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1.
Can J Anaesth ; 67(7): 857-865, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32240521

RESUMEN

PURPOSE: When people die in intensive care units (ICUs), as many as half of their family members may experience a severe grief reaction. While families report a need for bereavement support, most ICUs do not routinely follow-up with family members. Clinicians are typically involved in supporting families during death and dying, yet little is known about how they work with families in bereavement. Our goal was to explore how clinicians support bereaved families, identify factors that facilitate and hinder support, and understand their interest and needs for follow-up. METHODS: Mixed-methods study of nurses and physicians working in one of nine adult medical-surgical ICUs in academic hospitals across Canada. Qualitative interviews followed quantitative surveys to reflect, expand, and explain the quantitative results. RESULTS: Both physicians and nurses perceived that they provided empathetic support to bereaved families. Emotional engagement was a crucial element of support, but clinicians were not always able to engage with families because of their roles, responsibilities, experiences, or unit resources. Another important factor that could facilitate or challenge engagement was the degree to which families accepted death. Clinicians were interested in participating in a follow-up bereavement program, but their participation was contingent on time, training, and the ability to manage their own emotions related to death and bereavement in the ICU. CONCLUSIONS: Multiple opportunities were identified to enhance current bereavement support for families, including the desire of ICU clinicians for formal follow-up programs. Many psychological, sociocultural, and structural factors would need to be considered in program design.

2.
J Couns Psychol ; 66(6): 714-725, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31647284

RESUMEN

This study aimed to test the hypothesis that meaning making is a mediating process in the relationship between risk factors for prolonged grief disorder (PGD) and subsequent emergence of PGD symptomatology. A survey design was employed with prospective measurement of PGD. The following variables were assessed 2-12 months postloss among adults across North America and Europe (N = 357): (a) risk factors for PGD (insecure attachment, social support, neuroticism, violent loss, and spousal loss) and (b) meaning made. Meaning made was measured using the Grief and Meaning Reconstruction Inventory (GMRI) as well as using the Integration of Stressful Life Experiences-Short Form (ISLES-SF). At a 7-10-months follow-up (n = 171) symptoms of PGD were assessed. The mean age at the second assessment point was 44.3 years (SD = 16.1) and the majority of the sample identified as female (71.9%). Process analysis was employed to test a series of simple mediation models. When the GMRI was used as a measure of meaning, the indirect effect of each risk factor on PGD symptoms, as mediated by meaning made, was significant (95% CI). When the ISLES-SF was used to measure meaning, the indirect effect of each risk factor with the exception of violent loss was significant (95% CI). The study demonstrates that meaning making serves to mediate the adverse impact of multiple PGD risk factors on the development of PGD symptomatology. Specifically, the study suggests that PGD risk factors exacerbate symptoms of PGD by impeding the meaning-making process. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Pesar , Acontecimientos que Cambian la Vida , Negociación/psicología , Encuestas y Cuestionarios , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Negociación/métodos , Estudios Prospectivos , Factores de Tiempo
3.
J Clin Psychol ; 75(6): 1047-1065, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30801707

RESUMEN

OBJECTIVE: To address the etiology of prolonged grief disorder (PGD) by examining whether rumination moderates the role of meaning-making in mediating the impact of PGD risk factors. METHOD: A survey assessing PGD risk factors (low social support, insecure attachment, violent loss, neuroticism, and loss of a spouse), meaning, and rumination was administered 2-12 months postloss among adults across North America and Europe (mean age = 44.3, 71.9% female). At a 7-10 months follow-up, symptoms of PGD were assessed (n = 171). RESULTS: When measuring meaning with the Grief and Meaning Reconstruction Inventory, the moderated mediation pathway was significant for each PGD-risk factor. However, when measuring meaning with the Integration of Stressful Life Experiences-Short Form, the pathway was significant for every risk factors except violent loss. CONCLUSIONS: Rumination appears to moderate meaning-making in the development of PGD symptomatology. These findings highlight rumination as a target for intervention with at-risk grievers.

4.
Eur J Psychotraumatol ; 8(Suppl 6): 1503522, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-30128081

RESUMEN

Background: Prolonged Grief Disorder (PGD) is over-represented among those who have lost loved ones to violent causes. To tailor PGD interventions for this vulnerable population it is critical to examine the aetiology of PGD specifically in the context of violent death bereavement. Previous studies have suggested that violent loss increases symptoms of PGD by hindering the mourner's ability to make meaning of the death or its aftermath. However, these studies have relied on cross sectional data that preclude genuine prediction and have not differentiated among specific themes of meaning. Objective: This study aimed to identify specific themes of meaning that mediate the detrimental impact of violent loss on subsequent emergence of PGD symptomatology among the violently bereft. Method: A longitudinal, prospective design (N = 171) was used to assess violent loss and themes of meaning an average of six months post-loss allowing for prediction of PGD symptoms an average of eight months later. Results: Violent loss had a significant indirect effect on PGD symptomatology when meaning themes focusing on sense of peace and continuing bonds served as mediators. Conclusions: This study demonstrates the mediating role that specific meaning themes play in the development of PGD symptomatology following violent loss. These findings highlight the potential benefits of applying a meaning-based intervention approach with the violently bereft.

5.
BMJ Support Palliat Care ; 5 Suppl 1: A3, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25960520

RESUMEN

BACKGROUND: Family caregivers suffer physically, mentally, and spiritually. Community volunteers play an important role in supporting patients at the end of life or former caregivers in bereavement. However, there are no research reports of volunteer services focused on maintaining the wellbeing of end-of-life caregivers. AIM: To have volunteers, a hired volunteer coordinator, health care providers, and researchers implement and formatively evaluate a volunteer service to enable family caregivers to maintain their well being while providing care and subsequent bereavement. This presentation will focus on the volunteers' roles with the project as both agents of change to the service and as support for the caregivers. METHOD: A qualitative formative evaluation informed by Guba and Lincoln's Fourth Generation Evaluation (1989) participatory design was conducted. Data was collected through individual interviews, focus groups, participant observation during volunteer support meetings, and through volunteers' written reflections. RESULTS: Amongst the volunteers, volunteer coordinator, and principal investigator, there was mutual respect for and interest in learning about everyone's roles and experiences in the project. The experience was rewarding because they felt they helped the family caregiver and enjoyed developing and improving the service and working in a supportive team. Volunteers' challenges included being nervous for their first meeting with a caregiver, and frustration with some rules put in place to protect them (e.g. not helping the caregiver with direct care for the patient). CONCLUSION: Volunteers can be an effective part of the research team, while providing valuable support and encouragement for family caregivers to maintain their own wellbeing.

6.
Death Stud ; 39(7): 411-21, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25674830

RESUMEN

More effective psychosocial interventions that target uncomplicated bereavement are needed for those actively seeking support. The objective of this study was to assess the feasibility of evaluating a unique meaning-based group counseling (MBGC) intervention with a randomized controlled trial (RCT) design. Twenty-six bereft individuals were randomly assigned to either MBGC or a control bereavement support group. Twenty participants (11 experimental, nine control) completed all aspects of the study including self-report measures at baseline, postintervention, and 3-month follow-up of meaning in life, anxiety, depression, and grief. Results support the feasibility of an RCT with MBGC.


Asunto(s)
Cuidados Paliativos al Final de la Vida/métodos , Psicoterapia de Grupo/métodos , Aflicción , Consejo/métodos , Estudios de Factibilidad , Femenino , Cuidados Paliativos al Final de la Vida/psicología , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Escalas de Valoración Psiquiátrica
7.
Death Stud ; 38(1-5): 137-44, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24524541

RESUMEN

A growing body of scholarship has evaluated the usefulness of meaning-based theories in the context of bereavement counseling. Although scholars have discussed the application of meaning-based theories for individual practice, there is a lack of inquiry regarding its implications when conducting bereavement support groups. The objective of this article is to bridge meaning-based theories with bereavement group practice, leading to a novel intervention and laying the foundation for future efficacy studies. Building on recommendations specified in the literature, this article outlines the theoretical paradigms and structure of a short-term meaning-based group counseling intervention for uncomplicated bereavement.


Asunto(s)
Aflicción , Consejo/métodos , Psicoterapia de Grupo/métodos , Humanos , Teoría Psicológica
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