Anticipatory Grief

RACHEL PRUDHOMME
Introduction
Nurses in all areas deal with patients and families who are grieving
Article: Anticipatory grieving among parents living with a child with cancer
(Al-Gamal & Long, 2010)
Study compares anticipatory grief in parents with a child with newly
diagnosed cancer and with a diagnosis 6-12 months earlier
Grief v. anticipatory grief
Purpose

What is grief?
Definition of grief (Videbeck, 2014, p. 160)

Definition of anticipatory grief (Videbeck, 2014, p. 160)

Kubler-Rosss Stages of Grieving (Videbeck, 2014, p. 162)
Evidence for Care: Nursing Care Problem
Childhood cancer

Illness perceived as terminal

Anticipatory grieving
Evidence for Care: Nursing Theory
Human to Human Relationship Model (Current Nursing, 2012)

Joyce Travelbee (1926-1973)

Evaluation of the Evidence: Study Methods
Methods:
70 Parents in each group
2 hospitals in Jordan
Recruited by head nurse
30 minute individual interview with researcher
Results:
<1/2 at peace
Newly diagnosed = more severe grief
Moms v. Dads = no difference in grief reaction
Evaluation of the Evidence: Critique
Pros:
Adequate sample size
No conflict of interest
Credible authors
Cons:
Limitation: Cross-sectional design = changes over time not detected
Head nurse selected eligible parents
Attachment styles, coping, social support relationship



Patient Care Design: Collaboration
Encourage parents to talk about negative feelings (Al-Gamal & Long,
2010)
Provide targeted interventions (Al-Gamal & Long, 2010)
Assess for the need for additional support (Al-Gamal & Long, 2010)
Promote support groups (Al-Gamal & Long, 2010)
Be honest with patients and families
Act in a caring and compassionate manner


Patient Care Design: TRUEPIC
1
.

Identify
-Parents of a child with a cancer
diagnosis

-Speak English or Arabic

-Live in same household as child
2
.

Relate
Primary Proposition: Parents are
unable to cope with childs
diagnosis due to risk for death.
Possible Assumptions: Childhood
cancer is a terminal illness and
death is eminent.
Possible Confounding Variables:
Parents are unable to cope with
childs diagnosis due to lack of
support.
3
.

Understand
Proposition: Cancer, especially is
childhood, is extremely terrifying,
no matter how progressed it is.
Significance of Assumptions:
Cancer is perceived as a
terminal illness, even though
often times it can be successfully
treated.
Possible Confounding Variables:
It is important for families dealing
with cancer to have adequate
support in order to get through
the difficult time.
Patient Care Design: TRUEPIC Continued
4
.

Explain
Proposition: Explain to the
family that you
understand how difficult
this situation must be for
them.
Assumptions:
Confounding Explain to
the family that there are
options for treatment
that can put their childs
cancer into remission.
Variables: Explain to the
family how important it is
to have support.
5
.

Predict
Proposition: Parents will
think that the healthcare
team is not empathetic for
them and will have
difficulty coping.
Assumptions: Parents wont
understand that their
childs illness is treatable
and will live in fear.
Confounding Variables:
Parents wont have
anyone to talk to that
understand what they are
going through and will
have ineffective coping.
6
.

Influence
Proposition: Act in an
empathetic and caring
manner when dealing with
the family of the child with
cancer.
Assumptions: Explain to the
parents the different
treatment options that would
be beneficial to the child and
the likelihood of survival for
their child.
Confounding Variables: Refer
the parents to a support
group that includes other
families dealing with
childhood cancer.
7
.

Control
-Create a comfortable and
soothing environment.
-Assure families that treatment
options are available and
remission is possible.
-Provide adequate support
through referrals to support
groups.
Nursing diagnosis: Ineffective coping r/t cancer diagnosis a.e.b. lack of peace with situation
Advocate Role: Research & Reflections
Demonstrate understanding

Provide social support

Honesty
Advocate Role: Importance & Impact
Empathy

Equity
Advocate Role: Significance to Practice
Grief and death in all areas of nursing

Empathetic care

Support systems


References
Al-Gamal, E. & Long, T. (2010). Anticipatory grieving among parents living with a child
with cancer. Journal of Advanced Nursing, 66(9), 19801990.
Current Nursing. (2012). Human-to-human relationship model. Retrieved from
http://currentnursing.com/nursing_theory/Joyce_Travelbee.html.
Videbeck, S. L. (2014). Psychiatric-mental health nursing (6
th
ed.). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.