The grief experienced by mothers and fathers when their child is diagnosed with a life threatening chronic-illness was investigated in order to validate the presence of grief in these parents and look at the factors that influence it. More specifically, I was interested in whether the grief experience differed for mothers and fathers and the impact that perceptions and coping have on both these gender differences in grief and on grief in general. The particular population investigated in this study were parents of children with Cystic Fibrosis. Participants were recruited through questionnaires randomly sent out by the National Cystic Fibrosis Association. In all, 37 mothers and 15 fathers took part. Results not only confirmed presence of grief in these parents but also indicated that this grief differs for mothers and fathers, with mothers reporting significantly higher levels of physical distress. In line with the literature no gender differences were found in regards to perception of impact parents felt their child's chronic-illness had had on their lives. Contrary to what was expected, however, no differences were found amongst the coping strategies used by mothers and fathers. In regards to the question of which factors have the greatest impact on the grief experienced by mothers and fathers combined, the coping strategy of self-blame was found to be the most important, followed closely by negative perceptions. The significance of these findings and their implications for parents and the people who work with them was discussed.

Grief that accompanies significant loss is a universal human experience. It has long been presumed that grief should resolve over a finite period of time. Because of the difficulties with defining the appropriate time limitations for uncomplicated grieving, an alternate conceptualization of grief resolution, in which sorrow is expected to recur periodically rather than dissipate over time was introduced as a conceptual perspective. The research followed a retrospective design in which three groups of persons who had experienced significant, yet different, types of loss were examined to determine the pattern of grief resolution over time. The groups included those whose loved one had a congenital cognitive deficit (Congenital), persons whose loved one had an acquired cognitive deficit (Acquired), and bereaved persons (Bereaved). The outcome variables of initial and present grief, recurrent sorrow, and depressive symptoms were examined for relationship to the covariates of attachment, spirituality, and perceived social support. Participants completed questionnaires that referenced past and present feelings about the loss. Instrumentation included a new scale, the Recurrent Sorrow Inventory, developed to assess pattern of grief over time. Data were analyzed with descriptive and chi-square statistics, analysis of variance, and factor analysis. In addition, graphic format data were used to supplement analysis of the other Likert-format scales. One hundred twenty subjects completed questionnaires. For the combined sample, a significantly greater number of participants selected graphs and descriptive phrases representative of recurrent sorrow over time, than the other choices that suggested either time-bound grief resolution or persistent sadness following loss. The findings did not differ across groups when the sample was separated by type of loss. As hypothesized, the data supported separate, orthogonal factors of initial and present grief, recurrent sorrow, and depression. This supports distinction of depression from grief and recurrent sorrow and suggests avenues for theory development regarding human response to loss. The findings of the study support the need to continue examination of the pervasive nature of grief over time, particularly for relevance to emotional and psychosocial well-being. Nursing science is an appropriate context in which to consider these relationships.

The purpose of this study was to gain a better understanding of the paternal experience of perinatal loss. Perinatal loss is a significant life experience for childbearing families and this study helped to reveal the meaning of the paternal experience, how meaning was constructed and what factors both contributed and/or hindered coping following the loss. Although extensive research in grief and loss has been conducted there existed a significant knowledge gap related to the experience of perinatal loss and even more of a paucity concerning the understanding of the paternal experience. A qualitative study with a phenomenological approach was conducted with a purposeful sample of seven fathers who had experienced a perinatal loss. These fathers helped provide a basis for understanding through partaking in interviews conducted in a venue chosen by fathers. Data analysis involved procedures with roots in Heideggerian traditions of phenomenology, to allow for meaning interpretation of the father's narratives. The analysis resulted in four shared meanings 1) Perinatal Loss - Unexpected Reality, 2) Acknowledgment and Remembrance, 3) Significance and Strength and 4) Crisis, which consisted of 12 themes (World Falling Apart, Absolute Shock, Stoicism, Wishing for Answers, Silent Shelter, Concern for Wife, Communication, Time Heals - Though Never Forgotten, Continued Support and Understanding, Life Changing Moment, Opportunity of Growth and Avoidable Choice). Results indicated that fathers felt ill prepared for this unexpected life event and that they needed to remain strong or to live up to perceived expectations. Although the loss was never forgotten, through reflection, communication and continued support and understanding healing transpired over time and crisis was an avoidable choice. Further exploration of the paternal experience of perinatal loss with varying socio-cultural backgrounds, younger aged population group as well as different religious and cultural backgrounds is recommended. Research is also indicated to explore: 1) educational interventions focusing on both short and long term supportive care to bereaved families, 2) the impact of substantive bereavement programs on healing and meaning-making, 3) the impact of a perinatal loss experience on other members of the family unit, and 4) the impact of recurrent perinatal loss to a family.

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Rationale and Aims: Grief research has highlighted the difficult reactions experienced by people bereaved by suicide, with studies also looking at the importance of sense and meaning making. There is limited research looking at experiences of individual kinships, for example partners of people who have taken their own lives. The current study therefore aimed to gain an in-depth understanding of the experiences of people who have lost a partner to suicide, using a qualitative approach. The research sought to explore the following:What are the experiences of people whose partners have taken their own lives and how do people experience trying to make sense and meaning of their partner’s death? Method: Semi-structured interviews were carried out with seven participants (two men) who had lost their partner to suicide more than two years previously. Verbatim transcripts of the interviews were then analysed using Interpretative Phenomenological Analysis (IPA). Results: The analysis produced four master themes, including: “Pervasive impact of loss – “oh god, its such a disaster”; “The search for understanding – “There are so many questions that are unanswerable, like ‘why’?”; Challenges and ways of coping – “All the challenges they just come daily, hourly, minute by minute”; and, “Looking to the future – Its been a turning point for me, and a catalyst for change”. A description of these master themes and the related subordinate themes is presented. Conclusion: The results of the analysis are considered in light of existing theory and their clinical implications.

Background: The vast majority of research into the experiences of people with learning disabilities (LD) in regard to bereavement and grief involves the collection of data from second-hand sources, or via quantitative measures. This qualitative study aimed to explore the lived experiences of bereavement and grief in a group of adults with mild LD. Methods: Semi-structured interviews were carried out with 13 adults (aged 20-72 years) with mild LD who had experienced bereavement within the last 3 years. Data were analysed using interpretative phenomenological analysis (IPA). Results: Qualitative analysis highlighted 4 themes which mediated individuals’ experience of bereavement and grief: (1) Intra- and inter-personal experiences, (2) Core beliefs about life and death, (3) Level of inclusion, and (4) Continuing relationship with the deceased. Participants also showed an ability to evaluate their lived experience in terms of having been helpful or otherwise. Conclusions: Overall, the findings suggest that individuals with mild LD experience bereavement and grief in a manner much like the general population, in that they experience a wide range of oscillating emotions, are subject to the same (if not more) losses, and hold similar values when it comes to maintaining their relationship with the deceased. The study endorses the role of clear and open communication, the facilitation of informed choice, and a culture of inclusion.

Suicid är en avsiktlig, självdestruktiv handling som leder till döden. Varje år begås närmare 800 000 suicid runt om i världen och av dessa uppskattas cirka 1100 suicid begås i Sverige. I genomsnitt sörjer sex personer för varje fullbordat suicid, vilket innebär att sjuksköterskor i stor utsträckning kommer att möta dessa anhöriga inom vården. Syftet med studien var således att belysa anhörigas upplevelser av att mista en familjemedlem till följd av suicid. Föreliggande studie är en litteraturbaserad studie baserat på kvalitativa artiklar. Studien behandlade begrepp som hälsa och lidande, vilket vidare relaterades till suicid och de efterlevandes upplevelser. En sammanställning av totalt nio vetenskapliga artiklar användes som grund i utformningen av resultatet. Resultatet redovisade att de efterlevande i hög omfattning upplevde känslor av skuld och skam, relaterat till att bli dömd av andra och att döma sig själv. Att bli dömd av omgivningen framgick bero på att denna sortens handling inte var accepterat i samhället, det beskrevs vara ett tabubelagt ämne. Stöd beskrevs upplevas som antingen tillfredsställt eller bristande. Att genomgå sorg innefattade ett känslomässigt kaos och de efterlevande hade ett stort behov av att få sörja. Att därefter gå vidare i livet gjordes med hjälp av olika metoder, bland annat ritualer för att bevara minnen av den avlidne men även att uppnå acceptans för att förmå att leva vidare. Dessa efterlevande upplevde ofta både psykiskt och fysiskt lidande, genomgående i kris- och sorgeprocessen. Det beskrevs att de efterlevande upplevde stort behov av stöd, men att flertalet inte erhöll tillgodosedda stödinsatser. Sjuksköterskors förmåga till utveckling av vårdkvaliteten för att förmå att minska lidande och förebygga ohälsa hos dessa anhöriga beskrevs därför som viktig. Sjuksköterskor bör således även ha en grund i vårdvetenskap för att kunna bidra till kunskapsutveckling inom detta område. / Background: Suicide is defined as a deliberate and self-destructive act that leads to death. It’s considered as a extensive health problem and each year, nearly 800 000 people die as a result of suicide around the world. Six people in each case estimates to be affected about the suicide. Sufficient support is considered important for these people. Aim: The aim of this study was to illuminate relative’s experience of losing a family member as a result of suicide. Method: A literature-based study including qualitative studies was chosen, according to Friberg (2006), in order to illuminate the relative’s experience of losing a family member as a result of suicide. The results of a total of nine scientific articles were compiled. Results: The results are presented in four themes, and a total of eight subthemes. The presented themes where grief, to be judged by others and to judge themselves, need of support and to continue living. Conclusion: The relatives often experience great suffering, but the results in this study shows that most suicide survivors don’t receive sufficient support. The care of these survivors thus requires a big commitment from the nurses. A guidance to relevant support measures is therefore of great importance, because sufficient support relieve illness, suffering and depression. The nurse should have a reflective approach and a scientific base in the care of these suicide survivors.

D.Litt. et Phil. / In this phenomenological study, art therapy is explored and described for its mediating effect on the grieving process of parents who have been traumatically bereaved by the loss of a child. The focus is on the ‘inner world’ of the bereaved parents and their subjective experience of being part of a psychotherapy group that uses artworks, as well as language, to explore and express feelings and to clarify existential meaning systems. Traumatic bereavement can result in detrimental long-term psychological consequences. The therapeutic value of existing grief therapies is currently under debate in the literature. To evaluate art therapy as an alternative therapeutic approach, art therapy sessions were held and a ‘text’, consisting of the participants’ artworks and reflections, established. From this text themes were drawn, which facilitated an in-depth understanding of the participants’ lived experience of traumatic bereavement and elucidated their perceptions of the usefulness of art therapy. Art therapy appears to offer a viable alternative to mainstream, language-based therapies. It provides a context in which creative play can facilitate healing and angry feelings sublimated. It assists the participants to rebuild their fragmented sense of ‘self’ through an exploration of their ‘inner world’ via the symbolic function of the artwork. It facilitates the revisiting of the traumatic event and encourages the reconstruction of new meaning. It promotes adaptive grieving through the expression of emotions and cognitions too painful and/or threatening to be verbalised.

Although several studies have characterized common and unique neural circuitry associated with social and non-social emotions, none to date have attempted to differentiate between social emotions that occur in very different contexts. Grieving the death of a loved one and being a target of perceived discrimination may implicate potentially distinct social processes (e.g., attachment versus affiliation). When examined separately, prior neuroimaging research has shown that both grief and perceived discrimination involved diffuse brain regions implicated variously in social stress processing and emotion, however no studies to date have directly compared these experiences. In the present study, we examined neural correlates of grief and perceived discrimination among South Asian women (n = 10), using an idiographic emotional imagery task. Grief-related imagery elicited activation in the precuneus, midbrain, dorsal striatum, and thalamocingulate regions, consistent with previous neuroimaging studies of grief and attachment. Participants showed greater activation in the anterior cingulate, hippocampus, occipital cortex, and cerebellum during Grief relative to Discrimination. We observed dorsomedial prefrontal cortex (dmPFC) activation in Discrimination>Neutral, which may reflect greater self-regulatory effort involved in coping with discrimination experiences. Greater temporal pole and amygdala activation in the Discrimination condition were associated with greater lifetime perceived discrimination, poorer self-reported physical health, and more depressive symptoms. Results of this pilot study suggest that there are observable differences in the brain response to these two types of social stressors, suggesting future directions for a more fine-grained view of the mechanisms through which the social environment may influence health and well-being.