Nancy S. Hogan

Development and validation of the Hogan Grief Reaction Checklist.

The purpose of this article is to provide data on a recently developed instrument to measure the multidimensional nature of the bereavement process. In contrast to widely used grief instruments that have been developed using rational methods of instrument construction, the Hogan Grief Reaction Checklist (HGRC) was developed empirically from data collected from bereaved adults who had experienced the death of a loved one. Factor analysis of the HGRC revealed 6 factors in the normal trajectory of the grieving process: Despair, Panic Behavior, Blame and Anger, Detachment, Disorganization, and Personal Growth. Additional data are provided that support reliability and validity of the HGRC as well as its ability to discriminate variability in the grieving process as a function of cause of death and time lapsed since death. Empirical support is also provided for Personal Growth as an integral component of the bereavement process. The article concludes by considering the substantive as well as psychometric findings of this research for such issues as traumatic grief, anticipatory grief, change in the bereaved persons self-schema, and spiritual and existential growth.The purpose of this article is to provide data on a recently developed instrument to measure the multidimensional nature of the bereavement process. In contrast to widely used grief instruments that have been developed using rational methods of instrument construction, the Hogan Grief Reaction Checklist (HGRC) was developed empirically from data collected from bereaved adults who had experienced the death of a loved one. Factor analysis of the HGRC revealed 6 factors in the normal trajectory of the grieving process: Despair, Panic Behavior, Blame and Anger, Detachment, Disorganization, and Personal Growth. Additional data are provided that support reliability and validity of the HGRC as well as its ability to discriminate variability in the grieving process as a function of cause of death and time lapsed since death. Empirical support is also provided for Personal Growth as an integral component of the bereavement process. The article concludes by considering the substantive as well as psychometric findings of this research for such issues as traumatic grief, anticipatory grief, change in the bereaved persons self-schema, and spiritual and existential growth.

Testing the grief to personal growth model using structural equation modeling.

The belief that loss can result in growth has been hypothesized for centuries.Yet, traditional grief theories have viewed grief work as a process of resolving grief and returning to normal. Formal conceptualizations of grief to growth models have been recently delineated by several grief theorists.The Grief to Personal Growth model represents one emergent perspective of the qualitative changes resulting from the loss of a loved one.The model delineates a pathway through grief that indicates the bereft experience despair and detachment followed by intrusive thoughts and later avoidance of intense preoccupation with grief. Social support is shown to facilitate the bereft as they reconstruct their lives and find new meaning in life. A second path indicates that some bereaved individuals become mired in grief and need help to proceed toward personal growth.The model was tested in a sample of bereaved parents using structural equation modeling as a method of theory testing.The results of testing this model are presented within a framework of theory testing as a mechanism to bridge the gaps between theory, practice,and research. Implications for practice are considered.

An Experiential Theory of Spiritual Care in Nursing Practice

Spiritual care has been recognized as integral to nursing care for centuries, as described by Florence Nightingale, and has been studied in both medicine and sociology. Health care institutions, particularly faith-based health systems, also have recognized the importance of spiritual care. Both qualitative and quantitative research support the importance of spirituality in patient health. Although the profession, health care institutions, and research support spiritual care, there is no empirically derived theoretical framework to guide research in spiritual assessment and spiritual care. We used focus group data from registered nurses who care for the chronically ill (n = 25) in a large Midwestern academic health center to generate a grounded theory of spiritual care in nursing practice. What emerged from this study was a beginning theoretical framework to guide future spiritual care research.

Toward an Experiential Theory of Bereavement

The Experiential Theory of Bereavement was derived from open-ended, telephone interview data provided by thirty-four adults who had experienced the death of a loved one. Strengths of this grounded theory study are that it was developed with nonclinical persons, it encompasses the illness and dying course, taking into account the full context of illness survivors grief, and it encompasses personal growth as a vital component of the grieving process. Regardless of the cause of death, the timeliness of the persons death, or the relationship of the survivor to the deceased, the process of bereavement follows a consistent overall pattern. Illness survivors were not found to have an ameliorated or foreshortened bereavement process as predicted by the anticipatory grief hypothesis.

Adolescent Sibling Bereavement Symptomatology in a Large Community Sample

This study presents data on a recently developed instrument assessing symptomatology in a 13-to 18-year-old community sample of bereaved adolescents. Adolescents assessed within 18 months of their siblings death showed consistently high levels of grief symptomatology. A second sample assessed more than 18 months after their siblings death reported lower levels of grief symptomatology. However, a significant group of adolescents in this second sample continued to have high levels of grief reactions. Groups high and low on reported grief symptoms, when the death had occurred more than 18 months earlier, were compared on the Offer Self-Image Questionnaire. The data revealed dysfunctionalpatterns of self-concept in adolescents with high grief symptom levels. This pattern was not evident in the adolescents who were able to normalize their lives despite the traumatic experience of having a brother or sister die.

Development of substantive theory in nursing

The lack of a comprehensive, substantive theory base has resulted in the profession of nursing borrowing theoretical assumptions, concepts, and research instruments from other disciplines to examine nursing phenomena. Nurse researchers have focused their attention primarily on applied research leaving the development of substantive theory to others. If the nursing profession is to develop a scientifically-based practice, nurses will need to engage in debates about the need for and methods of generating substantive theory and shift from the use of borrowed knowledge and methods to original nursing research. In order to broaden the theoretical conceptualisations and directions of nursing research for the development of a substantive theory base, multi-method perspectives are necessary. Triangulation of qualitative and quantitative methods is one way to design research that will allow for development of substantive theory through the use of multiple methodology. This paper describes one method of preparing doctoral nurse students for triangulation of methods and to develop substantive theory for nursing practice.

Making meaning in the legacy of tissue donation for donor families

Context Individuals needing lifesaving (heart valves, skin grafts for repair of critical burn injuries) and life-enhancing (corneas, bone and tendon grafts, skin, and veins) tissue donations outnumber the tissues available for transplant. Objective To describe the grief family members experienced 6 months after donation and to learn how family decision makers gained meaning from the decision to donate a loved ones tissues. This is phase 1 of a longitudinal study in which family decision makers will be surveyed again at 13 and 25 months after donation. Design Qualitative descriptive. Participants One hundred seven family decision makers whose family member died a traumatic sudden death and who authorized donating tissues for transplant. Data Collection and Analysis Data were written responses to the questions, “If you could ask or tell your dead family member something, what would it be” and “What meaning does donating tissue to others have for you” Data were analyzed by using content analysis procedures. Results Concepts derived from the first question represent the context of family members grieving the sudden death of a loved one. Concepts were (1) feeling empty, (2) missing and loving, (3) being grateful, and (4) having regrets. The concepts derived from the second question were (1) fulfilling their family members wish, (2) doing the right thing, (3) believing something good came from the death, (4) helping others, and (5) living on. Reasons for donating were based, in part, on honoring the legacy of their loved ones who had given of themselves to others in life and now continued to give to others after death. Conclusion The results of this study provide a basis for health professionals and donation staffs to better understand the context within which families grieve and give meaning to tissue donation.

Considerations in Conceptualizing Complicated Grief

Findings from the study that was published in Omega 2004 was first presented by William Worden and Nancy Hogan at the 2001 Association of Death Education and Counseling conference (Worden & Hogan, 2001). In 2003 Holly Prigerson, Selby Jacobs (authors of the Complicated Grief Disorder criteria) and Nancy Hogan were invited to discuss issues related to complicated grief in a symposium at the 2003 ADEC conference. Jacobs and Hogan accepted this invitation (Hogan & Jacobs, 2002). After the presentation, presenters were invited by Ken Doka to submit the presentation for publication in Omega (Hogan, Worden, & Schmidt, 2004). Our interest in assessing the psychometrics of the Complicated Grief Disorder Criteria (CGDC) builds upon our previous studies on assessing the psychometrics of instruments used in grief research. These studies focused on testing the operational definitions and assessing the validity evidence for grief and related constructs. Operational definitions are perhaps one of the most important aspects of science in providing the bridge between the theory-hypothesisconstruct level of inquiry and observable data in the empirical world. Operational definitions assign meaning to constructs through specification of actions needed to measure a construct (Kerlinger & Lee, 1999). For the current discussion, the