For family caregivers, response to the death of the care recipient is marked by a high degree of variability. In recognition of this variability, a range of services and interventions is available to assist individuals in the adjustment to bereavement. The present dissertation, consisting of three related studies, was conducted to examine the utilization of bereavement services by family caregivers. The first study examined the role of psychological distress in the utilization of bereavement services by spousal caregivers in the Changing Lives of Older Couples (CLOC) study. The second study examined bereavement service utilization among dementia caregiver participants in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) study. Both employed Andersen's Behavioral Model of Health Services Use. The third study examined bereavement service utilization, barriers, and preferences among bereaved spousal caregivers of patients of three hospices in Tampa Bay. Taken together, results of the current studies point to the importance of family physicians and members of the clergy in the provision of services to bereaved family caregivers and to the prominent role of bereavement outcomes (e.g., depressive symptoms, grief) as need factors in the utilization of bereavement services.

The focus of this thesis is to investigate the use of art therapy in the treatment of an individual diagnosed with schizophrenia. In this qualitative narrative single case study, eleven art therapy sessions are described using non-directive spontaneous art making with a 37-year-old man residing in a psychosocial rehabilitation program. The research study describes this client�s delusional world, and explores the struggle of making sense of his traumatic experiences in early childhood. The themes that emerge in this exploratory study are many and grief and bereavement are the focus as the client uncovers the connections between the past and the present. The process of the art therapy sessions and the progression in the imagery from chaos to serenity is described as the client moves from darkness into light, and as we witness his exploration of space in the images of the whirlwind that reappear throughout the sessions.

Empowerment for those supporting the bereaved lies in understanding the processes by which meaning is constructed out of a loss. My concern is that models currently underpinning understanding and practice in grief recovery provide limited assistance to loss and grief practioners. These theories, based around set stages and tasks with pre-determined objectives, offer stereotypic "after the event" perspectives on the recovery process. This has value as background information, but in the extreme promotes a clinical, de-personalised approach to uderstanding and support. My experiences over more than a decade of working alongside the suicide-bereaved in particular, suggest that a more enlightened pathway lies with people and their stories. Working in an empathic dialogic relationship, with an emphasis on understanding rather than closure, is more appropriate in assisting those treading the very sensitive, very personal, bereavement path. Furthermore, the narrative grounded approach is more in tune with the processes involved; and more likely to lead to productive outcomes in both the short and long term.The presented model argues that bereavement recovery is a re-educative reconstruction process: trialogic, semiotic sign or symbol related; recognising significant personal autonomous control; genetically or organically activated and driven; dynamic and ongoing; and constructed out of the individual's socio-cultural knowledge base. The model further argues that recovery is best constructed in a climate of empathic understanding and genuine non-judgemental acceptance of the bereaved individual's current perceptual world. In expounding and supporting this model, the tradition of pragmatic educational philosophy has been found useful - in particular, relevant apects of the theories of Carl Rogers, John Dewey, Alfred Shutz and Charles Stanford Peirce.I contend that the proposed model may be applied to all forms of profound loss, however the main context for this research is a Bereaved-by-Suicide Support Group.

Thesis (MA.(Theology)Trauma)-University of Pretoria, 2007. / Includes bibliographical references (leaves 83-88)

Thesis (D. Min.)--Mid-America Baptist Theological Seminary, 2004. / Includes bibliographical references (leaves 165-171).

<p>Grief research generally demonstrates that children and teenagers who have lost a parent in suiciderisk developing severe psychological and physical morbidity, as well as social disabilities, in adultlife as a result of traumatic aspects of the death and complicated grief reactions. The youngbereaved also run a highly increased risk of developing suicidal behaviour or to commit suicidethemselves. Despite these alarming reports, the research field is poorly explored and studies thattake an interest in the long-term consequences and the subjective experiences of the bereavedyoungsters are lacking. A qualitative study using narrative methods has been carried out toexamine the experiences of four young women, who during adolescence lost a father in suicide.The study specifically focuses on the grief process, the short- and long-term consequences, and theneed for social support in relation to family, extended network and society. The study reveals thatthe women’s traumatic loss has shattered their basic assumptions about the world as a safe andmeaningful place. A fear of losing another significant person, i.e. the remaining parent, siblings ora life partner is also a common denominator. The women have experienced complicated griefreactions such as guilt, shame, anger, feelings of abandonment and “why-questions” regardingtheir fathers’ suicide motives. They have found it difficult to receive social support due to moralaspects of suicide as a death cause – sometimes even within their own family – and due to a fear ofbeing condemned or regarded abnormal if they told others about their trauma. The time aspect isnot found to have affected the grief process. This process has been facilitated, however, throughsocial support from family, relatives, friends and professionals. Moreover, “sense-making”, or thecapacity to construct an understanding of the loss experience, as well as the active process of“re-membering”, has been found valuable in the grief process as it contributes to the constructionof an inner representation of the father. A continued relationship to the father after his death has inmost cases been regarded as helpful in the grief process. The women describe that the father’ssuicide has affected their self-conception and their life contents. Coping with the loss the womenseem to have developed stronger self-esteem, but at the same time some of them have come toregard themselves as “odd” and more mature in comparison with their peers. All women talk abouttheir fathers’ deaths with high actuality, indicating that the grief is most present. The womendescribe a re-priority of what they find important in life; close relationships are portrayed as moreimportant, as well as being helpful to others.</p>

<p>Each year over 3000 children in Sweden lose a parent. The loss of a parent may cause some grave changes in a child’s life, leading to both mental and physical consequences. The purpose of this literature study is to examine the different ways in which health care personnel can better receive and relate to children whose parents are dying or have passed away.</p><p>Data was collected through such sources as Pubmed, Academic Search Elite and Cinahl, which resulted in the inclusion of sixteen subsequent articles, ten of which were quantitative and six of which were qualitative. Thirteen of the said articles illustrate how children act in response to a dying or deceased parent and what measures were needed for them to move on with their lives. The child, bereaved parent and health care personnel were all examined within the studies. However, the authors of the remaining three Swedish articles had quite a different purpose from those already mentioned. There aim was to examine recommendations as to whether a child should visit a seriously ill relative at an Intensive Care Unit, as well as the subsequent opinions of both parent and health cars personnel to this visitation. Results showed that it was very beneficial for children and parents alike to receive information and support from health care personnel both during and after the parents period of suffering and eventual death. It was found that, if health care personnel or other adult for that matter regularly engaged with the child, alleviating any fears, then the risk for further psychological problems was reduced.</p> / <p>Varje år förlorar över 3000 barn i Sverige en förälder. Då ett barn förlorat en förälder innebär detta stora förändringar i deras liv som kan leda till konsekvenser för hälsan, både psykiskt och fysiskt. Syftet med denna litteraturstudie var att ta reda på hur vårdpersonal på olika sätt kan förhålla sig till och bemöta barn vars föräldrar är döende eller avlidit. Data samlades in genom sökningar i Pubmed, Academic Search Elite och Cinahl. Sökningen resulterade i sexton inkluderade artiklar. Av dessa var tio kvantitativa och sex kvalitativa. Tretton artiklar hade syftet att på olika sätt belysa frågan hur barn som hade en förälder som var döende eller avlidit reagerade och vad de behövde för att kunna gå vidare i sitt liv. Studierna hade både barnet, den överlevande föräldern och vårdpersonal som undersökningsgrupp. I tre svenska artiklar hade artiklarna ett annat syfte. De undersökte om det fanns rekommendationer för huruvida barn skulle besöka sina svårt sjuka anhöriga på en intensivvårdsavdelning och hur vårdpersonalen och föräldrarna tyckte om att barnen var på besök. Resultatet visade att det var värdefullt för både barn och föräldrar att få information och stöttning från vårdpersonal både under den döende förälderns sjukdom och även när föräldern avlidit. Om vårdpersonal eller någon annan vuxen regelbundet förklarar och pratar med barnet så minskar riskerna för att barnet skall få psykiska problem</p>

<p>Syftet med denna litteraturstudie var att beskriva vilka behov närstående har vid nära anhörigs dödsfall. Litteratursökningar gjordes i databaserna Medline och Cinahl. Sökningarna resulterade i 19 artiklar med ett bortfall på 3 artiklar. Studiens resultat grundades på 16 vetenskapliga artiklar som granskades och analyserades. I resultatet framkom sex kategorier. De närstående hade ett behov av att få ärlig och förståelig <em>information </em>från sjuksköterskan samt att få försäkran om att sjukvårdspersonalen gjort sitt bästa för patienten. Att vara välinformerad hade en positiv effekt på de närståendes förmåga att bemästra sorgen. De närstående beskrev ett behov av att få <em>möta samma personal</em> för att känna trygghet och stöd. En <em>avskild plats</em> <em>och möjlighet till ett sista farväl</em> var högt värderat. Att få ett <em>respektfullt och empatiskt bemötande</em> av sjuksköterskan var betydelsefullt för de närstående samt att familjen och patienten betraktades som mänskliga. De närstående hade ett behov av att sjuksköterskan <em>gav dem tid</em> och var fullt närvarande. Många närstående upplevde ett behov av <em>hjälp i ensamheten</em> efter dödsfallet, denna hjälp kunde bestå av brev eller uppföljningssamtal. Sammanfattningsvis är det är av stor vikt att sjuksköterskan är medveten om närståendes behov vid nära anhörigs dödsfall samt det faktum att sörjande är en individuell process.</p> / <p>The aim of this literature study was to describe the needs of family members when a loved one dies. Searches were carried out in the databases Medline and Cinahl. This resulted in 19 scientific articles from which 3 were excluded. The results of this study were based on 16 scientific articles which were examined and analyzed. The result showed six categories. The family members had a need of getting honest and understandable <em>information</em> from the nurse and to get reassurance that everything has been done for the patient. When the family members were well informed, they could easier cope with their grief. The family members described a need of <em>meeting the same staff</em> to feel secure and supported. <em>A separate area and a possibility to say a last goodbye</em> were important needs. To be <em>met with respect and empathy</em> and to be treated as humans were valuable for the family members. The family members also expressed a need of having a <em>nurse who gave them time</em> and was fully present. The family members felt a need to be <em>helped in the lonely times</em> that can occur after the death of a loved one, letters and follow up calls were appreciated. In conclusion, it is very important that nurses are aware of the needs of the family members when their loved one dies and also the fact that grieving is an individual process.</p>

<p><strong>Bakgrund:</strong> Suicid är den vanligaste dödsorsaken i Sverige för män mellan 25-44 år och kvinnor mellan 20-39 år. Vid ett suicid kan så många som 25 närstående beröras. År 2007 begicks 1126 konstaterade suicid vilket kan resultera i över 25 000 berörda i Sverige detta år <strong>Syftet:</strong> Syftet var att beskriva upplevelser av och vad som påverkar sorgearbetet för närstående efter ett suicid. <strong>Metod:</strong> En allmän litteraturstudie genomfördes genom sökning av kvantitativa och kvalitativa artiklar. Sammanlagt nio stycken artiklar granskades och analyserades. <strong>Resultat:</strong> Sorgen efter ett suicid är mer komplicerad och långdragen än efter ett väntat eller naturligt dödsfall. Sorgen efter ett suicid utmärks av skam, skuld och stigmatisering. Konflikter inom familjen är vanligt, vilket ytterligare försvårar sorgen. Ilska är en annan utmärkande faktor för sorg efter ett suicid. Ilskan bidrar till ökad skam, skuld och stigmatisering då detta kan uppfattas som en ”förbjuden” känsla i samband med ett dödfall. <strong>Slutsats:</strong> Närstående som upplevt ett suicid behöver längre tid än andra att få sörja. I dagens samhälle saknas denna förståelse både från omgivning, vårdpersonal och olika instanser i samhället. Det finns väldigt lite forskning inom detta område i Sverige och denna uppsats visar på behovet av ytterligare forskning och utbildning.</p> / <p><strong>Background:</strong> Suicide is the leading cause of death in Sweden for men between the age of 25 and 44 and women between the age of 20 and 39. Vid ett suicid berörs så många som 25 närstående.A suicide could affect as many as 25 relatives.År 2007 begicks  1126 konstaterade suicid vilket kan resultera i över 25 000 berörda i Sverige detta år Syftet: Syftet var att beskriva närståendes till personer som begått suicid, upplevelser av  och vad som påverkar sorgearbetet. In year 2007, 1126 suicides were established in Sweden, which could have affected more than 25 000 persons that year. <strong>Aim:</strong> The aim was to describe the experiences of and what things that affect the process of grieving for next of kin of persons who had committed suicides.Metod: En allmän litteraturstudie genom sökning av kvantitativa och kvalitativa artiklar. <strong>Method:</strong> A literature review of quantitative and qualitative articles.Sammanlagt 9 st artiklar granskades och analyserades. Resultat: Sorgen efter ett suicid är mer komplicerad och långdragen än efter ett väntat/naturligt dödsfall. A total of nine articles were reviewed and analyzed. <strong>Results:</strong> The grief following a suicide is more complicated and lengthy than the one that occurs after an expected or natural death.Sorgen efter ett suicid utmärks av skam, skuld och stigmatisering. The grief following a suicide is characterized by shame, guilt and stigma.Konflikter inom familjen är vanligt, vilket ytterligare försvårar sorgen. Conflicts within families are common, which further complicates the grieving.Ilska är en annan utmärkande faktor för sorg efter ett suicid. Anger is another distinguishing factor in the mourning after a suicide.Ilskan bidrar till ökad skam, skuld och stigmatisering då detta kan uppfattas som en ”förbjuden” känsla i samband med ett dödfall. Anger contributes to greater shame, guilt and stigma as anger may be perceived as a "forbidden" feeling associated with a death.<strong> Conclusion:</strong> Relatives that experience a suicide needs more time than others to grieve.I dagens samhälle saknas denna förståelse både bland omgivning, vårdpersonal och olika instanser i samhället. In today's society there is a lack of such understanding among both those close to the relative, the health professionals and various agencies in the community. Det finns väldigt lite forskning inom detta område i Sverige och denna uppsats visar på detta behov av ytterligare forskning och utbildning.There is very little research in this field in Sweden and this paper demonstrates this need for further research and education.</p>

Thesis (M.A.)--York University, 2003. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 93-101). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ86319