parental grief, the behavioral reactions that characterize the grieving process and result in the resolution of grief at the loss of a child from expected or unexpected death. All people who survive the loss of a loved one normally experience symptoms of both somatic and psychological distress, such as feelings of guilt and hostility accompanied by changes in usual patterns of conduct. When the death of a child with a terminal illness is expected, there is time for anticipatory grieving, so that parents can evaluate their relationship with the child, set priorities for the duration of time involved, and prepare for the actual death of the child. In such cases, parental grieving begins with the discovery of the diagnosis of a life-threatening condition. Parents’ adjustment to the diagnosis involves a complete cycle of reactions that extends over an indefinite period, depending on the severity and nature of the disease. The immediate reactions are shock and disbelief, followed by acute grief at the anticipation of losing the child. Periods of depression, anger, hope, fear, and anxiety alternate during induction therapy, remission, and maintenance of the disease as parents learn to accept and cope with the situation. Heightened anticipatory grieving recurs during episodes of relapse, and the parents experience increased fear, depression, and final acceptance of death during the terminal stages of the illness. Although families can prepare themselves for the expected loss, at the time of death there is a period of acute grief, during which parents need to express their deep sorrow and anger. An extended phase of mourning follows, with the eventual resolution of grief and reintegration into society. In sudden, unexpected death, parents are denied the advantages of anticipatory grief and, because of the lack of time to prepare, usually have extreme feelings of guilt and remorse. Each member of the health care team can play an important role in helping such parents assess their feelings so that they can work through them and progress through the resolution of grief and the mourning process, which in unexpected death take a much longer time. The function of the health care providers during all phases of parental grief is primarily supportive, and the degree of intervention depends on the family’s strengths and weaknesses in coping with the crisis. Health care team members can act directly, or they can help find other potential sources of support for the parents, such as extended family members, other parents who have lost children, or specific community services or agencies. A large part of the support involves helping families explore new ways of coping, not only to meet the present crisis but to grow and change. Always an important nursing consideration is the education of the parents about all aspects of the child’s illness, especially in terminal conditions. See also death, grief reaction.
