Let Dillen

Confirming the Distinctiveness of Complicated Grief from Depression and Anxiety among Adolescents.

Studies in adult populations have shown that symptoms of complicated grief (CG) constitute a form of bereavement-related distress distinct from symptoms of depression and anxiety. The purpose of this article is to replicate these findings in two samples of bereaved adolescents by investigating the latent structure of symptoms of CG, anxiety, and depression measured by self-report questionnaires. The first study (N = 245) focuses on one of the most prevalent losses in adolescence, namely the death of a grandparent. In the second study (N = 351) the authors further the examination of the distinctiveness question by inspecting not only the latent structure of CG, depression, and anxiety but also whether the distinctiveness of the emerging latent structure holds across subgroups of bereaved adolescents suffering different types of losses. Confirmatory factor analyses in both studies confirm the distinctiveness of CG from depression and anxiety in a younger population.

Aged parents’ experiences during a critical illness trajectory and after the death of an adult child: A review of the literature

Background: Given the growing life expectancy, the likelihood increases that health-care providers are confronted with older people having an adult child with a life-limiting disease. Aim: This literature review aimed to (1) explore the experiences of aged parents with regard to their position and role as a parent of an adult child with a life-limiting illness, (2) detect gaps in the existing literature and (3) make recommendations for future research. Design: A literature search of English articles, including both quantitative and qualitative designs. Data sources: Four electronic databases and the reference lists of included studies. Results: In total, 19 studies (7 quantitative and 12 qualitative) were included. Few studies describe the experiences of older people whose adult child has cancer or has died of cancer. Existing studies are merely descriptive and give no concrete recommendations for health-care providers in daily practice. The studies suggest that aged parents carry deep burdens from the prospect of losing their adult child. Aged parents want to stay involved but need to reconfigure their parent role. As soon as the cancer diagnosis is disclosed, parents are confronted with a re-awakening of parental nurturing, which clashes with the autonomy of the adult child. Even after the adult child is deceased, older parents retain the image of themselves as parents. Conclusions: There is a need for more in-depth research to understand the lived experience of these parents and what health-care providers can do to assist them.

When puppets speak: Dialectical psychodrama within developmental child psychotherapy

Rigid relational representations often contribute substantially to childrens psychosocial problems. One of the core tasks of any developmental child psychotherapy is therefore to trace and chart these (relational) representations. The present article illustrates how a child-oriented protocol of the action sociogram is a valid candidate for dealing with these representations. It outlines the theoretical basis of the protocol, describes the construction and application of the action sociogram, and reviews the possibilities offered by the protocol.

Grief and loss in older people residing in nursing homes : (un)detected by nurses and care assistants?

AIM The aim of this study was to explore how nurses and care-assistants (nursing staff) working in six Flemish nursing homes experience and describe their involvement in grief care. BACKGROUND Although grief in older people is widely described in literature, less is known about how nursing staff in nursing homes offer and perceive grief care. DESIGN A qualitative research design with elements of constructivist grounded theory was used. METHODS Loosely structured face-to-face interviews were done with fourteen nurses and care-assistants. Data were collected from October 2013-March 2014. Interview transcripts were analysed using the Qualitative Analysis Guide of Leuven (QUAGOL) method with support of NVivo 10. FINDINGS Grief care in nursing homes is characterized by a complex tension between two care dimensions: (1) being involved while keeping an appropriate distance; and (2) being while doing. Nursing staff described key enablers and influencing factors for grief care at the level of both the individual and the organizational context. CONCLUSION Findings suggest an established personal sensitivity for grief care considered from the nursing staff points of view. Nevertheless, a common denominator was the necessity to further develop a supportive and multidisciplinary grief care policy ingrained in the existing care culture. Suggested components of this grief care policy are: (a) centring attention on non-death-related loss and the cumulative nature of loss in residents; (b) building capacity by means of reflective practices; and (c) the importance of self-care strategies for nursing staff. Furthermore, the findings from this study point towards a need for education and training.

Advance care planning in dementia: recommendations for healthcare professionals

BackgroundAdvance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual’s preferences and values concerning future treatment and care, including end-of-life care. Despite universal recognition of the importance of ACP for people with dementia, who gradually lose their ability to make informed decisions themselves, ACP still only happens infrequently, and evidence-based recommendations on when and how to perform this complex process are lacking. We aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP in dementia care.MethodsFollowing the Belgian Centre for Evidence-Based Medicine’s procedures, we 1) performed an extensive literature search to identify international guidelines, articles reporting heterogeneous study designs and grey literature, 2) developed recommendations based on the available evidence and expert opinion of the author group, and 3) performed a validation process using written feedback from experts, a survey for end users (healthcare professionals across settings), and two peer-review groups (with geriatricians and general practitioners).ResultsBased on 67 publications and validation from ten experts, 51 end users and two peer-review groups (24 participants) we developed 32 recommendations covering eight domains: initiation of ACP, evaluation of mental capacity, holding ACP conversations, the role and importance of those close to the person with dementia, ACP with people who find it difficult or impossible to communicate verbally, documentation of wishes and preferences, including information transfer, end-of-life decision-making, and preconditions for optimal implementation of ACP. Almost all recommendations received a grading representing low to very low-quality evidence.ConclusionNo high-quality guidelines are available for ACP in dementia care. By combining evidence with expert and user opinions, we have defined a unique set of recommendations for ACP in people living with dementia. These recommendations form a valuable tool for educating healthcare professionals on how to perform ACP across settings.

The suffering in silence of older parents whose child died of cancer: A qualitative study

ABSTRACT As life expectancy grows, the death of an adult child becomes a highly prevalent problem for older adults. The present study is based on nine interviews and explores the experience of parents (≥70 years) outliving an adult child. The bereaved parents described some silencing processes constraining their expression of grief. When an adult dies, the social support system nearly automatically directs its care towards the bereaved nuclear family. Parental grief at old age is therefore often not recognized and/or acknowledged. Health care providers should be sensitive to the silent grief of older parents both in geriatric and oncology care settings.

Het actiesociogram als methode voor assessment van hechtingsbelevingen bij kinderen

De afgelopen decennia is het onderzoek naar gehechtheid (attachment) enorm toegenomen. Deze expansie zorgde voor verdere empirische ondersteuning van het gehechtheidsconcept en belichtte de potentiële implicaties ervan voor de klinische praktijk. Desondanks staat het wetenschappelijk onderzoek naar hechting in de basisschoolleeftijd nog in de kinderschoenen. Dit komt onder meer door het ontbreken van een diagnostisch instrument dat aansluit bij de eigenheid van deze leeftijdsgroep. In een poging om tegemoet te komen aan dit tekort wordt hier het actiesociogram voorgesteld. Bij deze methode ligt de nadruk op actiegerichte exploratie van de zelfbeleving in de gezinscontext. Vanuit theoretisch en praktisch oogpunt illustreren we hoe het actiesociogram – met gebruikmaking van poppen en actie – mogelijkheden biedt om op efficiënte en kindgerichte wijze de kwaliteit van hechtingsbelevingen te meten.