1 1 1\1 (C.1 MARI A PARENT'S EXPERIENCE OF THE COUPLE RELATIONSHIP AFTER CHILD BEREAVEMENT JEANETTE ELIZABETH MARITZ MINI-DISSERTATION Submitted in partial fulfilment of the requirements for the degree MAGISTER CURATIONIS in PSYCHIATRIC NURSING SCIENCE in the FACULTY OF EDUCATION AND NURSING at the RAND AFRIKAANS UNIVERSITY Supervisor: Prof. M. Poggenpoel Co-supervisor: Prof. C.P.H Myburgh Co-supervisor: Dr. M. Oberholster 2003 This research is dedicated with love to the memory of our children. (The following names are printed with the permission from the parents) Life matters, no matter how long or how short. K Katafiasz 2000 Roy Ryall Erbstoesser 18/04/1962 27/12/1989 Sean Peter Greaves 01/03/1987 01/03/1987 Robert Sean Greaves 05/05/1988 16/06/1992 Jacobus Marthinus Maritz 02/10/1985 04/10/1985 Petrus Johannes Maritz 26/03/1983 21/01/1988 Tshepo Sithole 15/07/1988 15/7/1988 Itumeleng Gregory Sithole 01/03/1990 08/08/1991 Desiree Smit 12/12/1989 13/04/2001 Zayn Clifford Chan Ton 08/11/1978 16/04/1995 Marcus Julius Van Platen 18/11/1982 25/11/1996 My daughters Lindi and Anne - marie A light in your own right SUMMARY The death of a child is like none other. The impact shakes the world of parents in its entire being. This research tells the story of parents' experience of the couple relationship after child bereavement. The objectives of the research are to: > explore and describe a parent's experience of the couple relationship after child bereavement; and > describe guidelines for the advanced psychiatric nurse practitioner to provide support to parents who have experienced child bereavement in order to promote their mental health through the mobilisation of resources. The paradigmatic perspective of this study is guided by the Theory for Health Promotion in Nursing (Rand Afrikaans University, Department of Nursing Science, 2002:2-8). The focus is on the whole person. A functional approach was followed based on Botes's model (Botes in Rand Afrikaans University: Department of Nursing, 2002:9-15) for nursing research. The researcher utilised a qualitative, descriptive, exploratory and contextual design (Mouton, 1996: 102). An authoethnographic strategy was implemented, & Bochner in Denzin & Lincoln, 2001:739, 747). In-depth, semi-structured, phenomenological interviews were held with parents meeting the sampling criteria. Consent for the research was obtained from the Rand Afrikaans University and informed consent was obtained from the parents volunteering to participate in the research. Trustworthiness was maintained by using strategies of credibility, applicability, dependability and confirmability, as described by Lincoln and Guba (1985: 289- 331). Recorded interviews were transcribed and analysed using the descriptive analysis technique by Tesch (in Creswell, 1994:155 -156). The services of an independent coder were utilised and a consensus discussion held between the independent coder and the researcher highlighted the themes. A literature control was undertaken to highlight similarities and differences between this research and other research. The results were described in a narrative format that included the content as well as the processes of a parent's experience of the couple relationship after child bereavement. These included their stories of life before child bereavement, the extremity of the experience as they struggled for control, the confusion that it brought and the role conflict that ensued. Although individuals and relationships are unique, most of these parents experienced emotional responses of grief, anger, loneliness, guilt and blame. Parents attempted to alleviate their anxiety through the use of defensive coping mechanisms and responses such as repression, suppression and avoidance. Attempts were made to fill the vacuum that the loss created through substitution and replacement. The couple's communication is severely tested during the process. The permanence of the loss is acknowledged along with new meanings and values. The aftermath sees parents' relationships either strengthened, weakened or remaining in nominal relationships. No parent and relationship were untouched by the death of their child. Conclusions were drawn and recommendations made concerning nursing practice, nursing education and nursing research. Guidelines were described for the advanced psychiatric nurse practitioner to provide support to parents who have experienced child bereavement, to assist them in mobilising their resources to facilitate the promotion of their mental health. ii OPSOMMING Die dood van 'n kind is soos geen ander dood nie. Die impak daarvan skud die wereld van hierdie ouers in die diepste wese daarvan. Hierdie studie vertel die verhaal van ouers se ervaring van die egpaar se verhouding na 'n kindersterfgeval. Die doelwitte van hierdie studie is om: ➢ 'n ouer se ondervinding van die egpaar se verhouding na 'n kindersterfgeval te verken en te beskryf; en ➢ riglyne te beskryf vir die gevorderde psigiatriese verpleegkundige praktisyn om ondersteuning te verskaf aan ouers wat 'n kindersterfgeval ondervind het ten einde hulle geestesgesondheid te bevorder deur die mobilisering van hulpbronne. Die paradigmatiese perspektief van hierdie studie is gerig deur die Teorie vir Gesondheidsbevordering in Verpleegkunde (Randse Afrikaanse Universiteit, Departement van Verpleegkunde, 2002: 2-8). Die fokus is op die persoon as geheel. 'n Funksionele benadering is gevolg, gebaseer op Botes se model (Botes in Randse Afrikaanse Universiteit: Departement van Verpleegkunde, 2002: 9-15) vir verpleegkundige navorsing. Die navorser het 'n kwalitatiewe, beskrywende, verkennende en kontekstuele ontwerp gebruik (Mouton, 1996: 102). 'n Outo- etnografiese strategie is geImplementeer (Ellis & Bochner in Denzin & Lincoln, 2001: 739, 747). Indiepte, semi-gestruktureerde, fenomenologiese onderhoude is gevoer met ouers wat aan die steekproefkriteria beantwoord het. Toestemming vir die studie is van die Randse Afrikaanse Universiteit verkry en ingeligte toestemming is verkry van die ouers wat onderneem het om aan die studie deel te neem, iii Vertrouenswaardigheid is gehandhaaf deur die strategiee van geloofwaardigheid, toepaslikheid, vertroubaarheid en bevestigbaarheid, soos beskryf deur Lincoln en Guba (1985: 289 — 331), te gebruik. Onderhoude wat opgeneem is deur middel van Tesch in Creswell, 1994: 155 — 156) se tegniek van beskrywende analise getranskribeer en geanaliseer. Die dienste van 'n onafhanklike kodeerder is gebruik en in 'n konsensusbespreking wat tussen die onafhanklike kodeerder en die navorser plaasgevind het is die temas uitgelig. 'n Literatuurkontrole is onderneem om die ooreenkomste en verskille tussen hierdie studie en ander studies te belig. Die resultate is in 'n verhalende formaat beskryf wat die inhoud asook die prosesse van 'n ouer se ervaring van die egpaar se verhouding na 'n kindersterfgeval ingesluit het. Dit het hulle lewensverhale voor die kindersterfgeval, die uiterste nood van die ondervinding terwyl hulle geworstel het om beheer te verkry, die verwarring wat dit meegebring het en die rollekonflik wat daaruit voortgevloei het, ingesluit. Alhoewel individue en verhoudings uniek is, ondervind die meeste van hierdie ouers emosionele reaksies van verdriet, woede, eensaamheid, skuld en blaam. Ouers poog om hulle angs te verlig deur die gebruik van verdedigende hanteringsmeganismes en reaksies soos verdringing, onderdrukking en vermyding. Daar word gepoog om die Ieemte wat die verlies gelaat het deur middel van substitusie en vervanging te vul. Die egpaar se kommunikasie tydens die proses word ernstig getoets. Die permanensie van die verlies word saam met nuwe betekenisse en waardes erken. Na so 'n ingrypende verlies word ouers se verhoudings versterk, verswak of dit bly slegs 'n verhouding in naam. Geen ouer of verhouding word onaangeraak deur die dood van hulle kind nie. iv Daar is tot gevolgtrekkings geraak en aanbevelings gemaak in verband met die verpleegkundige praktyk, verpleegkundige opvoeding en verpleegkundige navorsing. Riglyne vir die gevorderde psigiatriese verpleegkundige navorser is daargestel om ouers wat 'n kindersterfgeval ervaar het te ondersteun, om hulle te help om hulle hulpbronne te mobiliseer ten einde die bevordering van hulle geestesgesondheid te fasiliteer. v LIST OF CONTENTS PAGE CHAPTER 1 RATIONALE AND OVERVIEW OF THE STUDY 1.1 INTRODUCTION 1 1.2 RATIONALE 2 1.3 PROBLEM STATEMENT 4 1.4 OBJECTIVES OF RESEARCH 7 1.5 PARADIGMATIC PERSPECTIVE 7 1.5.1 Metatheoretical assumptions 7 1.5.2 Theoretical assumptions 8 1.5.2.1 Central Theoretical statement 10 1.5.2.2 Definitions 10 1.5.3 Methodological assumptions 11 1.6 RESEARCH DESIGN 12 1.7 RESEARCH STRATEGY 12 1.8 RESEARCH METHOD 12 1.8.1 Ethical measures 13 1.8.2 Measures to ensure trustworthiness 14 1.8.3 Data collection . 15 1.8.3.1 Population and sample 15 1.8.3.2 Data Collection 15 1.8.3.3 Data Analysis 15 vi 1.8.3.4 Literature control 16 1.9 DIVISION OF CHAPTERS 16 CHAPTER 1 Rationale and overview CHAPTER 2 Research design and method CHAPTER 3 Results of Phase 1 CHAPTER 4 Phase 2: Guidelines and literature control, conclusion, limitations and recommendations 1.10 CONCLUSION 17 CHAPTER 2 RESEARCH DESIGN, STRATEGY AND METHOD 2.1 INTRODUCTION 18 2.2 OBJECTIVES OF THE RESEARCH 18 2.3 RESEARCH DESIGN, STRATEGY AND METHOD 19 2.3.1 Research design 19 2.3.1.1 Qualitative 19 2.3.1.2 Exploratory 20 2.3.1.3 Descriptive 20 2.3.1.4 Contextual 20 2.3.2 Autoethnographic strategy 21 2.3.3 Research method 21 2.3.3.1 Phase 1: Exploration