Loss of a Child to an African Family: A Phenomenological Case Study

CHAPTER FOURTEEN

LOSS OF A CHILD TO AN AFRICAN FAMILY: A PHENOMENOLOGICAL CASE STUDY

Jacqueline Kigundu and Titus Sairo

This study investigates the effects of grief on one family system and how the family was able to cope with the loss of a family member. This is accomplished by following a qualitative research case study design with a phenomenological approach. The researcher interviews an African immigrant couple to determine how the family has handled grief and mourning. The rationale for undertaking this study is to find out if we can discover ways of helping grieving parents following the loss of a child or any significant loss. Several concepts are evaluated for applicability.

REVIEW OF THE LITERATURE

Elisabeth Kübler-Ross (1969) first described the five stages of grief. These stages are part of the Kübler-Ross model inspired by working with terminally ill patients. The five stages do not occur in a linear fashion but can occur in any order according to the person or persons dealing with grief. The five stages include denial, anger, bargaining, depression, and acceptance. Denial is the stage wherein the survivor imagines a false preferable reality. Survivors do not believe that their loved ones are gone forever, but instead have an unrealistic view of the death. Anger is referred to as the stage where a person’s anger is directed at the person who died and at oneself for being unable to prevent the loved one’s death. Bargaining is the stage where the individuals who are grieving believe that they may have been able to control and prevent the loss of their family member, and depression is the stage where the individual becomes saddened by the certainty of death, and the individual becomes silent, refuses visitors, and spends much of the time being mournful and sullen. This stage is necessary for the process of healing to begin. Lastly, acceptance is the stage when the individuals are at a point where they recognize the current state of their lives, without their loved one, as a reality and can live with that understanding.

According to Bolden (2007), Kübler-Ross and Kessler noted multiple roles that individuals hold in life and the need to mourn those losses. There is a general expectation by many that people should live for a long time. Therefore, the death of a child is considered to be exceptionally shocking. This shows that grief does not end with the loss of a loved one but that it extends to all the aspects of the grieving person’s life. For example, planning the holidays and anniversary events bring back the memory of the loved ones. Changes in the bereaved sexual life, as well as personal self-care habits, were also noted in those involved in grief. Also, details surrounding one’s death can significantly affect the way in which individuals grieve. The shame associated with suicide affects how one grieves, and grieving and coping with death as a result of a disaster, chronic disease, such as Alzheimer’s, and sudden death are different in each case. Lastly, failure to grieve a loss has also been noted to leave a void when the loss has not been effectively addressed (Bolden, 2007).

Holtslander and McMillan (2011), define bereavement as the objective loss of someone significant, and grief as a reaction. It is important to observe and assess the effects of grief and bereavement on an individual and the family. One theory that facilitates the understanding of the family function and role is the family systems theory. The family systems theory is based on the belief that the family is an interconnected unit or system wherein the actions of one family member affect all members in the family system. The theory examines the organization, structure, and complexity of families and familial relationships. Bowen, a family systems theorist, discusses family therapy patterns in families over generations. These patterns are also known as the multigenerational transmission processes. For example, one death in a family will affect several generations in different ways leading to reorganization of the family. The death of an adult child will affect the biological parents and siblings, but it may also affect the grandparents. If the great grandparents of the adult child are alive, they may also grieve for the loss as well. The grandparents will not only grieve for their great-grandchild but also the great-grandchild’s children (Bowen, 2004).

Most family theorists also explore family members’ emotional, social, and psychological boundaries with one another. Minuchin, another family systems theorist, discusses concepts that are focused on familial boundaries. These boundaries are defined as respectful limits or social rules that govern the development and maintenance of interpersonal relationships. In family systems theory, healthy interpersonal boundaries permit appropriate degrees of emotional intimacy between two people. Families with few boundaries may be considered enmeshed or so deeply involved with one another that individual family members have difficulty establishing individual identities separate from their families. Family therapists often examine healthy and unhealthy boundaries within a family system (Bowen, 2004).

RELEVANCE TO NURSING

Nurses deal with patients during all stages of life that span from birth to death. The literature review reveals that research is lacking on the effect of grief on family systems. Much research has been done relating to the loss of neonates, infants, and children, but not much research has been done regarding the loss of adult children and the effects of the loss on the family systems. Ineffective coping with loss has been associated with negative emotions that can lead to disease. Effective coping, on the other hand, has been found to improve family relations. The aim of this research is to establish the effects that grief has on family systems and if there are lessons nurse practitioners (NPs) can learn from this study about overcoming grief. NPs can then apply the findings to assist other individuals or families that find themselves in similar situations. The findings of this research can generate evidence-based knowledge for the family nurse practitioner (FNP) profession.

Grief Related to the Family Systems Theory

The loss of a loved one through death can have many effects on the bereaved. Death and grieving can prove to be an intense undertaking for affected families. Some of the effects of grief and dying on family members can include feelings of despair, sadness, depression, and conflict among family members. Coping with the loss of a loved one effectively can prove to be beneficial for the bereaved, whereas ineffective coping can lead to mental illness, marital problems, and behavioral disorders (Carmon, Western, Miller, Pearson, & Fowler, 2010).

It is important to understand the family systems theory to better understand the effects of grief on the family. The family systems theory is a conceptual framework theory that tackles the concepts of looking at the family as one entity that is made up of many parts. Therefore, using the family systems theory, it is theorized that grief will not only affect the individual that is bereaved, but the family as a whole. This point of view can enable the researcher to observe the conceptual effects of grieving on the role and function of the family. Looking at a family as a unit enables the researcher to observe the processes of the family as well. These grieving processes of overcoming grief include mourning rituals, teamwork toward overcoming grief, social and emotional support among family members, and therapeutic conversation among family members.

According to the systems view of the family, effects of grief of one family member have been theorized to have an effect on the other family members. The associated reactions of grief of an individual are also associated with the relationships among family members. There are two types of major constructs to consider when looking at grief related to the family: structural forms and general constructs. Structural forms of family systems theory will help the researcher understand any gaps in the structure in the family following the death of a loved one. General concepts, on the other hand, will help the researcher understand any multigenerational processes in which similar themes of dealing with grief may be seen emerging among generations (Rosenblatt, 2013). Observing both can be beneficial for the researcher in the assessment of the effects of grief on the family.

To gain more understanding of the effects of grief on the family, the researcher has to understand effective interviewing skills related to family/relationship concepts that show how the relational concepts and theories can be applied to any multicultural family. The concept of energy transfer is an important factor to consider when interviewing family members (Rosenblatt, 2013). According to the family system theory, the environment and the family transfer energy among themselves creating a feedback loop (Environmental Influences, 1990). It is important to consider that fueling a family by helping them achieve physical and psychological sources of energy through the help of outsiders can help with bringing potential positive reactions of grief for all members involved. The sources of fuel can involve the environment, which uses support groups that input energy into the family so that the family outputs back into the environment via positive behavioral outcomes (Rosenblatt, 2013).

Another relational concept to consider during the interview process is the reality that the dead may still be “alive” to the bereaved victims. Being “alive” does not necessarily mean that the dead come back to life, but that they are active in the family’s emotional and psychological lives. In those families where the dead are active members of the family, the dead influence the choices of the family members in their everyday lives. Family systems grief researchers should acknowledge the dead as part of the family to better understand the relationships between the dead and those who are actively present during the interviews. Acknowledging the dead as a member of the family rather than as an idea that used to exist helps the researcher obtain ground in receiving detailed information about the relationships between the dead and the grieving (Rosenblatt, 2013).

Lastly, the “dangerous witch is the cause of death” relational concept is important to consider when assessing the family for effects of grief. This concept defines situations where the family blames another evil object as the reason their loved one is dead. An example of the witch-is-the-cause-of-death concept is a case in which the family blames physician malpractice as the reason of the death. Incorporating blame and “malevolence” assessing strategies to family systems grief can be beneficial in providing assessments and interventions that can be geared toward helping the family move forward in the grieving process. It is important for the researcher to remember to place importance on the assessment of the family’s culture during family grief assessments. Not all families are alike, and the approach of assessments used will depend on the affected family’s definition of family. Family can be defined as nuclear, multigenerational, or as anything the family understands it to be. Definitions of grief and family vary according to different cultures. Assessment of both before making any conclusions can prove to be beneficial in defining the effects of grief on the family (Rosenblatt, 2013).

According to Carmon et al. (2010), family communications patterns (FCPs) were also found to be important for researchers in assessing the effects of grief on the family. The FCP are patterns that often observe how families communicate with each other within and outside the family. These communications help to mold and influence family behavior.

Using a qualitative research design, Carmon et al. (2010) collected a convenience sample of 203 participants’ surveys to assess the effects of FCP on grief. FCP and grief results were analyzed according to the survey results. The study was looking to observe how FCP are related to the victim’s views of grief reactions after bereavement. Conversation orientation was found to significantly increase views of personal growth as the main reaction to grief. Families with high-communication abilities showed tendencies toward high self-esteem, low stress, and improved communication skills all of which are vital in achieving positive grief reactions. Aspects of the FCP can prove to be beneficial when assessing the family for effects of grief for the researcher.

Similarly, Gaudio, Zaider, Brier, and Kissane (2011) found that assessing families who are psychologically at risk because of grief and bereavement was of utmost importance to prevent negative grief outcomes. Using the family-focused grief therapy (FFGT) improves overall family functioning by increasing the family closeness, conflict resolution abilities, and open communication of illness-related outcomes. This model has been found to be easily adaptable by health care professionals in the community. FFGT has been found to increase successful engagement and relations of the family. The implementation of the model has also been found to increase the researcher’s ability to assess the family history, identity, and formulate focus of therapy for the family’s affected families. Using assessments and implementations that are similar to the FFGT model in assessing bereaved families can prove to be advantageous in the study of assessing effects of grief on the family (Gaudio et al., 2011).

Incorporating the family systems theory as well as the aspects of the FCP and FFGT models into the interview and therapy processes can help the researcher in applying proper family assessment and implementation techniques when assessing effects of grief on family members. Understanding different cultural perspective about death and dying can also prove to be beneficial to family systems grief researchers. Lastly, implementing interviews and/or therapies that encourage high communication among family members can point the way for family systems grief researchers in maximizing the research on obtaining information on the effects of grief on the family.

Expected Limitations

Certain limitations exist in the studies related to family system grief assessments. There is a gap in the research relating to family systems theory related to the loss of adult children and the effects of grief on the family system. Research on the effect of grief on parents of older or adult children is particularly limited. The weakening of concepts and/or therapy implemented can happen over time, and there is no effective method of measuring the causes of the weakness. These newfound weaknesses in the family systems grief therapies can lead to ineffective treatment results as well as lack of cohesion to the therapy. There are also some difficulties in processing the work of family systems grief research because most of the analysis is based on the answers of each individual in the family. It may not be possible or practical to interview all members of the community who were considered as part of the family system by the nuclear family. Creating a measure of disparity among the levels of grief can help with realizing the gaps in assessment that exist so that the whole family’s views can be better analyzed. Lack of follow-up interventions and control groups creations can act as limitations on intervention of family systems research when it comes to assessing the results. Lastly, more research that includes different cultures, races, and ethnicity needs to be performed to add to the knowledge of how different types of familial systems function during grief in agreement with (Hayslip & Page, 2013).

METHODOLOGY

Design

A qualitative research case study design with a phenomenological approach will be applied. This design will be most appropriate in investigating the effects of grief on the family system. Grief is something experiential and only the person experiencing it can describe it. Not all the effects of grief can be observed, but the victim can describe them and that way enable other people to study them with the hope of gathering information that can be used to prevent or decrease or treat the negative effects of grief in other people who may be faced with similar circumstances.

Sample

The sample consisted of one family system. The criterion for inclusion into the study was that a family should have experienced the death of one of its members.

Setting

Interviews took place in the family’s home.

Instruments

The family was encouraged to tell their story.

Tell me your definition of family.