Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2001. / Typescript. Bibliography: leaves 138-148.

Thesis (D. Min.)--New Orleans Baptist Theological Seminary, 2007. / Abstract and vita. Includes final project proposal. Includes bibliographical references (leaves 139-142, 56-57).

Thesis (D. Min.)--Abilene Christian University, 2007. / Abstract and vita. Includes bibliographical references (leaves 94-96).

Thesis (D. Min.)--Midwestern Baptist Theological Seminary, 2002. / Abstract. Includes bibliographical references (leaves 170-172).

Spousal bereavement has been consistently demonstrated in the literature to be one of the most highly stressful experiences in an individuals lifetime. In addition many deaths in the United States are preceded by a period of caregiving, which is also believed to be highly stressful and have a profound impact on bereavement. However the literature has been inconsistent as to the exact nature of the relationship between caregiving and bereavement and there has been some debate as to whether or not positive and negative affect variables are mutually exclusive. This dissertation sought to further address the issue of the relationship between caregiving and the bereavement experience through a series of three studies which utilized information from two datasets. The first was the Changing Lives of Older Couples (CLOC) study, a project that included both pre- and post-loss data. The second was a subset of a dataset that recruited elderly spousal caregivers of terminally ill patients from a large, local non-profit hospice. This dataset included both pre- and post-loss data and included a variety of widely used and validated measures that allowed for the examination of caregiving stressors, appraisals, and social support and their effect on both positive and negative mental health outcomes during bereavement.The first study examined the impact of caregiving on well-being during bereavement, specifically within the domains of psychological, social, and physical health, utilizing both positive and negative affect measures.

In this dissertation, I seek to better understand the sensemaking process among surviving family members after a tragic loss of a teenage or young adult child. Using social constructionism (Gergen, 1991) as a theoretical framework, I focused on how meanings of loss are constructed through the use of language and other symbols. I specifically looked at the role of family stories and rituals in making sense of the sudden loss as well as how a survivor's role as a sibling or parent may impact the grieving process. The participants in my research were all members of families in which a child had died unexpectedly in adolescence or young adulthood. I combined multiple in-depth interviews with parents and siblings in each family with episodes of participant-observation. Then I used inductive thematic analysis to examine the patterns of ritualizing in each family, and a process of narrative analysis focusing on the accounts of three siblings and two parents in order to explore how survivors structure their experience in stories. I found that rituals and artifacts play a significant role in assisting family members in coping with bereavement. Even though previous family rituals and traditions are disrupted by the death, families find ways of creating and enacting new rituals. The invention and adoption of new rituals seems to serve an important role in "successful" grieving as a way of sustaining bonds with lost loved ones. I also found that survivors, in sharing with me the stories of sudden loss, worked to construct storylines that tie events together by showing how they are meaningfully, and sometimes causally, connected. In addition, the stories showed how survivors "find benefit" by reframing painful events as positive and growthful. Throughout my analysis of rituals and stories, I looked for similarities or differences between the siblings' and parents' experiences. One insight to emerge from the study was that bereavement is a very individual event, and the resulting differences in expressions and degrees of grief among different family members can put a strain on the family system. Another key theme that emerged was the protective stance taken by surviving siblings towards their parents after the death of a brother or sister, which sometimes involved minimizing the display of their own emotions. In this sense, the siblings seem to have experienced what the literature has called "prohibited mourning," By contrast. parental grief seems to be more socially acknowledged. This study holds potential benefits for those scholars interested in bereavement as a meaning-making process as well as the effects on the family system. Therapists who treat families might find the insights these participants contribute to be helpful in creating ways to communicate with their clients.

Mild cognitive impairment (MCI) has long been associated with depression; however, few studies have addressed the presence of (prolonged) intrapersonal grief or its contribution to emotional distress in MCI. This may be a result of both an over-reliance on interpersonal models of grief (i.e. bereavement) and a systematic undervaluing of MCI individuals’ perspectives. Thus, this study took a qualitative approach, using interpretive description, to understand the first-hand experience of persons with MCI, with the intent of 1) determining whether grief occurs for this group and, if so, 2) comparing this experience to well-defined grief constructs. Six themes were identified: Uncertainty and ambiguity, losses of self and role, disenfranchisement and disconnection, primacy of MCI, emotional distress, and coping. A relationship between themes was found, such that uncertainty and ambiguity, losses of self and role, and disenfranchisement and disconnection comprised the core dimensions of the MCI experience, with losses of self and role serving a central and binding role between the other two. These core dimensions then contributed individually and collectively to the primacy of the MCI experience and emotional distress, which in turn exhibited a reciprocal relationship with coping. The overall experience of MCI reflects features of several grief reactions to nonfinite loss, most notably chronic sorrow and disenfranchised grief. Implications for practice and further investigation are discussed. / Graduate

Bakgrund: Närstående inom palliativ vård har en viktig roll som patientens språkrör och funktion att upprätthålla patientens identitet. De antar ofta rollen som vårdare vilket är förknippat med många negativa känslor som ångest, rädsla, oro och sorg. Närståendes behov kan vara så stora att de överträffar patientens. Det är viktigt att närstående involveras i vården och att de får stöd i sin situation för att minska de negativa konsekvenserna. Stödsamtal kan utgöra en avgörande skillnad mellan en orimlig situation till en situation som är hanterbar. Stödinterventioner har dock begränsad evidens för långsiktiga resultat. Kunskapen om närståendes erfarenheter från stödsamtal är liten. Syfte: Att undersöka närståendes erfarenheter från en samtalsintervention inom palliativ vård. Metod: Beskrivande och tolkande design. Datainsamlingsmetoden är kvalitativ forskningsintervju. För analysen användes kvalitativ innehållsanalys. Resultat: Initialt var närstående skeptiska mot stödsamtal som kändes nytt och främmande men ansåg efteråt att samtalen var nödvändiga och att de borde vara obligatoriska inom palliativ vård. Det kändes viktigt att få prata med någon som kände till patienten och visste hur familjesituationen såg ut. Samtalen gav tid för reflektion där man dels pratat om existentiella frågor, dels om relationer och olika praktiska saker. Samtalen gav också vägledning för hur situationen kunde hanteras såväl under som efter vårdtid samt för att kunna gå vidare i livet. Diskussion: Resultatet diskuteras mot pendlingsmodellen där sorg ses som en stressor i en process som kan hanteras genom förlustorientering eller återhämtningsorientering och pendlingen däremellan. Samtalen har handlat om saker som kan ses vara förlustorienterande samtidigt som de handlat om andra saker som kan ses vara återhämtningsorienterande. / Background: In the context of palliative care, family carers have an important role to play as the patients spokesperson and help maintain the patients identity. They often take on the role as nursing carer which often is associated with many negative feelings such as anxiety, fear, concern and a sense of bereavement. Family carers need for support may be so great that they exceed the needs of the patient. It is important to involve family carers in caring and to support them in their situation in order to decrease negative consequences. Counseling support could make a crucial difference between an unreasonable and a manageable situation. However, there is limited evidens to the longterm impact of support interventions. Knowledge of family carers experiences of counseling support is limited. Aim: To examine family carers experiences of a counseling support intervention in palliative care. Method: Descriptive and interpretive research design. Qualitative research interviews used for data collection. Qualitative content analysis used for data analysis. Results: Initially the family carers were skeptical about counseling support which felt new and strange but afterwards felt necessary and ought to be mandatory in palliative care. It felt important to talk to someone who knew the patient and who knew the family situation. Counseling gave time for reflection where they both talked about existential questions, relationships and different practical tasks. Counseling also gave guidance on how to handle the situation during and after caring and to move on in life. Discussions: The results are discussed in the context of the dual process modell where bereavement is a stressor that can be coped with a loss orientation or restoration orientation and the oscillation in between. The counseling has focused on tasks that could be seen as lossorientated and at the same time on tasks that could be seen as restoration-orientated.

Thirteen nurses were interviewed over an eight week period to explore their adaptive responses to neonatal death. A process of adaptation was identified that included several phases through which these nurses proceeded before they finalized the death experience for themselves. These phases included responses to the resuscitation of the infant; the measures taken to console the bereaved parents; feelings associated with difficult moments during the dying process; the behaviors utilized to strengthen themselves before and after the death; reactions to the silence in the unit that occurred afterwards; the values they discovered when reflecting on how the death was handled; and the development of a philosophical meaning from their experiences. Data were collected and analyzed using grounded theory methodology.

BACKGROUND: Several people die every year. The numbers of deceased in Sweden were 91449 in 2008. This often brings bereavement for the relatives and in hospital with end-of-life care it can be important for the health professionals to support and also take care of the relatives. AIM: The aim of this study is to illuminate relatives’ experiences of the caring situation with end-of life-care when a close relative is dying METHOD: Literature review. A number of thirteen scientific articles were analyzed. These were previous research of both qualitative and quantitative methods. RESULT: The result shows that many relatives are in need of a good treatment from health professionals, where the treatment includes components like providing support, providing information, creating a good relationship and having a good communication. A trust in health professionals was important for the relatives because it brought knowledge that good care was provided to the patient. It also indicates that participation was important in end-of-life care. There was a safety in having someone at the relative´s side who could offer aid. A quiet and calm environment was positive. DISCUSSION: The nurse´s experience and knowledge about bereavement is an important part of the care providing to the relatives. / BAKGRUND: Varje år dör många människor och i Sverige dog 91 449 människor år 2008. Detta medför sorg för många närstående och medför även att vårdpersonalen har en stor del i att ge stöd och ta hand om de närstående samtidigt som de tar hand om vårdtagaren. SYFTE: Syftet är att belysa närståendes upplevelser av omvårdnadssituationen kring vården vid livets slut av en nära anhörig. METOD: Litteraturstudie. Tretton vetenskapliga artiklar analyserades. Dessa var tidigare forskning av både kvalitativa och kvantitativa studier. RESULTAT: Resultatet visar att många närstående är i behov av ett gott bemötande från vårdpersonal, där det med bemötande ingår komponenter som att ge stöd, att ge information, att skapa en god relation och att ha en god kommunikation. Ett förtroende för vårdpersonalen var viktigt för att närstående skulle veta att en god omvårdnad gavs till vårdtagaren. Det visar även på att delaktighet var betydelsefullt i vården vid livets slut. Det var en trygghet att ha någon vid sin sida som kunde erbjuda stöd. En lugn och behaglig miljö med hemtrevlig inredning var positivt. DISKUSSION: Sjuksköterskans erfarenhet och kunskap om sorg har en betydelse i hur närstående tas om hand.