Perinatal bereavement: A principle-based concept analysis

Aim: To report an analysis of the concept of perinatal bereavement. Background: The concept of perinatal bereavement emerged in the scientific literature during the 1970s. Perinatal bereavement is a practice-based concept, although it is not well-defined in the scientific literature and is often intermingled with the concepts of mourning and grief. Design: Concept Analysis. Data sources: Using the term \u27perinatal bereavement\u27 and limits of only English and human, Pub Med and CINAHL were searched to yield 278 available references dating from 1974-2011. Articles specific to the experience of perinatal bereavement were reviewed. The final data set was 143 articles. Review methods: The methods of principle-based concept analysis were used. Results reveal conceptual components (antecedents, attributes and outcomes) which are delineated to create a theoretical definition of perinatal bereavement. Results: The concept is epistemologically immature, with few explicit definitions to describe the phenomenon. Inconsistency in conceptual meaning threatens the construct validity of measurement tools for perinatal bereavement and contributes to incongruent theoretical definitions. This has implications for both nursing science (how the concept is studied and theoretically integrated) and clinical practice (timing and delivery of support interventions). Conclusions: Perinatal bereavement is a multifaceted global phenomenon that follows perinatal loss. Lack of conceptual clarity and lack of a clearly articulated conceptual definition impede the synthesis and translation of research findings into practice. A theoretical definition of perinatal bereavement is offered as a platform for researchers to advance the concept through research and theory development. © 2013 Blackwell Publishing Ltd

A model of palliative care for heart failure

The heart failure illness trajectory is both complex and unpredictable, which makes providing palliative care services to patients with heart failure a challenge. As a result, although services are needed, few tend to be offered beyond basic medical management. The traditional model of palliative care is typically based on palliative care being considered a system of care delivery most appropriate for patients with a predictable illness/death trajectory, such as terminal cancer. This type of model, which is based on the ability to predict the course of a terminal disease, does not fit the heart failure trajectory. In this article, we propose a new model of palliative care that conceptualizes palliative care as a philosophy of care that encompasses the unpredictable nature of heart failure. © 2009 The Author(s)

Achieving medical stability: Wives\u27 experiences with heart failure

The incidence of heart failure continues to rise as innovative treatments are developed. Despite life-prolonging interventions, morbidity and mortality in patients younger than 65 remain high. Few studies have focused on this younger cohort and/or their family caregivers as they navigate the complex illness trajectories manifested in heart failure. Instrumental case studies were employed to present exemplars for each of the five identified heart failure trajectories. Culling data from a longitudinal study of female spousal caregivers, each case study represents a wife\u27s discussion of caring for a husband (years) in response to the husband\u27s changing heart failure trajectory. The goal of medical stability and the notion of uncertainty permeate throughout the case studies. Suggestions for supporting these wives are presented. © The Author(s) 2010

Maintaining Validity: The Development of the Concept of Trust

Maintaining validity while moving a concept to a higher level of maturity is a dilemma that faces all qualitative researchers. In this section, research projects related to the concept of trust will be used to illustrate how new studies can be built on previous ones and then all studies integrated to develop a comprehensive model without compromising validity. The multiple stages of inquiry will be elucidated using the strategies of deconstruction, development of a skeletal framework, and scaffolding as described by in the opening section by Morse and Mitcham. The strategy of deconstruction was used in the initial project (Morse, 2000), which was a multidisciplinary concept analysis to determine the level of conceptual maturity. Once it was determined that trust was not well developed in the context of health care interactions, literature was used as data (Morse, 2000) to advance the concept further for the purposes of concept clarification. Although this began the process of identifying the structural features of the concept, these data left us with many questions, particularly since the trust literature was context bound and thus not easily applied to health care relationships. A skeletal framework was then developed to investigate trust in health care relationships using grounded theory (Hupcey, Penrod, & Morse, 2000). This project also advanced the concept further toward maturity, but some aspects still remained unclear. For example, risk as a precondition for trust as found during the concept clarification was not necessarily seen when trust was applied to health care relationships. The strategy of scaffolding was then used as data collection continued with other types of participants and in different contexts to clarify discrepancies in the data and verify the developing model of the concept of trust in health care interactions (Hupcey, Clark, Hutcheson, & Thompson, in press; Thompson, Hupcey, & Clark, in press). Here, I focus on the process of deconstruction, and briefly describe the development of a skeletal framework and the scaffolding process for this research program related to the concept of trust

Support for Young Black Urban Women after Perinatal Loss

© 2019 Wolters Kluwer Health, Inc. All rights reserved. Purpose: To describe the bereavement support needs of black urban women in late adolescence after perinatal loss. Study Design and Methods: Eight black women aged 18 to 21 years who had experienced recent perinatal loss were interviewed in person or by telephone at three points in the 12 weeks that followed their loss to describe their perinatal bereavement experience and support needs. Data from the interviews were analyzed using constant comparative analysis. Results: Black adolescent women need culturally appropriate bereavement support targeted at key transition points along the bereavement trajectory. They need accurate information, compassionate and respectful communication, and support from their mothers, grandmothers, and other women from their community of faith who have experienced perinatal loss. They value mementos, such as photographs and footprints. Clinical Implications: Nurses are well-positioned to be consistent caregivers and to provide clear, compassionate communication and anticipatory guidance to young black women experiencing perinatal loss. Attending to spiritual needs, harnessing family support, providing mementos, and encouraging reflection through journaling may help adolescent women find meaning and new perspectives on their bereavement experience

A Model of Palliative Care for Heart Failure

The heart failure illness trajectory is both complex and unpredictable, which makes providing palliative care services to patients with heart failure a challenge. As a result, although services are needed, few tend to be offered beyond basic medical management. The traditional model of palliative care is typically based on palliative care being considered a system of care delivery most appropriate for patients with a predictable illness/death trajectory, such as terminal cancer. This type of model, which is based on the ability to predict the course of a terminal disease, does not fit the heart failure trajectory. In this article, we propose a new model of palliative care that conceptualizes palliative care as a philosophy of care that encompasses the unpredictable nature of heart failure

Palliative needs of spousal caregivers of patients with heart failure followed up at specialized heart failure centers

As the incidence of heart failure increases, more patients and their caregivers are faced with needs related to the unpredictable nature of the illness. Palliative care interventions are an appropriate way to meet these needs; however, palliative care remains underutilized. Family caregivers, particularly spouses, play an important role providing care to these patients; thus, it is important to consider their needs when planning interventions. The purpose of this article was to describe the needs of spousal caregivers of patients followed up at specialized heart failure centers within the context of the dynamic ebb and flow of heart failure. Forty-five spouses (n = 45) were interviewed over 12 to 18 months to follow their changing needs. Grounded theory methods were used to collect and analyze data. Four categories of overarching needs amenable to palliative care interventions were identified: informational, financial, psychosocial, and physical. These needs were always present but changed during times of medical stability versus exacerbation/medical instability. Caregivers continually reprioritized their needs in response to the heart failure experience; therefore, episodic offerings of palliative care during exacerbations are inadequate. Nurses can play a pivotal role in facilitating comprehensive palliative care interventions to improve the experience of those caring for and living with heart failure. © 2011 The Hospice and Palliative Nurses Association