Grieving Process Research Articles

A qualitative study exploring barriers and facilitators in deceased organ donation process among transplant coordinators in India

Although India’s organ donation rate is less than 1 per million population, significant disparities exist between the regions and centres within the country, leading to varying consent rates among different organ donation centres. Therefore, this study aimed to understand the experience of transplant coordinators and their barriers and facilitators in the deceased organ donation process across various organ donation centres in India. A phenomenological study using interviews was conducted among fourteen transplant coordinators purposefully recruited from public and private organ donation centres in India, with experience between six years and more than a decade. Audio recordings were transcribed and analysed using framework analysis. Five themes were identified namely: (1) supportive management policies, (2) infrastructure for the deceased organ donation process, (3) delays in the processing time, (4) active involvement in the identification process, and (5) explaining the concept of brain death. The study identifies that implementation priorities include strengthening teamwork, streamlining processes, optimising infrastructure for sensitive discussions, efficient donor identification, and empathetic handling of donor families’ grief stages. Collaborating with law enforcement, applying successful medico-legal strategies, improving family communication, and clarifying brain death concepts ethically and legally can boost consent rates, fostering informed decisions and possibly achieving self-sufficiency in deceased organ donation.

Impact of French lockdowns on bereavement experiences: Insight from ALCESTE analysis revealing psychological resilience and distinct grief dynamics amidst COVID-19.

At the beginning of 2020, the entire world was shocked by a global health emergency. According to the literature, fear, high mortality and health restrictions had significant psychological consequences on the population. This study evaluates the French lockdown's impact on the grieving process and how people worked through their grief. Two semi-structured interviews were conducted with 31 participants who had lost a loved one between March 2020, June, and September 2021 (T0) and 6 months later (T1). Subsequently, they were divided into two groups: those who lost someone during the first lockdown (Group 1) and those who lost someone outside the lockdown periods (Group 2). The interviews were analysed using the ALCESTE software, a statistical analysis tool for textual data based on word co-occurrences. This research significantly advances the understanding of bereavement during crises, providing new perspectives and practical insights for policymakers, healthcare professionals and support organisations. Its methodological innovation and detailed analysis contribute to the ongoing discussion on grief and resilience in challenging circumstances. Ultimately, this study lays the foundation for improved support and intervention strategies tailored to the needs of bereaved individuals during crises.

Qualitatively exploring continuing bonds: Navigating spousal bereavement through keeping the deceased alive

The experience of spousal bereavement can be life shattering, and the grieving process which comes after is inevitably difficult. Recent psychological research has found that those who are bereaved exhibit deterioration in emotional and physical wellbeing. Yet some bereaved show resilience when positively changing their lives and transforming their difficult experience. The present study explores the phenomenon of continuing bonds in spousal bereavement and its role in the adjustment. A qualitative approach was chosen due to its exploratory nature of personal experiences and 11 stories in form of blogs were analysed by using Thematic Analysis. The findings demonstrate continuing bonds to be comforting and pleasant, however contradictory feelings were also experienced. Thus, the present study proposes that the experience of continuing bonds in bereavement not to be a dichotomous one. This study argues for a perspective of ‘both-and’ rather than ‘either-or’, and that the role of continuing bonds can be twofold; adaptive as well as maladaptive. The findings are discussed in relation to previous research. The implications of the present study suggest professionals carefully examine the authentic experiences of bereaved individuals to consider whether continuing bonds is an appropriate part of intervention, suitable to individuals’ needs, in moving them towards recovery.

“Liberating Grief”: Applying an Anti-Oppressive Framework to the Field

ABSTRACT Grief is a complex and individualized experience that accompanies substantial life losses. Cultural beliefs and traditions have influenced the interpretation, attitudes, and management of grief across time. Moreover, psychological and social constructs via White supremacy and colonialism have shaped a dominant narrative that promotes oppressive practices and structural inequities. These pathological paradigms and expectations may impede meaningful healing and grief processes for bereaved people based on their social identities. In response, this article examines grief through the lens of Liberatory Consciousness to invite professionals to reevaluate their thoughts and interventions as well as assess the fairness of bereavement policies and structures. The Liberatory Consciousness framework is utilized to explore the intersections of grief and oppression within bereavement work and conceptualize intentional strategies for change. More importantly, it will illustrate the importance of acknowledging disparities and provide recommendations for social work professionals on how to increase their awareness of injustices and harmful practices to provide equitable care to bereaved persons.

The Effect of Forgiveness Psychoeducation on Death Anxiety, Caregiver Burden, and Forgiveness Tendencies in Caregivers of Patients at the End of Life: A Randomized Controlled Trial.

Providing caregivers with the skills and awareness of forgiveness is crucial to help them express their emotions, navigate the grieving process more smoothly, enhance their interaction with the patient, and make the time until the patient's death more meaningful. To examine the effect of forgiveness psychoeducation on death anxiety, caregiver burden, and forgiveness tendencies in caregivers of patients at the end of life. A randomized controlled experimental method was used, including a pretest, posttest, 1-month follow-up, and 3-month follow-up. The research sample included 56 caregivers of patients (experimental group = 28, control group = 28) at the end of life. During the study, forgiveness psychoeducation was administered to the experimental group, whereas no intervention was carried out in the control group. Data were collected using the Personal Information Form, Thorson-Powell Death Anxiety Scale, Caregiver Burden Scale, and Heartland Forgiveness Scale. The average scores of death anxiety and caregiving burden in the posttest and follow-up measurements of caregivers in the experimental group were statistically significantly lower than those of caregivers in the control group (P < .05). Forgiveness psychoeducation reduces death anxiety and caregiving burdens in caregivers of patients at the end of life. It is recommended to provide psychoeducation on forgiveness. The psychoeducation conducted by Consultation Liaison Psychiatry Nurses aimed at increasing the internal process of forgiveness can positively influence the communication, emotions, and spiritual development of caregivers of patients at the end of life. Thus, improving the quality of care can be achieved through forgiveness.

Losses and support in the grieving process –– pastoral and media context

The loss of a close person is accompanied by various emotional, cognitive, behavioural, physical, spiritual and social reactions. The process of grieving therefore has an impact not only on the course of grief, bereavement itself, and the perception of losses, but also on the human being generally. In accordance with experts, grieving after a loved one who died of the virus that causes COVID-19 is specific. In most cases, it is characterized by a lack of personal contact with a seriously ill person due to infection and quarantine measures during hospitalization, and later a characteristic ban on personal farewells or touching due to the potential threat of infection. In addition, this specifics is accompanied by reflections on how the infection occurred in the first place, or anger at the lost person for not being careful enough, or anger at the health system that provided help to the sick loved one. The paper takes into account the aforementioned as a starting point for the presentation of grief and bereavement, which also takes place in the space of social media during the pandemic. The article seeks to contribute to the overall concept of pastoral bereavement support and contemporary digital support for grief and bereavement. It can be achieved by presenting the possibilities of online support for mourners in the context of the French philosopher Vladimir Jankélévitch's (1977) relational model of death. Rabatel and eventually Floréa referred to this issue and started the research on the announcement of death in the media. The goal of such studies was to show that the conventional media focuses on the death of distant people that "doesn’t concern us" (i.e., "third person death"), whereas new technologies give the opportunity and space to talk about the death of close people (i.e., "second person death") as well as one's own death (i.e., "first person death"). The text presents the online space as a place where pastoral care and accompanying the mourners or grieving men is not only possible but also beneficial.

Loss of a Parent in Disney and Pixar Films: What We Can Learn?

Early parental loss is a tragic experience for children causing complex reactions to the loss. Providing a supportive environment where they can express their feelings is crucial to help them cope with this challenging experience. This study analyses the depiction of parental death in animated films by Disney and Pixar using a multimethod design and including the QUAGOL approach. We identified 13 films showing the death of one or both parents. The qualitative analysis of the films, published from 1937 until 2022, revealed seven concepts that potentially affect the way children see their grieving process reflected in the films: The representational techniques, finding protection and relationships, searching for identity, being different and having alternative skills, talking about death, dealing with emotions and coping with the loss. The identified films can be used to open a conversation with children who have lost one or both parents to discuss their situation.

Our grief matters – loss, grief, and mourning in Black vertically infected HIV-positive adolescents

Within the South African context, psychoanalysis as praxis and research has not located itself outside of the country’s long, violent, and oppressive socio-political past. A major area in which psychoanalysis continues to demonstrate a deficit is in its lack of attention to race as constitutive of psychological development and a site of intense psychological pain. A further area that is often overlooked in both the theory and praxis of psychoanalysis in South Africa is the diseased body as a site of socio-political violence and oppression, and the subsequent impact of this trauma on intrapsychic development. This situation is particularly applicable in the development of Black children who are vertically infected with HIV. The focus of this article, the fourth in a series of five articles, is on the process of grief and mourning in three vertically infected HIV-positive adolescents. Findings indicate that children who are vertically infected with HIV suffer multiple losses leaving them with intense unprocessed grief despite having access to individual therapy. In addition, their raced subjectivities add to experiences of non-being leading to grief which remains minimised and overlooked within the psychoanalytic canon, keeping the mourning process hidden in historically oppressive systems as melancholia.

Perceived Dying Experience and Compassion in Oncology Patients and Nurses Following Implementation of the Forever Heart Program: A Pilot Study.

This pilot study explored the feasibility of a Forever Heart Program and the impact it has on oncology nurses' perception of the dying experience and their own compassion competence. Guided by Kubler-Ross's framework, the Forever Heart Program consists of a gemstone keepsake offered to patients and families during end-of-life care to support the grieving process. A mixed-methods approach utilized pretest/posttest design in a convenience sample of oncology nurses in an academic medical center over a 3-month period. The study collected demographics, Compassion Competence Scale scores, and qualitative responses via survey and an optional focus group. Twenty-five nurses participated in the presurvey, and 14 participated in the postsurvey. Seven nurses attended the focus groups. Overall, compassion competence scores were high, both pre and post. Qualitative themes included appreciation, connection, positive nursing, patient and family experience/relationships, grieving guidance, program benefits, and process opportunities. Although the study did not show statistically significant differences in compassion, it did show program feasibility and the potential positive impact that keepsakes like the Forever Heart Program can have on nurses and their role in the dying experience.

Translation and cross-cultural adaptation of the Posthumous Dignity Therapy Schedule of Questions to Brazilian Portuguese.

Dignity Therapy (DT) is a brief form of psychotherapy that helps people with life-threatening illnesses and their loved ones cope with emotional pain and demoralization. Unfortunately, not everyone has the opportunity to receive DT during their lifetime. Posthumous Dignity Therapy (PDT) was then devised to be administered to bereaved family members. However, PDT has not yet been validated or studied in the specific cultural and linguistic context of Portuguese-Brazilians. This study aims to fill this gap by validating PDT for the Portuguese (Brazilian) context. Using Beaton's methodology, including the processes of translation, synthesis, back-translation, evaluation by an expert committee, and pre-testing, the PDT Schedule of Questions underwent validation and cultural adaptation. The research was conducted in a Palliative Care Unit at a tertiary cancer hospital in Brazil. The questionnaire was translated, back-translated, and evaluated by the panel of experts, obtaining a Content Validity Index of 0.97. During the pretest phase, it was observed that the participant's interview method needed to be changed from remote (telephone or videoconference) to in-person. Additionally, it was necessary to modify some terms related to death and dying, as they caused discomfort to the participants. As a result of this process, the PDT was modified, and adapted to the Brazilian cultural and linguistic reality. This validation study will be significant for future DT research from the caregivers' perspective and for projects aiming to implement this therapeutic modality in palliative care units, in addition to helping participants remember their loved ones better by providing a tangible legacy document that assists them emotionally and materially in coping with the grieving process.

Personal Pilgrimage Aids in Processing of Traumatic Grief in Survivors of Parent Suicide

A twenty-six-year-old female suffers traumatic loss after her father’s suicide. Client has endured approximately four months of complicated grief to date. She experiences, among other things, preoccupation with the end story, intense sorrow, sleeplessness, and appetite issues. Embarking on a series of 45-minute weekly sessions just two weeks prior, Client and I have thus far addressed her grief through re-membering exercises and an experiential therapy tactic called the Personal Pilgrimage.

Grief, the Creative Process, and Making a Poem

The process of coping with grief through creative expression is explored in a poem dedicated to a late friend, David. By engaging with poetry, both as a creator and a reader, the grieving process is facilitated, promoting a sense of closure and acceptance. This poster examines how, through vivid imagery and introspective reflections, the poet navigates through themes of silence, nature, and memory, culminating in a heartfelt tribute to the departed friend. Ultimately, the creative process becomes a pathway towards understanding and processing the complexities of grief, allowing for a sense of closure and healing. From the UB RISE 2023 forum.

"Grief Explodes all Relationships": Experiences of Grief and Coping Among Parents and Siblings Following the Death of a Child.

The death of a child is an intense loss for families, which impacts the wellbeing of parents, surviving siblings, and the family as a whole. This study expanded on existing literature by collecting qualitative accounts from bereaved parents and siblings about their experiences before, during, and after the death of a child in their family. In total, 15 participants from 9 families completed semi-structured interviews. Findings highlighted three periods of the grieving process, which were not linear but rather ongoing and often happening simultaneously: (1) Crisis; (2) Learning to cope; and (3) Establishment of a new equilibrium. Parents and siblings reported experiences unique to their role in the family and developmental stage, as well as shared experiences within the family system. Findings have implications for palliative care and bereavement professionals in terms of supporting parent, sibling, and family coping before, during, and after the death of a child.

Is COVID-19 loss more associated with prolonged grief disorder than other losses?

The COVID-19 pandemic raised fears about a rise in prolonged grief rates. To determine if these fears are justified, we examined an online sample of 329 Turkish adults for their level of prolonged grief symptoms (as well as probable Prolonged Grief Disorder-PGD) and associated factors in relation to losses during the pandemic. Respondents completed measures of prolonged grief, post-traumatic stress disorder, and depression. Overall, 10% of participants reported symptoms indicating a probable PGD diagnosis. Surprisingly, loss due to COVID-19 or disruption of the natural mourning process did not relate to higher levels of prolonged grief. Our findings suggest that although levels of prolonged grief (and rates of PGD) may have increased during the pandemic, prolonged grief (or PGD) during this time is likely not linked to losses due to COVID-19 or to disruptions in the normal grieving process.

Nursing Interventions in Primary Care for the Management of Maladaptive Grief: A Scoping Review.

Grief is a natural and self-limited adaptation process to a new reality that emerges after a significant loss (whether real or perceived), with a broad variety of manifestations that exert an impact on a grieving person's health. The study aim was to synthesize the evidence available about the interventions carried out by Primary Health Care nurses, by means of an individual approach to reduce maladaptive grief or maladaptive grief risk. A scoping review was conducted (November and December 2023) through searches in Medline, Cinahl, Web of Science, ProQuest and Scopus using MeSH terms combined with Booleans. Primary research of any design in adult people undergoing grief situations and receiving professional assistance by nurses in the primary, home and community care contexts published after 2009 in English, Spanish or Portuguese languages were included. Excluded publications were those conducted in in-hospital clinical settings and which did not correspond to research designs or the gray literature. The screening process was carried out by two reviewers using the appropriate JBI critical appraisal tools for each design and discrepancies were resolved by a third reviewer. A total of n = 10 studies were included (n = 4 qualitative, n = 2 RCTs, n = 1 quasi-experimental, n = 2 cross-sectional observational, and n = 2 mixed methods). The qualitative studies identified topics and subtopics of professionals' and families' experiences of grief. The observational studies analyzed symptoms and factors associated with the grieving process. Interventions consisted of cognitive-behavioral therapies delivered by psychological specialists who assessed the severity of grief in a range of cultural contexts using different instruments. The evidence retrieved from the studies that address the reduction in maladaptive grief or maladaptive grief risk is not conclusive. There is a need to increase both the number and the methodological quality of studies assessing the effectiveness of Nursing care in Primary Health Care for individuals experiencing maladaptive grief or maladaptive grief risk. Further research should focus on experimental studies, developing specific interventions conducted by nurses to address individual's grief and prevent maladaptive grief.

Meaning-making in psychotherapy after traumatic loss: therapists’ perspectives

ABSTRACT Sudden, unexpected loss can be particularly devastating for the bereaved as they struggle to make sense of their loss. We interviewed 11 therapists who specialized in loss/trauma about how each of them helped one client make meaning after a traumatic loss. Data, analyzed using Consensual Qualitative Research (CQR), revealed that the traumatic loss had negatively impacted clients’ relationships, mental health, and beliefs/religion/spirituality; therapists utilized a range of interventions to facilitate meaning-making, including supporting clients through the grief process, as well as helping them experience/regulate emotion and change their narratives around the loss; clients made meaning in diverse ways that could be broadly categorized under meaning-as-comprehensibility and meaning-as-significance; and clients experienced positive adjustment (in mental health, relationships, etc.) through the meaning-making work. Implications for counseling psychology research and practice are discussed.

Prolonged Grief, Posttraumatic Stress and Depression Symptoms Before and After COVID-19 in Brazil.

This study aims to explore the differences in prolonged grief (PDG), posttraumatic stress (PTSD), and depression symptoms (MDD) following the loss of a loved one before and after the COVID-19 pandemic. Using a cross-sectional design, 888 bereaved individuals were classified on different groups according to the cause of death. Results indicate that participants who experienced a loss during the pandemic, regardless of the cause, presented higher levels of prolonged grief, posttraumatic stress and depression when compared to those who lost a loved one before the pandemic. This study sheds light on the environmental influences (ex: the COVID-19 pandemic) on the grieving process, emphasizing the need to take the context into account when tailoring interventions in bereavement and mental health care.

Psychological Healing process of Grief Resolution: Nepali (Hindu) Cultural Perspective

Grief is a natural reaction to the loss; mainly due to the death of a loved one. Sometimes, such reactions may be problematic or complicated. Culture serves as a buffer to deal with such losses, and supports the mature way of coping. Nepali cultural practices or the death rituals favor the restoration-oriented grieving process and are prophylactic approach in order to prevent any form of grief-related psychological reactions. This paper provides a narrative approach in which the writer shares his experiences as a Psychiatrist in dealing with grief-related problems of the clients in his own clinical practice. In addition, he also shares his own personal experience of losing his father and illustrates how the traditional practices followed by himself and his family during that time facilitated the grief-resolution process. He is very much convinced that the Nepali cultural approach during death rituals is very much scientific and psychotherapeutic.

Losing a child with a severe developmental intellectual disability: Israeli mothers' accounts.

Caring for a child with a severe developmental intellectual disability is often extremely challenging. Consequently, if such a child passes away, the grieving process may be complex. In the present study, we sought to characterize Israeli mothers' meaning (re)construction in the face of such loss. Eight mothers who lost a child with severe developmental intellectual disability participated in in-depth semistructured interviews. Employing Interpretative Phenomenological Analysis, three primary meaning templates were identified from their narratives: regrieving the lost child, the duality of grief and relief, and continuous disenfranchisement. The findings revealed a distinctive rupture in the self-narratives of grieving mothers and depicted the intricately intertwined reality of living with and losing a severely disabled child. The interplay between personal and social aspects of this unique grief experience is highlighted, and practical implications are considered. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Excruciating existential suffering and complicated grief: The essence of surviving the suicide of a son or daughter.

Suicide is the fourth most common cause of death for the 15-29 age group. Research on the impact of suicide on parents is scarce and, therefore, poorly understood. To explore parents' experiences who have lost a son or a daughter due to suicide and their experience of the services available to them. This phenomenological study involved 1-2 interviews with ten parents aged 40-65, seven mothers and three fathers in all 13 interviews. The age range of their sons and daughters was 17-37 years when they died. For the parents, losing a son or a daughter to suicide is an overwhelming life experience characterised by Excruciating existential suffering and complicated grief where they are confronted with deep meaning-making and existential questions without answers since the person who can answer most of them is no longer alive. They, therefore, felt stuck in their grief for up to 4 years. The initial experience was an immense paralysing shock and sense of unreality. The subsequent period was a blur, and they were numb. Then, their psyche and bodies collapsed, and for a long time, they felt no grief processing was taking place. They sorely needed long-term professional trauma-informed support and felt that, in too many cases, they had to reach out for help themselves. They would have liked to see the healthcare system embrace them with more open arms, offer help and be met with information and individualised support. Standard operating procedures must be installed to support suicide-bereaved parents better. Long-term professional support and trauma-focused care are required following such major trauma, and providing such support could help to reduce their adverse health impacts. Nurses and other health professionals must be better educated on existential suffering in this context.