Grieving Process Research Articles

Grief Responses During the COVID-19 Pandemic: A Qualitative Study in Spain

IntroductionThe recent COVID-19 pandemic led to a rise in the number of people bereaved by the death of a loved one. There are many pandemic-related stressors that may have further complicated grief in these people. The aim of this research was to conduct an in-depth the experience of illness and death during the pandemic, as well as obstacles to and factors facilitating grief in people who had lost a loved one during this period, whether due to COVID-19 or to natural or sudden causes. MethodThe sample consisted of 42 participants who had lost loved ones to COVID-19 or other causes (both natural and sudden). An inductive approach using grounded theory with open, axial and selective coding was used to analyse the semi-structured open-ended interviews. ResultsThe resulting theory was structured around a central category: “Processes of Loss and Grief in Pandemics”. The other relevant and related categories were: disease processes during the pandemic, emotional responses to the loss, factors facilitating the grieving process and obstacles to the grieving process. The various analytical categories were then further classified with reference to the Dual Process Model. ConclusionThis study highlights the main features of grief during the pandemic, including the impact of restrictive measures on disease processes; the funeral rituals performed and subsequent coping; responses such as intense shock, anger, fear or loneliness; and the way in which factors facilitating the grief process were adapted to the circumstances.

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.

The Reciprocal Relationship Between Social Support in Bereavement and Posttraumatic Growth-A Random Intercept Cross-Lagged Analysis.

Social support can promote posttraumatic growth (PTG) in the general trauma population. However, evidence on the reciprocal predictive relationship between social support and PTG is lacking, particularly among the bereaved. In this longitudinal study, we surveyed 181 adults who had lost first-degree relatives within 1 year at three intervals, each 6 months apart. The study utilized The Scale of Social Support in Bereavement (SSB), which distinguishes four domains of social support for the bereaved: living support, economic support, grief processing and emotion restoration. Additionally, The Posttraumatic Growth Inventory (PTGI) was used to measure PTG. Random intercepts cross-lagged panel model analyses revealed that social support and PTG were positively correlated at each time point at the within-person level. Moreover, at the within-person level, the total social support, as well as social support in the restoration-oriented domains at Time 2, positively predicted PTG at Time 3, but this relationship was not observed for grief processing support. Additionally, PTG at Time 1 positively predicted the receipt of emotion restoration support at Time 2 at the within-person level. The mutual influence between PTG and social support, as well as the differential relationship between types of support and PTG, enriches our understanding of ways to promote positive changes among the bereaved. The findings underscore the importance of restoration-oriented social support for bereaved individuals in facilitating PTG.

Experiences and needs of Chinese women after a stillbirth: a qualitative phenomenological study

ObjectivesWe aimed to explore the lived experiences and needs of women after a recent stillbirth event.DesignQualitative phenomenological study.SettingThe current study was conducted in a tertiary obstetric hospital in East China...

Parental Grief After the Unexpected Death of a Child: A Scoping Review About the Impact on Parent's Social Networks and the Function of Self-Help Groups.

The unexpected death of a child, whether due to accident, sudden death syndrome, suicide, or homicide, causes profound parental grief that endures for years. Often, this grief is not fully understood by the social environment, leading parents to feel increasingly misunderstood and isolated. While initial support may be provided, it can become insufficient over time. Therefore, many parents turn to support groups, finding multiple benefits such as validation of their feelings, a safe space to discuss their children and express emotions, strengthening of their social identity, and a platform for reconstructing meaning in their lives. A scoping review was carried on to review the state of knowledge regarding the role that self-help groups can play in case of bereavement due to the unexpected death of a child and regarding the impact on social relationships referred to in these contexts. The search was conducted on 11 databases and grey literature and provided 22 final results. Reviewed studies confirm the impact of this loss, particularly on mothers, and suggest that self-help groups contribute to a more favorable development of the grieving process. Despite the scarcity of research, future studies could leverage newer theoretical models and measurement tools to confirm protective, predictive, and risk factors.