Bereavement

A resource a month over 2011 and into 2012

2012-02-01T07:04:00.000-08:00

1.Neimeyer RA, Harris DA, Winokuer HR, Thornton GF (eds)
Grief and bereavement in contemporary society. Bridging research and practice
Routledge 2011

This book has contributions from 60 eminent writers (both clinicians and researchers) on grief and bereavement from 10 countries around the world.
It is has 31 chapters and is divided into 6 main sections – current conceptualisations of the grief process, contexts of grieving, challenges in bereavement, specific populations, specialised treatment modalities, grief in a global perspective. If you have read widely on bereavement issues, you will recognise many of the authors. If you have not, you will be introduced to a wide variety of contemporary perspectives. I have dipped into a number of chapters and I was especially struck by the chapter on “The remedy is not working” – seeking just and culturally conscientious practices in bereavement by Valarie Molaison et al. It describes and comments on the issue of death and grieving in a case study of a young African-American youth in a poor inner city area in the United States. It was challenging, engaging and sad. One would like to know how the young man viewed his counselling many years on. Does he even remember it? – or will the experience be of any use to him sometime in his future?

2.Wimpenny P, Costello J (eds)
Grief loss and bereavement. Evidence and practice for health and social care practitioners.
Routledge 2012

This book also has a broad remit though it is aimed at practitioners to a greater extent and most of the contributors are working in Scotland, either as practitioners or as researchers. It has sixteen chapters and is divided into 3 parts – 1) bereavement across the life span 2) contexts of bereavement and 3) education interventions and organisation of bereavement care. The context of bereavement section covers topics such as bereavement in primary care, perinatal bereavement, bereavement in care homes and bereavement and occupational health. There is an interesting array of figures, tables and boxes (26 in all) that summarise key concepts in current thinking on bereavement issues. It is a book aimed at specialists in bereavement work but also at health and social care professionals who need to further their understanding of bereavement issues in the context of their overall work. A poem by a poet based in Scotland called The dead is on the introductory page and it can be viewed on the poet’s website:
http://www.pauline-prior-pitt.com/poems.html

3.Wicks Robert J
The resilient clinician
Oxford University Press 2008

This is not newly published, nor is it specifically on bereavement. However, it is for counsellors and any professional involved in working closely with people who need help with emotional problems. It is written by a psychotherapist and the essence of the book is about how clinicians care for and know themselves so that they can continue to have the “space” to offer to others. It enables one to assess the extent to which one is currently reacting to stress in dealing with one’s clients. The first three chapters provide some idea of the approach: Sensing the dangers - chronic and acute secondary stress: Enhancing resiliency - strengthening one’s own self-care protocol: Replenishing the self-solitude, silence and mindfulness. The author places great emphasis on daily debriefing and concludes with some questions to aid reflection.
I especially liked one quote, reputedly from the Russian playwright (and doctor) Anton Chechov “Any idiot can face a crisis – it’s the day to day living that wears you out”.

4. Bereavement Care. A recent issue focussed on evaluation of
bereavement services – below are key references from this issue
(2011 volume 30 no1)
SCHUT HENK STROEBE MARGARET
Challenges in evaluating adult bereavement services p5-9
ROLLS LIZ
Challenges in evaluating childhood bereavement services p10-15
NEWSOM C
Practitioners and researchers working together in an intervention
efficacy study: A fine example of synergy p16-20
ROBERTS AMANDA MCGILLOWAY SINEAD
Methodological and ethical aspects of evaluation research in
bereavement: A reflection p21-28
TRICKEY DAVID NUGUS DANNY
Evaluation of a therapeutic residential intervention for
traumatically bereaved children and young people p29-36
MCGUINESS BREFFNI FINUCANE NIAMH
Evaluating a creative arts bereavement support intervention:
innovation and rigour p37-42
Colin Murray Parkes, editor, has received (January 2012) the Sternberg Active Life Award from the Times newspaper.

5. The last posting referred to a literature review on bereavement published by the Department of Health in the UK. This was followed up by draft quality markers on spiritual and bereavement care
http://www.endoflifecareforadults.nhs.uk/assets/downloads/Draft_Spiritual_Support_and_Bereavement_Care_Quality_Markers.pdf
In November, the National Institute of Clinical Excellence in the UK published End of Life Care quality markers and there is a section on bereavement which refers to the above documents:
http://www.nice.org.uk/guidance/qualitystandards/endoflifecare/CareAfterDeathBereavementSupport.jsp
This represents the most up-to-date UK guidance on bereavement issues.

6. Leaflets for bereaved people.
The following is a list from the Irish Hospice Foundation. It is interesting to see one written in Polish and another on how to cope at Christmas (though that will not be needed for another year!)
http://www.hospice-foundation.ie/index.php?option=com_content&task=view&id=124&Itemid=50
St Christopher’s has a wide range of leaflets available for patients, carers, families and bereaved people. There are six specifically on bereavement:
http://www.stchristophers.org.uk/patients/leaflets

7. I have come across a few items on the effect of losing a parent
in childhood in the last year. Here are the references;
BIANK NANCEE M WERNER-LIN ALLISON
Growing up with grief: Revisiting the death of a parent over the
life course
Omega 11 v63 no3 p271-290
FITZ JANE FINLAY ILORA
The burden of bereaved children in society. Paper delivered at
the Glasgow GAPC Conference, 2011
Wales Pall Care Strategy Impl Board 2011 22p
http://www.eapcnet.eu/LinkClick.aspx?fileticket=5MdRLB--lc0%3D&tabid=752
PARSONS SAMANTHA CHILDHOOD WELLBEING RESEARCH CENTRE
Long-term impact of childhood bereavement: Preliminary analysis
of the 1970 British Cohort Study (BCS70)
https://www.education.gov.uk/publications/standard/publicationDetail/Page1/CWRC-00081-2011
London: CWRC 2011
PEARCE CAROLINE
Girl, interrupted: An exploration into the experience of grief
following the death of a mother in young women's narratives
Mortality 11 v16 no1 p35-53
TRACEY ANNE
Perpetual loss and pervasive grief: Daughters speak about the
death of their mother in childhood
BereaveCare 11 v30 no3 p17-24

8. Marshall F
Losing a parent. 2nd edition
Sheldon Press 2011
There are not many books for adults when their parents die. The book has 10
chapters and the ones that stand out as being especially pertinent to this
particular bereavement are: You and your dying parent: The abandoned child -
Inheritance – new possessions, new ideas: You and your remaining parent:
Getting on with your life. The author provides a variety of case studies, thus
capturing a range of experiences with which bereaved adult children
can identify. It is written in an accessible style and her last paragraph points
out that “ the lifting of grief is yet another kind of loss – you lose touch
with the emotions of grief that were a powerful link with your dead mother
or father and it is at this point that you begin to realise the value of your
experience in grief as the painful tribute paid to love.”

9. Agnew, A et al
Bereavement assessment practice in hospice settings: challenges
for palliative care social workers
British Journal of Social Work 2011 41 p111-130

A national survey, conducted in 2007, examined bereavement practice in
10 Marie Curie hospices across the UK. All hospices offered a bereavement
service but there was little standardisation across their sites. The study
highlighted ethical issues centred on documentation, user participation and
consent and found staff training was variable across the ten hospices. Some
of the differences are highlighted in various figures and tables. The findings
facilitated the development of a post-bereavement service model that was
implemented across Marie Curie Hospice Care. Although there are umbrella
hospice bodies in the UK, Marie Curie is one of the few hospice providers that
has a number of sites and this of course aids standardisation and is one
advantage of a large multi-site service.

10. Finally , a chapter worth noting. This is in a book edited by David Oliviere, Barbara Monroe and Sheila Payne, Death dying and social differences 2nd edition (Oxford University Press 2011). It is by Orla Keegan and is titled Bereavement – a world of difference(p207-204). This chapter succinctly describes different perspectives on bereavement, especially emphasising the concept of disenfranchised grief, the huge discrepancies in the idea of a good death across the world and the dilemmas associated with how best to support bereaved people. It has an extensive, interesting bibliography.

On 15 Februrary 2012 the Bereavement Research Forum will host their AGM and there are two interesting lectures as part of this event –a talk on Inherited genetic conditions and the implications for end of life care and bereavement by Professor Alison Metcalfe and Across generations of family members affected by Huntington’s Chorea by Professor Heather Skirton. Full details at
http://www.brforum.org.uk/2012/agm2012flyer.htm

Denise Brady St Christopher's Hospice library. Email. d.brady@stchristohers.org.uk

4 online documents and 3 books

2011-03-02T07:13:00.000-08:00

Arthur A et al.
Bereavement care services: a synthesis of the literature
Dept of Health 2011
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123810.pdf

This is a very useful report that builds on the work of Wimpenny (blog April 2007). It brings together a range of research-based evidence that underpins existing provision and future service developments in England. It provides an overall synthesis of the major literature and categories this under four headings a) need for service provision b)current provision c)effectiveness of bereavement care interventions and services d)cost effectiveness. It examines service provision in terms of levels of intervention similar to NICE guidelines
It provides useful summaries of key literature and concludes with a number of recommendations for future practise and research.

Scottish Government Health Directorate.
Shaping bereavement care.
Scottish Government 2010
http://www.scotland.gov.uk/Resource/Doc/327965/0105922.pdf

This document was for consultation and its aim is principally to suggest policy changes that would enable quality care prior to death, at the time of death and immediately post-death for all dying people and their relatives. It sits a complementary doc

Shaping bereavement care – consultations responses
http://www.scotland.gov.uk/Publications/2010/12/22154532/0

44 responses were received using a questionnaire. There are an interesting array of organisations that responded to the consultation and the current developments involve employing a coordinator, setting up some short –term projects and having a major conference following these initiatives – sometime towards the end of 2011.
http://www.sehd.scot.nhs.uk/mels/CEL2011_09.pdf
(24th February 2011)

Relf M, Machin L, Archer N
A study into implementing “Guidance for bereavement needs assessment in palliative care”.
Help the Hospices 2010
http://www.helpthehospices.org.uk/hweb/get_Document.aspx?id=5265

This involved action research involving 3 British hospices and approximately 100 staff in those hospices and dealt with their responses to implementing bereavement needs assessment (BNA). The findings suggest that its implementation would a) have significant implications for organisations in terms of new procedures and protocols b)professional practitioners are challenged by the need to adopt and integrate new ways of thinking into practice. The original guidance is mentioned in May 2008 of this blog –and a book review provided lively debate between the reviewer and the authors. See below

Payne M. Book review. Guidance for bereavement needs assessment in palliative care. Bereavement Care 2008 v27 no3 p60
Relf M, Archer N, Machin L, Payne M. Book review discussion on "Guidance for bereavement needs assessment in palliative care". Bereavement Care 2009 v28 no1 p46-49

Graves Dodie
Talking with bereaved people. An approach for structured and sensitive communication.
Jessica Kingsley 2010

The author identifies six elements for establishing good communication with bereaved people. – a story, a relationship, a life to celebrate, a legacy for those left behind, a strategy for coping and a journey to undertake. Another chapter is about the exploration of difficult issues. A colleague has used this model in teaching a multidisciplinary group of palliative care professionals and has found it works well as an introduction to bereavement counselling. The author works at an English hospice.

Monroe B, Kraus F
Brief interventions with bereaved children.2nd edition
Oxford University Press 2010

Edited and partly written by St Christopher’s Hospice staff, this book provides a variety of interventions used by health professionals to help bereaved children. Some chapters provide an approach to dealing with these issues – other chapters focus on particular groups of children eg children with learning disablilities, very young children.
(Available from St Christopher’s Hospice bookshop. £29.95 plus postage d.brady@stchristophers.org.uk)

Buckle JL Fleming S
Parenting after the death fo a child. A practitioner’s guide
Routledge 2011

This Canadian study provides a detailed account of qualitative research with 10 bereaved parents, including 2 couples. Although the research as an in-depth evaluation of bereaved mothers and fathers separately, the impact of one spouse on another is accounted for in many of the themes. While is it is primarily a description of research, many verbatim extracts from the interviews are provided so it is a book that could be useful not only to practitioners but also to bereaved siblings and parents.

CONFERENCES

2010-07-30T09:10:00.000-07:00

I have examined the abstracts of 3 conferences in the past year that had a focus either on death and dying or on palliative care. I have found what seem to be the most relevant abstracts on bereavement issues. These are all short but provide some idea of research that may not yet be written up as articles. If you would like to read any of the abstracts contact me. Email: d.brady@stchristophers.org.uk or Phone 0044 20 8768 4660

1. European Association of Palliative Care Congress. 6th Research Congress Glasgow. June 2010
Palliative Medicine 2010 v24 no 4 Supplement.

Higginson IJ
Research methodology in bereavement: practical and scientific issues in conducting research in bereavement S18

Oyebode JR, Hassein H, Suhail, K, Aamodt-Leeper G
Influences of religion and culture on continuing bonds after bereavement
(study based in both England and Pakistan) S46

Fitz J, Finlay IG
The burden of bereaved children in society S95

Ellis JE, Lloyd-Williams M,
Supporting parentally bereaved children and their families: findings from a narrative study S142

Grenklo B et al
Did you talk about what was important with your dying parent? Feelings of guilt in bereaved teenage daughters S142-143

2. Abstracts of the 8th Palliative Care Congress Bournemouth March 2010
Palliative Medicine v24 no2 p202-252

Relf M, Machin, L, Archer N, Smale U, Rushton D.
Service development; experiences of implementing the guidance for bereavement needs assessment p248

Poultney J, Wiseman F, Waterhouse E, Faull C.
Why do bereaved carers agree to be involved in medical student education? p211

Relf M, Holly D, Diamond H, Llewelyn S, Bruce C
Aspects of bereavement support perceived as helpful by clients and their support workers p206.

3.9th International conference on death dying and disposal 9-12 September 2009Mortality v14 Supplement Sept 20009.
The abstracts in the journal are in alphabetical order by surname of first author.

Michael Ashby (Royal Hobart Hospital and University of Tasmania)
A snapshot of English grief and bereavement behaviour seen through two short scenes, 40 years apart, from the BBC radio series ‘The Archers’

George E. Dickinson and Heath C. Hoffmann (College of Charleston)
Roadside memorial policies in the United States: a place of identity
for a highway fatality

Vanessa Fredericks (Macquarie University)
Politics and mourning: the subject on trial

Christina Marsden Gillis (University of California, Berkeley)
Seeing and feeling differently: place, art and consolation

Tim Hutchings (Durham University)
Wiring death: dying, grieving and remembering on the internet

Maggie Jackson (University of Teesside)
My father’s hand: an exploration of memory and identity

Aliki Karapliagou (University of Bath)
Bereavement in trauma diasporas

Michele Knight (University of Sydney)
From grief’s Cavern come the voices of the voiceless: bereavement, grief and post-death contact

Vanessa Lockyer-Stevens (Bournemouth University)
Nurse interaction with families following sudden death of their child in
intensive care: an interpretive approach

Samantha Murphy (University of Westminster)
Stillbirth and gender: supporting the social construction of grief

Colin Murray Parkes (St. Christopher’s Hospice, London)
Love and loss: the roots of grief and its complications

Anna Petersson (Lund University)
Individual expression and grief work

Pamela Roberts, Talina Villao, Hortencia Romero and Rozana Ceballos
(California State University, Long Beach)
Travelling tributes: car memorials in Southern California

Liz Rolls (Lancaster University)
Emotional work within UK childhood bereavement services

Alice Scarlin (Durham University)
Harry Potter: death, grief and identity

Caroline Simone (University of Derby)
The liminality of loss: bridging the gap

Margaret Souza (Empire State College)
Bereavement: emotional component of changed roles

Josefine Speyer and Mary Murray
(Natural Death Centre; Massey University)
Grace in grieving: psycho-spiritual transformation through bereavement

M. Sque*, T. Long*, J. Macleod-Clark* and S. Payne{
(*University of Southampton; {Lancaster University)
Gift of life or sacrifice: is organ donation a blessing or burden for bereaved families

Darach Turley and Stephanie O’Donohoe
(Dublin City University; University of Edinburgh)
The loss adjuster: the year of magical thinking and the role of consumption
in meaning reconstruction

Christine Valentine (University of Bath)
Emotion, identity and the good death in the narratives of bereaved Japanese people

The 4th editions of two classic texts

2010-02-16T07:08:00.000-08:00

Parkes Colin Murray, Prigerson Holly G
Bereavement. Studies of grief in adult life. 4th edition
Routledge 2010.

In this book the author has broadened the content and involved a second author who is an expert on complicated grief. It is a text for health professionals but also for bereaved people.
Contents include:
Bowlby, Foreword to the First Edition. Lifton, Foreword to the Fourth Edition. Acknowledgements. Introduction. The Cost of Commitment. The Broken Heart. Trauma. Attachment and Loss. Mitigation. Anger and Guilt. Changing the Assumptive World. Complicated Grief. Determinants of Grief I: Kinship, Gender and Age. Determinants of Grief II: Mode of Death. Determinants of Grief III: Personal Vulnerability. Determinants of Grief IV: Social, Religious and Cultural Influences. Helping the Bereaved I: Bereavement Support – History and Evaluation. Helping the Bereaved II: Types of Help for Types of Problem. Helping the Bereaved III: Sources of Help. Reactions to Other Types of Loss. Disasters. Appendices. Organisation in the UK and USA Offering Help to Bereaved People. Recommended Further Reading. References

Worden William J.
Grief Counselling and grief therapy. A handbook for the mental health practitioner. 4th edition 2010

The fourth edition of this textbook has just been published and Worden continues to add information on new theories of grief and bereavement.
Contents include:
Attachment, Loss, and the Experience of Grief. Understanding the Mourning Process. The Mourning Process: Mediators of Mourning. Grief Counselling: Facilitating Uncomplicated Grief. Abnormal Grief Reactions: Complicated Mourning. Grief Therapy: Resolving Complicated Mourning. Grieving Special Types of Losses. Grief and Family Systems. The Counsellor's Own Grief. Training for Grief Counselling

2010-01-14T04:06:00.000-08:00

Report on a conference - ongoing projects in bereavement care in
hospices in the UK

Help the Hospices (a national organisation for hospice care in the UK) recently held their biennial conference in Harrogate. Two aspects of the conference are worth bringing to your attention.

Firstly:

There was a session on organisational challenges for today and tomorrow in delivering bereavement care. This was by Una Smale, Nikki Archer and Sharon Cornford.

Linda Machin delivered a presentation on service development: experiences of taking the “guidance for bereavement needs assessment” into practice.

Patsy Way delivered a talk on working with a young child in Candle, the child bereavement service at St Christopher’s Hospice.

These presentations are available by keying in the authors’ surname on the query box on this page:

http://www.helpthehospices.org.uk/our-services/running-your-hospice/education-training/2009conference/programme/

Secondly:

The following presentations were in poster form:

Promoting excellence in the training of bereavement volunteers
Hilary Minter, Hartlepool and District Hospice, Hartlepool
Ann French, University of Teeside, Middlesborough

Effective positive change with bereaved service users in a palliative care setting
Audrey Agnew, Marie Curie Cancer Care, Belfast
Joe Duffy, Department of Sociology, Queen’s University Belfast

COSTAL – adult group therapy programme following bereavement
Rebekah Clitherow, Susan Salt. Trinity Hospice and Palliative Care Services, Blackpool

Children and young people’s bereavement link project
Rebekah Clitherow, Susan Salt. Trinity Hospice and Palliative Care Services, Blackpool

Living with grief – a series of meetings for people who have been bereaved
Smale Una, Simon Spence, Highland Hospice, Inverness.

The conference took place in Novemberr 2009 at Harrogate Conference Centre. It is interesting to see some documentation on the variety of projects taking place in the UK in bereavement care.

6 items - 6 months!

2009-10-15T07:38:00.000-07:00

Bereavement Care. The journal

This journal is now published by Taylor and Francis. It still retains its links with CRUSE. It continues to be reasonably priced and its editor, Colin Murrary Parkes, provides continuity. However, for the fist time it is now also possible to have an online subscription.

http://www.crusebereavementcare.org.uk/ber_care.htm

Macmillan Cancer Support

There are two booklets available from Macmillan Cancer Support for care homes that would like to provide some training for their staff in bereavement care. They can either be ordered in print form or are available for download free of charge:

http://be.macmillan.org.uk/be/s-206-learning-resources-and-courses.aspx

If there is anything I can do….

Doughty Caroline
White Ladder Press 2007

This is written for those who would like to help someone who has been recently bereaved. It is particularly aimed at young parents with children and provides many concrete suggestions on how one might be able to them. The author is herself an expert as she has had to live through this experience and she has done so with the help of many people who have also been widowed. She met many of them through the WAY foundation, a support group for people widowed under 50. I think this is a refreshing book as it closely involves both the bereaved and those who have helped them.

http://www.wayfoundation.org.uk/index.htm

National Council for Palliative Care

National survey of patient activity data for specialist palliative care services.
MDS full report for the year 2007-2008.
NCPC (Dec) 2008

This is an annual publication by the National Council for Palliative Care and collates information on palliative care services in England, Northern Ireland and Wales.

There is a section in this document on bereavement services. It states that 278 bereavement services were listed in the Hospice Directory in this area in 2008. Data was received from 171 services. The type of contact was given by 56% services and 70% of contacts were either in the home, or as individual counselling. The main staff member for each of the contacts was given by half of all services and this showed that nearly half of all contacts were with a social worker or counsellor, 5% with a CNS and a third with a volunteer. A table on the services is also provided. This shows the actual and the mean number of clients seen, the number of contacts, contacts per client, the contact type, the staff type for each contact (eg social worker, clinical nurse specialist or volunteer) and the number of telephone calls that had been noted.

Financial Implications of Death of a Partner

by Corden, A., Hirst, M. and Nice, K.
Social Policy Research Unit, University of York, 2008

This research report investigates the economic and financial consequences of bereavement for a surviving spouse or partner and their household, using a mixed methods, prospective design. The study involves a quantitative element based on longitudinal analysis of the British Household Panel Survey, and a qualitative element comprising personal interviews with people at different life stages whose partner has died.

http://php.york.ac.uk/inst/spru/pubs/1148/

Evaluation of a bereavement evening service in a London hospice

Heal, Rosanna, Hartley Nigel.
Abstracts of the 11th Congress of the EAPC, Vienna 2009. p62.

Bereaved relatives are invited by a London hospice to attend an evening event about 3 months after the death of a patient. This consists of a) a talk by a member of staff at the hospice on common responses to bereavement b) group discussion.

The events take place each month and all those who attended the meetings over a 5 months period (n=105) and all those who had been invited to the meetings but did not attend (n=436) were asked to complete a questionnaire.
Overall the bereavement evenings were valued by respondents who participated and even those who did not attend appreciated being invited, seeing it as further evidence of the care extended to them by the hospice.

(The book by Caroline Doughty is available from the bookshop at St Christopher’s Hospice and the full report of the MDS data is in the library at St Christopher’s Hospice. A fuller abstract by Rosanna Heal is also available from the library. Contact me if you would like further details or have any other literature queries regarding bereavement. d.brady@stchristophers.org.uk or ph: 020 8768 4660)

One key text and one themed journal issue:

2009-04-28T01:46:00.000-07:00

BOOK

Stroebe M, Hansson RO, Schut H, Stroebe W (eds)

Handbook of bereavement research and practice. Advances in theory and intervention.

American Psychological Association 2008

The table of contents, which includes many renowned researchers in this area, is available from:

http://books.apa.org/books.cfm?id=4318045&toc=yes

This is almost the equivalent of the the third edition of an edited book published by most of these authors. However, each title has had a slightly different name. The first was Handbook of bereavement (Cambridge University Press 1993), and the second was Handbook of bereavement research. Consequences, coping and care (American Psychological Association 2001)

THEMED JOURNAL ISSUE

One of our doctors spotted a themed issue on bereavement in Psychiatric Annals. It is on bereavement-related depression. (October 2008). Details are available at

http://www.psychiatricannalsonline.com/view.asp?rid=32100

(The book is in the bookshop of St Christopher’s Hospice. We offer a copying service for articles. Email me: d.brady@stchristophers.org.uk

A pack, a booklet, a book

2009-02-09T06:46:00.000-08:00

CRUSE Bereavement Care
What to do following a death
Lawpack Publishing Ltd 2007

This Lawpack Kit, published in conjunction with CRUSE, contains information and advice to help bereaved people cope with both the administrative procedures and the emotions of bereavement following the death of a loved one. The information has been carefully compiled from reliable sources but there could be minor changes since publication. It includes ideas on how to prepare for a funeral.

British Association for Counselling and Psychotherapy
Ethical framework for good practice in counselling and psychotherapy.
Revised edition.
BACP, 2007

This 16 page booklet provides key principles for anyone working with clients or supervising counselling services. It incorporates key values, ethical principles, personal moral qualities, guidance on good practice, providing a good standard of practice and care, working with colleagues, professional conduct procedure, dealing with complaints.

Machin Linda
Working with loss and grief
Sage 2009 £18.99

In the introduction, the author indicates she will use the metaphor of journey to describe and explore the experience of grief. She elaborates on the metaphor by conceptualising theory as a “compass” and a new practice model as a “map”. She is concerned with capturing aspects of the universal as well as the individual aspects of grief – and with exploring their complementary roles as one helps bereaved people with their losses.

Chapter headings include Exploring the landscape of loss, Establishing theoretical and therapeutic bearings, Mapping grief, Listening to personal grief narratives with a focus on both vulnerability and resilience. The final chapter emphasises the responsibilities of practitioners to their clients as well as an awareness of the need for professional support to enable practitioners to maintain their own resilience and resourcefulness.

(available from bookshop at St Christopher’s Hospice Ph: 020 8768 4660
Email: d.brady@stchristophers.org.uk)

Update on bereavement research

2008-11-19T03:12:00.000-08:00

The most recent edition of the journal Grief Matters (Autumn 2008 v11 no1) coincided with the hosting of the 19th International conference on Grief and Bereavement in Melbourne Australia in the summer this year.

Articles include:
Stroebe Margaret S, Schut Henk
The dual process model of coping with bereavement: overview and update p4-10

Bonanno George A
Grief, trauma and resilience
p11-17

Neimeyer Robert A, Currier Joseph M
Bereavement interventions: present status and future horizons
p18-22

Prigerson Holly G, Vanderwerker Lauren C, Maciejewski Paul K
A case for inclusion of prolonged grief disorder in DSM-IV
p23-32

Mikulincer Mario
An attachment perspective on disordered grief reactions and the process of
grief resolution
p34-37

New books from the Dyregrovs

2008-09-30T09:13:00.000-07:00

Atle and Kari Dyregrov have completed many research studies in bereavement, mainly in Norway. These span a diverse age group and include research on bereavement in a variety of circumstances.

Dyregrov Atle
Grief in young children
Jessica Kingsley Publishers 2008

This is probably the first book on bereavement for pre school children.

Contents: 1. What Is grief? 2. What can be done to help children who have suffered a loss? 3. Children's participation in rituals. 4. How do children process what has happened over time? 5. Supporting children over time. 6. Advice to parents. 7. Specific advice. 8. Conclusion. Resources. Bibliography. Index

2008 has also seen a new edition of the book

Dyregrov, Atle
Grief in children. A handbook for adults. 2nd edition.
Jessica Kingsley Publishers 2008

Contents: 1: Children’s reactions to grief and crisis. 2: Different types of death (sibling, parent, grandparent, friend, suicide.) 3: Death and crisis at different developmental levels. 4. What makes grief worse? 5. Sex differences in children’s grief. 6. Care for children in grief and crisis (including viewing dead bodies, funerals, cremation). 7. Guidelines for taking care of children’s needs.
8. Handling death in the playgroup and at school. 9. Crisis-or-grief-therapy for
children. 10. Bereavement groups for children. 11. Caring for oneself.

In addition they have recently written

Dyregrov Kari, Dyregrov Atle
Effective grief and bereavement support. The role of family friends, colleagues,
schools and support professionals.
Jessica Kingsley 2008

Contents: 1. Introduction. 2. How does sudden death affect the close bereaved? 3. What types of support do the bereaved encounter and what do they want? 4. Children and young people - Their situation and help needs. 5. How does sudden death affect social networks? 6. Social network support - Challenges and solutions. 7. The main principles behind good network support. 8. What kinds of support can family and friends give? 9. What kind of support can the school and workplace provide? 10. When should professional help be brought In? 11. Support for the social network. Appendix. References. Subject Index. Author Index.

(All are available from the bookshop at St Christopher’s bookshop d.brady@stchristophers.org.uk)

A book, a report, an organisation…

2008-09-01T03:05:00.000-07:00

Hooyman Nancy R, Kramer Betty J.
Living through Loss. Interventions
across the lifespan.
Columbia University Press, 2006

This is an ambitious book written from the perspective of social work. General chapters focus on theories of grief, processes of grief, resilience, meaning making and self care.
The authors have divided the lifespan into five categories – childhood, adolescence, young adulthood, middle adulthood and older adulthood. Two chapters are devoted to each age group – one identifies issues that particularly pertain to that age group and the other details appropriate interventions for them. There are various useful charts and tables scattered throughout the text eg a summary of recommendations for grief counsellors, given current empirical evidence. This is a book worth dipping into!

Department of Health (UK)
End of life strategy
Department of Health 2008

Throughout the report there is great emphasis on practical and emotional support of patients and their carers and on the provision of information at all stages of dying through to bereavement. In fact this is one of the ten key objectives in the report. There is almost no mention of counselling per se in any part of the document.

Various examples of good bereavement support are provided. They tend to focus on the immediate aftermath of a death. The needs of bereaved children are mentioned a number of times.

In the measurement framework, the importance of education and training for health and social care and widespread provision of appropriate information on bereavement is regarded as vital. The number of carers supported by care after death on the Liverpool Care Pathway will be regarded as a measure of progress and measures of outcome will be assessed by carers’ reports of their own experience of support and care after bereavement.

The kind of training needed to support bereaved people in the aftermath of either a sudden or unexpected death is not provided. However, research into models of bereavement care is suggested.

It is also suggested that occasions of remembrance should be organised to help and support bereaved people. At these events, information about bereavement support should be available and further opportunities provided for people to self refer to bereavement services. The full report can be accesed via:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086277

Bereavement Research Forum.

This UK based organisation provides a forum for interested professionals to discuss, promote and develop bereavement research. Its website provides information on its own conferences as well as on other key bereavement conferences in the UK, useful research sites and some recent publications.

http://www.brforum.org.uk/

6 items for 6 months.....

2008-05-28T00:59:00.000-07:00

The aim of this blog is to highlight just one item per month which might prove interesting to professionals involved in bereavement care. On this occasion, as the blog has not been done for 6 months, you are referred to 6 items! The first is a book. The next four are chosen from a select review of articles cited on CINAHL, PsychLit and Medline for 2007. The last is an abstract from a new journal on end of life care which is published in conjunction with St Christopher’s Hospice.

One of the most recent useful publications on bereavement has been made available online:
Relf Marilyn, , Machin Linda, Archer Nikki.
Guidance for bereavement needs assessment in palliative care
Help the Hospices 2008
http://www.helpthehospices.org.uk/servicedev/downloads/bereavement_needs_assessment_guide.pdf

Reviewing the stages of grief in a new way:
Maciejewski PK, Zhang B, Block SD, Prigerson HG
An empirical study of the stages of grief
JAMA. 2007;297:716-723.
Full text
http://jama.ama-assn.org/cgi/content/full/297/7/716
(Many of JAMA articles are available free of charge electronically after 1 year. Comments on the article were made in the journal but are not yet available free electronically in full text. An erratum on a confusing sentence has also been published)

Another article published in the last year is now available online free of any fees:

Lautrette A, Darmon M, Megarbane B, Joly LM, Chevre ST, AdrieC, M.D et al.
A communication strategy and brochure for relatives of patients dying in the ICU
New England Journal of Medicine 2007; 356: 469-478

http://content.nejm.org/cgi/content/full/356/5/469

(The value of written information is confirmed in this research)

The following provide links to abstracts only though all will be available from the library at St Christophers’ Hospice

Currier JM, Holland JM, Neimeyer RA
The effectiveness of bereavement interventions with children: a meta-analytic review of controlled outcome research.
Journal of Clinical Child and Adolescent Psychology 2007; 36(2): 253-9
http://www.ncbi.nlm.nih.gov/pubmed/17484697

Moules NJ, Simonson K, Fleiszer AR, Prins M, Glasgow B
The soul of sorrow work: grief and therapeutic interventions with families
Journal of Family Nursing 2007; 13(1): 17-41

http://www.ncbi.nlm.nih.gov/pubmed/17220385

Platts R, Gray C, Vora V, Park J
The Teddy Bear scheme- supporting children and their families as they prepare for loss and bereavement.
End of Life Care 2008;2(2);78

This is the abstract of a poster presented at the recent 7th Palliative Care Congress in Glasgow. It is a project at St Luke’s Hospice in Sheffield which aims to ensure that children feel welcome and included when they visit the hospice. It centres on the imaginative use to which a teddy bear and a rucksack can be put, in enabling meaningful communication between patients and their young visitors.

Any queries, contact d.brady@stchristophers.org.uk

A collection of papers, a collection of books, a website

2007-11-28T07:49:00.000-08:00

A collection of papers, a collection of books, a website

It is useful to bring together a series of papers on one important piece of research. The following are references to a recent major study on adult bereavement services in the UK:

Field D, Payne S, Relf M, Reid D
Some issues in the provision of adult bereavement support by UK hospices. Social Science Medicine, 2007 vol. 64, no. 2, p. 428-38.

Reid D, Field D, Payne S, Relf, M
Adult bereavement in five English hospices: types of support. International Journal of Palliative Nursing, 2006 vol 12, no. 9, p. 430-7

Reid D, Field D, Payne S, Relf, M
Adult bereavement in five English hospices: participants, organisations and pre-bereavement support. International Journal of Palliative Nursing, 2006 vol. 12, no. 7, p. 320-7

Field D, Reid D, Payne S, Relf M
Survey of UK hospice and specialist palliative care adult bereavement services. International Journal of Palliative Nursing, 2004 vol. 10, no. 12, p. 569-76

Reflections on this type of research is discussed in:

Payne S, Field D, Rolls L, Hawker, S, Kerr C
Case study research methods in end-of-life care: reflections on three studies. Journal of advanced nursing, 2007, vol. 58, no. 3, p. 236-45

The Irish Hospice Foundation has a generous offer:

Delaney Susan (ed)
Irish stories of loss and hope
Irish Hospice Foundation 2007

This is a book of personal experiences of bereavement. Many types of bereavement are described and the writers reflect on a great variety of relationships that they have lost through death – from their own newly born infants to much loved elderly relatives. It is very well produced with colourful photographs and paintings. If you want to obtain it for clinical work, the librarian is happy to send it to you free of charge. Alternatively you can purchase it for personal use or as a gift. In that case, the cost is £7 including postage. Other new publications from the IHF are:
Bereavement at work by Breffni McGuinness. Free of charge
Lifestory. A journal where people record their own lifestory €40.00
Design and Dignity Baseline Review. Hospice Friendly Hospitals Programme Free of charge
Contact Caroline Pfeifer., Librarian, Irish Hospice Foundation. Phone 003531 6793188 or email: Caroline.pfeifer@hospice-foundation.ie

A website

http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Bereavement/Bereavementgeneralinformation/index.htm

This section of the Department of Health website in the UK provides some recent additions to their resources on bereavement – one is Bereavement: A guide for transsexual, transgender people and their loved ones. The second is a leaflet on neonatal loss: Devastating loss. Other key documents on the subject are avalable through this page and also via the drop down menu on the left hand side. Click on bereavement

A critique, a newsletter, a new directory

2007-08-07T00:55:00.000-07:00

Larson Dale, Hoyt William T
Deterioration effects in grief counseling: in search of the evidence

This is the Powerpoint presentation of a talk given at a National Hospice and Palliative Care Organization conference in the US in April 2006.

It is primarily a critique of the research cited in the US Center for the Advancement of Health(2003) publication titled Report on bereavement and grief research. (Cited elsewhere in this blog). This report suggests that bereavement counselling can often be regarded as ineffective and can even produce negative effects. In particular, Larson and Hoyt query the reliability of the TIDE statistical procedure which was originally used by Fortner in 1999 to complete a doctoral dissertation on the effectiveness of grief counseling. Larson and Hoyt’s study suggests that the negative views of grief counseling which have been given credence by researchers such as Fortner cannot be substantiated.

view Dale Larson’s publications page on
http://www.scu.edu/Hospice/
and then click on link to Deterioration effects in grief counseling
http://www.scu.edu/Hospice/larson_hoyt_nhpco_grief_counseling_panel06.pdf
Follow up with a press release that summarises an article soon to be published on their own analysis of bereavement research studies
http://huehueteotl.wordpress.com/ (Accessed 6th August 2007)

As a librarian, it is very satisfying to find a requested article freely available on the web. In the last week someone asked me for an article called Touching souls: healing with bereavement photography. This was in volume 29 no 2 of Forum. I found that Forum is the newsletter of the Association for Death Education and Counseling. 12 of these newsletters are available online at

http://www.adec.org/resources/Forum_articles.cfm

The Directory of Bereavement Services in the UK 2007 has recently been published by Cruse Bereavement Care, Help the Hospices and Resource Information Service.
A directory of national bereavement services was published in 1992 by the National Association of Bereavement Services. It is now well out of date and it is to be hoped that the partnership that has published this new directory will be able to maintain its currency over the coming years. (Cost £25).

2007-04-12T01:44:00.000-07:00

Joanna Briggs Institute (2006).
Robert Gordon Institute, University of Aberdeen (Accessed 2nd April 2007))

http://www.rgu.ac.uk/nursing/research/page.cfm?pge=41757

Literature Review - Bereavement Care Executive Summary
Literature Review - Bereavement Care

This report is based on an extensive literature review of all aspects of bereavement. It considers bereavement across the life span, specific areas of risk and challenge and the various types of interventions that assist bereaved people. The authors suggest that consideration should be given to establishing a ‘Centre’ (virtual or otherwise) for bereavement care in Scotland, which develops research, in conjunction with practice and education and could provide co-ordinated activity to enhance care.

Consultation and Mapping - Summary Report
Consultation and Mapping - Full Report

The institute have also conducted a mapping exercise which outlines the nature of bereavement support in Scotland. The mapping exercise involved interviewing previous contacts identified as sources of information for the literature reviews and in turn, asking them to recommend other people involved in the field. 59 people from 15 types of service were interviewed and this has produced a broad indication of the extent of bereavement support in Scotland at the current time.

Thanks to Orla Keegan, Irish Hospice Foundation, for identifying this report is available online and to the institute for being so generous in making it freely available

Love and loss. The roots of grief and its complications

2007-01-19T01:39:00.000-08:00

Parkes Colin Murray
Love and loss. The roots of grief and its complications
London: Routledge 2006. 430 pages

This work rigorously examines the relationship between secure and insecure attachments in childhood and the related subsequent reactions and experiences of grief when one is bereaved through death. It is based on a statistical analysis of replies to a questionnaire on a wide range of events in a population of 278 people who attended a psychiatric outpatient clinic where the author worked. Comparison is made with a control group. Major sections discuss a)attachment and loss b)patterns of attachment and patterns of grief c)other influences on attachment and loss d)disorders of attachment, other psychiatric problems and their prevention and treatment. The appendices are exhaustive and provide detailed statistical analysis.

The evidence concludes that patterns of attachment developed in childhood have a profound influence on the way people grieve. The text includes many case studies as well as varied reflections on the psychotherapeutic process.

The final paragraph comprises a fascinating analogy between love, loss and music.

Traumatic bereavement. Complicated grief. NLH.

2006-10-24T09:04:00.000-07:00

Three new resources:

1. National Health Service.
Help is at hand. A resource for people bereaved by suicide and other sudden traumatic death. 2006

This 46 page guide is aimed at bereaved people. It covers four main areas;
1) Practical matters eg inquests and investigations, the funeral, wills and estates
2) Experiencing bereavement eg early grief and mourning, emotions during
bereavement, the particular difficulties of bereavement due to
suicide
3) Bereaved people with particular needs eg parents who lose a child
children and young people, older people, lesbian and bisexual people,
people with learning difficulties
4) How friends and colleagues can help eg friends, employers, teachers

There is a short section on the impact of a death on health and social care
professionals, a reading list for bereaved people and a list of bereavement
organisations. There will be elements of the book which may be helpful to
both bereaved people and health professionals working in the field of
bereavement.

http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4139006&chk=hB9GCa

2. Department of Health and Ageing. (Australia)
A systematic review of the literature on complicated grief. 2006

This review covers 88 research studies that impact on the nature of complicated grief. It is a detailed report covering theoretical perspectives, various measures of grief, traumatic death, risk assessment and various types of intervention. The report concludes with a summary and 27 recommendations. The appendix includes a table of summaries of each of the research studies. This is a document which complements other recently published material on complicated grief. As with other studies on the subject it points to the complexities of assessing effectiveness of grief counselling. It also considers how complicated grief can be related to DSM-V (Diagnostic and Statistical Manual of Mental Disorders)

http://www.health.gov.au/internet/wcms/publishing.nsf/Content/palliativecare-pubs-rsch-grief

National Library for Health. Palliative and Supportive Care Library.
Bereavement services. 2006

I have compiled this using a template provided for the National Library for Health Specialist
libraries . It is an introductory article illustating how the search was conducted and pointing to some key documents. Comments to me (d.brady@sthristophers.org.uk) and/or to the Information Specialist for the the Library (r.j.stevens@sheffied.ac.uk) would be welcome. This could range from queries on the search itself, key documents you consider should be included, how the information on bereavement on the site could be improved etc.

http://www.library.nhs.uk/palliative/ViewResource.aspx?resID=126800&tabID=290&catID=9275

Adult bereavement in five English hospices

2006-08-31T08:51:00.000-07:00

Reid David, Field David, Payne Sheila, Relf Marilyn

Adult bereavement services in five English hospices: Participants, organisations and pre-bereavement support

International Journal of Palliative Nursing 2006 v12 no7 p320-327

This encompassed in-depth organisational case studies of five English hospices. It involved qualitative interviews, focus groups and scrutiny of documentary material at each of the five hospices. Both staff and bereaved people participated in the research.

All the hospices made contact with bereaved relatives or main carers shortly after the patient’s death. All provided some information on practical and emotional aspects of bereavement. There were no formal risk assessments but all had processes to identify people who might benefit from bereavement support. Pre-bereavement support and continuity between this and bereavement support were important aspects.

A major conclusion is that a clear and explicit rationale for bereavement support activities is a pre-requisite for the development of a cohesive and integrated programme of support to help resolve difficult decisions about individual bereaved people. Pre-bereavement support by hospice staff positively contributes to the person’s experience of bereavement. Hospices should address the issue of providing the appropriate level of bereavement support.

NICE guidelines, bereavement and information.

2006-07-18T08:29:00.000-07:00

Some abstracts from the 6th Palliative Care Congress in Sheffield 5-7th April 2006

Payne S, Reid D, Field D, Relf M
Adult hospice bereavement support: “NICE ” or not quite “NICE” yet?
Palliative Medicine 2006 v20 no2 p141

NICE guidance on palliative and supportive care recommends a three tier model of bereavement support. This paper explores the extent to which five hospice services in the UK fulfil these criteria. Qualitative data was collected and analysed using a variety of methods, mainly with hospice staff and bereaved services users. The total sample involved 301 people.

All the services appeared to provide NICE Level 1 services, including pre-death family care by nurses and other staff. All services provided a mixture of social and therapeutic activities at NICE Level 2 which bereaved people had a choice to take up. However, there was little evidence of NICE Level 3 provision for those with complex needs and access to external services was not readily available.

It appears that these hospice bereavement services were fulfilling Levels 1 and 2 but do not have the capacity to provide Level 3 support.

Another presentation was not explicit about adhering to the NICE guidelines. Chowns G, Bassey S, Jones A “It’s the truth, so keep it in”: researching collaboratively with children of seriously ill parents . (Palliative Medicine v20 no 2 p133-4). The findings indicated that children wanted to know the truth about parental illness, but wanted to be told earlier rather than later. Factual information was also prized. Thus this would appear to be providing the Level 1 tier on bereavement service provision of the NICE guidelines. It has a link with both the previous and following abstract.

McNulty A
Is the NICE guidance on bereavement support setting the bar too low?
Palliative Medicine 2006 v20 no2 p152-3

This forms part of a larger study on comparing bereavement support after home or hospice death. This study looks at Level 1 - that of information provision - of the 3 tier model for bereavement service provision in the NICE guidance, it being the minimal objective of all supportive and palliative care providers. There are various strands to the study. However, 5 focus groups (number 20 people ) revealed complex information needs including the pattern of grief, funeral arrangements and benefits advice. Written information was supportive. However, participants greatly valued personal contact as a source of information. This included discussions with staff involved in patient care through to sharing experiences with others. Conversely poor/absent information resulted in stress and anxiety.
The conclusion emphasised that information is one of the immediate and wide ranging needs for the bereaved. Nevertheless provision differs across services. Hospices appear consistently to offer information, yet written information is impersonal, compared to verbal contact. However, both service types offered far more than this single intervention. For this reason, the NICE guidance is a step in the right direction, but has the potential to develop further.

Reference: Chapter 12 in http://www.nice.org.uk/page.aspx?o=csgspfullguideline

Report on bereavement and grief research

2006-04-28T10:36:00.000-07:00

http://www.cfah.org/pdfs/griefreport.pdf

This excellent report published by the US Center for Advancement of Health contains the summary of an extensive literature review on research on bereavement. It also illustrates how research can be used to improve care.

It was published in an issue of Death Studies but the full version is also available on the above website.

Sorrow and solace. The social world of the cemetery

2006-04-04T10:57:00.000-07:00

Bachelor Philip
Sorrow and solace. The social world of the cemetery
Baywood Publishing Company, 2004

Though published in the US, this book is based on research in a cemetery in Australia. The author says “ large urban memorial parks are literally hives of activity by recently bereaved persons, and they hold a place among the most visited places in Western communities.” This study is about their importance to mourners and ways in which people draw meaning and value from their commemorative activities when they visit cemeteries. As we approach Easter, one can see this reflected in British graveyards when brightly coloured flowers can often be seen on many graves.

The book commences with some details on cemeteries, attitudes to death today, theories of grief and current research on the subject of bereavement.

The second section covers visitation patterns as well as social and cultural factors which affect grave visitations. For example, the author discovered distinct national variations in visitations. He also found that there is a greater total volume of visits made to graves of parents while graves or memorials of spouses and children receive more frequent visits.

The third section covers various issues around the experience of being bereaved and the emotions surrounding visiting a graveyard. Two primary emotions were identified. The first, not surprisingly, was sorrow but the second was solace. Through regular visitation soon after a loss, for most people, the cemetery progressively transforms from a “burial” place to a “healing” place. The reasons for visitations, their frequency, the activities when visiting (eg placing flowers, crying, prayer) are also described, as are reasons for non-visitation. This is a unique book and the author provides a great deal of short extracts from people who were interviewed for the study.

Philip Bachelor has also written a simpler book:
Life after death. Understanding bereavement and working through grief. 24 real life stories
Melbourne: Hill of Content 2002
(For specific aspects of bereavement, do consider contacting me for references from the library at St Christopher’s Hospice:
d.brady@stchristophers.org.uk)

PARENT EDUCATION PROGRAMME

2006-03-02T03:44:00.000-08:00

Christ Grace H, Raveis Victoria H, Siegel Karolynn, Karus Daniel, Christ Adolph
Evaluation of a preventive intervention for bereaved children
Journal of Social Work in End-of-Life and Palliative Care v (3) 2005

184 families completed a 12 month parent-guidance (experimental) or a parent telephone-monitoring (comparison) intervention initiated during one parent’s terminal cancer illness and continued until 6 months after the death.
The parent guidance intervention was designed to span about 12 months and included 6 or more 60-90 minute therapeutic interviews by experienced social workers during the terminal stage of the illness and six or more after the death. Ways of handling emerging problems with the children and current approaches to communication about the terminal illness were also discussed at each meeting.

Children in the parent-guidance intervention reported greater reduction in trait anxiety and greater improvement in their perceptions of the surviving parent’s competence and communication, a primary goal of the intervention. Of interest is the fact that 16% of the study children came from minority families and these were not included in the quantitative analyses as it was considered that there was an insufficient number of families of any one minority to analyse separately.

Various problems in implementing evaluations of experimental interventions with bereaved children include the following: a)available and commonly used standardised psychopathology measures do not adequately capture changes in non-psychopathological but bereaved distressed, grieving children and adolescents b) small changes in scores within the normal range
may be insufficient to allow measurement of meaningful differences between interventions. c)both experimental and control interventions must provide sufficient help to retain families for later evaluation.

Also of note is the fact that the level of general support and referral for other treatments, if adequately done, may be sufficient to blur differences in standardised psychopathology measure scores between any two interventions. It may only be in the specifically targeted intervention area that differences can be expected to be significant. This is, in fact what did happen.
Supportive care for parents was valued by them. The service was offered in the home and the authors consider the focus on patient education, rather than a more emotion-focused approach, fostered a more realistic understanding of the complex situation. Suggestions for improvement included more sessions with parents after the 6 month period, as they felt they were just beginning an intense period of their own grieving at that time – some would have liked more group work and some would have liked the children to have been seen more frequently by clinicians.This highlights the difficulty of using psyschological measures to capture positive change, yet it also highlights the helpfulness of such intereventions.
(Article available from library – email: d.brady’stchristophers.org.uk)

Bereavement Risk Index

2006-01-31T10:31:00.000-08:00

Kristjanson Linda J, Cousins Kerry, Smith Joanna, Lewin Gill
Evaluation of the Bereavement Risk Index (BRI): a community hospice care protocol
International Journal of Palliative Nursing 2005 v11 no12 p610-618

This reports on a study in an Australian hospice which examined the Parkes’ Bereavement Risk Index . This index comprises 8 items and was instigated in this hospice as a more precise outcome measure than simple observation of the bereaved person’s level of risk. Other instruments were also used to assess bereavement outcome for the purpose of this study.

172 bereaved family members were contacted to participate in the research. 150 individuals (87%) agreed to participate which examined the validity of the index.

Details of the bereavement risk index questionnaire is included in the article and the most interesting finding of the analysis is that 4 items were sufficient to assess risk of a complicated bereavement – a) clinging or pining behaviour, anger, self-reproach and a general opinion of how the well the bereaved person is likely to cope. The advantage is that the questionnaire is easier to complete than the longer version. The article also describes how the risk assessment is used to assist nurses to help bereaved people, in the absence of other available services.

Department of Health (UK). When a patient dies. Advice on developing bereavement services in the NHS . 2005

2005-12-01T09:39:00.000-08:00

Department of Health (UK). When a patient dies. Advice on developing bereavement services in the NHS . 2005

This document could seem a misnomer to some people involved in bereavement service provision in the UK. It is not about setting up a bereavement service to provide support to people some time after a death. It is about caring for dying and bereaved people in the days leading up to a death and in the immediate aftermath. It is aimed at good practice in NHS trusts.

The first section of the report provides advice on developing these services, mainly in a hospital service. It highlights the need for staff training in communication skills in order to provide a sensitive service. It also stresses the need for relevant information and for the provision of appropriate facilities eg private rooms for breaking bad news. It emphasises the need for staff support. It considers that a post should be created in each Trust to coordinate this service across the whole range of staff who have to deal with deaths in a hospital, this to include coordinating activity with outside agencies eg primary care trusts and voluntary organisations.

The second section suggests some practical solutions in developing these services eg ideas on how to return a patient’s property with dignity and flexible opportunities to view the deceased in the time after death, both on the ward and in the mortuary.

The NICE guidelines are mentioned in the context of the different levels of bereavement support that could be needed after a death - http://www.nice.org.uk/page.aspx?o=110005. However, the report goes into little detail about helping bereaved people who may need further support.

The report is available at:

http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4122191&chk=qAmIhT

A report on the current state of this type of service is available at:
http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4115879&chk=t1MSbi

A book and an article on bereaved parents

2005-10-20T10:21:00.000-07:00

Tedeschi Richard G and Calhoun, Lawrence G
Helping bereaved parents. A clinician’s guide
Brunner-Routledge, NY, 2004

This book provides a comprehensive overview of working with bereaved parents. The chapters are a)the experience of grieving parents b)grief perspectives models and myths c)a general framework for intervention d)bereaved parents and their families e)circumstances of the loss f)spirituality and religion g)issues for the clinician h)bereaved resources for bereaved parents and their expert companions. This last phrase “expert companions” is one which describes their work with parents and this seems a fitting way of thinking about working with bereaved people in other situations, also. Their use of recorded interviews within the text is also a useful way of illuminating interactions in work with bereaved people.

The profound importance of groupwork for many bereaved parents is also emphasised.

Clinton, J
“I can’t cope with life, I’m too different”
Medical Humanities (an edition of J Medical Ethics) 2004 v30 no1 p 50-51

This an account of the life of the author’s son, Robbie. He went both to special and mainstream schools as he was slightly brain damaged – throughout his life, he was often “on the edge” of groups and was, at times, subject to bullying. In his late teens, when his peers were happily becoming more independent, he started drinking heavily. His parents could not cope – in fact their marriage partly failed on the basis that they could not agree on how to manage him – and eventually he committed suicide dramatically. He died in 2001 and his mother wrote the article as a cathartic experience and after redrafting it, she considered it made her feel more “whole”. There must be many people who have children who live, or who have died outside “mainstream” society, and for whom there is constantly great anguish. This article may be helpful to parents or health professionals working with them.

In the library at St Christopher’s Hospice, we can assist with literature searching and book or articles suggestions for particular needs. Please contact me for details. d.brady@stchristophers.org.uk

2005-08-31T09:56:00.000-07:00

Beale EA, Sivesind D, Bruera E
Parents dying of cancer and their children
Palliative and Supportive Care 2004 v2 no4 p387-393

This article reviews 28 children who had been referred to a palliative care centre for assessment by their parents. The purpose was for assessment and intervention because one of their parents was terminally ill. The article commences with a literature review and various references to other studies on bereaved children are made at a number of points in the text.

The method involved interviews by either a child psychiatrist or a nurse specialist with each child. The children were asked a series of questions to provide an indication of their emotional state – eg the extent to which they needed reassurance, anger about abandonment, aggressive behaviour. Of 11 emotional domains the highest was for seeking reassurance (82%) and the lowest was fear for own health (18%). Only 14 had more than one interview which largely involved support, exploring emotions and reframing their perceptions. Three case studies are described with descriptions of drawings the children completed during the interview. The youngest child was 3 and showed a great understanding of her mother’s condition.

From the literature , the authors suggest six themes relevant both to the short and long term care of children with a parent with terminal cancer, the last of which would be probably be contested by health professionals. The authors suggest that meeting with a mental health professional provides an avenue for supportive discussions, which can model for the family how discussion can be conducted to clarify issues, dispel fears, bring people together, or plan for the future. The question is whether this has to be a mental health professional?

The conclusions, based as much on the literature review as on the work with these particular children, seem appropriate. It is not an easy task to recommend how to talk about terminal cancer – but discussions among parents, children and other caretakers are important. Ideally they should begin when the parens is first aware of his or her terminal condition eg at time of referral to a palliative care team. Assessment of both parents and children is necessary to ascertain the parents’ adaptation to the illness and the children’s developmental age, and understanding of the facts. Any work also needs to take place when there is enough motivation to accomplish a higher level of communication and possibly resolution of the conflicts, before death is imminent.

Integrating bereavement theories

2005-07-11T07:09:00.000-07:00

Field Nigel P, Gao Beryl, Paderna Lisa
Continuing bonds in bereavement: an attachment theory based perspective
Death Studies v29 no4 p277-299

This article stresses the importance of understanding attachment theory in helping bereaved people and seeks to integrate appropriate aspects of the theory of continuing bonds with that of attachment. For instance, the authors consider that the bereaved person’s recognition of a continuing bond with the deceased may be maladaptive soon after a bereavement but a sign of healthy adaptation at a later time.
An interesting description of the links between the theories is provided in the following extract: “Holding onto objects linked to the deceased may represent denial of the irrevocability of the loss, may serve as a transitional object in the movement towards internalisation, or represent keepsakes that are part of an enduring CB (Continuing Bonds) connection associated with the reorganisation phase”.

A terrible question

2005-06-14T04:38:00.000-07:00

Connor, Kelly
A terrible question
Counselling and Psychotherapy Journal
2005 (May); 19-21

This article introduces some discussion on a subject which is the nightmare of any driver: killing or injuring a pedestrian or someone in another vehicle. The author killed a pedestrian at the age of 17 and has never received appropriate or adequate assistance to deal with this trauma.

She provides statistics on such accidents, describes some of the results of the trauma as well as some unsuccessful encounters with various therapists. She has now written a book about the experience and feels that she has validated the experiences of a previously silent group of people.

She mentions a case where the media reported on such an incident and the person who was driving was reported as having no remorse. She queries whether this could really be the case. She is pleased her book has provided greater understanding of the issue to those involved in dealing with people who cause fatalities and quotes a Police Officer in family liaison work. He now considers the emotional needs of the drivers as well as of the bereaved.

This short article would assist anyone involved in such a situation as well as anyone working with them. (The book is titled To cause a death - the aftermath of an accidental killing. Clairview Books 2004)

Michael Rosen's sad book

2005-05-23T08:13:00.000-07:00

Michael Rosen writes great poetry and text for young people - but this is a picture book which can be used by both adults as well as children. The text is about Michael's sadness on the death of his son. He writes about happy memories, living a day at a time and how he sometimes feel just awful - then he can appear aggressive " I tell myself that being sad isn't the same as being horrible. I'm sad, not bad" . This is depcited, as with all the words in the book, with apt and often witty drawings by Quentin Blake. Although it is not stated, one can feel his fight with depression "Every day I try to do one thing I can be proud of. Then when I go o to bed, I think very very hard about this one thing". Sometimes he feels he is just looking on at the world "..sometimes I find myself looking at things, people at a window.... a crane and train full of people going past..." ... but he loves birthdays though they can also make him feel lonely.

The drawings also reflect his moods - they are all lively and full of life - but the grey wash that is a background to some of them, reflects the sadness in the author at various times.

And adult picture book! - as well as a children's one

(Published by Walker Books, 2004 ISBN 7445 9898 2)

The tsunami

2005-04-21T03:35:00.000-07:00

The latest edition of Bereavement Care contains an article on bereavement support at Heathrow Airport after the tsunami. It is written by Debbie Kerslake, Head of Service Planning and Development, Cruse Bereavement Care, London. It describes the services that have been set up in the UK to support those affected. (Bereavement Care 2005 v 24 no 1 pages 3-6). There is also a useful set of weblinks on psychosocial support for tsunami survivors on
p 15 of this issue of Bereavement Care.

The above items can be supplied by the library at St Christopher's - if anyone would like a copy of a workbook to assist children to help express their feelings after the tsunami, please also conact me d.brady@stchristophers.org.uk

http://news.bbc.co.uk/go/em/fr/-/1/hi/world/asia-pacific/4416267.stm - this describes the work of Dr Jones, a child psychiatrist with the International Medical Corps (IMC) working with children affected by the tsunami. She uses puppets to help them express their feelings.

Loss of homes and homelands

2005-04-01T04:00:00.000-08:00

Read Peter
Returning to nothing. The meaning of lost places
Cambride and Melbourne: Cambridge University Press 1996

This may not be a new book but it is worth bringing to the attention of anyone considering issues of loss and grief. Feelings about lost or destroyed places rouse our deepest emotions and may be entangled in grief over the death of a loved person.

This book,which originated in Australia, describes various scenarios of loss with regard to place - migration from other countries and the pain of return, for example returning to Croatia after the civil war there, Darwin after a cyclone, the flooding of towns to make a dam, the loss of a house due to fire, "slum" clearance which is of course the loss of a neighbourhood to some people.
There is also quite simply the loss associated with loss of "home" -and home can be described in many different ways from a house to a community to a much loved view from a window.

Childhood bereavement services

2005-03-11T09:07:00.000-08:00

Rolls Liz, Payne Sheila
Childhood bereavement services: issues in UK service provision
Mortality 2004 v9 no 4 p300-28

This article eloquently presents the broad key findings from a research project on UK childhood bereavement services, based on 8 different organisational case studies. They include a variety of management and administrative structures a)free standing services b)services attached to a host organisation such as a hospice or a child care service c)partnership services which arise from a partnership of a number of statutory agencies. This variety of services is detailed as well as the “level” of each service – from support through to psychotherapeutic work.

Research, audit and service evaluation is described though this area of activity is often an ideal rather than a reality.

The numbers of such services, albeit with varied aims and methods of delivery has increased in the UK in the last ten years and it is clear that they vary greatly. However, this article presents a broad idea of their scope and some discussion on the challenges for future evaluation.

AIDS and the stress of multiple bereavement

2005-03-04T06:50:00.000-08:00

Hunt Jennifer
Sole survivor: a case study to evaluate the dual-process model of grief in multiple loss

Illness Crisis and Loss 2004 v12 o4 p284-298

In Zimbabwe, deaths due to AIDS are common and the traditional grief models do not account for the ability of families to survive consecutive and concurrent deaths to which a degree of stigma is attached. This is a case study of one woman who lost many of her family due to AIDS but the death of her mother after these deaths was a catalyst for seeking some outside help. The author identifies where the dual process model was useful in this case study – and where it was not.

Counselling was seen to be helpful in terms of having someone external to the family to assist this lady to piece together the story of her lost family and the particular losses associated with each person who died - and to identify her previous resilience in coping with many deaths. The author considers the grief was not pathological but the lady ran out of energy. The oscillation described in the dual process model was not possible because it requires energy and this lady’s reserves were heavily depleted, due to all her other losses.

The case study provides many opportunities for discussion of models in practice , pathological grief and identification of useful counselling strategies.

Grandparents - the forgotten grievers

2005-02-22T07:28:00.000-08:00

This short article describes in-depth interviews that were conducted with four bereaved grandparents following the death of a grandchild. Themes that emerged included a)the nature of being a grandparent b)the support needed specifically for grandparents c)exploring sad and happy memories of the grandchild d)survivor guilt and e)the importance of providing support for all relatives in the family.

The author, who is a nurse at Great Ormond Street Hospital for Children, provides a useful reference list on the subject. She says that ethical approval was difficult as this research is very sensitive. The gatekeepers for the grandparents being approached were the parents of the child who died.

Recommendations for practice would include providing time for grandparents to ask questions and to talk about their loss as well as helping them to normalise feelings such as helplessness and guilt so they would feel less alone in their grief.

Hospice Information Bulletin 2004 v3 ano3 p8-9

Evidence based bereavement

2005-02-09T07:26:00.000-08:00

There was no posting for a few weeks - I was disheartened when I could not access the site on two occaions but it was easy today - so I start again

Type into GOOGLE
BMC Palliative Care and bereavement - and you will find a link to the following article

Forte Amanda L, Hill, Malinda, Pazder Rachel, Feudtner Chris
Bereavement care interventions: a systematic review

The authors identified 74 relevant studies evaluating diverse treatments designed to ameliorate a variety of outcomes associated with bereavement. Other than efficacy for pharmacological treatment for bereavement-related depression, they could identify no consistent pattern of treatment benefit among the other forms of interventions.

Conclusions: Due to the small number of clinically controlled trials, no rigorous evidence-based recommendations regarding the treatment of bereaved persons is currently possible except for the pharmacologic treatment of depression. They postulate the following as impeding scientific progress regarding bereavement care interventions:
excessive theoretical heterogeneity,
stultifying between-study variation,
inadequate reporting of intervention procedures
few published replication studies
methodological flaws of study design.

Add that to the fact it is a difficult subject on which to do randomised control trials anyway and one can see there is still a long way to go to discover the most appropriate treatments - however, practicitoners do know that bereaved people, both adults and children, can be helped by interventions - the best ways have simply not been pinpointed.

This article come from the open access publisher BioMed. Look out for other full text artilces on palliative care on the site

Denise

Bereavement services in the UK

2005-01-14T06:43:00.000-08:00

Field David, Reid David, Payne Sheila, Relf Marilyn
Survey of UK hospice and specialist palliative care adult bereavement services
International Journal of Palliative Nursing 2004 v10 no12 p569-76

There is a great lack of research on bereavement services and this is a very welcome addition to the subject. It is based on a postal survey of UK hospice and specialist palliative care services providing adult bereavement support. 300 services were identified and there was an 83% response rate.

Most of the services were based in England and the most common professional qualification was in nursing with 39% reporting they had some kind of counselling qualification. Paid professionals involved in bereavement services were nurses (36%) and social workers/counsellors (46%). Volunteers were involved in over two-thirds of the services –paid staff alone in about one quarter of services and volunteers alone in 4%. There were questions about the number of volunteers involved and their contribution was regarded as important in many services. Numbers of volunteers are not given.

83% provided an induction programme for their volunteers. It was most common for induction programmes to last from 6-15 hours although their duration ranged from 1-5 hours to over 65 hours. Most workers had supervision but 12% of paid staff and 7% of voluntary staff did not. These figures particularly illustrate the huge range in the type and probably the quality of service.
There was also a great range in the duration of support given to users and formal risk bereavement tools were used in just under half of the organisations. This article is likely to give an accurate picture of the range of services – their great variation is obvious. There is a need for audit on these services but the second phase of this study will elicit the views of bereaved people themselves.

The article compared these services with similar ones in the US (from a US survey) and outlined NICE guidelines on the subject.

They identified 6 types of bereavement service activities – one-to-one support, telephone support, referral to other agencies, memorial, remembrance and anniversary services, written information and advice and drop-in support.
This is a useful paper on the variety of services provided by hospices in the area of bereavement care.

New publications on bereavement

2005-01-05T03:04:00.000-08:00

I am the librarian at St Christopher's Hospice in South East London, UK

The hospice is the first of the modern hospices and it was founded by Dame Cicely Saunders .

The library has many resources on hospice and palliative care. Over 10,000 are catalogued and this includes books, journal articles and grey literature.

One of the strong points of the library is the material on bereavement. There are c30 subscriptions to journals on all aspects of palliative care, including 6 with a particular focus on bereavement.

There are also hundreds of books on bereavement in the library.

Any individual is welcome to contact me for information on bereavement. The database contains more than 1,000 references to articles, books, pamphlets and some unpublished material on bereavement, loss and grief issues in the stock of the library. It is aimed at those providing bereavement services but there is also material which would be useful to bereaved people.
Most people should be able to obtain references via their own libraries but we can supply articles for a charge. We lend books via other libraries.

The purpose of this blog is to publicise the new material on bereavement - as well as material available via links and some older material which is relevant

The plan is that is will be updated once a week