than the daughters, who scored higher than the sons. Culturally-and-religiously-proscribed gender and familial roles appear to contribute to the different bereavement response patterns. No respondents sought professional mental health counseling.

An Integrative Model of Personality, Coping and Appraisal for the Prediction of Grief Involvement in Adults

This Study Contrasts Two Opposing Conceptualizations Of Personality's Effect Upon Grief: A Traditional Ego Psychology (Risk Factor) View And Lazarus And Folkman's Contextual Coping Model. The Eysenck Personality Questionnaire, the Coping Inventory for Stressful Situations, and the Revised Grief Experience Inventory were administered to 101 bereaved adults. Predictor variables included neuroticism, extraversion, threat appraisal, emotion-oriented coping, task/problem-oriented coping, and avoidance coping. Significant predictive effects for emotion oriented coping, task/problem oriented coping, and grief-related variables were found. Results support contextual coping theory, indicating that immediate coping processes may be better predictors of grief involvement than longstanding personality traits. Clinical implications are discussed.

The Fundamental Paradox in the Grief Literature: A Critical Reflection

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.

Living beyond the Unanticipated Sudden Death of a Partner: A Phenomenological Study

This research project explored grief and its impact upon men and women who have experienced the sudden and unanticipated death of his or her partner.

It included what grief meant to them, how it was manifested in his or her everyday lives and how his or her partner's death had impacted upon his or her relationship with themselves, with others and the world. A Husserlian phenomenological approach was used to explore the experiences of the ten women and five men whose partner had died up to five years prior to being interviewed. The need for the surviving partner to continue to participate in everyday life placed great strain upon the internal resources of the surviving partner. The surviving partner needed to reinvent him or herself, in an attempt to become independent and regain functionality, whilst dealing with the sadness and loss that they had experienced. The surviving partner discovered that a new life order emerged that included hope, optimism, planning for the future and perhaps the prospect of a new relationship. The death of a partner left the surviving partner with a loss that would always be a part of them, with the memories of his or her relationship being maintained within them that will never be replaced by somebody else. The results of this research project reinforce the need for ongoing education of the community in grief and bereavement issues in order to increase the awareness of the support needs of the bereaved person. The length of time and amount of energy required to incorporate the experience into the survivor's life, is greatly underestimated by the community, and perhaps by some of the health and caring professionals. Colonial and hospital based bereavement support services need to be established and be proactive using outreach programs, actively offering the suddenly bereaved partner and family support and information.

Gender Differences in Grief Reactions following the Death of a Parent

This study examined gender differences in psychological functioning in a sample of college students who lost a parent to death. Male and female students ( n = 65) who had a parent that had died were asked to complete a series of self report questionnaires to assess psychological distress, feelings of grief and bereavement, and coping strategies. Overall, no gender differences were found between bereaved students on measures of psychological distress. However an avoidant coping style was related to symptoms of depression in females, but not in males. Students who lost a mother were more likely to report symptoms of depression, hopelessness, and suicidal ideation as compared to students who lost a father. Future research implications and the clinical importance of these findings are discussed.

Marital Status and Frailty in Older People: Gender Differences in the Progetto Veneto Anziani Longitudinal Study

OBJECTIVES

Marital status has been associated with disability and mortality, but its potential role as a factor influencing frailty has yet to be thoroughly investigated. The analysis of gender-related differences in the relationship between marital status and frailty is another interesting matter that remains to be fully elucidated. The aim of our study was to examine the association between marital status and the incidence of frailty in a cohort of older men and women over a 4.4-year follow-up.

MATERIALS AND METHODS

A sample of 1887 subjects older than 65 years, enrolled under the Progetto Veneto Anziani (Pro.V.A.) and with no evidence of frailty at baseline, were grouped by marital status. The incidence of frailty after 4.4 years was measured as the presence of at least three of the Fried criteria.

RESULTS

After the follow-up period, 414 (21.9%) new cases of frailty were identified. Multivariate logistic regression models demonstrated that male gender carried a higher risk of developing frailty among men who had never married (odds ratio [OR] = 3.84, 95% confidence interval [95% CI] = 2.76-5.35; p < 0.0001) and were widowed (OR = 1.43, 95% CI = 1.06-1.95, p = 0.02) than among married participants. For female gender, widows had significantly lower odds of becoming frail than married women (OR = 0.77, 95% CI = 0.66-0.91, p = 0.002). The determinants of frailty more influenced by marital status were unintentional weight loss, low daily energy expenditure, and exhaustion.

CONCLUSIONS

Marital status seems to significantly influence the onset of frailty, with some gender-specific differences. Unmarried men were at higher risk of frailty, while widowed women carried a lower risk of becoming frail than married women.

The effect of widowhood on husbands' and wives' physical activity: the Cardiovascular Health Study

This prospective study examined the effect of widowhood on physical activity by comparing widowed elders to health status-, age-, and sex-matched married controls. Participants included 396 married controls and 396 widows/widowers age 64-91 (M age = 72.7 years) who experienced the death of their spouse while participating in the Cardiovascular Health Study. Compared to married controls, widowed men, but not women, were more likely to increase their physical activity following the death of their spouse. However, this increased level of activity was not sustained and declines as time since spousal death passes. Moreover, during the year before spousal death, soon-to-be widowed men, but not women, increase their physical activity. Our results suggest that widowed men experience significant changes in physical activity and that the transition to widowhood contribute to these changes.

Spousal loss and health in late life: moving beyond emotional trauma

OBJECTIVE

This study queries the linkage of older adults' spousal loss to multiple dimensions of their health.

METHODS

Data are from the 2005-2006 National Social Life, Health, and Aging Project, nationally representative of U.S. adults ages 57 to 85. Analyses examine associations of spousal loss and time since loss with multiple health dimensions.

RESULTS

Spousal loss is linked to a system of mental, social, behavioral, and biological issues, consistent with a stress-induced weathering process. Biological problems are more uniformly associated with women's than men's loss. While emotional sequelae may partially subside with time, a range of other outcomes remain worse even among individuals a decade or more past loss, than those with current partners.

DISCUSSION

Older adults' spousal loss influences multiple dimensions of their health. Gender differences in biological linkages suggest women's greater physiological vulnerability to this weathering event. Effects of loss are long term rather than transient, especially with biological conditions.

Bereavement experiences of mothers and fathers over time after the death of a child due to cancer

The authors investigated longitudinally bereavement in mothers and fathers whose children died of cancer. Thirty-one parents were interviewed 6 and 18 months post-death. Analyses revealed parental differences and changes over time: (a) employment--fathers were more work-focused; (b) grief reactions--mothers expressed more intense grief reactions that lessened over time; (c) coping--mothers were more child-focused, fathers more task-focused; (d) relationship with bereaved siblings-mothers actively nurtured relationship with child; (e) spousal relationship--parents reported diversity in their relationship over time; and (f) relationship with extended family--mothers maintained contact with extended family more. Findings illustrate parental differences in bereavement over time that might be partly socially determined. These findings emphasize the need for tailoring bereavement support services in the family.

Unique aspects of women's emotional responses to disability

PURPOSE

To improve rehabilitation clinicians' awareness of gender differences in emotional responses to disability as a means of enhancing accuracy and sensitivity in diagnosis and treatment of persons in their care.

METHOD

A prospective survey study using a new grief measure, the Loss Inventory (LI), with a diverse convenience sample of persons undergoing inpatient rehabilitation in the USA. Focused review of the bereavement, depression, and disability literatures related to observed gender differences.

RESULTS

Study participants reported grief symptoms in varying intensities. Consistent with all literature reviewed, significant gender differences were found in kind and intensity of grief and depression symptoms reported. Ethnicity also significantly affected responses to disability by LI study participant responses.

CONCLUSIONS

While persons with disabilities as a whole may not necessarily develop depression, gender is a risk factor for onset of mood problems after illness or injury-related losses. As compared with study sample disabled men, disabled women reported more intense and different symptoms of grief and depression. Women with disabilities in the LI sample were twice as likely as disabled men to be depressed. Rehabilitation clinicians may wish to incorporate consideration of these differences in their mental health assessments, diagnoses, and treatment plans.

Condolence books: language and meaning in the mourning for Hillsborough and Diana

This article reports empirical research into public books of condolence signed following two key mourning events within British culture: the 1989 Hillsborough soccer stadium disaster and the death of Diana, Princess of Wales, in 1997. The author suggests that not only do condolence books provide valuable historical record of the way contemporary society mourns, but also that they reflect attempts to language loss in ways that can be used to evaluate the extent of society's engagement with death. In so doing, he points to ways in which condolence messages signed following these events oscillate between "conservative structures of meaning" (Marris, 1974) and contemporary "structures of feeling" (Williams, 1971). In turn he suggests that such distinctions--between public and private, modernity and tradition--are destabilized by the postmodern cultural forms that these events appeared to inaugurate. In addition, and in the purported absence of expressivist mourning rituals (Gorer, 1965), the author suggests that condolence books may provide a useful social platform for the social expression of grief.

Non-finite loss and emotional labour: family caregivers? experiences of living with motor neurone disease

AIM AND OBJECTIVES

This paper aims to add to nurses' knowledge concerning the losses and emotional labour family caregivers face caring for people living with neurodegenerative, life-limiting illnesses such as motor neurone disease.

BACKGROUND

Motor neurone disease is a relentless, progressive illness resulting in progressive loss of voluntary muscle mass and function. Previous caregiver research presents the salient losses such as social, financial and relationship loss. However, the non-finite, unpredictable losses faced every day by caregivers and the emotional labour experienced are not effectively represented and have not been explored for caregivers of adult patients with life-limiting, degenerative, illness.

DESIGN/METHODS

Semi-structured interviews, ecomaps of social support networks and field notes were used to collect data for this ethnographic case study. Data were attained at three time points over a 10-month period from 18 primary caregivers and once from six peripheral caregivers.

RESULTS

Data revealed new information about the psychosocial and emotional losses experienced daily, when living with motor neurone disease. The impact of the constancy of voluntary muscle degeneration and the uncertainty of the illness progression in terms of available time and functional loss, threatened people's understanding and expectations of life, their relationships, their personal identity and their future. Managing their relationship with the patient and their reactions to the devastation of motor neurone disease is consistent with the concept of emotional labour.

CONCLUSIONS

Family caregivers living with relentless, life-limiting illness experience non-finite losses and emotional labour on a daily basis. While each individual's experience of loss is unique, nurses need to include caregivers as well as patients, in their spectrum of supportive care.

RELEVANCE TO CLINICAL PRACTICE

Nurses can be independent confidants who share the emotional labour and work with caregivers to develop interventions to assist them to manage their losses and their changing needs for psychological and emotional support.

Survey on death and dying in Hong Kong: attitudes, beliefs, and preferred end-of-life care

Social Workers in end-of-life and palliative care have a particular opportunity to ease the dying process by providing culturally appropriate services to the dying and their families. In today's multicultural social environment, with an ever-increasing immigrant population, social workers are challenged to be knowledgeable about diverse cultures. Recently, a forum of health care professionals and social workers in Hong Kong conducted a survey of the general population to assess death and dying attitudes, beliefs, and preferences for end-of-life care. Four-hundred-thirty Hong Kong Chinese participated in a telephone interview. Responses were compared by gender. The survey results not only contribute to an understanding of Hong Kong Chinese, but can inform social workers who practice with Chinese immigrants to the United States.

Relation between grief and subsequent pregnancy status 13 months after perinatal bereavement

AIMS

The present longitudinal study sought to explore the relationship between parental grief following perinatal bereavement and subsequent pregnancy, according to the particular facets of grief and pregnancy state being considered.

METHOD

The study participants were 63 couples who had been bereaved by stillbirth (n = 31) or neonatal death (n = 32). The relationship of self-reported grief (Perinatal Grief Scale-33 Active Grief, Difficulty Coping and Despair) 1 month and 13 months after the loss to subsequent pregnancy status (Pregnant, n = 20, Live Baby, n = 10, Trying, n = 11, Not Trying, n = 22) at 13 months was investigated with repeated measures analysis of variance.

RESULTS

There were statistically significant main effects for Active Grief and Difficulty Coping in women and men and Despair in women, but not in men. There was a statistically significant Active Grief by pregnancy status interaction in women (F(3, 59) = 2.89, P = 0.04), but not in men. Simple main effects analysis indicated a statistically significant decrease in Active Grief in women who were pregnant (F(1, 59) = 52.8, P < 0.0005), women who were not pregnant and not trying to conceive (F(1, 59) = 27.5, P < 0.0005), and women who had had a live baby (F(1, 59) = 9.62, P = 0.003). There was no statistically significant decrease in Active Grief in women who were not pregnant but trying to conceive (F(1, 59) = 3.44, P = 0.07). The Difficulty Coping in women and men and Despair in women by pregnancy status interactions were not statistically significant. None of the between-subjects main effects for pregnancy status was statistically significant in women or men.

CONCLUSION

The relation between grief and subsequent pregnancy differed with the sex of the parent and the particular facets of grief and pregnancy state being considered. Subsequent pregnancy was related to Active Grief in women, but not to Difficulty Coping or Despair that are known to be predictors of chronic grief.

Methodological challenges in measuring quality care at the end of life in the long-term care environment

Understanding what constitutes quality end-of-life care from the perspective of the patient, their family, and health care professionals has been a priority for many researchers in the past few decades. Literature in this area has helped describe many of the barriers to measuring the quality of care in various environments, such as the hospital, hospice, and home. However, much of the work to date in defining the domains of quality care at the end of life has not been conducted within the long-term care environment. This environment is expected to provide care to an increasing number of dying persons with the concurrent aging of the population in many Western countries and demand for more formal services. In this review, the methodological issues involved in measuring quality care at the end of life are examined, with specific attention given to the challenges encountered in the long-term care environment.

From spirituality to coping strategy: making sense of chronic illness

This article explores how individuals might make sense of chronic illness. The spiritual aspect of self is described both as being central to finding meaning in suffering with a chronic illness and also the source of hope in meeting the challenges faced. Culture as the template for interpreting the significance of chronic ill health at a personal, familial and societal level is also considered. A conceptual model for understanding life transitions is modified to incorporate the spiritual and cultural perspectives of making sense of chronic illness in relation to coping skills. In understanding how patients make sense of their circumstances nurses are more likely to be able to offer appropriate support to effect coping.

The sound of death rattle I: are relatives distressed by hearing this sound?

BACKGROUND

Death rattle is the noisy, rattling breathing that occurs in many dying patients. Health professionals intervene because the sound is said to distress attendant relatives. We found no formal study to confirm or refute relatives' distress, so we decided to ask the relatives.

METHOD

Face-to-face semi-structured interviews with 27 bereaved relatives to investigate their experience of terminal care and what their response had been to the sound of death rattle if this had occurred. Interview transcripts were subjected to thematic content analysis.

RESULTS

We found that almost half of the 12 relatives who had heard the sound of death rattle had been distressed by it. The others were either neutral about the sound or found it a helpful signal of impending death.

CONCLUSION

We confirmed that some relatives do find it distressing to hear the sound of death rattle. However, our expectation that relatives are universally disturbed by this sound was unfounded. There is no justification for a 'blanket' approach to therapeutic intervention when death rattle occurs. A better understanding is required of how relatives make sense of the sound of death rattle.

Find a way out: bereavement support in Taiwan hospice

GOALS OF WORK

The aim of the study was to explore one of the possibilities to enhance bereavement care in Taiwan hospice due to insufficient attention and resources. Meanwhile, a theoretical assumption about the relationship between anticipatory grief and postdeath grief was made and examined.

PATIENTS AND METHODS

Through convenience sampling, 109 most bereaved families of terminally ill cancer patients were included. Data were collected by the Anticipatory Grief Scale (Theut SK et al (1991) Caregiver's anticipatory grief in dementia: a pilot study. Int J Aging Hum Dev 32:113-118), Perinatal Grief Scale (Potvin L, Lasker J, Toediter T (1989) Measuring grief: a short version of the Perinatal grief scale. J Psychopathol Behav Assess 11:29-45), and a background information sheet.

MAIN RESULTS

Anticipatory grief was correlated with postdeath grief significantly but mildly. Age was associated with anticipatory grief, not with postdeath grief. However, relationship and gender did not statistically relate to anticipatory grief and postdeath grief.

CONCLUSIONS

Although anticipatory grief could predict postdeath grief, the result was not encouraging enough. Prevention is still the best way not only for the bereaved in theoretical point of view but also for hospice staff in practical application. However, how to screen out high-risk bereaved family in order to provide help in advance require more effort.

Why nurses need to understand the principles of bereavement theory

This article considers the value of bereavement theory to nurses. The contexts in which nurses care for the bereaved are identified and the terms "bereavement", "grief"and "mourning" are defined. A selection of psychological and sociological bereavement theory and models are considered in relation to their value in nursing practice. The increasing richness of bereavement theory strengthens potential understanding of the process of grief. Critical and creative use of this theory can offer valuable guidance to nurses caring for the bereaved and can help promote confidence, thus enabling them to provide appropriate support.

Is caregiving hazardous to one's physical health? A meta-analysis

Caring for a family member with dementia is generally regarded as a chronically stressful process, with potentially negative physical health consequences. However, no quantitative analysis has been conducted on this literature. The authors combined the results of 23 studies to compare the physical health of caregivers with demographically similar noncaregivers. When examined across 11 health categories, caregivers exhibited a slightly greater risk for health problems than did noncaregivers. However, sex and the health category assessed moderated this relationship. Stronger relationships occurred with stress hormones, antibodies, and global reported health. The authors argue that a theoretical model is needed that relates caregiver stressors to illness and proffers moderating roles for vulnerabilities and resources and mediating roles for psychosocial distress and health behaviors.

Psychological factors and survival after bone marrow transplantation in patients with leukemia

Psychological factors may be associated with the outcome of cancer treatment, including bone marrow transplantation (BMT). However, studies on the issue have provided controversial results. In the present study, effects of mood status on the outcome was studied through a follow-up period of 1-3 years as well as in shorter periods (3 and 8 months) post-BMT in 72 Japanese patients with leukemia. Psychological status was evaluated 2 weeks before BMT using Profile of Mood States (POMS). The most major factor abstracted from the POMS subscales (Factor 1, mainly comprising anxiety, depression, anger, fatigue and confusion) was associated with disease-free survival rate at 3 months post-BMT. However, the factor most significantly associated with the outcome was gender. Females had better outcome than males through the period of 1-3 years as well as at 8 months post-BMT. When analyzed by gender, Factor 1 was associated with poor prognosis at 3 and 8 months in males. In females, however, Factor 1 was not significantly associated with the prognosis. The present results suggest an association between mood status pre-BMT and prognosis post-BMT in a gender-specific manner.

Helpfulness of nursing actions to suddenly bereaved family members in an accident and emergency setting in Hong Kong

BACKGROUND

The sudden death of a family member is always traumatic to the family. Nursing actions such as providing comfort measures and providing an opportunity to view the deceased were consistently perceived as helpful by the suddenly bereaved. Little is known about the perception of bereaved family members in Hong Kong concerning the care they received in accident and emergency (A & E) departments. This study serves to identify actions, which were perceived as helpful in A & E setting in Hong Kong.

AIM

To gain knowledge about what nursing actions bereaved family members in Hong Kong perceived as helpful.

METHOD

This study was exploratory and descriptive in nature, and used a quantitative approach. Data were collected through structured telephone interviews using a modified Tye's questionnaire.

RESULTS

Seventy-six bereaved subjects were recruited in an A & E department in Hong Kong. The subjects perceived written information, opportunity to view the deceased, and respecting individual customs and religious procedures as most helpful and conversely, offering sedation, discouraging viewing of the body, and providing comfort measures as most unhelpful. No statistically significant differences among the overall mean of helpful nursing actions according to the subjects' age, gender, education level, family income and religions were found while using Mann-Whitney's U and Kruskal-Wallis' tests. Significant correlations between some actions and the respondents' age, family income and educational level were found.

CONCLUSION

Accident and emergency nurses have unique role in offering helpful actions to support suddenly bereaved family members.

The Widowers' Bereavement Process and Death Rituals: Hong Kong Experiences

This study explores the function of death rituals in the widowers' bereavement process. Four widowers holding different beliefs were interviewed. It was found that the respondents benefited from the performance of death rituals and the participants' support. They also had self-evolved postfuneral rituals for creating a continuing bond with their deceased wives, and this is a crucial step toward the goal of accommodation in bereavement for the respondents. The authors postulate that to help the widowers, it is necessary for bereavement counselors to be familiar with the messages contained in the death rituals of different religions. The humanist funeral also needs to be developed for nonreligious communities. Furthermore, bereavement counselors need to develop their empathy toward clients who come from non-Christian communities (e.g., Chinese communities) because negative attitudes toward death may be deeply rooted in their cultures.

Experiences of families in which a child has a prolonged terminal illness: modifying factors

A significant proportion of children requiring palliative care have neurodegenerative life-threatening illnesses (NLTIs). While most of their care is provided at home by their families over many years, there is a paucity of research examining families' experiences when a child with an NLTI is dying at home. In this grounded theory study, data were collected from eight families through observations and audiotaped interviews. Families moved through a process of 'navigating uncharted territory' as they lived with their dying child. The strategies that families used to manage this phenomenon were influenced by four intervening conditions that reflected the broader structural context of the phenomenon; relationships with healthcare providers, availability of information, gender differences, and communication between parents. Each condition facilitated or constrained the strategies that families were able to use. Implications for research, education and practice are discussed.

[Inventory of experiences in grief (IEG): adaptation to Spanish, reliability and validity]

OBJECTIVE

To adapt to Castilian the Inventory of Experiences of Grief (IEG) of Catherine Sanders et al. (1977) and study its reliability and validity.

DESIGN

In two stages: cross-cultural adaptation of a questionnaire and cross-sectional study with control group.

SETTING

Primary care teams in Vizcaya.

PARTICIPANTS

147 people bereaved in the period between 3 months and 3 years before the study, and 36 who had lost no direct family member in the previous 5 years.

MEASUREMENTS AND MAIN RESULTS

The IEG in American English was translated, back-translated and finally reviewed by Sanders and her colleagues, whose valuation was that the Castilian version was the same as the original. Reliability: the internal consistency of each of the scales of grief on the IEG (Cronbach's alpha) ran from 0.43 to 0.85. Factor validity: the first IEG factor adapted was similar to the original one (despair, somatization, anger, blame, depersonalisation and social isolation). Discriminating validity: all the grief scales on the IEG, except anxiety in face of death, discriminated (p < 0.05) between grieving and not grieving. Validity by hypothesis: the IEG scales showed differences (p < 0.05) between the bereaved according to sex, age, place of death of the spouse and time elapsed since death. Convergent validity: all the IEG grief scales correlated positively (p < 0.05) with the scales in the Texas Revised Inventory of Grief.

CONCLUSIONS

The IEG adapted to Castilian is equivalent to the original and has similar reliability and validity.

Researching the bereaved: an investigator's experience

The issues discussed in this article concern the process of interviewing the bereaved relatives of organ donors, the personal impact, and the potentially painful nature of such research. Narrative interviews were carried out with 24 donor relatives. The relatively small number of donating families and their anonymity mean that little is understood about the experience of having a relative in a critical care situation that ends in donation. The purpose of this study was to develop a theory that explained the organ donation process for relatives of 'major organ' donors. A central concern of implementing the investigation was the possible threat it posed to the participants and myself. The sensitive nature of the research made access to relatives difficult. Undoubtedly, my nursing background and personal attributes had an impact on interactions with participants and the pursuance of the research agenda.

The dual process model of coping with bereavement: rationale and description

There are shortcomings in traditional theorizing about effective ways of coping with bereavement, most notably, with respect to the so-called "grief work hypothesis." Criticisms include imprecise definition, failure to represent dynamic processing that is characteristic of grieving, lack of empirical evidence and validation across cultures and historical periods, and a limited focus on intrapersonal processes and on health outcomes. Therefore, a revised model of coping with bereavement, the dual process model, is proposed. This model identifies two types of stressors, loss- and restoration-oriented, and a dynamic, regulatory coping process of oscillation, whereby the grieving individual at times confronts, at other times avoids, the different tasks of grieving. This model proposes that adaptive coping is composed of confrontation--avoidance of loss and restoration stressors. It also argues the need for dosage of grieving, that is, the need to take respite from dealing with either of these stressors, as an integral part of adaptive coping. Empirical research to support this conceptualization is discussed, and the model's relevance to the examination of complicated grief, analysis of subgroup phenomena, as well as interpersonal coping processes, is described.